Varying Diabetic Standards

By Travis Grubbs Monday, February 02, 2009

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Driving to work I have passed "the law" while cruising along at five to eight miles over the speed limit. Going ten miles over the speed limit has resulted in me being pulled over to the side of the road and having a conversation with a nice sheriffs deputy about the evils of speeding. Oh yeah, I got to pay for his time too.

I was really disturbed when I read the recommendations for the postprandial (blood sugar two hours after starting a meal). The ADA postprandial is <180 mg/dl, the AACE postprandial is - <140 mg/dl (7.8 mg/dl), and my postprandial is 150 - 190 mg/dl. My prescribed "goal" would have me exceeding the ADA recommendation by 10 mg/dl, and the AACE recommendation by 50 mg/dl! I am not a medical professional, but I am going to estimate that a prolonged postprandial difference of 50mg/dl equals "You are screwed!"

I am used to dealing with solid numbers, and now I am supposed to choose which glucose ranges I wish to apply to my life? Is it too much to ask for the medical soothsayers to get together and agree on a measurable standard for blood glucose ranges? I wonder how many of these "experts" have diabetes.

Take your prescribed ranges and see how you compare to the ADA and ACE recommendations. I, on behalf of the type 2 diabetic population, request that the medical community produce one uniform standard in which to measure the daily control of our diabetes. Such a standard would be then be "set in concrete".

Speaking of concrete, IRC Section R506.1 states that the minimum thickness of a house foundation concrete slab is three and one half inches.

E-mail received from the ADA

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Comments (6) | Add comment

Pauline.Barrett

2/ 3/09 11:59am

As a Food Service Administrator (retired), I, too, look behind the doors (discreetly) of restaurants to see if there are any code violations, and have walked out when I see practices that may reflect on the wholesomeness of the product, such as 50# of food on the floor and employees licking their fingers or playing with their hair.

As for the numbers.... I agree we who have some degree of intelligence can figure out how to manage the disease and make optimum choices (most of the time), but for newbies the seriousness of the disease cannot be stressed enough when the organizations from which we are looking for support disagree.

I have been Type 2 for over 10 years, A1c of 5.5, am 66, and AM glucose was 94. I am looking for a "support" group that centers on living a full life where diabetes is in the background, not the center of attention.

Pauline Barrett,

Kent, WA

Travis Grubbs

2/ 3/09 12:47pm

Hi Pauline:

It is so good to hear from another Inspector! No matter what we find, it is always "our fault." We protect the public from hazards that they seldom see such as electrical fires, salmonella, etc. I also appreciate your attitude about living your life in spite of your diabetes.

Take care,

Travis

Dr. Bill Quick, Health Pro

2/ 3/09 7:22pm

You asked "Why was there a difference in the values recommended by my doctor, the ADA, and AACE?"

ADA and AACE have differing experts, and presumably they used different studies (plus their own experiences) to come up with their differing values.

Now, to the much harder question of why your doctor came up with a differing recommendation:

First, it's unclear if your physician is a full-fledged card carrying member of ADA, AACE, or both: if he/she is, and practices diabetes care as a larger portion of his/her practice, then I'd take the personalized recommendation of your physician over that of any faceless authority. On the other hand, if he/she is a GP caring for measles, mumps, anxiety, pregnancy, geezers, and STDs and dabbling in diabetes, I'd tend to discount the recommendaion.

Second, your physician's recommendation may be "graduated goal setting" (look that one up in Google!). If so, then as you find you can reach these goals, you should look at progressively more stringent goals. Like if you were starting training for a four-minute mile, you might be comfortable with doing the mile in 6 minutes (or six hours?) then as you succeed in that goal, establishing a more stringent goal for your next step...

Hope this helps...

Bill

William W. Quick, MD, FACP, FACE

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Travis Grubbs

2/ 4/09 7:24pm

Dr. Bill:

My doctor is my GP. There is not an endo. within 50 miles of my location. I have yet to receive a favorable referral to one farther away. Due to me being told by my doctor, as well as other doctors (I can think of three), that the number of diabetes cases diagnosed can be tabulated not by the month, but by the week (we all now that type 2 diabetes is on the rise). I think that if I, a non-medical individual, were to state that GP's were "dabbling in diabetes" when treating their diabetic patients, that would be an insult. You, on the other hand, may be able qualified to make such a statement, but I believe that is an awfully broad statement. Especially for my area.

frankenduf

2/ 4/09 5:10pm

as a wise woman once said, there is no science of the particular- that being the case, the differing standards are problematic, and likely confounded by research and politics- historically, the AACE would have the most stringent standards, following the dictum the lower the better (or euglycemia as the gold standard)- the secondary medical field standards would be more lenient or 'realistic' as the previous comment pointed out- but there is also research which hints that the lower the better is not always true- it may well turn out that too tight control for diabetics may have adverse effects- so while standards may govern the macro numbers, I think wisdom must govern the individual: maintaining weight, eating healthy, exercise, and a stable HgBA1C is probably the healthy profile for a diabetic lifestyle

Travis Grubbs

2/ 4/09 7:13pm

I have to agree with your reasoning. By following the standards set by my doctor, losing 45 pounds, and at least attempting some form of moderate exercise, I have maintained an A1C of 5.6 and my glucose average is 86. I have also kept the weight off that I lost. But, I still prefer goals, standards, etc. in black and white.

Varying Diabetic Standards

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