My completely normal spouse, who has never tested higher than 115 after eating high carb meals has an A1c of 5.4%.

There is natural variation in how much people glycosylate hemoglobin, and the more I read the research the more convinced I am that the A1c is only useful in large population studies. For individuals it is not a good guide to blood sugar health.

Focusing on eliminating the sustained blood sugar peaks seems to me a much more healthy and achievable approach.

Re eating the same boring healthy things every day. My dad did that as long as I knew him (56 years). He also managed to live to be 100 and to practice his profession until age 92--while carrying the family diabetes gene. So it works. He developed significant heart disease by age 70--angina--but didn't have a heart attack until his late 90s. So, again, it works.

But he had an extremely rigid personality and did pretty much EVERYTHING the same way every day all his life. Nor did he get pleasure out of food the way that some of us do.

I'm not like that, so I've had to find a way that works for my very different, extremely mutable personality that needs continual change to be happy and which finds food one of life's main pleasures.

My take on it is that it is good to know what perfection might be, and it's smart to do the best we can, but those of us who don't have those rigid personalities have to work out something that we can live with.

I've done a lot better with a more flexible approach over the past five years than I did in my 3 years of near perfection followed by one year of utter meltdown.

Having access to insulin really helps too. Without insulin I have no choice about low carbing any more, not with my rotten post meal blood sugars. But with insulin, especially now that I am using Apidra, I can get wonderful 1 and 2 hour post meal blood sugars with a couple units--better than I was getting with Bernstein intakes and no insulin.

Bernstein is not familiar with any fast acting insulin but Humalog by his own testimony, and humalog is for me the very slowest of the fast acting insulins and one that IS impossible to match to food. Maybe if he'd found an insulin that matched carbs better in his own body, his attitude might be different. I can't see why if I'm at 100 an hour after eating my slice of regular toast, I can't eat toast.

I do know that if I eat 50 gram meals two times a day for a few weeks I will start to gain weight, so because I like being normal weight, I don't do that. But my blood sugar is not going high and that 5.7% A1c is as high as it is because I'm one of those "lucky" high glycosylators. No matter what I test at after every meal I am always 5.5% or higher.

Your Dad sounds like my kinda guy. Heh.

And Bernstein swears that Humalog is the fastest acting... I have heard that Novolog is faster acting but what do I know...

/ssmile

The way the various insulins perform varies from person to person. Some people find humalog fastest. Others, like me find it causes peaks and hypos no matter how timed. Since speed is all about how well it absorbs, it is possible that differences in our physiologies cause different absorption patterns.

Dose size matters too. I use only 2 or 3 units at a time. With a larger dose you get a different absorption pattern.

For me Novolog works pretty well, but I go higher after eating carbs than I do with Apidra. The 2 hour result will be the same, but the Apidra gives a near-physiological response and if I get my carb/insulin ratio right I will not go over 120 at all.

I think you are onto something, girl... and Novolog has never given me a hypo fortunately... but I don't use it all that often...

/smile

Yes, I think that personality has a lot to do with it and that needs to be considered when framing a meal plan. I think dietitians probably do try to accommodate different eating styles, but the problem is they are working with a set of bad assumptions.



Agreed. What is the point of living life if you are not happy?



I've come to the same conclusion. It's very hard on the psyche if you are constantly falling short too.



I agree that all diabetics should have access to insulin, even if it is only used to bring down an occasional high that may occur during illness or dietary indiscretion. There should be a choice in the mater at least. Apidra might be helpful for me in curtailing my morning rise after coffee. NPH has really helped with my fasting and I'm in the 70s and 80s most most mornings when I wake up. Humalog matches up very well for me eating low GI fruit. For a Bernstein-type meal, Regular works better on the protein. If I want to eat grains or pasta, I need to concoct a mix of H/R/N, which I don't bother with often. I could tolerate grains much more easily when I used NPH as a basal. I'm using Lantus as my basal now because I don't want to feed my insulin in the daytime and using NPH at night to zap DP. I'm mixing basals in that regard. It is a shame that they discontinued Lente because it was so helpful for type 1s.



Same here with too many carbs = more insulin = more weight. On the other hand, too few carbs = too much weight loss. I spike up sometimes being a type 1, but I correct immediately. I'm pretty happy with my A1cs. Life is good.

