What is good control?

by VBH

The “under 10 at 2 hours” is old standard NHS advice. Its what I was told at diagnosis 5 years ago. I think its because we are expected to “Fail” to some extent.

I think the problem is that they have had so many “non-compliant” patients in the past, particularly since many diabetics have been elderly, that their hopes for any diabetic to control the condition are not high. The other high profile group of diabetics is young type 1s and of course they are likely to deviate from “good control” as a matter of rebellion as much as anything else. So I think this advice was come up with some time ago so that we diabetics could be “a bit better” without going off the rails completely.

But for long term control, we want to minimise the chances of complications and in particular the big 3 terrifying ones – loss of sight, failed kidneys and circulation problems potentially leading to foot amputation. The odds of these have generally been linked to A1c, although that is probably not the full story.

According to statistics in Gretchen Becker’s “Type 2 Diabetes – The First Year”, the chance of retinopathy over 15 years for someone with an A1c of 6 is 2%. Over the same period with an A1c of 7 is 11%, A1c 8 = 40% and A1c 9 = 89%. So this is why so many of us strive for an A1c under 6%

But the full story may be slightly different. There have been several studies which suggest that damage is done at BG levels around 7.5 (and in some cases lower). Now there is little mention in these studies of how long your BG needs to be at that level for this damage to occur. So the standard NHS advice for “under 10 at 2 hours” seems to think that a certain amount of risk of damage is “acceptable”. This ties in with the received wisdom that diabetes is progressive and your situation will get worse over time.

Many of us believe that diabetes need not be progressive and that complications are NOT inevitable over a period of years. As a result we minimise the chances of any damage by keeping our BGs as close to “normal” or “non-diabetic” as possible.

Using Jennifer’s advice as a template, many of us have discovered combinations of foods which do not push the BG up very high, so reducing the chances of any damage. So by using your meter, you can find out what combinations of foods work for you and which do not. This does not mean that your diet becomes “limited” or “boring”, but just getting the combinations of foods and portion sizes right, you can eat relatively normally without pushing up your BG.

Personally I have found that I eat healthier foods overall, with more vitamins and vital nutrients than before, take more interest in food and enjoy food more. I keep my BGs in a lower range MOST of the time (we all like to be naughty sometimes).

The NHS approach seems to be generally for people to make slight changes to diet and exercise, then increase the drugs to keep the A1c low. By changing diet a little more, many people find they can do without the same level of drugs and it IS a sustainable lifestyle. If things do go downhill a little later, then an increase in drugs is there as backup just in case. However 5 metformin a day is the maximum dose so in some people’s cases, the backup is a more limited.

So the upshot of all this is that your medics may be happy to push your drugs up and set targets that you find it easy to reach. If you do a bit of testing of your BG and find out what works for you, then you can reduce the drugs so that they are always there later if you need them, reduce the risks of complications and as a bonus may well find yourself eating far better than you ever did before and living a healthier life for many years to come.

So I would suggest reading the testing advice and Jennifer’s advice and seeing if it can work for you too.