Re: threshold for complications

[Guest guest]

Consult the web page of Dr. Mirkin at:

http://www.drmirkin.com

I believe you will find it in one of his pages on diabetes.

threshold for complications

>

> A recent post said current research suggests that a post meal swing

> exceeding 160 contributes to glycation and long term complications. What

> is the source for the 160 level please?0

>

> xv

> ic|xc

>

>

>

>

>

[Guest guest]

most agressive diabetics and endos say 120 is the top for a two hour post

test.

Regards,

threshold for complications

>

>

> >

> > A recent post said current research suggests that a post meal swing

> > exceeding 160 contributes to glycation and long term complications.

What

> > is the source for the 160 level please?0

> >

> > xv

> > ic|xc

> >

> >

> >

> >

> >

[Guest guest]

,

No matter what I do it seems like my two-hour sugars are more like in the 130s

or 140s rather than 120s but my doc doesn't want to up the Actos either.

Fortunately, the readings don't usually go higher than that, but I still would

like 120 or less after 2 hours. My readings get within tolerance after 3 hours

though.

Bill Powers

[Guest guest]

At what carbohydrate gram consumption level are you talking about?

Is it the same every day at each meal?

Does it vary with a 15 gram, 30 gram or a 45 gram consumption level?

Re: threshold for complications

> ,

>

> No matter what I do it seems like my two-hour sugars are more like in the

130s or 140s rather than 120s but my doc doesn't want to up the Actos

either. Fortunately, the readings don't usually go higher than that, but I

still would like 120 or less after 2 hours. My readings get within tolerance

after 3 hours though.

>

> Bill Powers

>

>

[Guest guest]

My diet varies every day so my carb intake varies too. I try hard to keep my

total intake between 60 and 70 gm carbs per day but I put most of my carbs at

lunch time so I have more time during the day to burn them off and my main aim

right now is trying to keep myself in the habit of smaller (and less carb)

dinners. Boy it's not easy but at least I'm trying.

Bill

[Guest guest]

It is important to vary your diet, which you can do with a little practice

and still keep carb grams per meal the same.

I try to keep my carb grams at 15 per meal plus or ninus around 3 points.

Since I am insulin resistant, this small amount of carbs consumption makes

dosing with insulin more predictable for a two hour post meal glucose

reading less than 120.

Re: threshold for complications

> My diet varies every day so my carb intake varies too. I try hard to keep

my total intake between 60 and 70 gm carbs per day but I put most of my

carbs at lunch time so I have more time during the day to burn them off and

my main aim right now is trying to keep myself in the habit of smaller (and

less carb) dinners. Boy it's not easy but at least I'm trying.

>

> Bill

>

>

[Guest guest]

you are correct Bill. it isn't easy at all. all your life we get use to

eating a certain way and then we have to over night learn another way

because of this diabetes. plus, carbs is where we get our energy from. but

on the other hand, if we eat to many carbs at one meal, then our sugar goes

out of sight and we feel bad to boot. I find it very hard to come home from

a hard day at work and not eat every thing in sight. I work on a saw line

and it is pretty hard work. but you are right, after we get home from work,

we should eat a small meal, cause we don't really do much but sit around and

fall a sleep. breakfast is my biggest meal and my favorite also. then my

lunch is the next biggest and my dinner at night is the smallest. keep it

up, you are doing good

Re: threshold for complications

> My diet varies every day so my carb intake varies too. I try hard to keep

my total intake between 60 and 70 gm carbs per day but I put most of my

carbs at lunch time so I have more time during the day to burn them off and

my main aim right now is trying to keep myself in the habit of smaller (and

less carb) dinners. Boy it's not easy but at least I'm trying.

