normal? really?

Here's a secret. When it comes to blood glucose levels, nobody knows what "normal" means.

As noted before, medical research finds increased incidence and risk of diabetic comorbidities or "complications" (late-stage symptoms) correlating with blood sugar levels currently deemed "pre-diabetic" or even normal.

We know this more precisely now, yet it's nothing new. The correlation of elevated blood glucose with morbidity and mortality is long-established; it informs our current definition of normal as fasting blood glucose under 100 mg/dL, although in an entirely inadequate way.

As long ago as 1980, impaired glucose tolerance (defined as blood sugar levels of 96 mg/dL or greater after a clinically-administered "challenge" of 50 g oral glucose), roughly doubled risk of death due to coronary heart disease.

In short, that level of post-challenge glucose intolerance, several points within today's "normal" fasting range, kills people. Quibbling over the additional 25 mg/dL that distinguish the "pre-diabetic" from the diabetic seems as useful as speculating over how many angels can dance on the head of a pin.

more on the risks of current norms

p.s. I was recently surprised to find an untapped prescription for glucose test strips, and was able to get it extended. I'm gathering new data on my own progress and setbacks, and should be able to publish them soon. I shall also finally incorporate into the data the standards for normoglycemia that have been tightened - obviously to my mind not enough - since my original intervention in 2003.

back on track

I'm returning to the plan from 2003. I've been losing about three pounds a month since March.

I also finally got some pharmacy issues sorted out, and have glucose meter test strips again. Early results are good:

• Most results are in the normal range, less than 100 mg/dL glucose.
• I am still subject to some version of the "dawn phenomenon", with morning fasting readings around 120.
• On the other hand, I may have responded "non-diabetically" to a big dish of ice cream right as I started testing, with a 2-hour postprandial reading of 128. (But see below. And no, big dishes of ice cream are not part of the plan.)

Separating meals by a minimum of four hours is critically important for these results.

In the next series of tests, I need to get a better idea of where my postrprandial peak falls. I know it's longer than two hours, probably closer to three. With that done, I'll post more detailed results.

I have some new ideas about the elevated waking readings - sleep apnea has been ruled out - and hope to be able to score some more strips to test those soon.

p.s. I've updated the dataset download page with PDFs of some input and outcome overviews.

eye risk before diagnosis

A recent study proposes new thresholds for predicting risk of diabetic retinopathy. Using more precise gradation in the "good control" or "prediabetic" range than comparable earlier research, Massin et al. found the following correlations among 700 French volunteers studied for ten years, and were confident in proposing them as predictive:

HbA1c %	fasting plasma glucose mg/dL	predicted retinopathy
6.0	—	6.0%
—	108	8.4%
—	116	14.0%
6.5	—	14.8%

The takeaway? A difference in the range of half a percentage point of HbA1c, or 8 mg/dL of fasting plasma glucose, roughly doubles one's risk of potentially blinding retinopathy, from about one in 15 to one in 7. This risk correlation held even among subjects who did not develop diabetes, as currently defined, over the course of the study, retaining their diagnosis of "impaired fasting glucose".
The current diagnostic threshold for diabetes is an HbA1c of 6.5, the highest value in the proposed predictive model. Since the diagnostic threshold in terms of fasting blood glucose is 126 mg/dL, the remaining values are well below the threshold, in the so-called "prediabetic" range. Normoglycemic, neither diabetic nor prediabetic, is currently defined (at the upper end) as under 100 mg/dL fasting glucose or under 5.7% HbA1c.
I have two reasons for highlighting this study:

• Absent a risk of going hypoglycemic—into dangerously low blood glucose levels—there is a compelling argument for driving blood glucose levels down even if you are being told, as people in the "prediabetic" range often are, that they have "good control". A level of control that may double my risk of blindness doesn't seem to me to have much good about it. (Type 1 diabetics or others considered to be at higher risk for "going hypo" may want to check with their care team about the extent to which tight control might mitigate both short- and long-term risks.)
• If diabetes is a progressive, degenerative, debilitating, and potentially fatal disease with multiple comorbidities—it is—and if "prediabetes" is an independent mortality risk whose defining numbers successfully predict so-called "complications", or more precisely late-stage symptoms, of diabetes—it is and they do—why on Earth is the diabetic establishment still sugar-coating the reality of this disease by mucking around with terms like "prediabetes"? When will medicine catch up with science and lower the diagnostic threshold? It has done so before, and can do so again. Come the day!

source: Massin P et al. Archives of Ophthalmology, 2011: 129(2): 188-195

surprise

New meter. Last 9 tests ranged from 85 to 106. Scheduled for an A1C soon. Looking forward to it. Also need to run a series with old meter, as soon as I get supplies sorted out.
edit 2011/02/18: For those of you who are not glucose geeks, under 100 is considered normal.

remission? cure? control?

2003/12/16 "Looks to me like you're not diabetic anymore."
—my Kaiser Permanente doctor

Wow. I didn't think they were allowed to say that. Nor that any doctor would ever say, as mine did later in the same conversation, "You've cured yourself."

As I've learned since, only the first of these statements is true. Being "not diabetic anymore" can serve, with certain caveats, as an attainable goal in diabetes control. This is what I, along with more and more lay people and professionals, call remission.