Institutionalizing Frustration

If there’s anyone out there living with diabetes who does NOT find it frustrating, send me an email. I’d like to hear your secret. For the rest of us, living with it just got that much harder through a yet another “standardized guideline” announced by the IDF (International Diabetes Foundation) last week.

“The new IDF Guideline recommends that people with diabetes try to keep post-meal blood glucose levels to less than 7.8 mmol/l (140 mg/dl) two hours following a meal.”

Now I understand that postprandial (post-meal) glucose values are important, ’cause they sure can impact your A1c — that gold standard for measuring your average glucose level over the last three months. And that’s important, ’cause that helps you understand your chances of developing the nasty complications of diabetes in the long run.

So I get that the IDF feels it’s important to make some kind of statement here, given that until recently, the key recommendations for good diabetes management were only about lowering your fasting or pre-meal blood glucose levels. PWDs all around the world need to know that you don’t want to go sky-high after every meal.

HOWEVER — and this is my big bone to pick — nothing seems to be really new here except for a more aggressive number, putting yet more pressure on us patients to “perform.”Guilty_tshirt

By this I mean that I thumbed through the 32-page guideline document (if it’s possible to “thumb” on the Internet), and discovered that:

* most of the contents are taken up with arguing that high post-meal BG is indeed harmful, causing oxidative stress, inflammation, and other things that lead to heart disease (the same problems you get from a high A1c overall)

* the recommended “treatment strategies” are the basics: frequent SMBG (self-monitoring of blood glucose) with a traditional or continuous monitor, exercise, diet — with an emphasis on low-GI foods — and “a variety of pharmacologic therapies,” ie. insulin and a bunch of other drugs.

I guess the idea is just to get doctors and other folks treating diabetics around the world to put more emphasis on keeping post-meal numbers low. But as we all know, the details often get lost in translation. So what’s likely to come through to most patients is nothing but yet another number to stress over (!)

As a Type 1 who actually eats carbs (gasp!), I can’t remember ever hitting 140 BG after a meal when I wasn’t heading for a low. To be perfectly honest, I’m lucky to hit 180 post-meal most of the time, but most of the time, I still manage to get back in range by hour 3 or 3-1/2.

What I’m saying here is, most of us are going to look at that 140 goal, and feel like screaming: “Are you kidding me? I feel guilty enough all the time as it is!”

Thoughts?

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37 Responses

  1. Dan Fahey
    Dan Fahey September 25, 2007 at 9:32 am | | Reply

    My wife is pre-diabetic, and with diet alone has been able to pull down her BS levels below 140 after 2 hours, both by losing weight an by modifying diet. A real key is balancing carbs with proteins: carbs alone will still spike her BS value after 2 hours.
    I’m an insulin-dependent diabetic of 40 years, and use two types of insulin [Humalog and Lantus]. It is possible by using these effectively to keep BS after 2 hours NEAR 140, BUT the potential for hypoglycemia goes up too.
    I think the 140 is a reasonable number to be aware of, as long as one doesn’t beat oneself up when one overshoots.
    My experience is that what’s really important is to knock down high blood sugars quickly, something only possible if one is testing enough to notice.
    Exercise is another important variable though: a 140 is dangerous if that’s a starting point before exercise.

  2. CB
    CB September 25, 2007 at 9:34 am | | Reply

    I agree with you, Amy. At the moment it’s hard to imagine how I could consistently keep my 2-hr post-meal BG lower than 140mg/dl w/o suffering hypoglycemia later, since my Novolog’s effective about 4 hr in my body. This “recommendation” is like trying to thread a needle w/o your reading glasses on. I think we’ll be seeing more “recommendations” like this in the future and it’s a form of diminishing returns from the folks who like to set medical standards – as opposed to those of us who actually live w the disease every day. In effect, organizations like the IDF and for that matter the ADA are forced to add more “recommendations” over time (to show that they’re relevant), but the additional recommendations don’t usually have as much effect as the 1st ones [like managing our D so our A1c is less than 7.0]. So my reaction to this new IDF “standard” is to mostly dismiss it – after all, as you mention it’s mostly covered by keeping our A1c below 7.0. Perhaps the IDF and its brethren would do better to recommend making the A1c tests far more broadly available to us 246 million Ds worldwide, especially since I’ve seen survey results that 90% of Ds in the US (where D care is presumably better than in many countries) don’t know what their A1c’s are. How about first things first!

  3. val
    val September 25, 2007 at 9:38 am | | Reply

    Amen! A new target without a new treatment isn’t going to help.