>

> Bill

>

>

[Guest guest]

I'd say base the increase of meds off your last a1c reading. If your a1c

readings are 5.5 or less, then a 3 hour post test of 120 or less is working

for you. However, if your a1c is 5.8 to 6.5 range, I'd say the 3 hour post

test of 120 or less is not good enough. I know for me, to run an a1c of 5.3

my post meal test of 120 is 2.5 hours past eating and not 2 hours. If I try

to get it 2 hours past eating, I get to low sugared since am taking humalog

to do it. So, like I was saying, if you can get your post meal test 120 or

less either 2 or 3 hours past eating, and if your a1c level is 5.5 or less,

then I say good boy leave it alone. Main point I want you to hear is your

a1c reading. Focus in on your a1c reading and if it is 5.5 or less, then

good enough. However, Dr. Bernstein's a1c reading is 4.5 and so is his

patients. They are able to run such low a1c readings because they only eat

30 grams of carbs a day so they only require like 1 or 2 units of insulin

per meal. That is way to strict for me. So, it is a balance of carb grams

per meal, medication, 2 or 3 hour post meal test 120 or less, but the key

component to wrap it all up is if your a1c level is 5.5 or less.

BTW you could get your 2 hour post meal test to be 120 or less easily by

cutting more carbs out of your meal. I.E if you ate 45 grams per meal,

bumped it down to 30 grams, your 2 hour post meal test would be 120 or less

since there is only 30 grams of carbs, rather than 45, so not enough carbs

to push your sugar higher than 120 2 hours past eating.

Regards,

Re: threshold for complications

> ,

>

> No matter what I do it seems like my two-hour sugars are more like in the

130s or 140s rather than 120s but my doc doesn't want to up the Actos

either. Fortunately, the readings don't usually go higher than that, but I

still would like 120 or less after 2 hours. My readings get within tolerance

after 3 hours though.

>

> Bill Powers

>

>

[Guest guest]

keep trying Bill. That is key, keep on keeping on and not giving up. I'd

suggest to eat an amount of carbs that you feel are good to suffice your

appetite but not stuff you. For example, for breakfast, I can hang with 15

grams, lunch 45 grams, but my dinner I keep at 60 grams since I like a

decent dinner. Try to go the minimum/happy level you can take for each meal

with always trying to keep your 2 hour post meal test 120 or less. If you

can't do it, IMO you are going to have to get on lantus and humalog to cover

the carbs since humalog is nothing but a carb killer.

Regards,

Re: threshold for complications

> My diet varies every day so my carb intake varies too. I try hard to keep

my total intake between 60 and 70 gm carbs per day but I put most of my

carbs at lunch time so I have more time during the day to burn them off and

my main aim right now is trying to keep myself in the habit of smaller (and

less carb) dinners. Boy it's not easy but at least I'm trying.

>

> Bill

>

>

[Guest guest]

that's true harry, you can keep them the same and be creative within the

carb grams. good point.

Regards,

Re: threshold for complications

>

>

> > My diet varies every day so my carb intake varies too. I try hard to

keep

> my total intake between 60 and 70 gm carbs per day but I put most of my

> carbs at lunch time so I have more time during the day to burn them off

and

> my main aim right now is trying to keep myself in the habit of smaller

(and

> less carb) dinners. Boy it's not easy but at least I'm trying.

> >

> > Bill

> >

> >

[Guest guest]

hey that is another neat approach Mark... decent breakfast, decent lunch,

small dinner. This really makes sense if you think about it folks... we are

very active during morning/afternoons but lazy in the evenings and do not do

too much activity in the evenings. Well, that is more the norm than not I am

certain some are very active in the evenings. Just wanted to say that is a

good approach Mark and keep it up.

Regards,

Re: threshold for complications

>

>

> > My diet varies every day so my carb intake varies too. I try hard to

keep

> my total intake between 60 and 70 gm carbs per day but I put most of my

> carbs at lunch time so I have more time during the day to burn them off

and

> my main aim right now is trying to keep myself in the habit of smaller

(and

> less carb) dinners. Boy it's not easy but at least I'm trying.

> >

> > Bill

> >

> >

[Guest guest]

,

Very good points you made about the relationship to carbs and postprandial

readings, also to the Hemoglobin A-1-c. My last reading several months ago was

5.4 and I'm going to be getting another reading very soon when I can get over to

the lab early enough in the morning to do fasting blood work. That's a trick

because I have to get up early enough to get ready, take the bus, walk 20

minutes off the bus line to get to the lab, then wait who knows how long for the

draw, all before I can eat. I've always hated that but then anyone who's a

diabetic knows what I'm talking about.

