Blood glucose

[gwix98]

Recent changes in "normal ranges" for fasting serum glucose levels have
made a significant number of boomers and others fall into the
"pre diabetes" catagory.

For instance the lab for which I work now has moved the upper limit for
a fasting glucose to 99 mg/dl. Several years ago it was 110, and 20 years
ago when I started my career it was 125.
This puts a significant number of people into this classification.

I now fall in this range. I am curious as to what others on this board
are doing to control blood sugar levels besides exercise, diet or traditional
oral hypoglycemics such as Metformin. Particularly interested in those
having success with natural products like cinnamin.

Diabetes is a huge problem in this country, and growing.

Rich..any ideas comments?

 

[windsurf]

I was shocked when I recorded a 124 fasting glucose. Earlier in life, it had been below 100 but decades of eating refined flour porducts, tons of cereal, bread, pizza, pasta and potatoes took a toll in resulting insulin resistance (another name for pre-diabetes and, then, adult on-set, type II). I was heavy into sports drinks and energy bars which typically have a load of sugar that also assaults the insulin receptors of your cells. I bought a glucometer so I could check it peridically without an MD visit. I reduced refined food carbs and avoid anything with sugar (occasional desserts at a birthday or something) and it has come down. Genetics can play a role here as my wife never recorded the levels I had. On the other hand, she never ate the quantitities of the crap that I had. Diet is absolutely a culprit here but it takes will power to resolve to get your carbs from whole foods. Most of what I eat comes from the perimeter of the grocery store.

 

[rs0460a]

Since I've "managed my condition" since being diagnosed 5 years ago, I attribute my "success" primarly to three things:

- Diet (control those carbs!)
- Exercise (helps keep glucose down)
- Stress reduction (you would be surprised how stress impacts glucose!)

- Ron

 

[Rich_by_the_Bay]

There have been changes in the old 1997 criteria, as follows:

* Normal — Fasting plasma glucose<100 mg/dL (used to be <110 mg/dL)

* Impaired fasting glucose (IFG) — Fasting glucose between 100 and 125 mg/dL

* Diabetes mellitus — fasting at or above 126 mg/dL, or a two-hour post-glucose load at or above 200 mg/dL (11.1 mmol/L), or a random (or "casual") plasma glucose concentration greater than or equal to 200 mg/dL in the presence of symptoms.

What's less clear is whether IFG really represents a risk factor for the usual targets of diabetes damage. It looks like high glucoses in response to eating are a bit more accurate as predictors of cardiac events, survival, etc. At the very least, if you have IFG it is time to really embrace the diet and exercise thing.

Another issue is that abdominal fat cells have been found to be pretty active, almost like an endocrine organ. They cause resistance to insulin and lots of other bad things. Lose them and you make good headway in risk reduction, even if you total body weight or BMI is not that high.

For me, that abdominal girth is the last thing that goes when I lose weight - it really doesn't want to go and I have to push to the limit to lose it in waist circumference.

 

[windsurf]

Rich_in_Tampa's point about waist girth and the activity of those fat cells is interesting. Consequent of my cutting refined carbs was, of course, weight loss and a couple of inches off the waist.

 

[gwix98]

Well it has really become interesting to me.
Having been involved in lab values for over 20 years to see
significant changes in the glucose range. Most other chemistry
analytes have ranges that have been pretty stable

The Hemoglobin A1C range for our lab has not changed in
20 years. Interestingly mine is the same as it was 20 years ago when
my typical fasing glucose was in the 85-95 range, about 5.1%.

Lets hope the IFG turns out to not be a strong indicator for the usual targets
of diabetes damage. I'm not holding my breath..time to get serious about this stuff.

 

[Rich_by_the_Bay]

The Hemoglobin A1C range for our lab has not changed in
20 years. Interestingly mine is the same as it was 20 years ago when
my typical fasing glucose was in the 85-95 range, about 5.1%.

Well, that one is under close scrutiny now, too. It looks like the HgbA1C level does correlate with risk fairly well but when you get down below the mid-5's, the risk is low enough that it's hard to distinguish from the general population risk, i.e. if there is any correlation at all, it's almost too little to detect. Get well up in the 6's and you start to see some correlation.

Bottom line has not changed: get fit, get skinny if you have risks.

 

[FIRE'd@51]

Most other chemistry analytes have ranges that have been pretty stable

The "normal" cholesterol levels (total and LDL) have been reduced significantly, I believe.

 

[Rich_by_the_Bay]

The "normal" cholesterol levels (total and LDL) have been reduced significantly, I believe.

Just to be clear, it is not the laboratory techniques or the general population that changed, but rather it is recognition that risk increases at lower levels than realized, so a previously "normal" cholesterol of 300 is now known to represent significant risk. The level at which to get concerned has thus been lowered, rather than a technical or statistical adjustment.

In these cases is it not so much about bell-shaped curves or 2 standard deviations from the mean, but rather the clinical outcome implications of specific values, even if 30% the population is considered "abnormal" as a result. I think this is reasonable, since we would otherwise keep raising the normal range as we grow increasingly obese in the false impression that the new normal range is just fine.

