You want to control your diabetes as much as possible. You wouldn’t be reading this if you didn’t.
So you regularly check your A1C level. This is the best measurement of our blood glucose control that we have now. It tells us what percentage of our hemoglobin — the protein in our red blood cells that carry oxygen — has glucose sticking to it. The less glucose that remains in our bloodstream rather than going to work in the cells that need it the better we feel now and the better our health will continue to be.
As we are able to control our diabetes better and better, the reasonable goal is to bring our A1C levels down to normal — the A1C level that people who don’t have diabetes have. But before we can even set that goal, we have to know what the target is.
The trouble with setting that target is that different experts tell us that quite different A1C levels are “normal.” They tell us that different levels are normal — but I have never heard of actual studies of normal A1C levels among people without diabetes — until now.
The major laboratories that test our levels often say that the normal range is 4.0 to 6.0. They base that range on an old standard chemistry text, Tietz Fundamentals of Clinical Chemistry.
The Diabetes Control and Complications Trial or DCCT, one of the two largest and most important studies of people with diabetes, said that 6.0 was a normal level. But the other key study, the United Kingdom Prospective Diabetes Study or UKPDS, which compared conventional and intensive therapy in more than 5,000 newly diagnosed people with type 2 diabetes, said that 6.2 is the normal level.
Those levels, while unsubstantiated, are close. But they comes along one of my heroes, Dr. Richard K. Bernstein, the author of the key text of very low-carb eating for people with diabetes, Dr. Bernstein’s Diabetes Solution. Dr. Bernstein himself developed type 1 diabetes in 1946 at the age of 12.
“For my patients…a truly normal HgbA1C ranges from 4.2 percent to 4.6 percent,” he writes on page 54 of the third edition of that book. “Mine is consistently 4.5 percent.” Then in his July 30, 2008, telecast he reiterated that as far as he has been able to determine, a normal A1C is 4.2 to 4.6.
What Dr. Bernstein says is normal is so at odds with the other experts that at least a year ago I determined to find scientific proof of what a normal A1C level actually is. It turned out to be a lot more difficult to find than I ever imagined.
My personal quest for a normal A1C level and that of my favorite Certified Diabetes Educator drove that search.
When I learned in 1994 that I had diabetes and that my A1C level was 14.4, I was gradually able to bring it way down. Lately I have been doing everything I can think of to try to get my A1C down to normal. But in 2008 my level in nine separate A1C tests always ranged from 5.2 to 5.6. That’s far from normal, according to Dr. Bernstein.
My favorite Certified Diabetes Educator is also doing everything she can to get a normal A1C level. And she doesn’t even have diabetes — which she double-checked by taking a glucose tolerance test — but her most recent A1C was 5.4.
What could we be doing that is so wrong? Each of us is thin, eat a very healthy diet, exercise a lot, take care of our teeth and gums, which is a major source of infection. Could we have other infections or stresses that prevent us from getting our A1C levels down to “normal”?
It turns out that my favorite Certified Diabetes Educator and I have normal A1C levels after all. I learned this just yesterday when I finally tracked down actual research determining what normal levels are.
A friend suggested that I contact the people who run the standardization program for A1C testing. This organization affiliated with the University of Missouri is the NGSP. Those initial used to stand for the National Glycohemoglobin Standardization Program. But now that the NGSP is international, they changed the name.
So I called Curt Rohlfing, the NGSP data manager and technical writer/research analyst at the University of Missouri. And finally hit pay dirt in my quest for learning what a normal A1C is.
Curt told me that every three or four years his lab at the university studies a group of people who don’t have diabetes to scientifically determine what a normal A1C level is. The results from one study to the next are always close, Curt told me. In their most recent study they tested 29 people who lived nearby in central Missouri.
I asked how they knew if the people they tested didn’t have diabetes. “Because we did fasting glucose tests on them, they had no prior history of diabetes, and none of them were obese,” Curt replied.
So what were their levels? They ranged from 4.5 to 6, Curt replied. That’s at plus or minus 3 standard deviations.
I am certainly no statistician. But Curt tells me that it includes about 99 percent of the values.
The range is narrower — 4.7 to 5.7 — at plus or minus 2 standard deviations. This includes about 95 percent of the values.
“The upper limit is the more important one,” Curt explained further. “The lower limit doesn’t convey as much meaning.”
They also see “a little skew toward the high end of the range, a bit of tailing at the high side,” Curt continued. In fact, levels below 4.5 are “quite unusual,” and usually are only when people have anemia or other abnormalities of the red blood cells.
Remember these are the ranges obtained by the people who set the standards for A1C tests. Sadly, however, not every laboratory or home test kit meets those standards. Maybe the lab that Dr. Bernstein uses doesn’t. Does yours? Curt suggests that you ask your doctor if the lab running the test uses a method that is certified by the NGSP.
The first conclusion of the research for me is that we need to shoot for a normal A1C level of no more than 6.0 instead of trying what may be impossible, a level of 4.2 to 4.6.
However, an A1C level of 6.0 can cause people who take insulin injections or one of the sulfonylureas to go hypo. That’s why the American Diabetes Associations sets the goal conservatively at 7.0.
Still, a lower A1C level among people who take those medications is possible without hypos. Dr. Bernstein has amply shown that both in his own life and that of thousands of his patients.
And certainly, for those of us who don’t take insulin injections or one of the sulfonylureas we can set our goal even lower.
That’s because we have to understand the different between normal and optimal. For example, two-thirds of all American adults are overweight. Thus it has become normal in our culture to be overweight. Likewise, the average American gets little exercise, and that is also normal. We know that being a chubby couch potato isn’t optimal.
“I’m going to aim to be in the lower end of the normal A1C range,” my favorite CDE tells me, “because that is what I believe is optimal for human health.” And now that I know my A1C is in the normal range I am still going to do my best to bring it down as much as possible. Are you?
This is a mirror of one of my articles that Health Central published. You can navigate to that site to find my most recent articles.
104 responses so far ↓
1 Christina Jones // Mar 12, 2009 at 5:36 am
I don’t know if you will get this comment, or answer it, but I’m asking anyway. How long does it take to drop your A1C? In early January, I had an A1C of 10, and blood sugars averaging in the 300 range. I immediately grasped control, began daily exercise and cut out all sugar and most of the carbs, and my average sugars now are below 120. I have been chomping at the bit to go to the doc and get another A1C, but I don’t want to be horribly disappointed. How long will it take before all of these major lifestyle changes (and believe me, they are major!) will show up on the test?
2 David Mendosa // Mar 12, 2009 at 8:20 am
Dear Christina,
Your A1C level is probably already much lower. The key fact is that the A1C measures your average blood glucose level over the past two or three months and it is weighed heavily toward the more recent levels.
Best regards,
David
3 alice // Apr 14, 2009 at 6:42 am
Hi , I had my A1C checked my Dr said that it is 6.8 It never goes higher Thank Goodness. I check my sugar s at home and . at times it is low 70 sometimes or 100. He took mine 2 hrs after eating and it was 130 , but because my A1C is 6.8 he wanted to put me on Metformin, im scared because i was put on Avandia and januvia, and my sugars dropped low and landed me in hospital , also metformin 500 and I got dry mouth. can you tell me what I can take to help me naturally ? my Husbands A1C is 7.7 he is on junamet 50/500. now he also gave him glumetza 500. is that to much meds ? your help would be greatly appreciated
Thank you
Alice
4 David Mendosa // Apr 14, 2009 at 7:45 am
Dear Alice,
Thanks for asking. As you read in the article above, your A1C is higher than normal and will probably in time lead to complications that you can avoid if you take action now. Your doctor’s recommendation of metformin is an excellent one, and it will not make your blood glucose level go too low. However, you do have one natural choice that will work, and that is a very low-carbohydrate diet as I have written about here.