    Actually with Symlin I was 140 after meals – but then shot up to 350-400 four hours post prandial, every time. I figure it’s better to skip the Symlin and be 250 two hours after and back to normal by 4 then get a correction resistant high after four hours.

  4. Suzi
    Suzi September 25, 2007 at 9:44 am | | Reply

    Yes. And let me tell you that I suspect some of this is a cover for selling Symlin. While that’s very possibly a helpful drug (sometimes–what I found was a lot of lows just after meals followed by huge rebounds later), I worry about making the big pharma companies even wealthier. Also, as you note, being at 140 an hour or two after a meal is like a big prescription for a massive low. (At least for people with Type 1.)

    I like the T-shirt with GUILT all over it. Perhaps you can make them & sell them. We wear them all of the time anyway! It’s only that people can’t always SEE them.

  5. Ryan Whitaker
    Ryan Whitaker September 25, 2007 at 9:55 am | | Reply

    I know you mentioned that you were a “carb eating” diabetic and that reducing carb (either drastically or moderately) is not always a path of interest to folks. But in the interest of sharing my own personal experience (I am type 1 of 28 years, now 33) with very normalized blood sugars using a lower carb and low insulin approach I wanted to share a website I built to aggregate information on that topic at: http://www.dsolve.com

    Like I said, I know lowering carbs isn’t for everyone (I only eat 30g of carb per day), but my post-prandials are actually flat 90% of the time. The fat and protein along with the low amount of carbs (mostly from green vegetables) slows even that carb absorption (the pizza effect) leading to normal blood sugars. My A1c before this was 8.0 and is now 5.0.

  6. Chloe B.
    Chloe B. September 25, 2007 at 10:08 am | | Reply

    I thought anyone with an endo (or at least AACE accredited) already had those numbers as goals.
    So what’s new?

  7. CrazyACpumper
    CrazyACpumper September 25, 2007 at 10:35 am | | Reply

    As I continue to read the blogs and posts on Diabetes Mine, I hear myself shouting, “me too!” or “uh huh” or “oh yea I know how that is.”

    Interestingly enough I also find myself saying “what?” “how does that work?” “can that work?”.

    My point is, no matter what is blogged, it opens a very important forum. This forum allows ALL Diabetics to be heard. We deal with this disease every moment of every day. All the while, every single one of us is different. Very different. We all react differently and deal differently.

    It is great to see what others are doing or trying. It is even better to hear of the successes. It is a tough disease and what works for you, only works for you.

    For me personally, I WISH I could try this, try that and get results. I have been living a trial and error life for 22 years. My Endo and I try this, try that. He wants to see how it is working in 2 weeks and I tell him I need a month, I know how my body is, what it needs. Time is nice but life does not stop for a formula change. Or a diet change or an exercise program. Unfortunately stress in my life is the biggest factor. I maintain it, I deal with it the best I can (we are human and that is all we can do!). Growing up with this disease is difficult when your body is constantly changing, you are personally changing, life changes, things happen, etc. etc.
    But, it is inspiring and encouraging to read the posts of those that it is working for. It gives me hope.

    Thank you to all of you and your openness about what you go through!

  8. Dave
    Dave September 25, 2007 at 11:09 am | | Reply

    I would be curious to know how many people who commented are using pumps or fast acting insulin to balance out there meals. I hate to say this but if I have a 140 bg level 2 hours after I eat there is a serious problem. The only time I would expect this to happen is if I just ate a bunch of pizza and didn’t dual wave bolus properly. Am I missing something??

  9. chinston
    chinston September 25, 2007 at 11:56 am | | Reply

    I’m confused. Is the better approach for the medical establishment to soft-pedal evidence that patients can lower risks of complications by “try[ing] to keep” to 140 after eating? Or to use a different term for the number than a “guideline”?

    If the beef here is that “nothing seems to be really new here except for a more aggressive number,” why draw the line at 140? The same principle would apply to a lowering of target BGs from 300 to 200, or from 200 to 180. If there’s evidence that 200 is better than 300, then 200 should be the guideline–same for 180 versus 200, and, in this case, the same for 140 versus 180.

    I agree that the follow-on communication from doctors to patients has to be solid, but that seems like a separate issue from the initial decision to announce a certain “more aggressive” guideline based on medical evidence.

  10. chinston
    chinston September 25, 2007 at 12:02 pm | | Reply

    That said, I wouldn’t call 140 two hours after eating a “serious problem,” just cause for some minor present and possibly future adjustments.