Like you, I don't want to mess with something if it's working, but I would

always like the " idea' reads of 120 after 2 hours if I can attain them, yet it's

not always going to work that way, though I am getting better at it over time as

I discipline myself to what I can and can't eat. It's hard though, I think it is

for any of us because we all like to eat and often times love the things that

are the worst for us diabetics. I just have to keep trying though.

Having a nondiabetic wife makes it difficult because she can eat things I can't,

for example, we both love Kozy Shack pudding. I've been trying not to have it

around because I love it, but can't deny her either. But boy it's loaded with

carbs. So if I _do_ eat some, I have to eat such a small amount of it I might as

well not bother. Or if I do eat it, then I need to do it early enough that I can

take an extra evening walk to work it off. That's not so hard as there's plenty

of safe walking area around here, but sometimes it just sounds like a lot of

work. I try not to deny myself everything I like, but I have to be realistic and

know there's a price if I really, really want something.

On the whole, I'm doing pretty well and in large part because of the things I've

learned from this board, much more so than from my dietitian or from my doc. I'm

the one that pays the price so I'm doing this the " right " way according to the

best info I have available, and you know what? The doc can't argue with success!

Neither can I.

Bill

[Guest guest]

is 247 when you have a flue, too high a reading?

Have''' a nice day.

and stay away from girls who serve French champagne!

Re: threshold for complications

> ,

>

> No matter what I do it seems like my two-hour sugars are more like in the

130s or 140s rather than 120s but my doc doesn't want to up the Actos

either. Fortunately, the readings don't usually go higher than that, but I

still would like 120 or less after 2 hours. My readings get within tolerance

after 3 hours though.

>

> Bill Powers

>

>

[Guest guest]

When your blood sugar is above 120, it is too high. Even though you hae the

flu. the trick is to keep it under 120 by taking more insulin. However,

you may have to call your doc if you do not take insulin. Illness usually

makes your BS rise, letting it stay high, will aggrevate the flu (or what

ever) symptoms and it makes your illness prolonged.

Re: threshold for complications

is 247 when you have a flue, too high a reading?

Have''' a nice day.

and stay away from girls who serve French champagne!

Re: threshold for complications

> ,

>

> No matter what I do it seems like my two-hour sugars are more like in the

130s or 140s rather than 120s but my doc doesn't want to up the Actos

either. Fortunately, the readings don't usually go higher than that, but I

still would like 120 or less after 2 hours. My readings get within tolerance

after 3 hours though.

>

> Bill Powers

>

>

[Guest guest]

That's a good way of eating, mark. You sound like you expend all your

energy with your very physical job, so don't need the extra calories at

night. Extra veggies, however, wil fil you up without adding toomany carbs.

Re: threshold for complications

you are correct Bill. it isn't easy at all. all your life we get use to

eating a certain way and then we have to over night learn another way

because of this diabetes. plus, carbs is where we get our energy from. but

on the other hand, if we eat to many carbs at one meal, then our sugar goes

out of sight and we feel bad to boot. I find it very hard to come home from

a hard day at work and not eat every thing in sight. I work on a saw line

and it is pretty hard work. but you are right, after we get home from work,

we should eat a small meal, cause we don't really do much but sit around and

fall a sleep. breakfast is my biggest meal and my favorite also. then my

lunch is the next biggest and my dinner at night is the smallest. keep it

up, you are doing good

Re: threshold for complications

> My diet varies every day so my carb intake varies too. I try hard to keep

my total intake between 60 and 70 gm carbs per day but I put most of my

carbs at lunch time so I have more time during the day to burn them off and

my main aim right now is trying to keep myself in the habit of smaller (and

less carb) dinners. Boy it's not easy but at least I'm trying.

>

> Bill

>

>

[Guest guest]

Bill.

I just want to point out at the problem with oral medication and exercise is

exactly what you are explaining... absolutely minimal flexibility for when you

want to eat some food you enjoy. One *slight* benefit of taking insulin, lantus

for long acting and humalog to handle carbohydrates, is you can eat the foods

you enjoy here and there. I.E if in the pudding you enjoy there were 30 grams of

carbs, I would only have to dose 3 units of humalog, eat it, enjoy it, and have

no high sugar from it since the humalog is way more powerful than any oral

medication and my pancreas didn't have to do any work, the insulin did it

relieving my pancreas from burn out over time.