As to your husband, the three medicines he’s taking for diabetes is a lot (three because Janumet is Januvia and metformin). It’s about the maximum, and doctors try not to prescribe a lot of different medications because of the many unknown complications when we take many drugs.
Best regards,
David
5 Serena // May 11, 2009 at 8:24 am
Hi, David,
I’m also wondering about what is normal A1C levels. I have a hx of diabetes on my father’s side (he passed due to a major heart attack), and his mother (my paternal grandmother) also had diabetes. Imagine my surprise last year when I learned that my A1C was 6.2%. My fasting glucose was good, however. The dr. started me with post-prandial testing, and I found that I was insultin resistent. I have had additional A1C testing every 3 months, and it’s gone down to 6.0% and has stayed there. I know it can go lower if I just cut out the sugar and junk (guilty as charged).
But I’m just wonderning, considering my family history of diabetes, could 6.0% be good enough??
My dr. encourages me to get my 2-hr post-prandial level down to under 100. However, I went to a dietician recently and she said, considered I had a hx of diabetes, that under 140 should be what I aim for.
So who’s right???
Thanks!
6 David Mendosa // May 11, 2009 at 4:16 pm
Dear Serena,
Compared with most of your doctor’s patients, you are fine. What your doctor and dietician say is the conventional wisdom.
But your chances of any number of the awful complications of diabetes do go up when your A1C is higher than normal, i.e. higher than what people who don’t have diabetes have. Please for the sake of your health do everything in your power to get your level below 5.0.
Best regards,
David
7 Janeen // Jun 8, 2009 at 9:18 pm
I was just diagnosed type 2. My oral glucose test went over 200 at the 1 hour and 2.My a1c is 6.1.I am over weight and have been trying to lose the lbs. I tried for many months to lose the weight before I went to the doctor about my blood sugar. I have been tracking my glucose for years and ordered my own test. Before she ordered my a1c as the reslut of my ogt I brought in, she looked at me like my eating must be out of control. My results speak for themselves. She said she wants to put me on metformin for the weight not the diabetes, she said it is under control. However, even small amounts of carbs can send my blood sugar over 200 an hour after meals.Are there any other things I could do? I try to really read all labels and avoid rice,bread,pasta.Thanks for your time.
8 David Mendosa // Jun 8, 2009 at 9:29 pm
Dear Janeen,
We have two great ways to control our weight, and I have successfully use them both. First, I lost well over 100 pounds by taking Byetta. Then, when I wanted to stop using any drugs, I began to follow a very low-carb diet instead, and lost even more weight and have kept it off. Both strategies together may work even better, as Dr. Bernstein’s patients will tell you. I have written many articles about both Byetta and low-carbing.
Best regards,
David
9 Tariq Siddiqui // Jul 29, 2009 at 5:45 am
Excellent research. Very helpful in understanding the normal Levels.
10 Jill // Oct 15, 2009 at 7:51 pm
Hi David,
I had the 2 hour glucose test. After an hour I was at 250. I had the A1C test and it came back normal. I don’t know what the numbers are yet. I will be seeing my doc on Wednesday. Does this mean I have diabetes? I am not over weight. I am nervous about this. I am so thristy all the time and urinate 15-20 times a day. I am very tired and hungry all the time.
Thanks for your help!
11 David Mendosa // Oct 15, 2009 at 8:41 pm
Dear Jill,
Generally, an A1C test cannot diagnose diabetes or not. But the fact that you are thirsty and have to urinate a lot are classic signs of diabetes. It could be something else. I can’t say.
Best regards,
David
12 Jill // Oct 16, 2009 at 9:12 pm
What about the 2 hour fasting test that I had? At the half hour mark my glucose level was 193, at 1 hour it was 250, then it went down to 146. Does this mean I have diabetes?
Thanks for your help.
13 Kevin Leahy // Oct 16, 2009 at 10:01 pm
Hi Jill,
I have to start by saying I am not a health professional, but I am studying to be one. I also am a type I diabetic. Your doctor would be the person to diagnose you with diabetes, but certainly the blood glucose values you describe are abnormal. I would schedule an appointment if possible and talk to you doctor about treatment options. The first thing they will say, and I agree, is to focus on lifestyle changes. It is incredibly difficult for some people, but it is worth the fight. Even healthy individuals should be striving to eat their fruits, vegetables, and whole grains, but we must be extra vigilant. That may not be enough for you, so metformin is a good starter medicine to help you keep your sugar levels under control. Good luck and good health.
14 Jill // Oct 17, 2009 at 8:02 am
Thanks David. I do have an appointment with my doc on Wednesday. I am 51 years old and NOT over weight. That’s the strange thing. I am a pretty healthy eater and exercise 4-5 days a week. Now I will just have become a healthier eater. I will be following the doctors orders.
Thanks again for all your help!
15 Jill // Oct 17, 2009 at 8:03 am
Oh! I mean Kevin. Thanks for your help. Sorry.
16 Kevin // Oct 17, 2009 at 8:27 am
Jill, you unfortunately may fall into that category of people who develop this metabolic disease without having any of the common risk factors. In your case diet and exercise sounds like it will not be enough if the doctor diagnoses you. Definitely speak with the doctor about the different classes of medications that can help with diabetes, but also those to help the heart, arteries and kidneys. I am encouraged by some of the preventative medications that doctors are prescribing for people like me. Good luck.
17 Jean Thomason // Oct 19, 2009 at 12:28 pm
Hey David,
I am facing the Dr. on Nov. 4th. Last year at this time I was not diabetic but I am afraid that this year I will be. Is this site a current site or have you quit working with it. I noticed that some of the articles are from 2001
18 David Mendosa // Oct 19, 2009 at 1:20 pm
Dear Jean,
Good question. I have been writing about diabetes for more than 13 years. So some of my articles date back to 1996. I hope that every one of the more than 1000 articles that I have written about diabetes show the date. I keep writing at least two articles EVERY WEEK about diabetes, so the site certainly is current, while parts of it are not; therefore the dates on my articles.
Best regards,
David
19 Ellen // Nov 2, 2009 at 9:34 am
David-
I’m type 2- diagnosed at 6.8, and lost 44 pounds on a strict low carb diet (I am doing very little carbs- just veggies, seldom even eat fruit) and my weight is now fine. Not taking meds. A1C went to 5.9. I have been monitoring my BS very carefully the past few months and with the meter that Dr. Bernstein recomments. My numbers range from 69-89 random, and from 94-104 two hours after meals. (In the past 3 months- seldom hit 120 two hours after meals). And yet I just had an A1C test of 5.9 again. That is an average of 133. How can that be?