    Oh, and yes, living with diabetes is an exercise in frustrations large and small. It’s a damn nuisance.

  11. Ed
    Ed September 25, 2007 at 12:07 pm | | Reply

    I’d be happy if my 2 hour post meal reading goal was 140 – I shoot for 100; I know if I’m in the 110s or 120s an hour after meals I’m headed for a low but 100, 2 hours after a meal usually doesn’t send me low – although my basal rate is small. Granted my body is still probably producing some insulin but with the right diet and good math I think that is an obtainable goal.

  12. AmyT
    AmyT September 25, 2007 at 12:08 pm | | Reply

    Hi Chinston,
    The way I understand it, at least from my doctor, the old “guideline” was up to 180 after meals. That worked well, because as long as I didn’t top 180 post-meal, I usually came down nicely into range. The 140 number seems frustratingly unobtainable to me. This post was just putting it out there: do others agree?

  13. Jana
    Jana September 25, 2007 at 12:10 pm | | Reply

    I completely agree with you. My A1Cs are usually quite good (varying between 5.1 and 6.9), but I still feel guilty about my excursions after breakfast in the morning. I am actually just now recovering from a low of 56 which I think resulted from over-bolusing at breakfast to avoid the kind of number I saw yesterday after breakfast–a 212. Today I still saw a 160, but then an hour and 45 min. after the 160 I’m at 56… I’m ready to give up again.

  14. Dave
    Dave September 25, 2007 at 12:35 pm | | Reply

    Hello Chinston,

    I am a type 1 pumper. For me 140 2 after I eat represents a problem. I am very good at bolusing and accounting for the carbs I eat so if I am at 140 then I did something wrong. I enjoy having A1c’s under 6.0 and very few hypo’s.
    If people would moderate their carb intake, exercise and check their blood regularly this wouldn’t really be a big deal.
    You may be all over your treatment plan and I am not saying that I am perfect but many diabetics need more stringent guidelines to help keep them inline.

  15. Melitta
    Melitta September 25, 2007 at 1:23 pm | | Reply

    IDF fails to distinguish between those who use insulin (all Type 1′s and some Type 2s) and those who don’t (the majority of Type 2s). That is a serious failure on IDF’s part. If you use insulin and eat some carbs, this is a very difficult number to achieve without excessive hypos.

  16. AmyT
    AmyT September 25, 2007 at 1:27 pm | | Reply

    Thank you, Melitta, for putting that so succinctly ;)

  17. SH
    SH September 25, 2007 at 1:44 pm | | Reply

    My endo has always said post-prandials should be below 140, but I was only able to achieve that when I was still “honeymooning”. I think this is very difficult for type 1s to achieve. It’s a great goal, but even with my obsessive monitoring and dosing and sophisticated carb counting, I still struggle with numbers over 180 or into the 200s often. I’ve been feeling terribly guilty lately. This leads to overhauling my basal rates, and often “rage bolusing” in utter frustration with highs.

    It seems that post-prandial highs are not as much of a problem for type 2s, so I think it’s hard to compare us side by side. It’s just not the same disease.

    Well, I’m shooting for the 140 or below, but I’ve never eaten so many jelly beans in my life!

  18. chinston
    chinston September 25, 2007 at 1:49 pm | | Reply

    Dave – Sorry, I was a little cryptic. I should have said that, for me personally, I wouldn’t call a 2-hour postmeal 140 a serious problem, but that’s probably because I would reserve the word “serious” for something like sudden severe hypoglycemia or maybe repeated 140s with no obvious explanation, etc. In fact I meant to come down more on the stringent side of things, so I think we basically agree.

    Amy – Your post did get me thinking. I do agree with the basic theme which I would say is that “the perfect is the enemy of the good.” If your goal is solely perfection (or, say, 140 bg), you may be worse off in the end than if you had aimed for some less lofty, but more achievable, target–and worse off not only in terms of guilt but also in substance, too. So I hear you.

  19. Bernard Farrell
    Bernard Farrell September 25, 2007 at 4:03 pm | | Reply

    It’s funny how the ‘experts’ like to change the numbers every few years. The recommended cholesterol levels for folks with diabetes was dropped several years ago, which gave me ‘high’ cholesterol.

    Now the post prandial level is dropped. To a number that is hard for most of us to achieve. In fact there are only two (maybe) three ways of accomplishing this that I can see. First, try using Symlin. But that’s not easy and doesn’t work all the time. Second, don’t eat many carbs. Which only works when you can stick with the plan. And the third (possible) solution is to eat while running on a treadmill.

