Re: Is this too high?

[Guest guest]

Craig,

Did you take your bg before you ate? What was that reading? How far did

your bg raise after eating?

anne

If you aren't making waves, you aren't kicking hard enough

Is this too high?

> Hi all,

>

> I've just had two slices of wholemeal bread with margarine and tasty

cheese plus a cup of coffee.

>

> I 1/2 hours later my BG was 7.5 (135).

>

> Is this an acceptable level after this amount of time?

>

> Thanks in anticipation.

>

> Craig

>

>

>

[Guest guest]

Craig,

95% of the time, I am back in my normal range of 90 - 105 two hours after

eating. If a meal puts me any higher, I figure out why and adjust my choices

in the future.

Carol T

Diet/Exercise

---- Original Message -----

From: Craig Weavers

To: diabetes_integroups

Sent: Tuesday, October 31, 2000 7:42 PM

Subject: Is this too high?

Hi all,

I've just had two slices of wholemeal bread with margarine and tasty cheese

plus a cup of coffee.

I 1/2 hours later my BG was 7.5 (135).

Is this an acceptable level after this amount of time?

Thanks in anticipation.

Craig

[Guest guest]

Hi, Craig. We'll see what the others have to say, but for me, the answer would

be no. I would be unhappy with a reading above 120 at that point.

Teri

Is this too high?

Hi all,

I've just had two slices of wholemeal bread with margarine and tasty cheese

plus a cup of coffee.

I 1/2 hours later my BG was 7.5 (135).

Is this an acceptable level after this amount of time?

Thanks in anticipation.

Craig

[Guest guest]

Re: Is this too high?

> Hi, Craig. We'll see what the others have to say, but for me, the answer

would be no. I would be unhappy with a reading above 120 at that point.

>

> Teri

>

> Thanks Teri. Oh well I guess it's back to the drawing board! I thought I

try the bread & see what happened.>

Craig.

>

>

> eGroups Sponsor

>

>

> Public website for Diabetes International:

> http://www.msteri.com/diabetes-info/diabetes_int

>

>

>

>

>

>

>

[Guest guest]

You're welcome, Craig. I suspect you'll find that you'll need to change the

ratio of bread to other foods to get a satisfactory pp reading. Perhaps a bit

more cheese or add a piece of meat and have only one slice of bread.

Teri

Re: Is this too high?

> Hi, Craig. We'll see what the others have to say, but for me, the answer

would be no. I would be unhappy with a reading above 120 at that point.

>

> Teri

>

> Thanks Teri. Oh well I guess it's back to the drawing board! I thought I

try the bread & see what happened.>

Craig.

>

>

> eGroups Sponsor

>

>

> Public website for Diabetes International:

> http://www.msteri.com/diabetes-info/diabetes_int

>

>

>

>

>

>

>

[Guest guest]

This is how we learn, Craig, so you did good. I'd do what Teri said. I was

going to say the same thing.

Barb

--------

Rainbow Farm Unltd.

Premium Oldenburgs & sport ponies

http://www.RainbowFarm.com

Equine photography

http://www.RainbowFarm.com/photos.html

[Guest guest]

Re: Is this too high?

95% of the time, I am back in my normal range of 90 - 105 two hours after

eating. If a meal puts me any higher, I figure out why

Thanks Carol. Your input is appreciated, I guess that I will have to aim for

lower levels.

Best wishes,

Craig Weavers

> http://www.msteri.com/diabetes-info/diabetes_int

>

>

>

>

[Guest guest]

Re: Is this too high?

Thank you Barb,

It certainly is a learning experience, albeit sometimes a tough one, I'm

determined to eventually get it under better control.We'll wait and see what

the HbA1c says but I'm expecting it to be a little high this time.

Regards, Craig

[Guest guest]

thanks for that response, ...I agree with you totally! Vicki

In a message dated 00-11-02 10:00:16 EST, you write:

<<

<< I can't help thinking that some of us are over-cautious. >>

Why shouldn't we be over-cautious?? I have been diabetic since I was

thirteen and I plan on getting through many, many years complication free!

I have read (as I am sure you have, too) many books on diabetes and not one

fails to mention complications. Like complications are a given when it

comes

to diabetes. It doesn't have to be that way, though. It just takes us

being

a little " over-cautious " at times.