20 David Mendosa // Nov 2, 2009 at 9:45 am
Dear Ellen,
First, an A1C of 5.9 is equivalent of an average glucose level of 123, not 133. Second, which of the various meters that Dr. Bernstein has recommended from time to time are you using? Then, perhaps the particular meter that you are using isn’t accurate enough. I do know that the WaveSense meters, like the Jazz, always test higher than most other meters. When I approached company representatives about this, the acknowledged the fact and showed me that their meters test right in the middle of Clarke error grids and that some other meters regularly test lower.
Best regards,
David
21 Ellen // Nov 2, 2009 at 10:09 am
I’m using the Accu Chek Aviva. I called his office and that’s what they told me. Also have used the Accu-chek Compact Plus and the Freedom Lite. Have used all three at the same time to compare and sometimes they were close and sometimes not. Once, meter A was 117, meter B was 94. Immediately after tested again, and meter A was 100 and meter B was 104. Go figure.
22 Ellen // Nov 2, 2009 at 10:12 am
BTW- I was using a scale that Dr. Bernstein used for A1C averages. He says 5.9 is 133 but maybe he is off. Thanks
23 David Mendosa // Nov 2, 2009 at 10:15 am
Dear Ellen,
Yes, the Aviva is Dr. Bernstein’s current recommendation. But you do have to remember that NONE of our blood glucose meters are accurate enough.
Best regards,
David
24 Ellen // Nov 2, 2009 at 10:37 am
How frustrating. Makes me wonder why I bother testing and spending all that money on strips.
But thanks for your site and newsletter and your responses.
25 David Mendosa // Nov 2, 2009 at 10:51 am
Dear Ellen,
Good point. Considering how much you already know about how different foods effect your blood glucose levels and how well you are controlling your diabetes, maybe you need to test only in exceptional circumstances — while of course you continue to get regular A1C tests.
Best regards,
David
26 Ellen // Nov 2, 2009 at 11:00 am
Can I trouble you with one more question? Since you are also on a low carb diet, have you ever had any kidney problems? My blood tests always show a slightly high BUN, BUN Creatinine Ratio, and now a slightly low eGFR and slightly high hematocrit. Everything I’ve read points toward dehydration. (That could even cause a slight rise in A1C I think). I also have extremely dry eyes. But I urinate a lot because of the protein I eat. Can just drinking more water help? Dr. Bernstein swears eating more protein doesn’t hurt the kidneys.
27 David Mendosa // Nov 2, 2009 at 12:24 pm
Dear Ellen,
I have not had kidney problems. And do remember that we need either fat or carbohydrate for energy. Not protein. How much protein we need is still an open question. Dr. Hamdy, whom I wrote about at http://www.healthcentral.com/diabetes/c/17/41992/protein-carbs , probably represents a view at the upper limit. However, you may not need more than the 46 grams/day that most women need, according to the Institute of Medicine, as I wrote at http://www.healthcentral.com/diabetes/c/17/63252/protein-muscles
You might try drinking more water. Of course, it could just result in your peeing even more!
Best regards,
David
28 Tina // Nov 5, 2009 at 2:48 pm
Diagnosed with Type 2 after a 6.5 A1C and GTT with over 250 at 1 hour and 300 at 2 hours. That was 3 months ago. A new A1C report today shows 5.8 which is within the normal range for this lab. Is it possible to be diabetic and have normal A1C? I am so confused. My main problem is the post prandial sugars as my fasting is usually okay ranging from 105 – 124, but occasionally higher like in the 130 or 140. I can always tell if my sugar is higher because my vision blurs. Also, I have had several hypo spells recently, but didn’t check sugar, I just know that is what it was, because my mother is insulin dependent and I have seen her hypo episodes.
Appreciate any comments.
29 David Mendosa // Nov 6, 2009 at 2:23 pm
Dear Tina,
Good for you! Your A1C is in the normal range, which is about 4.5 to 6.0. So you are in the high end of normal. Remember that the medical profession uses the term “normal” as being the equivalent of what we generally think of as “average.” And average is not where we want to be, when perhaps half of all Americans are insulin resistant and therefore pre-diabetic. We want to be optimal — a different concept entirely.
Yes, it is not only possible but always true that we can have diabetes and have a normal — even an optimal — A1C. Good blood control doesn’t cure diabetes, because when we stop controlling it with diet, exercise (and drugs if necessary), our blood glucose levels will go sky high again. You and I have pushed our diabetes INTO REMISSION. That’s wonderful. But we always have to watch it so it doesn’t bounce back.
Always check your blood glucose when you go hypo! Otherwise, you don’t know how to get it back into normal range. The best way to do that is something I wrote about at http://www.healthcentral.com/diabetes/c/17/74755/glucose-tabs
I can understand if taking insulin made you go hypo. Taking the right amount of the right kind of insulin at the right time is really tricky at first. The only other drug that is likely to make you go hypo is one of the sulfonylureas, an old diabetes drug that most people think should be retired in place of newer and better drugs.
Best regards,
David
30 Ellen // Nov 6, 2009 at 2:30 pm
I had numbers similar to yours and didn’t think of myself as a “diabetic” for almost a year although I did stick to my low-carb diet. Then I started testing my normal husband after we ate meals. He could eat french fries and a milkshake. I could have a few of his fries and a tiny taste of his milk shake. My BS one hour later was 158. His was 104. That will remind you that you have diabetes.
I’m a newbie here, so I don’t pretend to be an expert, but wondering if you are on medication? If not, I don’t think you don’t need to worry as much about hypos. Let me just tell you my experience. When your body is used to your blood sugar being a little high- and then you bring it down, you may experience the feelings of hypo, e.g., hunger, the shakes etc. That’s adrenalin kicking in and signaling your brain to eat carbohydrates because your body wants you to get your BS back up a little. This is just an adjustment. I felt that way when my BS first went to 74 which I now realize is not really low. So after your body adjusts to having normal blood sugars you shouldn’t experience that “low” feeling. But like I said, if you’re on medication, that’s a completely different story.
31 David Mendosa // Nov 6, 2009 at 3:27 pm
Dear Ellen,
Two excellent points. I hope that Tina sees your message. Your second point was one that I would have made if I had remembered to write it!
Best regards,
David
32 Carol // Nov 10, 2009 at 8:26 am
I had and A1C level of 5.8 the first week of June 2009. I began Dr. Neil Benard’ program for reversing diabetes at the end of June. It is a vegan diet with very low fat and low glycemic index food. My A1C level yesterday, Nov. 9 was 5.1. It appears that fat is a problem in the control of diabetes. My results are inline with what Dr. Benard has to offer in his program and explained in his book. Yes, A1C of 6 or 7 is not acceptable for me, because I was having to increase my level of medication after 3 years of knowing I have diabetes. And yes I have been exercising too. This is just one example. It is working for me. Thanks for listening.
33 Ellen // Nov 13, 2009 at 10:13 am
David- I would love to see you comment on Carol’s comments above. I have been doing high protein/fat- low carb and getting good results. However I try to be open-minded to any possibility. However I can’t understand how eating less fat and more carbs (even the so-called good carbs) could do anything but raise my blood sugar (plus leave me hungry all the time). I have read Barnhard’s (Sp?) articles and I know he has a book- I think it’s called “Rerversing Diabetes” and he advocates a vegetarian diet. Everything I’ve read just contradicts that so I’ve just dismissed that as dangerous. But as I said, I want to keep an open mind. In fact, fat is supposed to be the one type of food that doesn’t cause a reaction from insulin. So would love to hear from you on that. Thanks
34 David Mendosa // Nov 13, 2009 at 12:28 pm
Dear Ellen,
I have read Dr. Barnard’s book and several of his articles. His vegan diet may work for some people, but, like you, I don’t see how it could because it is necessarily high in carbohydrates.