Most type 2 diabetics that I know prefer to use lantus and humalog to fight the

diabetes, that is a new concept to many doctors, but it gives them greater

eating flexibility and better sugar control. However, there is a negative to any

positive *smile*. If you go on insulin, you have to check yourself a lot, and I

mean a lot, since you run the risk of running low sugars frequently. Not only

that, you are taking 5 to 6 shots a day. The other option is to get on an

insulin pump so you don't have to take multiple shots a day but that is a whole

can of worms as well having its own set of challenges. While on insulin, you

*must* check pre meal and two hour post meal and never miss it since you can go

low and bye bbye.

So, you have to ask yourself, is eating the foods I enjoy worth taking shots of

insulin, 5 to 6 shots a day, and always having to check my sugar pre meal and 2

hour post meal. That is what you have to ask yourself.

For me, being type 1, I don't have a choice of oral medications verses insulin.

However, I can eat the foods I enjoy and run an a1c of 5.3. But, is that really

good as well? Being able to eat sweets and stuff you like because of insulin?

Most folks would not be disciplined enough to eat an occasional sweet and would

get on lantus/humalog to only over eat and self-indulge not even concerned about

what the foods do to their bodies. Most go on insulin to run good a1c levels,

get tighter control, and eat an *occasional* sweet or high carb food they enjoy.

I.E most would abuse it, not use it... eating foods that can increase

cholesterol, put weight on you, etc.

There is a lot of contemplation involved when deciding which route of treatment

to take as a type 2 diabetic but the key thing I'd like to point out is the main

reason you choose what you choose... better a1c levels and tighter blood sugar

control. Any type 2 diabetic I know on insulin shots, or insulin pumps, do it to

get maximum tight control and run a1c levels of 5.0.

Would you be disciplined enough to only eat an occasional sweet on insulin? That

is what you need to ask yourself and be honest about. It is a difficult struggle

for me, at times, since I have a bottle of humalog on me that can handle any

carb I want to eat having learned carb counting and dosing insulin. I.E other

day at work they came in with tons of doughnuts from krispy cream. I went to

calorieking.com and for 1 krispy cream doughnut it was 36 grams. I could have

ate it, dosed humalog to cover it, but I didn't do it. Why? Simple, I didn't

need the calories nor the sugar in my body. Now that is not to say I never do

it, I just try to limit myself and stick to low carb foods / meats and green

leafy veggies.

Hope some of this has helped you.

Regards,

Re: threshold for complications

,

Very good points you made about the relationship to carbs and postprandial

readings, also to the Hemoglobin A-1-c. My last reading several months ago was

5.4 and I'm going to be getting another reading very soon when I can get over to

the lab early enough in the morning to do fasting blood work. That's a trick

because I have to get up early enough to get ready, take the bus, walk 20

minutes off the bus line to get to the lab, then wait who knows how long for the

draw, all before I can eat. I've always hated that but then anyone who's a

diabetic knows what I'm talking about.

Like you, I don't want to mess with something if it's working, but I would

always like the " idea' reads of 120 after 2 hours if I can attain them, yet it's

not always going to work that way, though I am getting better at it over time as

I discipline myself to what I can and can't eat. It's hard though, I think it is

for any of us because we all like to eat and often times love the things that

are the worst for us diabetics. I just have to keep trying though.

Having a nondiabetic wife makes it difficult because she can eat things I

can't, for example, we both love Kozy Shack pudding. I've been trying not to

have it around because I love it, but can't deny her either. But boy it's loaded

with carbs. So if I _do_ eat some, I have to eat such a small amount of it I

might as well not bother. Or if I do eat it, then I need to do it early enough

that I can take an extra evening walk to work it off. That's not so hard as

there's plenty of safe walking area around here, but sometimes it just sounds

like a lot of work. I try not to deny myself everything I like, but I have to be

realistic and know there's a price if I really, really want something.