>>

[Guest guest]

In a message dated 00-11-02 13:43:56 EST, you write:

<< I have decided to rely on the

assessment made by conventional science rather than that of a best-

selling book author. >>

If you're referring to Bernstein here please do bear in mind that not only is

he a best selling book author but a diabetic of 50 years and an MD (and

former engineer) who has devoted his medical practice to treatment of

diabetics for many years. Vicki

[Guest guest]

In a message dated 00-11-02 13:43:56 EST, you write:

<<

But complications ARE a given when it comes to diabetes - being " over-

cautious " is not going to beat the odds, . >>

Not necessarily so, . While it's perfectly true that the complications

are there waiting for us, by gaining good BG control we can totally avoid

them. I for one have no complications and I'm sure there are many others on

this list who also have no complications. My only goal in maintaining good

BGs is to avoid those complications. And I'm sure I'll succeed. Vicki

[Guest guest]

> Why shouldn't we be over-cautious?? I

> have been diabetic since I was thirteen

> and I plan on getting through many, many

> years complication free!

By over-cautious I mean more cautious than is necessary to achieve

the stated aims. I like your plan, but the odds are against

you, I believe. Minimize the risk factors is my plan and since I

cannot assess the risk factors myself, I have decided to rely on the

assessment made by conventional science rather than that of a best-

selling book author. Being over-cautious means, by definition,

wasting effort and resources that could be devoted to improving

quality of life.

> Like complications are a given when it

> comes to diabetes. It doesn't have to be

> that way, though. It just takes us being

> a little " over-cautious " at times.

But complications ARE a given when it comes to diabetes - being " over-

cautious " is not going to beat the odds, . Most diabetics

already have some of the complications when they are diagnosed. Being

prepared might help to minimize the consequences but that is about

all we have at the moment in my opinion.

[Guest guest]

> It was my understanding that the test

> subjects were tested repeatedly at various

> times following meals, and that they were

> followed for many years. That is how they

> in fact determined the correlation between

> the two-hour postprandial readings, in

> particular, and HbA1c and complications. It

> took years of observation to arrive at these

> conclusions.

The study I was referring to was the famous " Avignon " study:

Avignon, A., Radauceaunu, A., Monnier, L.: " Non-fasting plasma

glucose is a better marker of diabetic control than fasting glucose

in type 2 diabetes " ; 20 Diabetes Care (1997), 1822-1826.

The 66 patients were enrolled, i.e. somebody advertised for them,

some were on diet only, some were on diet plus oral medication. The

work was all done in a clinic. Multiple daily blood samples were

taken at 8 am (fasting), 11 am (1 hr before lunch), 2 pm (2 hrs after

beginning of lunch) and 5 pm (5 hrs after beginning of lunch).

The patients were divided into 3 groups (HbA1c under 7%, between 7%

and 8.5%, and above 8.5%).

" The results of the study indicated that good glycemic control (HbA1c

concentration less than 7%) is characterized by extended postlunch PG

levels that are lower the the fasting value whereas poor glycemic

control is associated with extended postlunch PG levels higher than

fasting. Therefore, FPG was not a good predictor of blood glucose

concentrations at other times of the day. The best correlation

between PG and HbA1c was evident with the 2 pm and 5 pm samples which

represent the early and the extended postlunch values. Thís

illustrates that postprandial increases in PG levels are better

predictors of overall glycemic control than FPG and that both early

and sustained increases in PG following a meal make a significant

contribution to overall glycemic control. "

The values that were illustrated were scattered all over the dial.

The conclusions drawn were based on multiple linear regression

analysis of the data. It looks to me like they just drew a line

through the middle and hoped for the best.

The straight lines they drew were as follows:

1. Prebreakfast PG v. HbA1c: 100 mg/dl at 4% 250 mg/dl at 13%

2. Prelunch PG v. HbA1c: 90 mg/dl at 4% 300 mg/dl at 13%

3. Postlunch PG v. HbA1c: 40 mg/dl at 4% 350 mg/dl at 13%

4. Extended postlunch PG v. HbA1c: 40 mg/dl at 4% 300 mg/dl at 13%

You can draw the lines yourself on squared paper to get the

intermediate values. Needless to say, they had some values in the

raw data that were way out of line, a few up in the 400s and one at

450 for 2 hr pp. That is what I meant when I said that the studies

always seem to take patients in poor control just so that they can

get a few data points at the extremes.

What they didn't comment on and what strikes me most was the

prolonged hypo risk of having an HbA1c of 4.0 - at least 3 hours at

40 mg/dl!