Best regards,
David
35 Carol // Nov 13, 2009 at 4:01 pm
Presumably, fat in the cells interfers with the action of insulin. I think we are all familiar with the observation, that as a person looses weight, they are better able to control their blood glucose level. And again, I am only one example and it is working for me.
Regarding the high carb diet, it involves eating food that is low on the glycemic index along with low fat. Both parts are important.
36 Ellen // Nov 13, 2009 at 5:29 pm
I don’t want to seem argumentative because I do believe everyone can learn different points of view from these forums. But fat in your cells is totally different from dietary fat. In fact, if you eat more fat and less carbs, you are more likely to burn fat, and not store fat in your cells. It’s when you eat a lot of fat and a lot of carbs that you will store the fat. Gary Taubes has some wonderful articles on fat and carbs. As for the GI, only some of the foods lowest on the index can be tolerated by diabetics. It recommends a lot of food that is very bad for diabetics (generally). For example, whole grains can raise BS levels by 4 or 5 times what they should be. The ADA continues to recommend oatmeal. The tiniest amount of steel cut oatmeal will send my BS up to 300. Pasta will act more slowly but over several hours will raise BS. I’ve seen some information on the glycemic index that I can try to dig up.
37 Carol // Nov 13, 2009 at 6:57 pm
Yes, every change in diet does not work for everyone, that is why there are so many different ones out there. All I am saying is that I read Dr. Barnard’s Book, studied which vegan foods would give me appropriate protein, looked at the GI and what foods were high and low and found food I like that fits the progam. I have been doing this since June and my A1C went from 5.8 to 5.1 so far and my glucose levels have been very near normal. I have also reduced my medication to one Avandamet pill per day. I had been following the ADA recomendations and they took me only so far. I did not read the book with the intention of doing anything different. But by the time I finished it, I had decided to try it. It works for me, lost weight, blood glucose under control, healthy and feeling great. I am making good wishes for you to find what works for you.
38 Ellen // Nov 14, 2009 at 1:07 pm
I didn’t realize you were taking medication. That makes a difference. You can tolerate more carbs with medication. But 5.1 is fabulous in any case!
39 Sally Ann Lycke // Nov 17, 2009 at 7:32 am
Boy! Am I ever glad to have found this site… I’ve been a diabetic since 1987 and find myself on more and more medication. Right now I’m taking Tolazamide, Metformin, Lisinopril, Lovostatin, and am now on 13 units of Lantus insulin each night. My last blood work resulted in a NORMAL glucose fasting but a high A1C of 9.5; my doctor wants me to retake the tests “because there must be some mistake.” My biggest problem is: what to eat for breakfast. The American Diabetes Association says I should be eating a small bagel with low-fat cream cheese; however, eating that would shoot my blood sugar levels up to almost 300! I usually eat brussel sprouts or butternut squash with a dab of I Can’t Believe It’s Not Butter…but I’m getting really tired of THAT. Any suggestions? The highest my blood sugar levels have ever been is 330, usually right around 100 (but Kaiser Permanente doctors always spout that blood sugar levels need to be under 100). Mine are–most of the time.
40 David Mendosa // Nov 17, 2009 at 8:33 am
Dear Sally,
I am likewise glad that you found this site! Unfortunately, to be taking more and more medicine seems to be the rule when you follow the ADA’s diet advice (I wrote about that at http://www.mendosa.com/blog/?p=211 ).
You understand, I’m sure, because of your comment on the bagel. Eggs in any form make a much better breakfast. Personally, I like mine poached in a little microwave poacher. Sometimes it’s just egg whites, sometimes whole eggs. Many people, of course, enjoy their eggs with bacon, ham, or sausage. All of these are very low carb and won’t raise your blood glucose levels much if at all. The British often like kippers and perhaps other fish for breakfast; another excellent choice.
Sometimes instead of eggs or in addition to them I have a very low carb (5 grams) drink of greens powder. Now, I know from my own experience, that most greens drinks taste terrible, but the one I drink is delicious. Please see http://www.mendosa.com/blog/?p=382
Best regards,
David
41 Tyra Somers // Nov 19, 2009 at 11:14 am
Hello,
What should I be shooting for as far as post prandial rise in blood sugar? When is the best time to measure?
Also, how do you tell if you are insulin resistant? And what happens to the extra insulin you produce?
Thanks,
Tyra
42 David Mendosa // Nov 19, 2009 at 2:21 pm
Dear Tyra,
Most (but not all) organizations say that a post prandial level of 140 mg/dl or less should be our goal two hours after the first bite of the meal.
Doctors can test to see if you are insulin resistant or not or if your pancreas doesn’t produce any insulin. If you are insulin resistant, your pancreas is pumping out too much insulin and it makes the glucose stay in your blood rather than being uses by the cells that need it. It is precisely this that causes all of the dire consequences of diabetes.
Best regards,
David
43 SAMMY G DAILY // Nov 29, 2009 at 11:34 am
DAVID, I HAVE BEEN READING YOUR BLOGS FOR A COUPLE OF MONTHS NOW AND FIND THEM VERY HELPFUL. I AM A 76 YEAR OLD MALE DIAGNOISED WITH TYPE 2 SOME ONE YEAR AGO. I HAVE MANAGED TO GET MY AIC DOWN FROM 7.25 TO 6.6 AND I AM STILL WORKING THE PROBLEM, BUT I AM HAVING SOME SYMTOMS MY DOC CANNOT EXPLAIN. IF I EAT A MEAL WITH HIGH FAT OR HIGH CARBS, SOME 2-3 HOURS LATER, MY HEART BEAT GOES TO MAX, AND ALSO BOUNDING OCCURS. HAVE YOU EVER HEARD OF THIS AS RELATED TO DIABETES. I UNDERSTAND YOU ARE NOT A DOC, JUST HAVE YOU ENCOUNTERED THIS BEFORE. THANKS-SAM DAILY
44 David Mendosa // Nov 29, 2009 at 1:15 pm
Dear Sammy,
I haven’t encountered that before. Sorry. All I can suggest is testing your blood glucose level when your heart beat goes up and see if you can find any pattern.
Best regards,
David
45 angus mcphail // Dec 6, 2009 at 10:07 pm
My story was recently written up in “GI News:
here in Australia.
a 23 yr vet of type 2 i was constantly told by
medico’s including endocrinologist that i was
in the non diabetic range of A1c.
having been on a 5year research for diabetics
on a chol .lowering drug, i recently obtained my
data and found although my fasting bgls average
was in10mmol/s my /a1c ranged from 3.8-4.4!
this yr I was at last told that I had a suspected
hemoglobinopathy!
i,m a 68 yr old scot with irish ancestry and i,m at
a loss as to why the pathology labs and Drs did
not question these low A1c’s
It would have saved me years of frustration and
heartbreak.
