14 Responses

  1. Natalie Sera
    Natalie Sera June 4, 2011 at 6:36 am | | Reply

    As for older people, I think targets have to be individualized there too. I’m 63, (only 2 years away from Medicare!), and have had diabetes for 20 years. So far, no complications of any kind, and pretty healthy, otherwise (I had a recent angiogram, because I’ve had coronary artery spasms since before I had diabetes, and my last gram was 20 years ago — both came out clean and clear!). I would like to aim for an A1c in the 5′s because I’m a low glycator, anyway (diagnosable in 1991 with an A1c of 4.8), but my PCP’s APN told me that was too low, because I’m older.

    Well, what’s the definition of older? With my health, I could live another 20 years with diabetes, whereas someone who is younger than me, but already has severe artery disease or kidney disease might only live another 5 years. So, life expectancy among us “older” folk varies a lot, too. I don’t want to exacerbate my risk of complications because someone thinks I’m too old. I’d rather live optimistically than pessimistically disabled in a nursing home!

  2. Jana
    Jana June 4, 2011 at 8:08 am | | Reply

    I liked your answers today a lot, Wil, except for this part: “Let me end with this thought setting nutritional value and fat aside for the moment, a 200-calorie meal is waaaaaay on the light side, containing only 10% of your daily calorie allowance to maintain your weight.”

    This seems to continue the deception that *everyone* needs 2,000 calories a day (the number that’s always on the food labels). I’m sure you know this, but a lot of people fall on either side of this line (I once had to convince my father that despite what he considered her very light eating, my 85 year old 4′ 11″ and 95 lbs. grandmother was *not* running a calorie deficit…her calorie needs at that age and size were only about 1250/day), and most people would be well-served by using a simple calculator (such as the one found here: to find an estimate of their daily needs.

  3. Leighann of D-Mom Blog
    Leighann of D-Mom Blog June 4, 2011 at 8:13 am | | Reply

    Another consideration about popcorn is the high fiber content. For foods with more than 5 grams of fiber, some people subtract a portion of the fiber from the total carb count.

    For my daughter, she can eat 4 cups of popcorn and we count it as 15 carbs. This is how HER body reacts to it, so it might not be the same for someone else.

    As with all things diabetes, it’s trial and error.

  4. Leighann of D-Mom Blog
    Leighann of D-Mom Blog June 4, 2011 at 8:16 am | | Reply

    Oh, and Wil, I personally L-O-V-E tofu.

    Watercress, not so much.

  5. tmana
    tmana June 4, 2011 at 8:16 am | | Reply

    I think there’s a third set of goal numbers out there: the Bernstein numbers (the ones which say your average blood glucose should be 85 and your A1c 4.5).

  6. David
    David June 4, 2011 at 2:28 pm | | Reply

    Love the column. The natural variability of MDI means I’m happy to wake up under 120. If I target lower, I risk lows along with killer headaches.

  7. Reyna
    Reyna June 4, 2011 at 3:53 pm | | Reply

    I hate seeing the guidelines. They make me feel bad. Joe’s numbers are NEVER in the guidelines. UGH. Great, as always, Wil. Thank you.

  8. Mary Dexter
    Mary Dexter June 4, 2011 at 5:15 pm | | Reply

    If I get a 140 reading 2 hours after a meal, I can count on my bg plummeting a few minutes later. Ideal theoretical numbers are great for theoretical people; for those of us who are flesh and blood…..

  9. Nancy
    Nancy June 5, 2011 at 3:02 pm | | Reply

    Good discussion on the carbs/fat thing, Wil. I was thinking the same thing as Leighann – popcorn has that excellent added benefit of being high fiber. It’s a great snack for anyone, even popped in oil or drizzled with a bit of butter.

    And, re: above commenter, I don’t think anything was said about everyone’s calorie needs being the same, as in all of us need 2000 calories per day. Even at a low-end of someone needing 1250, the example of having three 200 calorie meals a day is less than half that – still not meeting any reasonable calorie goal for an adult.

  10. Sysy
    Sysy June 6, 2011 at 6:20 am | | Reply

    I agree that it can be unsafe to run sugars too close to normal, but I think it depends on who we’re talking about. I have keep mine under 100 most of the time and I’ve never had problems with lows and I don’t get too many lows a week (2-3). I stay at home so life isn’t particularly hectic and I find I can manage.

    In the past 6 months I’ve run my sugars higher because my twin toddlers require a lot of chasing after and I adjust for safety to 120-130 range. I spent so many years with constant high blood sugar and I’m willing to spend a decade or so with 5% A1c levels because they make me feel so good and because doing so has helped me reverse damage from the first decade.

    I think targets should vary according to a person’s situation, environment, and lifestyle. When I find that I don’t feel my lows as well, you can be sure I’ll run my sugars higher.

  11. Frank Tsu
    Frank Tsu June 6, 2011 at 8:06 am | | Reply

    There is a lot of conflicting information out there about carbs and the impact on levels. I read here
    that cutting carbs in already obese patients doesn’t seem to impact the diabetic onset. Have you seen anything along these line?

  12. T1 in Boston
    T1 in Boston June 6, 2011 at 8:51 pm | | Reply

    Just checkin’, Wil, re: postprandial Bg’s (– that is, ‘after eating’ –) when you say, “I do think, however, that keeping under 180mg/dL eighty percent of the time is realistic and achievable.” Are you saying 20% of the time, in your opinion, it’s hard to expect any better? If so, that would be a balm to my weary T1 soul, as I often go even higher after meals, but if I don’t treat (with insulin), it usually comes down pretty steadily/nicely — just depending on lots of junk, you know the drill…. – but maybe you meant that the other 20% a person could aim to be closer to the under 140 range….

    Thanks – really enjoying your column!

  13. Diabetes Therapy
    Diabetes Therapy June 7, 2011 at 4:53 pm | | Reply

    Very Enjoyable.

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