I never saw anything on a follow-up study, Susie. This study drew no

conclusions about the correlation between 2 hr pp and the risk of

complications. There are other studies which found a correlation

between 2 hr PG concentration and the risk of cardio-vascular

disease. Some of them concluded that HbA1c was not as well correlated

with the risk of cardio-vascular disease as was the average 2 hr pp

PG. You figure! When you get home please send me the name of the one

you mentioned.

[Guest guest]

> While it's perfectly true that the

> complications are there waiting for us,

> by gaining good BG control we can totally

> avoid them.

> ....

> My only goal in maintaining good BGs is to

> avoid those complications. And I'm sure I'll

> succeed.

I am sure you are, Vicki. But I am not so sure about " totally avoid " .

The figures that we are given here for retinopathy, for example, are

as follows (most of the data comes from the US):

The WESDR [1] indicated that 98% of all Type 1 diabetics showed a

more or less pronounced diabetic retinopathy after at least 15 years

of diabetes of which half of them went on to develop a proliferative

diabetic retinopathy. Diabetics with a diagnosis dating back more

than 30 years showed a different picture. Differentiating in this

group between insulin-dependent and non-insulin-dependent diabetics,

the insulin-dependent diabetics have a prevalence of 84.5% with some

form of retinopathy and 20.1% of proliferative retinopathy after more

than 15 years since diagnosis. In all groups, the duration of the

diabetes is the most important factor for the appearance of a

diabetic retinopathy in which the prevalence for a proliferative

retinopathy after 15 years diabetes FIVE times higher is for Type 1

diabetics as for non-insulin-dependent Type 2 diabetics.

About 3% of all newly diagnosed diabetics show signs of retinopathy

at diagnosis (almost all of them adults). Very few diabetic children

are found with retinopathy even with fluorescent angiographic

methods. The risk of childeren showing retinopathy increases steeply

after puberty.

The appearance of macular oedema is one of the most important sight-

threatening complications during the course of a diabetic

retinopathy. In the WESDR, 29% of diabetics had a macula oedema after

more than 20 years since diagnosis whereas no diabetic in the group

had a macula oedema under 5 years since diagnosis.

The most important risk factors for the appearance of a macula

oedema, apart from the time since diagnosis, are proteinuria, the use

of diuretics, male sex, raised HbA1c. Of diabetics aged more than 30

years when they were diagnosed, 3% of those with a diabetes duration

under 5 years had a macula oedema whereas 28% of those with a

diabetes duration over 20 years had a macula oedema. Risk factors for

this group were high systolic blood pressure, insulin-dependence,

raised HbA1c, presence of proteinuria. In the 10-year follow-up,

20.1% of the diabetics under 30 years, and 25.9% of the insulin-

dependent diabetics over 30 years and 13.9% of the non-insulin-

dependent diabetics over 30 years had developed a macula oedema.

If all the identified risk factors were present, the risk of a

massive loss of sight within 2 years (without treatment) was 36.9%.

It sems to me to be strikingly clear that the the risk of retinopathy

is increased markedly by the use of insulin (there is no mention of a

cause-and-effect, just a risk factor). The improvement to be obtained

by reduction of HbA1c is subject to a threshold at about 8.5%, under

which no further improvement has been found. One thing seems sure, no

successful medication has yet been found so that is one less pill to

take!

I have resigned myself to getting retinopathy in a few more years,

sooner if I have to move on to insulin, later if I can keep my blood

pressure and proteinuria down, I don't think I can do much about my

sex at this late stage! There does not appear to be any advantage to

be gained from blood glucose reduction below 8.5% HbA1c so far as

retinopathy is concerned.

[1] Klein, R., Klein, B.E., Moss, S.E.:Wisconsin Epidemiological

Study of Diabetic Retinopathy: A Review. Diabet. Metab. Rev. 5 (1989)

559

[Guest guest]

Depression seems to go with diabetes, so some doctors prescribe

anti-depressants for us. I'm using one now, and have for several months. If

you need help, ask your doctor for it!!

Re: Re: Is this too high?

hiya All or anyone:

I am really down in the dumps over trying to get all this right.........

what

do you do when you get depressed....just tough it out????

Damn I was doing so good, have been testing before and after meals and

trying

to really adjust my foods to lower my carbs........but been stressed at work

noticed that my levels were staying steadily up for me......