46 Amina // Dec 9, 2009 at 12:06 am
when i eat in the morning my blood comes 230.when when i walk in the evening it is 160,so iwant your advice
47 David Mendosa // Dec 9, 2009 at 10:31 am
Dear Amina,
Both your evening and morning blood glucose levels are too high. Since you are already exercising, you have only two other courses of action to bring down your levels. They are a better diet and more or different diabetes medications. With a better diet you will also lose weight if it is too high, and for most people with diabetes it is. A better diet basically means eating less but particularly less starchy and sugary foods — cut way back on wheat and wheat products, including bread as well as corn, rice, and potatoes to reduce the starch in your diet and cut out the table sugar (sucrose) and high-fructose corn syrup entirely. That is the best first step with diet, but eventually you may want to go further and follow a very low-carb diet. For the diabetes medication you will need to discuss this with your doctor.
Best regards,
David
48 Carol // Dec 9, 2009 at 11:40 am
Amina, I would also like to say that, following Dr. Neil Barnard’s Program for Diabetes has brought my A1C level to 5.1(within the range for non-diabetics) and my twice daily check of blood glucose in the normal range. The program is in a Book form and has recipes with it. It is another alternative. There are many choices, because one theory or diet does not work for everyone. you might want to read it and see what you think and if you want to try it. Good wishes, Carol
49 Anne // Dec 10, 2009 at 10:42 am
I have lost the weight, and lowered the cholesterol levels (under 100) and raised the good! I weigh 103 pounds (5′2″), walk daily and my A1C is 5.6. Down from 8.8 (August 2008) I take 2.5 metformin per day and wondering if I should try to get my A1C lower. I do subscribe to a low-carb diet, under 100 carbs per day. I am a very active 56 year old and teach yoga and pilates. Any suggestions for doing more? I am a bit of a perfectionist. My post prandial numbers after meals run from 90-120 (occasionally higher).
50 David Mendosa // Dec 10, 2009 at 12:06 pm
Dear Anne,
You don’t want to lose any more weight, because it’s now at the very low end of a normal BMI. That’s wonderful!
Your A1C could, however, be a bit better. Normally, I would say that an A1C of 5.6 is fine — it is indeed in the normal range — but since you say that you are a perfectionist (like me!), you might consider just a little fewer grams of carbs per day. That’s basically because as A1C levels go up from about 5.2 the long-term risks of complications increase.
Best regards,
David
51 Elaine // Dec 17, 2009 at 2:53 pm
I am currently taking Glipizide ER 2.5mg. I am having trouble with my morning levels being high, sometimes 185, but my bedtime levels are between 100/130. I have tried eating fruit, cheese, peanut butter for a bedtime snack but sometimes it’s high and sometimes it’s normal. What should I do? This is driving me crazy. I talked to my MD, but he gave me no advise. Please help
52 David Mendosa // Dec 17, 2009 at 3:08 pm
Dear Elaine,
By far the most important number for those of us with diabetes is our A1C level. What is yours?
Meainwhile, please see “Good Drugs, Bad Drugs” at http://www.healthcentral.com/diabetes/c/17/98218/good-drugs-drugs-bad
Best regards,
David
53 Mike // Dec 23, 2009 at 6:14 pm
Hi David,
I have never been diagnosed as diabetic or pre-diabetic. I have been monitoring my fasting BS during my annual physical for the past 20 years, and it usually comes back to around 90. But the results from 2 years ago and last year went up to mid-90’s. That caught my attention, and I immediately did a baseline A1C test with a result of 5.9.
Since then I have been following a low carb diet (60 to 70 gm a day) for about a year, and I have been monitoring my BS everyday. I can see my BS drops over time, both fasting and after meals. A few days ago I had my annual physical again, and my fasting BG dropped to 87, which is in line with my measurements at home. But what is surprising is that my A1C shot up to 6.1.
A 6.1 A1C translates to an average BS of 129. In a typical day, my BS does not go up beyond 125 at ANY time, including 1 and 2 hour after meal measurements. Every 2 to 3 weeks I will do continuous measurements for a day, where I check my BS every hour during the 16 waking hours. The average usually comes out to between 100 and 105. That puts my A1C betwen 5.1 and 5.3. If I include the 8 hours during sleep, I expect the average will be even lower.
So far I have only one data point in calibrating my meter. A few days ago I used my meter at my doctor’s office to check my BS right after the nurse drew blood for the fasting BS test. My meter came out to be 7 points higher than the lab test.
I have read that certain people have A1C higher or lower than their measured average BS value. Is it possible they could be off by as much as 0.8 to 1.0%?
At this stage I am not sure whether I should rely on my measurement values or the A1C result to determine the next course of action. If my measurement values are correct and I am one of those less common individuals who have inflated A1C results, I can just stick with my current approach of BS management. On the other hand, if the A1C results trumps my daily measurements, I may have to consider medication since I already exercise 5 days a week and I am very thin.
Appreciate any comments. Thanks.
54 David Mendosa // Dec 23, 2009 at 6:37 pm
Dear Mike,
I wouldn’t be too concerned. Yet it would be wise to watch your diet (fewer carbs), lose weight if necessary, and get enough exercise. Similar to what President Reagan once said, “Trust, but verify.”
Your A1C levels — whether 5.9 or 6.1 — are right on the cusp of normal, as I point out in the article above. My guess is that your most recent level of 6.1 is within the range of normal variation. All tests have some inaccuracy built in to them.
But to get a “second opinion” and perhaps set your mind at ease, why not buy a home A1C test like I wrote about at http://www.mendosa.com/blog/?p=400 and http://www.mendosa.com/blog/?p=339 ?
Best regards,
David
55 Karen // Dec 30, 2009 at 12:41 pm
In June of 2006 I got diagnosed with Impaired Glucose Tolerance. My 2 hr. GTT #’s were.
Fasting – 84
1 hour – 218
2 hour – 178
A1c – 5.4
My A1c’s have been 5.5, 5.7, 5.5, 5.7.
I had anothe r 2hr GGT a few weeks ago and #’s were as follows:
Fasting – 88
1 hr – 115
2 hr – 97
A1c 5.7
I have no idea what I am now. How can I go from one extreme to another. Dr. said I must have changed my lifestyle and I did get rid of a lot of carbs. This has me stumped.
Any insight is appreciated.
56 David Mendosa // Dec 30, 2009 at 12:49 pm
Dear Karen,
Yes, it does seem strange that your A1C went up a bit (although within a normal margin of error) while your GGT went down at the 1 and 2 hour marks. But I certainly agree with you and your doctor that going on a low-carb diet really helped. You are on the right track.
Best regards,
David
57 madhavi // Jan 28, 2010 at 3:45 pm
Hi David,
I just found your site, and wow – it’s so informative! I feel like I’ve come to the right place for my question!
I am not diabetic – was never diagnosed as such before, but I have family (mom’s side) history full of diabetes.
I just came home all sullen today, because I was given my blood test results (without consultation with the doc yet). I couldn’t wait to find out what the results indicated, hence the anxiety now.
My A1C had been in the upper 5.0 range, then it jumped to low 6, and now, today, it’s at the highest – 6.6!! My fasting sugar is 109, but it’s been in that range before too.
I’m really scared.. really!! My appointment with the doc is not until next week, and I am dreading to be told what I fearfully think I may have. Do you think it’s diabetes?? Or would it be considered pre-diabetes? Either way, I’m going on a diet with low carbs – and absolutely NO sugar whatsoever!