 

[gwix98]

Just to be clear, it is not the laboratory techniques or the general population that changed, but rather it is recognition that risk increases at lower levels than realized, so a previously "normal" cholesterol of 300 is now known to represent significant risk. The level at which to get concerned has thus been lowered, rather than a technical or statistical adjustment.

In these cases is it not so much about bell-shaped curves or 2 standard deviations from the mean, but rather the clinical outcome implications of specific values, even if 30% the population is considered "abnormal" as a result. I think this is reasonable, since we would otherwise keep raising the normal range as we grow increasingly obese in the false impression that the new normal range is just fine.

Yes, I forgot about total cholesterol. We have reduced our ranges for that.


Interestingly regarding age and normal ranges, I was having a talk with our medical
director/pathologist recently regarding PSA's. I believe we still report one range for men regardless of age. I think there is the feeling that more age dependent "normals"
for PSA's may eventually be used. Maybe the guy who is 46 and has a PSA of say 3.5 may be at
more risk than the guy who is 85 and has a 3.5.

Rich, you are an internist right? Whats been your experience with patients in the
IFG range (100-125) demonstrating any diabetes related complications, such as
peripheral neuropathies, early kidney disease (elevated creats),etc?

 

[LOL!]

The beauty of a lower recommended range for blood glucose, is that your doc can get a "Hgb-A1c" test done on your blood. That can help "know who you are."

OTOH, if you get the answer you don't want, does that create a pre-existing condition for future health insurance?

 

[Rich_by_the_Bay]

Rich, you are an internist right? Whats been your experience with patients in the
IFG range (100-125) demonstrating any diabetes related complications, such as
peripheral neuropathies, early kidney disease (elevated creats),etc?

Any one physician's experience in a question like this is irrelevant since it takes thousands of people over several years to detect a statistically important difference. So I try to monitor the large cohort trials to stay abreast of what this all means. So far, it seems rare to see an excess of such complications in the IFG group according to most studies.

 

[spideyrdpd]

Hi Gwix
As you probaly know from your experience some how many people live as undiagnosed diabetics. So lowering the numbers will hopefully make people aware earlier. Many people have been diagnosed because they already have complications or the constant waking in the nite to pee.
As far as your risk you have to look at the entire picture. Diet, stress, weight, cholesterol, blood pressure and family history as well as your blood glucose numbers.
They also are or should be very aggressive with the cholesterol and the blood pressure.
Rob

 

[Mountain_Mike]

I think it is the cynic in me, but "normal" blood glucose levels may have been adjusted downward at the behest of the pharmaceutical corporations as a way of creating more clients. But then, maybe not.

 

[FIRE'd@51]

I think it is the cynic in me, but "normal" blood glucose levels may have been adjusted downward at the behest of the pharmaceutical corporations as a way of creating more clients. But then, maybe not.

Oh, I don't think this is the case at all. From what I have read, a substantial number of endocrinologists believe that by the time the fasting numbers reach 126, there has probably been substantial loss of pancreatic beta cells due to years of high post-prandial (after meals) glucose toxicity. Many recommend an oral glucose tolerance test for those in the pre-diabetic (100-125) range, especially if there is a family history of diabetes. Apparently, you can have normal fasting readings even with diabetic levels of glucose after meals.

 

[rs0460a]

From what I have read, a substantial number of endocrinologists believe that by the time the fasting numbers reach 126, there has probably been substantial loss of pancreatic beta cells due to years of high post-prandial (after meals) glucose toxicity.

After I was diagnosed (2001), I took the diabetes management class at a local hospital. They mentioned a statistic that you are diabetic (or a "diabetic in process") for up to 10 years before your levels are at the point of being diagnosed.

Also, in reference to the comment about the drug company, I (like many others) manage it with diet/exercise. Someday I'm sure I will take meds, but it's been 5 years and still have A1C's in the 5.x's.

- Ron

 

[WM]

This seems to be the most recent discussion here of blood sugar tests - anyone know of updated info on problems associated with slightly elevated levels (100-125)?

DH (age 36) just had a fasting blood test done and his was 101. His excuse was that he'd worked out that morning before the test, but that would make it go down, not up, right? His cholesterol and blood pressure were great, but he's got a family history of serious diabetes problems, so I guess I'm wondering how worried I should be. (He's very fit, and already eats pretty healthy)

 

[WhoDaresWins]

Yikes! I am going to have to work harder on my "muffin top". And maybe talk to my PCP about cholesterol and blood glucose testing. It has been years since I have had a complete panel and have never had a thorough physical. I think 55 is a good age to get a baseline. I have a really good diet I think but I know I eat too much for the two or three times a week that I workout. If I were retired, I could get to the gym, jog, bike more regularly.

 

[Rich_by_the_Bay]

This seems to be the most recent discussion here of blood sugar tests - anyone know of updated info on problems associated with slightly elevated levels (100-125)?