So got home, had dinner and have just be down and crying....thinking about

the statistics of complications and etc.....hate to be a whiner.......many

on

here are so much worse off than me.....but didnt know who else to talk to

about my diabetes than all of you here...........

hugs

[Guest guest]

,

I started glucophage when I was first dxed; the dose was lowered at my 1st

quarterly visit and discontinued at the second quarterly dr appt. By testing

before and after meals, I learned which foods had the lowest impact on my bgs

and my post prandial numbers started dropping too low. I was able to go off

the glucophage and my bp dropped to normal, also.

I later asked my dr why he started me on meds right away instead of a trial

with diet/exercise alone. He explained that most T2 dmers are not careful

with their care and he wanted my numbers in the normal range quickly. He said

that only about 5 % of patients in his practice work as hard as I do to stay

on top of DM. Most prefer the meds in order to have more dietary freedom.

I've been dubbed a " boring " patient and will only check in with him once a

year. In this case, " boring " is good!

, I would rather control DM than have it control me.

Carol T

In a message dated Fri, 3 Nov 2000 9:37:11 PM Eastern Standard Time,

cariapat@... writes:

<< Carol:

Thanks so much for the words of encouragement.

Went to my Dr today and she put me on glucophage and said if my diet and

exercise along with the meds can keep my bs under control I may be able to

get off the meds in the future. I hope so! I was trying so hard to get

things on track without the oral meds. But such is life.My HbA1c when I was

diagnosed was, If I remember right, 7.0.I have modified my diet and I am

walking everyday. When I got weighed today

I gained another pound in the last three week......darn...

Again, thanks for your kindness

hugs

[Guest guest]

wrote:

<< I have modified my diet and I am walking everyday. When I got weighed

today

I gained another pound in the last three weeks......darn... >>

, I have gained as much as 8-1/2 pounds in one day from eating too many

carbs. A lot of those weight fluctuations are just water weight. As

diabetics, we are told to check our blood glucose regularly. But there are

many other things we can do, including using a blood pressure cuff regularly,

to check our b.p. and pulse, as well as a good scale to check our weight. And

we can take our measurements. We often find that when we begin a regular

exercise program, we gain muscles, which weigh far more than dopey old inert

body fat. So taking measurements (or using a pair of " reference jeans " to

check) tells us more about the state of our bodies.

Susie

[Guest guest]

> bacon & eggs sounds wonderful! and it's

> been oh so long since I had them.

> Thanks for the suggestion.

Craig, I have spent some time trying to find out what

the " nutritional time constant " is and as far as I can see it is at

least one week.

In other words, many people assume that because it has been shown

that a high-fat diet is well correlated with the risk of

atherosclerosis, for example, that they cannot eat bacon and eggs

for breakfast without risking atherosclerosis.

But one breakfast does not make or break a nutritional balance. It

seems to me (and my physician and some assorted hospital

nutritionists confirm) that it is sufficent to monitor your weekly

totals divided by 7. If your daily average is low in fat then you are

on a low-fat diet. This lets you eat bacon and eggs once a week

without compromising anything and you won't have to go " oh so long "

between hearty breakfasts.

I have even seen suggestions that the daily mean over a 30-day period

is an even better indicator. The nature of averages is that many

samples of a large number have to depart from them in order to pull

the average to any marked extent to one side or the other.

If you believe that then you have a lot more freedom in choosing what

you eat.

The same goes for the HbA1c. My wife recently had a bad gastric

infection for which she received antibiotics. She was running a high

temperature for a few days with high pulse rate, etc. Her blood sugar

showed very high (>250 mg/dl) post-meal readings for several hours at

all meals for a few days. Her HbA1c taken two weeks after that was

slightly lower (6.2) than it was two months before (6.4) (normal

range 3.8-6.6) which is well within the error margin. It takes quite

a lot of change to really pull an HbA1c up or down in one test

period. Most of the reported variations are due to normal measurement

error, in my opinion.

Variety is the spice of life. You CAN have it and keep good control

under all normal conditions if you keep the long view.

[Guest guest]

Thornton wrote:

<< Her HbA1c taken two weeks after that was slightly lower (6.2) than it was

two months before (6.4) (normal

range 3.8-6.6) which is well within the error margin. >>

The Normal Range at that testing lab strikes me astoo broad. Let's pretend

that those parameters are body weight. Multiply them by 30. Would you say

that a woman or man weighing 114 and a woman weighing 198 pounds are both in

Normal Range? That's what youre wife's testing lab pretends. Your lab creates

this gigantic spread of 3.8 to 6.6, thereby making more patients " normal. "

Good for public relations, perhaps, but not realistic, IMO.