58 David Mendosa // Jan 28, 2010 at 5:28 pm
Dear Madhavi,
I am sorry to say that you probably have diabetes. But it’s a close call based on your A1C level of 6.6%. Your doctor — or you — might want to have to take a fasting blood glucose test, which until now has been the standard. But now the A1C is accepted, as this article says:
TUESDAY, Dec. 29 (HealthDay News) — In its latest set of clinical guidelines, the American Diabetes Association is promoting a more prominent role for the hemoglobin A1C blood test in the diagnosis of type 2 diabetes and prediabetes.
Long used in the management of diabetes, the A1C blood test measures average blood sugar levels for the previous two to three months. The new guidelines call for the diagnosis of type 2 diabetes at A1C levels above 6.5 percent, and prediabetes if the A1C levels are between 5.7 and 6.4 percent.
“We’ve added another test that can make it easier to find out if you have diabetes,” said Dr. Richard Bergenstal, president-elect of medicine and science for the American Diabetes Association (ADA).
The new guidelines will be published in the January issue of Diabetes Care.
In ANY case your low-carb diet makes great sense!
Best regards,
David
59 madhavi // Jan 28, 2010 at 7:27 pm
Dear David,
Thank you so much for the quick response!!!
Yes, I think I did remember an article like that last year. I was wondering why 6.5 seemed like the “magic” number.
I just got home from the gym – trying to ease my nerves.. the swimming/water exercises did help. but..still.. was worried..so the next best thing I did was speak to my doctor at home right after that! And.. the good news was that…while the A1C was quite high, he kept repeating that I do not have diabetes. He strongly advised me to continue to lose weight (low carb diet with exercise). I’m sure there’s more to it, and so he told me so too – until the appointment next week.
It is still scary – no doubt. My mom told me if you can prevent it, you must in every way – as unfortunately, there’s no cure. =( My heart goes out to all the people with this condition. Interestingly enough, I’m def. not out of the woods – as I read somewhere recently that people that are in the border line for diabetes.. are at same high risk for diabetes related diseases & ailments (i.e. kidney, heart disease, retina, neuropathy, etc.) as full blown diabetes patients. It’s something that I am now reminding myself.
Thank you again for being there!
60 Amanda // Feb 3, 2010 at 7:57 am
I have a fasting bs level of around 115-120. I’m usually 225 1 hour after a regular carb meal. 150’s around 2 hours after meal. It takes about 4 hours for me to drop to 130’s. My doctor says this is normal. I don’t thing so. Looking for a second opinion from anyone.
61 David Mendosa // Feb 3, 2010 at 9:06 am
Dear Amanda,
You are right, your levels are absolutely not normal. They are, however, typical for people with diabetes. For example, the American Diabetes Association says that a level of up to 180 at two hours after a meal is OK. However, the other major organizations set the max at 140. But those are not “normal” levels, i.e. the levels that people who DON’T have diabetes would reach. They don’t go above about 120 even with a lot of carbs. We people with diabetes cannot handle a heavy carb load, as your numbers show. This is not a technical question — it is a question of life and death, specifically one of complications. High levels like you experience will lead to complications sooner or later.
Best regards,
David
62 Ellen // Feb 3, 2010 at 10:24 am
Amanda-
Are you taking any medication for blood sugar control? If not, why don’t you try a low carb
diet. I have controlled my diabetes for over 18 months now with a diet of no grains, and a cup of vegetables and one cup or one piece of fruit daily. I eat a lot of meat and fat. I am so much healthier and my post meal numbers are never above 120. Also lost 45 pounds. I put my non diabetic husband on a similar diet and he has lost 50 pounds and his cholesterol improved so
much that his doctor asked him if he had put him on cholesterol medication.
63 Amanda // Feb 3, 2010 at 10:39 am
Thank you so much for you information. My husband is type 2. (6.2 barely weighing in at 185) My daughter is type 1 (diagnosed at age 3). I’m well educated on diabetes. My doctor knows I’m not on meds. I actually just randomly checked my blood sugar to show my youngest of three children that it’s not that bad to get pricked by the lancet, and low and behold I was above 200. I’ve been self monitoring to see what increases my levels the most. I am fine with low carbs which makes since. I guess I just wanted to see for myself if I do fit in the Type 2 category. I feel that my Dr. was going by the normal levels for a “diabetic” and not a person with normal insulin function. Thanks again! I’ll eat low carbs. I need to lose about 20 lbs.
64 Mike Harris // Feb 11, 2010 at 10:22 am
I just had my A1C and it registred @ 6.7. My dr said that it was fine as I am insulin dependent (lantus). However, I take about 15 units each night and if I do not have something sweet right after that I drop to the 50’s sometimes even 40’s. I feel the effects around 2am – 5am. I usually always awaken with coldsweats and light headed. He will not adjust my lantus and states it is the appropriate dose. Should I be worried.
65 David Mendosa // Feb 11, 2010 at 12:05 pm
Dear Mike,
Covering insulin with carbohydrates is not the best of strategies! If I were in your shoes, I would be worried — about your doctor. Maybe it’s time to get a second opinion from another doctor?
Best regards,
David
66 Amanda // Feb 11, 2010 at 12:26 pm
I have a daughter that is type 1. We have supplies in the home to test. I’ve monitored my own blood sugar and had noticed some highs. I’m in an above post. A week ago my 14 year (non-diabetic) old randomly checked her blood levels and was 170 an hour after a normal carb meal. I didn’t worry until I had her check her ketones and she tested “large”. I monitored her over the weekend and she did not go over 140 one hour post meals. However, she did experience some odd lows such as 59.. 69.. Her A1C at Dr. office was 5.5. What is going on? Dr. once again says this is normal. Could we be in the early stages of type 1? She does carry the antibodies that attack the pancreas.
67 David Mendosa // Feb 11, 2010 at 12:57 pm
Dear Amanda,
Unfortunately, your 14-year-old daughter’s normal A1C level won’t tell if she had diabetes or not. That’s because her levels vary so much with the lows canceling out the highs. I would recommend that you get her tested for diabetes with one of the two standard tests.
While the A1C has now been approved as a possible test for diabetes, please note these recommendations of the American Association of Clinical Endocrinologists/American College of Endocrinology. These are the first three:
AACE/ACE support the ADA recommendations for use of a confirmed A1c as an available option to
diagnose diabetes, with the following recommendations:
1. A1c should be considered as an additional optional criterion, not as the primary criterion.
2. AACE/ACE suggest using traditional glucose criteria for diagnosis when feasible.
3. A1c is not recommended for diagnosing type 1 diabetes.
Best regards,
David
68 Amanda // Feb 11, 2010 at 1:24 pm
Thanks for responding. I wish all doctors would update their information about diabetes. It was suggested to me by a friend that if her A1C is “normal” but, she’s shown large and traces of ketones that she may be anorexic. I honestly don’t think this is the case. I have thought about it and have kept a very close eye on behaviors at meals and after. I don’t think the few episodes of above normal range is coincidence. Could it be that her pancreas is still trying to work? Have I caught something early and the evidence is not totally there? I’m very concerned. I’ve adjusted to one type 1 diabetic. Two in the family would be a bit of a mind challenge for me.