On the whole, I'm doing pretty well and in large part because of the things

I've learned from this board, much more so than from my dietitian or from my

doc. I'm the one that pays the price so I'm doing this the " right " way according

to the best info I have available, and you know what? The doc can't argue with

success! Neither can I.

Bill

[Guest guest]

if you have a flu, high sugars are normal but are you type 2 or type 1 diabetic?

When you get a flu, there is several attack / approaches you can take to keeping

your sugars down.

Regards,

Re: threshold for complications

> ,

>

> No matter what I do it seems like my two-hour sugars are more like in the

130s or 140s rather than 120s but my doc doesn't want to up the Actos

either. Fortunately, the readings don't usually go higher than that, but I

still would like 120 or less after 2 hours. My readings get within tolerance

after 3 hours though.

>

> Bill Powers

>

>

[Guest guest]

,

Man you are a fountain of info and thought on the subject of type 2's using or

not using insulin. Most of the time I can discipline myself in the sweets arena

because I can visualize what I'll have to do earn that sweet if I eat it, and I

have to ask myself if it's really worth it? Just as I would ask myself if I

could really afford it if I was down to my last few bucks. And most of the time

that psychology works for me. I may eat a dessert once a week which is a lot

better than I was last year when I'd eat something sweet almost daily. And I'm

getting better about doing that for known high-carb or medium-carb foods. It's

still a struggle but I believe that slowly I'm getting the upper hand on it.

There are times I wish I could just dose insulin to counter it and then " pig

out " but that's not the purpose of the insulin. The thing I would not like about

the insulin is that I already do fingerstix 5-6 times a day and then having to

shoot myself a few times a day? Not sure I'm ready for that but I guess if it

ever becomes necessary, I would have to contend with it.

Many times what helps me not eat as many sweets is that some are so sickeningly

sweet that I literally feel like I'm suffocating when I bite into something

very, very sweet like a krispy kreme donut. I don't know what causes that

effect, but the best way I can describe it is, it feels like I'm underwater and

gasping for air or something. So that's enough to keep me from eating something

that's really too sweet.

Most of the time I can make good decisions on eating by figuring out what my

physical cost for eating that food would be. One example I always use is French

fries. I'm not a big french fry eater anyway but when I do eat fast food that

comes with fries, I pick a number between 1-5 and that's the number of fries I

eat and I throw away the rest (or give them to somebody who wants them.) Why? If

I eat 'em all, I wear 'em. And besides, it's easy to visualize french fries for

what they are, a big stick of lard. How appetizing is that? (Hello Mickey D's?).

Of course not all fries are stick of lard, In-And-Out Burgers and Carl's Jr.

fries are pretty good and seem like they're real potatoes, but most are just

sticks of lard. Easy to walk away from.

I've also learned to walk away from margarine which I thought for years was good

for you. Problem is, margarine is one step away from being plastic. I can do

without eating plastic. If I want plastic I guess I could always eat the tray my

fast food is on, huh?

Oh enough rambling for this time.

Thanks again for your thoughts. I'll keep your post as good food for thought.

Take care,

Bill Powers

[Guest guest]

I'm type 2.

Have''' a nice day.

and stay away from girls who serve French champagne!

Re: threshold for complications

>

>

> > ,

> >

> > No matter what I do it seems like my two-hour sugars are more like in

the

> 130s or 140s rather than 120s but my doc doesn't want to up the Actos

> either. Fortunately, the readings don't usually go higher than that, but

I

> still would like 120 or less after 2 hours. My readings get within

tolerance

> after 3 hours though.

> >

> > Bill Powers

> >

> >

[Guest guest]

Hi Bill.

Another thought is to perhaps talk to your doctor about using only humalog,

quick acting insulin, for dosing to cover a carb treat here and there. I.E keep

a bottle on hand and when you want a treat, just dose some insulin to cover it.

Since you are on oral meds for the type 2, your doctor would have to work

closely with you to help you figure out how much insulin to dose per 15 grams of

carbs. The starting point is 1 unit of humalog per 15 grams of carbs. However,

since you are on oral medications, it may be, in your case, .5 of a unit per 15

grams. I.E half of a unit of humalog to cover the carbs since the orla meds are

kicking in gear as well.

Just food for thought *wink*.