DH (age 36) just had a fasting blood test done and his was 101. His excuse was that he'd worked out that morning before the test, but that would make it go down, not up, right? His cholesterol and blood pressure were great, but he's got a family history of serious diabetes problems, so I guess I'm wondering how worried I should be. (He's very fit, and already eats pretty healthy)

126 fasting is the current cut-off for diabetes. 100-125 is the "prediabetes" range. The latter is not associated with serious increase in the risks of side-effects, but is definitely a warning sign that frank diabetes may be on its way. Exercise lowers blood glucose, correct.

If his diet and weight are good and he is fit, there may not be too much to do. Low carb diets may help but we don't know for sure.

In these situations I often order a glycohemoglobin test (HgA1C). While this is not yet considered the best test to diagnose diabetes (though I think that will change soon), together with the fasting glucose it can give you a better idea how to interpret it.

Doesn't sound like you have much to worry about, but only his own doctor can safely make that call. Hope that helps.

 

[WM]

Thanks, Rich, that is helpful. I kind of doubt he'll request the additional test but I'll pass that along and see what he thinks. If nothing else maybe he'll get better about getting tested once a year or so.

 

[FIRE'd@51]

First of all, there are error bars on the lab test. So the 101 reading might have been 99 (or lower). Even for a diabetes diagnosis, you need to have two fasting readings greater than 125. If you are concerned, I would recommend having a glucose tolerance test done. An HbA1c is good, but it is just an average of your blood sugar over the past 90 days, and someone could be diabetic and be having lows which will pull down the average. IMO, the best test, if you really want to know, is a glucose tolerance test. It's more expensive than an A1c, but can be used for diagnosis. They give you a known amount of fast-acting carbs, then measure your blood sugar every 15 minutes for two or three hours, to see if your blood sugar spikes, and how long it takes to come back down. This will tell you if you are insulin resistant, or becoming so. As I said in an earlier post, by the time the fasting number reaches the diabetic level of 126, you have probably been diabetic for a while. I believe if your blood sugar spikes over 180 on a glucose tolerance test, you are diabetic.

BTW, you can buy a cheap meter at Walmart for about $8 and some strips and do your own testing. No prescription is needed. Then you can do your own glucose tolerance test.

 

[Rambler]

I had a 101 or 102 on my fasting glucose test for my annual physical back in Feb. Doctors here are still using 110 as the baseline for pre-diabetes (Japan), but I knew the baseline was lower in the US. My cholesterol had also spiked...LDL was up, and HDL was down. HbA1C was still in the same range as usual. Since I was ill last year with another condition, I have been having the docs take a test every 2-3 months just to be sure about a couple of things, so I knew that all of these figures were out of my normal range.

When I went in for a test about 5-6 weeks later (my usual doc), I had him test things again. Cholesterol was back to my normal range, blood glucose was back to 93, in line with the narrow 91-93 range is has been in for a few years.

...and, I did get one of those cheap meters, and test on a saturday morning between doc's blood tests. It has been 91 every time.

I'm just wondering, what can cause spikes like this? I can't remember eating anything the night before, or even for a few days before, that was outside my normal eating patterns. I was happy that this was just a spike, but in the next couple of years I will be shopping for private health insurance, and I really don't need a spike on the day I take my blood test for that!

R

 

[Amethyst]

I have a "family history" of Type II diabetes (one sibling, very obese and inactive). Parents never showed any signs of it.

I am in the mid-range for BMI (21.8), so, I am neither fat nor thin. Despite a sedentary job, I keep active and fit. My diet is pretty healthy. I neither avoid carbs, nor gobble them. But, I do have episodes of sudden energy level drops (especially when starting to work out in the morning - sometimes I start shaking and can't go on until I eat something). Also, I do get up in the night more than once, which I don't like. Oddly, the less I eat, the more I have to go.

Given that glucose tolerance tests are expensive and (I've heard) highly unpleasant, is it worth alerting my doctor to my symptoms? I'm sure he'll prescribe a test, since he is a conscientious doctor.

 

[Rich_by_the_Bay]

We rarely do glucose tolerance tests any more, except some pregnant women. It doesn't add to the fasting glucose level, esp when the latter is combined with glycohemoglobin. The WHO criteria still use it as one option, but the American Diabetes Assoc no longer recommends it. While not harmful it is cumbersome and doesn't help patients compared to the alternatives.

True hypoglycemia was once quite the rage for a wide variety of symptoms, but it is not common. "Functional" hypoglycemia is temporary drops in glucose levels, often entirely within the normal range and what you feel is your body producing glucagon and other chemicals in an effort to keep it high - those things cause the shakiness most people describe.

 

[jambo101]

Since I've "managed my condition" since being diagnosed 5 years ago, I attribute my "success" primarly to three things:

- Diet (control those carbs!)
- Exercise (helps keep glucose down)
- Stress reduction (you would be surprised how stress impacts glucose!)

- Ron

Good job on the Diabetes management Your solution is exactly what the N.American lifestyle lacks and thus the epidemic of type2 Diabetes.
Fat,Lazy,complacent lifestyle is a sure bet to develop Diabetes.