69 David Mendosa // Feb 11, 2010 at 1:32 pm
Dear Amanda,
Like you, I sincerely hope that your second daughter doesn’t have diabetes. But it is, of course, better to be prepared.
Yes, her pancreas may still be working to some extent. People with type 1 often have what’s called “the honeymoon period.”
Best regards,
David
70 Jeanne // Feb 20, 2010 at 12:12 pm
Dear David,
Thank you so much for the good work you do on this site–since I was first alerted to my own levels three years ago, I have been following your directions and Dr. Bernstein’s books very carefully.
I just went to my latest test–and I was 126 and 5.4 A1c. The doctor told me I am fine and not to worry –to continue what I am doing (low carb, no sugar) and should be fine. Somehow this does not seem right to me. I lost 30 pounds, but have gained back 12 (inactive at a computer job) and went a bit wayward with the low- carb diet.
Does it seem like it is correct to say I am not diabetic?
J
71 David Mendosa // Feb 20, 2010 at 5:49 pm
Dear Jeanne,
If your doctor ever diagnosed you as having diabetes on the basis of a standard test, I would think that your diabetes is “in remission” now. Please keep it that way by keeping the weight off and following your excellent diet.
Best regards,
David
72 Ron // Apr 5, 2010 at 5:41 pm
Dear David,
I was diagnosed with type 2 several months ago.
A1c was 7.5. Since that time I’ve lost 21 pounds, walk 2.1 miles a day. My glucose in the morning is average less than 108 and my average after meals (2 hours) is 104? That doesn’t seem to make sense but thats what the meter tells me.
I’ve just checked my A1c using the bayer A1cnow and it was 6.0. Thats after only 2 months so I would hope it would drop a bit after another month under my belt.
Now I’m told I have diffuse fatty liver (Insulin resistance I assume).
Is there a test to test insulin resistance. I fear that now that I’m wathching carbs that the fat is now becoming a problem
73 David Mendosa // Apr 10, 2010 at 4:51 am
Dear Ron,
Yes, your doctor can test your insulin resistance — which would determine whether your have diabetes or not. There are now three tests including the A1C. Your A1C level would not indicate that you have diabetes, but it would be wise to confirm with your doctor.
Best regards,
David
74 Ellen // Apr 10, 2010 at 5:17 am
Re fatty liver. Eating low carb should improve that. Eating fat and protein doesn’t cause fatty liver. In fact if you read about how fois gras, they force feed corn mush to geese. My fatty liver went away as soon as I went low carb. (I eat no grains at all).
75 Ellen // Apr 10, 2010 at 5:19 am
Sorry- meant to say “how fois gras is made.” And by the way- I believe it means “fat liver” in French.
76 Steve // May 3, 2010 at 8:21 am
My A1C is 5.9%, however I have had very normal fasting and after meal BS (in the 70’s, 80’s and low 90’s). I haven’t been diagnosed as diabetic; at least not yet. I read that a 5.9% A1C corresponds to an averge glucose reading of 133. My issue is this, how can this be when my readings on different glucose monitors have been what I stated above? There is no way that my average BS is 133. What’s wrong here?
77 David Mendosa // May 3, 2010 at 10:36 am
Dear Steve,
Here is exactly the same answer I gave Ellen here last year:
First, an A1C of 5.9 is equivalent of an average glucose level of 123, not 133. Second, which of the various meters that Dr. Bernstein has recommended from time to time are you using? Then, perhaps the particular meter that you are using isn’t accurate enough. I do know that the WaveSense meters, like the Jazz, always test higher than most other meters. When I approached company representatives about this, the acknowledged the fact and showed me that their meters test right in the middle of Clarke error grids and that some other meters regularly test lower.
Best regards,
David
78 jennifer // May 21, 2010 at 12:34 pm
David, do you have opinions regarding T1 versus T2s and their uses of insulin pumps + CGMs?
I just started using a CGM (T1 for 35 years), and it’s so awesome, and the missing link, in my mind, for soooo long.
Now that I finally understand better what insulin pumps do, I’m [finally] looking into that as well.
Along that path, I met a T2 woman using a pump, and some T2s who are way out of control.
I have come to see that combination as the best answer for both types, given the benefits of the CGM and the capabilities of the pumps. And you are right on, it’s all SO much easier to control if using a low-carb diet (carbs make me whack out, as much as I love a good cheeto). Salads and protein are pretty reliable re my insulin reuirements.
What is your opinion of T2s using a pump + CGM to get more even control, also?
79 David Mendosa // May 22, 2010 at 10:02 am
Dear Jennifer,
I absolutely agree with you. Even people who have type 2 that is not in good control can benefit greatly from using a pump and continuous glucose monitor to get them in control. Sadly, however, few type 2s do.
Best regards,
David
80 Schelia Watkins // May 23, 2010 at 11:43 am
Dear David,
I was diagnosed with type 2 diabetes 7 years ago. I finally decided to change my eating habits and joined a fitness club since May 2009 I have loss 80lbs and 46 inches. My A1C has gone from 6.5(2009) to 5.9(2010). would love to be diabetes free but, even with the results that I have my doctor stated to continue with routine and Rx. My goal is to lose 65lbs by December 2010. What should my A1C be in order to be completely off my Rx.
Schelia
81 jackie // May 29, 2010 at 8:13 am
Hello to David and any others who might know about things below!
I have been eating a super-low carb diet ( no grains or starches or fruit or dairy) with about 900 calories. It has been 30 days since I switched to almost no carbs, but I have never eaten a lot of calories.
I have always done heavy aerobic exercise 4-6 days a week for one hour (it is getting harder as I run out of gas partway through now).
I need to lose about 50 lb.
I am barely losing weight- maybe a pound a week.
My endo says that low ketotic diets DO have a big risk- something about how they shut off the production of a compound produced in the bone marrow that removes the plaques or lipids in the arteries.I cannot locate this study. Has anyone ever heard of this?
I also have slightly high BP (140/95) now – I am shocked.
I am also hypothyroid- endo is raising my doses of T4 now. If that does not work, we will have to work with insulin-resistance.
How can I be doing all this and have high BP and not lose much weight???
82 Saddaf Sultana // May 29, 2010 at 11:18 am
dear david
finally, i have started loosing weight, 2 kgs in 25 days, following a low carb diet, yet fat is not high. i am hungry all the time and yet my weight loss is not really significant. correct me if i am wrong, calories do not count on low carb? 1200 cal/day is my allowed limit. and i try to make it even less by eating less fat.
regards
83 David Mendosa // May 29, 2010 at 6:10 pm
Dear Saddaf,
Sadly, in my experience calories do count even on a very low-carb diet. Yes, I have read that all calories aren’t equal, and that may well be so. But when I increase my calorie intake, I increase my weight at the same time. So sorry!
David
84 David Mendosa // May 29, 2010 at 6:12 pm
Dear Jackie,
I think that you put your finger on the problem — your thyroid. Take care of it and you will solve your weight problem at the same time.
Davi
85 David Mendosa // May 29, 2010 at 6:20 pm
Dear Schelia,
Your question is essentially what is a normal A1C level, because only at that level can you be reasonably confident of not getting one of the complications of diabetes. A normal level is 6.0 or below. Some people who I respect very much say that it is 5.0 or below. When you get down to that level, you can probably go out your diabetes medication safely.