    In an ideal world we’d all not have diabetes. Given that we do, why are IDF and others giving us these impossible goals. Given the lack of coverage for CGM devices or adequate test strips we’ve little chance of accomplishing this.

    I think we need another T shirt “Eat, Drink and Be Merry for tomorrow we die!”. And I don’t mean to be morbid about this. Maybe we’d all do better if we were allowed to worry a little less about the numbers and just enjoy life as we live it.

  20. Khurt Williams
    Khurt Williams September 25, 2007 at 4:16 pm | | Reply

    I was able to lower my A1C from 7.2 to 6.5 by limiting the amount of carbohydrate per meal to between 50g and 60g. My pre-meal BG is between 70 and 90 and my two hour post-meal BG is between 100 and 130. It took a lot of trial and error over 6 months.

  21. Felix Kasza
    Felix Kasza September 25, 2007 at 8:16 pm | | Reply

    Melissa — the IDF doesn’t distinguish between type 1 and type 2 because for the purposes of this guideline, there is no distinction. High average BG and, very likely, high variance, are risk factors for vascular disease, no matter by which mechanism the BG (and variance) are caused.

    To all those who spike: Try all three rapid-acting insulins. For me, insulin aspart (Novolog) is dog-slow; insulin lispro (Humalog) is OK; insulin glulisine (Apidra) is perfect: Smooth and rapid onset, short tail. YMMV.

    Also, eating carbs does not have to mean meals of white rice with a side of baked potato, people. Moderation is the key — and trading that baked potato for steamed or roasted veggies.

    Oh, and smoother BGs also make for fewer frustrations, fewer lows from overcorrecting, and fewer rebound highs after treating the lows. Win-win!

    Cheers,
    Felix.

  22. Lyrehca
    Lyrehca September 25, 2007 at 8:42 pm | | Reply

    Actually, the 140 post meal is the same (or similar) to what docs counsel type 1 women to achieve while trying to conceive and during pregnancy. It can be done, but it requires a ton of testing, eating something like an apple one or two hours after a meal, and perhaps lowering basal rates (for those on pumps) post meal to counteract the (often inevitable) lows. As someone mentioned above, it can be done, and many pregnant diabetic women do it, but it’s a ton of work and tough to sustain.

  23. Jayne
    Jayne September 25, 2007 at 9:15 pm | | Reply

    If I get this post right ~ it is not about the numbers…it is about the frustration! When I got type 1 at age 36…I set out to be a hero. Thirteen years later, I am drawing the line on just how much I will do for my failed pancreas…and my future, for that matter. I am not willing to live each moment for the numbers. I am doing my best and reserving alittle brain space for enjoying life. Please tell me there will be an end to all the recommendations someday. Now, that would be progress in my estimation.

  24. Suzy
    Suzy September 25, 2007 at 9:55 pm | | Reply

    140 is hard, damn hard. I’ve been doing that for 6 months, and while I do go over sometimes, I mainly stay within that goal. My A1C is 5.2. I want to live as long as possible, with as few complications as possible, and if that means eating less of the things I love, well, that’s what it means. And, yes, I love carbs. I adore them. I would eat nothing but simple carbs if I could.

  25. Dan Fahey
    Dan Fahey September 26, 2007 at 6:27 am | | Reply

    Follow up from Dan Fahey.
    Two issues that I see from the comments:
    Type 1 vs Type 2, and time a diabetic.
    I’ve only been a Type 1, and that for 40 years.
    Over time, the swings a diabetic experiences get greater [referred to as "brittleness"]. The more brittle, the harder it is to achieve a post-prandial 140 without almost assuredly hitting a low later. For those in that category, shooting for a 140 is probably not a great idea. However, there are ways to manage lows, particularly when you know they are going to come. So maybe this type should use a 160 as a guide, just so they don’t feel like a “failure.” Over time, it’s better than 180 as a guide. Ultimately, I would argue that whatever helps to minimize the amount of time our body is over 140 is a good thing.
    For Type 2′s, I would surmise that 140 should be a more achievable number simply because the risk of lows is somewhat less. That allows for being more aggressive.

  26. Dan Fahey
    Dan Fahey September 26, 2007 at 6:32 am | | Reply

    Dan Fahey again:
    As much as I’d rather not be a diabetic, I’ll take that any day vs the many devastating diseases one COULD have. Not too many cancer patients, for example, get to talk about having the disease for 40 years and counting.
    Despite diabetes, I live a normal life, am healthy, play handball 3 times a week, and walk 4 miles the other days. I see myself as very fortunate, despite the frustrations of diabetes.