BTW yes, I know exactly what you are talking about the choaking while eating a

sweet LOL LOL LOL. I wonder if it is just a diabetic feeling? I have had that

happen many times and just have to pitch the sweet. Sometimes, I can feel it

starting when it is offered to me LOL.

Regards,

Re: threshold for complications

,

Man you are a fountain of info and thought on the subject of type 2's using or

not using insulin. Most of the time I can discipline myself in the sweets arena

because I can visualize what I'll have to do earn that sweet if I eat it, and I

have to ask myself if it's really worth it? Just as I would ask myself if I

could really afford it if I was down to my last few bucks. And most of the time

that psychology works for me. I may eat a dessert once a week which is a lot

better than I was last year when I'd eat something sweet almost daily. And I'm

getting better about doing that for known high-carb or medium-carb foods. It's

still a struggle but I believe that slowly I'm getting the upper hand on it.

There are times I wish I could just dose insulin to counter it and then " pig

out " but that's not the purpose of the insulin. The thing I would not like about

the insulin is that I already do fingerstix 5-6 times a day and then having to

shoot myself a few times a day? Not sure I'm ready for that but I guess if it

ever becomes necessary, I would have to contend with it.

Many times what helps me not eat as many sweets is that some are so

sickeningly sweet that I literally feel like I'm suffocating when I bite into

something very, very sweet like a krispy kreme donut. I don't know what causes

that effect, but the best way I can describe it is, it feels like I'm underwater

and gasping for air or something. So that's enough to keep me from eating

something that's really too sweet.

Most of the time I can make good decisions on eating by figuring out what my

physical cost for eating that food would be. One example I always use is French

fries. I'm not a big french fry eater anyway but when I do eat fast food that

comes with fries, I pick a number between 1-5 and that's the number of fries I

eat and I throw away the rest (or give them to somebody who wants them.) Why? If

I eat 'em all, I wear 'em. And besides, it's easy to visualize french fries for

what they are, a big stick of lard. How appetizing is that? (Hello Mickey D's?).

Of course not all fries are stick of lard, In-And-Out Burgers and Carl's Jr.

fries are pretty good and seem like they're real potatoes, but most are just

sticks of lard. Easy to walk away from.

I've also learned to walk away from margarine which I thought for years was

good for you. Problem is, margarine is one step away from being plastic. I can

do without eating plastic. If I want plastic I guess I could always eat the tray

my fast food is on, huh?

Oh enough rambling for this time.

Thanks again for your thoughts. I'll keep your post as good food for thought.

Take care,

Bill Powers

[Guest guest]

Ah ,

Re the " choking feeling " about sweets. You mean I'm NOT crazy after all? Well,

that might be pushing the envelope a bit, or wishful thinking that I'm not

crazy. Seriously, I would wonder if it is some kind of diabetic reaction, but

then how can that be, since it's such a quick response to something I've just

barely put into my mouth? Some could argue it's psychological, but then I've

always felt that way even when I was very little, when I'd eat something way too

sweet or rich. And not that I even like pecan pie but I noticed that right away

when I took a very small bite of it one time, and I notice the same feeling if a

punch drink is overly sweet, but I don't have that sensation with melons,

bananas or even chocolate cakes. Go figure.

One day we may actually know whether I'm crazy but for now we'll just have to

wonder.....

Bill Powers

[Guest guest]

LOL pecan pie I get the same effect LOL and I have had it with punch before to

man!

Regards,

Re: threshold for complications

Ah ,

Re the " choking feeling " about sweets. You mean I'm NOT crazy after all? Well,

that might be pushing the envelope a bit, or wishful thinking that I'm not

crazy. Seriously, I would wonder if it is some kind of diabetic reaction, but

then how can that be, since it's such a quick response to something I've just

barely put into my mouth? Some could argue it's psychological, but then I've

always felt that way even when I was very little, when I'd eat something way too

sweet or rich. And not that I even like pecan pie but I noticed that right away

when I took a very small bite of it one time, and I notice the same feeling if a

punch drink is overly sweet, but I don't have that sensation with melons,

bananas or even chocolate cakes. Go figure.

One day we may actually know whether I'm crazy but for now we'll just have to

wonder.....

Bill Powers