Susie

[Guest guest]

> I've never officially been diagnosed,

> but with BG's such as I was getting

> the doc's quite satisfied that I have.

I had much the same kind of diagnosis as you, Craig, I just slowly

drifted into it over a period of many months. One day my doctor

pushed a pack of tablets across the table at me and said: " Try these

for a few weeks and if there is an improvement then we can assume

that you have diabetes " .

A few weeks later he just gave me a prescription to buy a hundred of

them without saying what they were for and I didn't ask. It was much

latter that I started taking measurements and working out weekly mean

BGs. Looking back at my old records I find that I was very impressed

at my own progress when my weekly pre-meal mean BG went down from

nearly 180 to around 140.

When I showed the plotted curve to a physician at a diabetes seminar,

he advised not to be satisfied with that. I really had expected him

to say how good it was so that came as my biggest shock to date.

Now I am down to a weekly pre-meal mean BG of 95 sd=5 n=14 and post-

meal mean BG of 110 sd=10 n=12 so only now am I beginning to again

feel that I have reason to be satisfied. That is 14 months after

my " diagnosis by default " .

> I'm still trying to figure out

> what to eat or not.

Yes, I know the feeling - but the joke is that it just couldn't be

more simple. I still don't know why I made such heavy going of it

until the penny dropped suddenly.

> I know that if I eat something that I

> shouldn't and my Bg's are elevated for

> a period my eyesight tends to become a

> bit blurry until the levels come down

> again - that's my " you've been a naughty

> boy " indicator.

That's a bad sign, Craig. Have you had an eye examination recently?

Maybe you are starting a cataract (grey star).

Diabetes is one of the greatest risk factors for grey star. I have

just the first traces of it in each eye but since normalization of my

BGs it has not progressed but also not disappeared (it won't). It

might be worth having an eye doctor look at you when you are in that

condition.

And watch out for impairment of your night-driving performance in

that condition - you probably will be much more sensitive to oncoming

headlight glare than would otherwise be the case. Most eye doctors

can simulate that lighting condition and give you an assessment of

your night-driving impairment.

The prognosis for retinopathy is vastly improved if it is caught

early on. A few laser shots at the periphery now are much better than

a lot around the macula later.

[Guest guest]

Re: Is this too high?

Thanks ,

Haven't had the bacon & eggs yet, but the idea of averaging the reading

over a week or month is interesting and makes sense; as you mention it would

take a fair deviation to drag the average too far either way.

if my Bg's are elevated for

> a period my eyesight tends to become a

> bit blurry until the levels come down

That's a bad sign, Craig. Have you had an eye examination recently?

Maybe you are starting a cataract (grey star).

No, didn't really associate it with having the possibility of having eye

problems, I merely put it down to having elevated blood glucose levels - I

assumed that the sight would normalize when the sugar levels did. I guess

this thinking was too simplistic. I'll mention it to the Doctor though on my

next visit.

A few laser shots at the periphery now are much better than

a lot around the macula later.

I don't much like the concept of someone shooting a laser into your eye, but

as you say if it has to be done a few now are better than a lot latter. How

can you hold still enough to allow them to do that? I'm assuming that they

must put you out to do it?

Thanks again for the help.

Best wishes,

Craig

[Guest guest]

> I don't much like the concept of someone shooting a laser into your eye, but

> as you say if it has to be done a few now are better than a lot latter. How

> can you hold still enough to allow them to do that? I'm assuming that they

> must put you out to do it?

I had laser surgery done on my left eye almost a year ago. It was to release

extra fluid in my eye from glaucoma. They don't put you out and mine was

painless. Took about 5 minutes. I'm not saying all eye surgery would be the

same but for me it was nothing. I'd go back without hesitation if I needed it

done again.

Annette

[Guest guest]

> I don't much like the concept of

> someone shooting a laser into your

> eye, but as you say if it has to be

> done a few now are better than a lot

> latter. How can you hold still enough

> to allow them to do that? I'm assuming

> that they must put you out to do it?

No, there is no anaesthetic for that because it doesn't cause too

much pain, I'm told. I haven't had it myself but I have sat there

alongside my wife as she had hers. Sure she jumped a bit but the shot

comes unexpectedly and was over by the time she jumped!

The main problem is if she moved between the time that the shot was

lined-up and the time the doctor pressed the button. In that case,

she lost a wee bit of good eye!