  27. AmyT
    AmyT September 26, 2007 at 8:10 am | | Reply

    Hey Jayne and Bernard,
    Yes, it’s about living life and not being crippled by guilt! Thanks for your affirmations on that.

  28. Bonny C Damocles
    Bonny C Damocles September 26, 2007 at 10:21 am | | Reply

    Amy,

    I have been living with type 2 diabetes since July 1991 when I was diagnosed based on a sky-high fasting sugar reading of 468 mg/dl and fortunately have never been frustrated.

    How can I say that? Very easy.

    Our family physician then was Dr. Adelto Adan, a cardiologist at Mid-Michigan Medical Center, who believed that my problem was diabesity. Please understand that this has nothing to do with type 1 diabetes nor does it have any similarity to it.

    This being the case, the best course of action I had to take was to exercise. So exercising I did and have been doing it for 2 hours total every day in the first 6 months of my diabetes life and have since reduced it a little bit to 80 minutes/day in 4 sessions of 20 each, 1 session before each of my 3 full meals and 1 session before bed.

    What have I been eating? Only heart-healthy foods, mostly carbohydrates from fresh fruits, vegetables, grains, beans, nuts. For protein, I have been eating fish.

    Of course my pp sugar levels are always high but 2 hours before my next meal, they are always in the normal range. I have been learning that temporary and short-lived sugar highs are harmless to me.

    I am not supposed to say this but as far as I am concerned, it works wonders: after-meal sugar highs should never be controlled. What I am actually saying is that my exercise routine is so effective that my body has been learning, altho very slowly but surely, to operate like a normal one.

    I would think that when it comes to treating type 2 diabetes (I am making it very clear that type 1 is a very different beast), the frustrating part is the impossible task of keeping pp sugar levels to a fixed safe level, like 140 mg/dl 2 hours after a meal.

  29. CB
    CB September 26, 2007 at 11:50 am | | Reply

    Well Amy, you’ve got us going on this one, congrats. As a brittle T1 pumper who’s been D for over 52 yrs, I’m all for keeping in “good BG control.” I still stick with what I said in my early post yesterday, that “guidelines” will only become stricter as time passes. However after re-reading the IDF Guideline document more carefully, I think this IDF guideline is more than meets the eye.
    First, the IDF appears to be recommending very tight BG control. At the very end of the Guideline document, Table 2 “Glycaemic Goals for Clinical Management of Diabetes”, states that the IDF wants us to keep our A1c’s below 6.5% (not 7% as the ADA and other US D groups recommend), our fasting BG’s less than 100mg/dl and our post-meal BG’s less than 140mg/dl. [It’s this 140 recommendation, not the others that we’ve been focused on in our blogs. I’ve summarized their recommendation as 6.5/100/140.]
    Second, the Guideline presents some interesting (but disheartening) results from a number of clinical experimental studies, including the following from page 16 (that’s p. 18 of 36 of the pdf): “… SMBG [self-monitoring of blood glucose] showed a reduction in HbA1c of 0.4% compared with interventions without SMBG. When regular medical feedback was provided to people, the HbAlc reduction more than doubled… The recently published DiGEM study failed to show SMBG significantly reduced in HbA1c, which was only 0.17% lower in the group using intensive SMBG compared with usual care WITHOUT SMBG.” [Emphasis added.]
    The Guideline document talks a lot about the various all too-well-known complications of D that can be mitigated by good control. But the IDF nowhere states that if we move to 6.5/100/140, we’ll reduce our risks of complications any more than my staying at say 6.99/120/160. They can’t because there are NO empirical studies I’m aware of that have measured the consequences (presumably benefits) from following very stringent control protocols versus “regular,” good control protocols (e.g., the difference between 6.5/100/140 v. 6.99/120/160). Despite following stricter controls personally, I don’t really know (nor does the IDF) how much better/longer my life will be as a D because of these stringent controls – it’s merely my assumption that there’s some linearity involved in the benefit.
    What the IDF appears to be recommending as new BG guidelines is that we Ds should implement SMBG-based control of their BGs (even though, paradoxically the studies cited in the Guideline show very marginal benefit from SMBG, even after getting a few words of “feedback” from our doctor) to levels that are VIRTUALLY THE SAME as people with “normal glucose tolerance” (I take this phrase to mean non-D folks). This is a big deal. Keeping my BGs to 100/140 on average would likely have my endo telling me it’s too risky – unless I want to show up at the ER as a hypo more often. Maybe this guideline was pushed by Lily (who makes glucagon) or by Amylin Pharmaceuticals (who makes Symlin), as Suzi mentioned. If far more Ds really follow this new guideline (which of course is unlikely), I’ll bet hypoglycemia will become a word known to far more people.