Love the explanations for how you are using insulin. Much more geeky, than obsessive. Both have their place. A really good diet guru offered me some advice, which I appreciated. But I realized that doing what I already was doing exhausted my obsessive capabilities. (taking medications, eating low carb, gym workouts). I have access only to Lantus and Regular insulin at this point. I hope my new doctor will help remedy that. I really want to try Lispro, and after seeing what you and Jenny wrote, Apidra.

You found a new doc that is not waiving ACCORD at you and scolding you for a good A1c?

Yeah, I'm a geeky tweaker by nature. Each of us has to find their own insulin path because they all work differently for any one of us. Doctors can give you guidelines (and hopefully prescriptions), but only you can write the owner's manual for your body. You know how to do it and being obsessive will help you keep records to spot trends.

There's always Canada for Humalog.

Great thread, very interesting.

I don't have to use insulin, so, for me, striving for "perfection" isn't too much of a burden. My goals are to be in the mid 80s upon waking, and in the 90s two hours after eating. I generally meet those numbers, so, maybe I'm doing my body some good.

I think it is a lot easier for a type 2 that has insulin production. Dr. Bernstein must not be a heavy glycator to consistently hit 4.5. My FBGs are usually in the 70s and 4.9 is my best A1c. I think Jenny is correct in that A1c doesn't tell the whole story. Dr. B's A1cs are lower than Jenny's non-diabetic husband.

I must buy Jenny's book soon - even though I'm not a type 2 - as I think her advice on diabetes is the most sensible I've read anywhere.

I may order her book tonight I enjoy her posts, for sure.

I don't know how the hell Dr B gets his A1c that low.... different labs, different results, maybe?

My sister's doctor in home town likes normal BGs, and put my sister on insulin right off the bat. He evidentally likes Bernstein, and what she told him about Jenny. My insurance has a copay for a 3 month supply, and I think I will first ask for a pen of Lispro and Apidra.

I just went for my blood work again.

I am making an appointment this week to get all the results.

I am hoping to see an A1C 5.0 or less.

I am striving for the 4.6. I don't think I made it since life can get very boring being perfect.

But the statistics support the fact that the lower your A1C is and the closer to "normal" the better off you will be avoiding complications and improve your mortality rate.

I use "industrial" strength doses of Levemir and I use "industrial" strengths of Novolog when I choose to have more carbs.

I generally keep my carbs under 60 and certainly under 100 but sometimes; ah well. LCing is the baseline. I always target for 30-40 and end up happy with 60. If I am to lose weight then I must do 30-40.

I view Dr. Bernstein and his achievements as the ideal target.

To the extent I am willing to get there terrific. I certainly gained a whole lot of information reading his book and still go back to it for reference.

Ralph

Hi all,

Do studies really show that extremely low A1cs prevent complications better than A1cs that are simply below 6.5? I'm very interested in any links people might have to these studies. For myself, my target is simply below 6.5, which I mostly meet. Any lower and I'm getting lots of lows. I have no complications, but granted it's only been 12 years since I was dx'd.

V

All the data connecting A1c with outcomes is data that looks at averages in large groups. The A1c is very useful in population studies, but because of natural variations in how much your hemoglobin glycosylates, it isn't all that good for individuals.

There is enough data linking post-meal blood sugars to outcomes in individuals, in situations where A1c is not predictive, especially re neuropathy, that I would (and do) focus on post meal spikes over A1c, especially if you are someone like me whose A1c is always much higher than predicted by measurement.

A1c may be higher because blood cells are living longer than normal and hence collecting more glucose. The higher the blood sugar the shorter lived the blood cells. I don't have the link for this handy but it's been tested and proven.

Overall the A1c has become so central to diabetes research because it is a cheap test that doesn't require fasting and gives an erroneous sense of knowing all about blood sugar.

So if you are testing rigorously and not seeing blood sugars over 120 or 140 and your A1c is higher than expected, don't stress. OTOH, if you have a great A1c but lots of highs, well, you might just be anemic which dramatically lowers A1c without lowering the risk of complications!

I've always been interested in how A1C is calculated.
It would seem you would have to know the age of the
individual blood cells i.e. older cells will have a higher
hemoglobin content.Maybe blood cells fill with hemoglobin
quickly therefore all blood cells,other than those with very
small hemoglobin content,can be assumed to be full of it
(so to speak).Does anyone know?
<confused>
Eddie