Assuming she managed to keep still (and my wife was told sharply

about it every time she moved!) then the laser shot coagulates only a

part of the retina that was damaged anyway and so no extra harm is

done. The tricky part is not hitting any areas of the retina that

were not already damaged, apparently.

My wife's eye doctor said he can normally give up to 300 shots at a

sitting but since she was moving about so much he could only get in

about 75 before her time was up. That meant she had to come back

again for some more and that puts up the price sharply! I asked the

eye doctor if I could hold her head still but he said that that was

against medical ethics; strapping it in also.

She was moving about so much because the arrangement was such that

the chair wouldn't fit under the table on which the machine is

mounted and she had to lean far forward to fit her head into the

frame. She also has back pains so all the time she was leaning

forward she was getting sharp stabs in the back. It took two sessions

before I realized what was happening and asked the doctor to

rearrange his set-up to let her sit up straight. That amounted to

criticizing the way he was doing his work and it required all my

diplomacy to avoid him throwing us both out but in the end he got the

work done.

She gets another check-up in December and he expects some new

bleeding will have appeared by then. Naturally, we hope not but have

no false illusions about the chances.

Before he could start work on the coagulation in her left eye, she

had to have the cataract removed by replacing the lens with a

synthetic one. It is a routine operation that hardly ever goes wrong

(infection risk!) these days. Her left-eye cataract was too far gone

to be able to see the retina clearly enough to do the laser shots but

her right eye cataract is much better and the eye doctor could shoot

through it. We are hoping that with better BG control, her right-eye

cataract will stabilize and another eye operation will be unnecessary.

It all sounds much worse than it really is and it is some comfort to

see the crowded waiting room, full of patients getting their eyes

lasered, and you never hear anybody yell, which is more than I can

say for our dentist's practices!

I hope your eye check turns out negative but it is better to get it

over with than wait and hope for the best.

[Guest guest]

In a message dated 00-11-04 07:27:21 EST, you write:

<<

I don't much like the concept of someone shooting a laser into your eye, but

as you say if it has to be done a few now are better than a lot latter. How

can you hold still enough to allow them to do that? I'm assuming that they

must put you out to do it?

>>

No, they don't put you out for it but they do hold your head in place with a

device. I have a few friends who have had laser surgery for cataracts and

they all say the anticipation is worse than the reality. (I think you do get

a local tho - or a tranquilizer). Vicki

[Guest guest]

> That's what youre wife's testing lab

> pretends. Your lab creates this gigantic

> spread of 3.8 to 6.6, thereby making more

> patients " normal. " Good for public relations,

> perhaps, but not realistic, IMO.

You are too mistrusting to be true, Susie. But there might be a

difference between US and European standards. My present lab's HbA1c

normal range is even wider than my wife's. It is 3.5 to 6.6% but

those values do not justify the label " gigantic " . They have to

include the high-reading non-diabetics with iron deficiency and a

larger proportion of older erythrozytes and the low-reading non-

diabetics with liver cirrhosis and chronic kidney deficiency and

short-lived erythrozytes or hemolytic anemia. It may well be that we

have more non-diabetics with iron deficiency than you have over there.

The textbook normal ranges over here are:

HbA1 measured with ion exchanger has a theoretical normal range of 5 -

8% and an average value of 6.5%.

HbA1c measured with high-pressure liquid chromatography (both my

wife's lab and my present lab) has a theoretical normal range of 3.1 -

6.0% and an average value of 4.5%.

GHb measured with thiobarbituric acid colorimetry (not used in

clinics any more) has a theoretical normal range of 5.3 - 7.5% and an

average value of 6.4%.

Naturally there is a concerted effort to avoid false positives here

but very little attention is paid to the value after the decimal

point, anyway, because of the inherent inaccuracy of the method. Most

physicians (primary care and clinic) are interested in the figure

before the decimal and the trend between two successive measurements.

Type 2 diabetics are kept above 5.0% for safety reasons - the risks

of going below 5% being far greater than any marginal advantage to be

gained. So the classification seems to be: anywhere in the 5s and you

are well-adjusted, in the 6s and you are safe from complications for

now (age-dependent) but we will see how it goes, in the 7s and we

need to try a higher dose, 8 and above and you are badly adjusted and

need something more, like insulin. Variations of less than 1% point

in the same person are considered to be personal physiological

variations or measurement error. This whole HbA1c thing has about the

accuracy of a urine test strip, in my judgement!

What kind of normal ranges are found in the US?