  30. Lauren
    Lauren September 26, 2007 at 7:34 pm | | Reply

    I try to never go above 130 unless I’m about to start a long jog or bike ride. My A1c is 5.3 and I test 10x a day. Yes, testing is a pain; but I cannot stand to see those high numbers on my meter. In my opinion there is no way to have an A1c under 6 without testing at least 8 times a day. (I’m Type 1 by the way.)

    My goal is to come as close to normoglycemia as possible, which means 70-120 mg/dl pretty much all the time. I’m not a pumper; just taking good old fashioned Humalog and Lantus. AND I’m a vegan (no animal products) which means 95% of my diet is carbohydrate. If a starch eater like me can consistently smack down those high post-prandials, anyone can.

  31. AmyT
    AmyT September 27, 2007 at 10:49 am | | Reply

    Hi Lauren,

    I test a lot more than 8x/day. And if you can eat 95% carbs and achieve those kind of numbers, you must be in a very strong honeymoon phase, or something. That’s pretty incredible (as in hard to believe).

  32. Dan Fahey
    Dan Fahey September 28, 2007 at 7:14 am | | Reply

    To Lauren:
    Without commenting on teh credibility of a Type 1 to be virtually always below 130 [and a A1c of 5.3], let me just say it’s not helpful to the majority of diabetics to make statements like “if I can do this, anyone can.”
    Most diabetics dedicated to good control CANNOT achieve those numbers, and trying to will only lead to a sesne of defeatism, which may lead folks to give us the effort.
    I’d hope these blogs will be supportive of others, not a breast thumping session.

  33. John
    John September 30, 2007 at 10:16 am | | Reply

    A Type 1 diabetic does not produce glucagon. Targeting 140 post meal, without glucagon to compensate for the larger amount of insulin that’s required to hit such a low post-prandial target, is a dangerous endeavor.

    First; product a closed loop system that both monitors BG in real time and delivers insulin and glucagon demand. All the technology is there, and has been for some time. Only thing missing is that Type 1′s don’t make up a large enough portion of the market, so only half our condition will be treated — the same half that treats a Type 2′s insulin resistance.

  34. JC Jones
    JC Jones October 2, 2007 at 10:38 am | | Reply

    Fascinating information & great insight for us non-diabetic clinician types…Thanks.

  35. baddecisionmaker
    baddecisionmaker October 3, 2007 at 10:34 am | | Reply

    Yes. I agree (and already feel guilty!), thanks for writing this.

  36. Chris
    Chris October 29, 2007 at 2:18 pm | | Reply

    Dear All:
    I firmly believe the old saying that the cure should not be worse than the disease.
    If diabetes are “guilted” into the “new” goal of 140 after meals and then suffer dangerous lows, one needs to use a little common sense and decide if they want to end up so low that they pass out or end up in a coma to “please” some endo. Keep in mind that your doctor will not be the one to leave a family without a mother because of some minimal effect of keeping the new 140 post-meal reading at the cost of passing out and cracking your head open or falling and injuring your spine for life. You’d be shocked if you do a little research on the internet as to how poorly some of these studies are conducted and how much the medical professiona is influenced by the drug companies. If you doubt me, look up how companies use “Relative” and “Absolute” statistics when they advertise how much their drugs reduce things like a heart attack — it amounts to fraud! I recently decided to drop my endo after his “nurse practicioner/educatord” bragged about how she could have a blood sugar level of 50-60 and be “just fine” and that it would just take some getting used to by me, implying that I should do the same. I love it when all these Minute Clinics spring up and the doctors come out blasting them saying “they’re just manned by nurse practioners and they might miss something important” yet, I make an appointment with my endo and they have me see only a nurse practioner, talk about talking out of both sides of your mouth.
    My advise, reserach, research, research, and as one medical researcher in my family advise me,
    you are your own best doctor, get second opinions, reserach a lot, and follow your heart and use common sense.
    Chris

  37. Oh, The Grand Rounds you will have!

    [...] is tiring of standards so tough Doesn’t she already feel guilty enough? Finally there stands out our dear Dr. Val Who cheers us med blogger types (Oh what a [...]

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