David
86 Ellen // May 29, 2010 at 6:57 pm
Saddaf-
I would add that even if you can get your A1C numbers down to a better number ( and most charts say that with every .1 increment over 5 you raise your risk of doing damage) that doesn’t mean you’re “diabetes free.” I control my blood sugar through diet but if I cheat, I’m reminded of my diabetes when I test my BS 2 hours later and see that it is much higher than my husband’s who probably ate a lot more carbs than I did.
87 Ellen // May 29, 2010 at 7:08 pm
Saddaf-
Re diets. I would like to tell you about the diet my endo put me on two years ago and I lost all the weight I needed to and am never hungry and my A1C is good . This is extreme but it works for me. You could talk to your Dr. and see what s/he thinks. I eat two meals a day- no snacking. I eat 8 oz. of meat with each meal and am allowed 1/2 cup vegetables, 1/2 cup salad and 1/2 cup or 1/2 piece of fruit. I avoid all grains and starches.
If I want to lose a little more weight the only way to do it is to cut back a little on the meat- maybe to 5-6 oz. per meal. But if I go lower than that I will get a little hungry. But it passes and I’ve learned to live with it. My weight is really fine now but I’d just like to lose a few more pounds for vanity reasons!! So calories do count somewhat although I think they’re secondary to the type of calories you eat. And I never worry about fat. I believe that fat is not bad for you as long as you’re eating very low carb. Read Gary Taubes and Dr. Richard Bernstein for great information.
88 David Mendosa // May 31, 2010 at 9:14 am
Dear Ellen,
I couldn’t agree with you more!
I especially like your comment that you can live with a little hunger. In fact, I will go further — whenever I have a little hunger I know that it means I will be losing weight, and I like that feeling!
Best regards,
David
89 saddaf sultana // Jun 1, 2010 at 12:33 pm
dear Ellen & dear David
yes, you are right. infact, i knew about the right portion size as told by my doctor three years ago.. i was just hoping to find a way to eat more. ..i know it is me vs. me.. if i want to stay healthy.
90 saddaf sultana // Jun 1, 2010 at 10:11 pm
…. and to do that i am embarking on a strict menu control regime:
tea with full cream milk at 7.am
breakfast: one full egg omelete + tea at 9am
midmorning: 1/2 cup melon or apricot at 11am
lunch:1 cup vegatable/meat curry+ 1/2 cup yogurt
tea: 1cup tea with milk + 1/2 regular buiscuit
dinner: 1 cup meat/vegetable curry + 1/2 cup yogurt
after dinner: green tea with lemon
30 miute daily on elliptical treadmill.
bhindi water as medication in the morning.
do advise if it can be improved upon.
thanks
91 David Mendosa // Jun 2, 2010 at 6:31 pm
Dear Saddaf,
Sounds very good! Two questions: do you have rice with your curry? If so, how many grams of carbohydrate in it and in your biscuit? (Or is that 3 questions?)
David
92 saddaf sultana // Jun 3, 2010 at 12:20 am
dear david
1. i generally donot take any rice or roti with meals. below mentioned quanities are one full day’s consumption on those days ( maybe twice a week) when temptation takes over me ( i loath myself later on). also, i take no more than 2 tablespoons of curry with 2-4 ounces of cooked meat or vegetables per meal. some chutney and green salad without dressing( we call it kachumer salad). so my not so often rendezvouz with no no food in a whole day is quantified below:
1). 1,2 tablespoon cooked white rice (carbs -15 gm) or
1/2 whole wheat roti(carbs-10gm, calories-40)
2). 1 little buicuit (carbs-3gm,calories-10)
93 Ron // Jun 3, 2010 at 12:37 pm
Dear David,
I started a really low carb diet myself.
To my dismay the glucose levels have been rising.
I’m not really sure whats going on or how to change it.
My BS seems to be around 100-110 in the morning and then rises to mid 120’s during the day. This occurs even without food, only water.
I’ve limited my carbs so that I very rarely rise above 140 after 1 hour.
Is there something I can do to get this level down. I’m stuck at an A1c of 6.0 and can;t seem to get any lower.
It does go lower after I exercise, it can drop into the 70’s. But it quickly rises even without eating.
I have not tried any medication up until this point, just diet.
Is something I should reconsider? Is there any harm in taking meds. My only real objection is getting too comfortable with the lower levels using meds and getting back into bad habits.
94 David Mendosa // Jun 3, 2010 at 1:40 pm
Dear Mike,
It is possible that you no longer have enough beta cells and need to start taking insulin. If I were you, I would discuss your situation with an endocrinologist.
Best regards,
David
95 sysy morales // Jul 2, 2010 at 10:39 am
This is a very interesting post. Personally, my lowest A1c was 4.5% and coincided with me getting pregnant with twins (after being told before that I couldn’t get pregnant). Not easy, but possible. Low carb is what does it for me.
96 chris // Jul 24, 2010 at 8:51 pm
I have had high a1c’s for about 10 years (avg around 10-11) I am 25 and have been diabetic since 7. I haven’t really taken that great of care of it since about 13 years old or so.. I was wondering if I started taking good care of it now, what are the chances of a good (or bad if that calculates better) outcome for my case?
97 David Mendosa // Jul 25, 2010 at 3:58 pm
Dear Chris,
Great question. If you don’t already have any of the many complications of uncontrolled diabetes, you can prevent them if you keep your blood glucose levels down to normal. Even if you already have complications, you may be able to reverse most of them with a normal A1C. The chances of a good outcome in either case remain high. Dr. Bernstein has proven this in his own life and that of his many patients, most of whom, like you, have type 1 diabetes. Please read his book, Dr. Bernstein’s Diabetes Solution, and follow his recommendations.
Best regards,
David
98 sysy morales // Jul 26, 2010 at 8:50 am
Chris, I second what David says. I had 10-11 years of high A1c’s myself! Then I began turning everything around following Dr. Bernstein’s recommendations of eating low carb and not using the pump. I ended up getting my A1c’s way down AND I reversed nerve damage in my feet
It is not too late for you! You can definitely turn things around. Now is the best time to start.
99 Jennifer // Jul 26, 2010 at 8:59 am
What is this about the pump?
I have been trying to get a pump. Outrageously, because me getting devices is like continually jumping through hoops, my 30-day-glucose-average before seeing the nutritionist was 129, or approx a 5.7 A1C, I believe. I was eccstatic!
Upon following the nutritionist’s daft advice to never correct within 4 hours of administering a correction for a high, after only 2 weeks of this my 30-day average is 163. I am outraged.
And, it’s left me almost all-high, all the time, even eating almost no carbs, as before. It’s left me all unstable, I feel.
But, because I’d wanted to get even more even than in my sometimes-low 129-average days, I had begun the pump process.
What is negative about pump usage? I just naturally eat low carbs mostly but don’t know about the badness of using a pump — what is it?
100 sysy morales // Jul 26, 2010 at 9:48 am
Since a pump is a tool and not a cure or anything close to a cure, I would say that it all depends on how a person uses the pump whether it works or doesn’t work for them. Just like 2 people on injections can have 2 very different results. If you are on the pump and have been consistently high you should speak to your doctor because perhaps your insulin requirements need to be adjusted. For me personally, the pump gave me hurdles to better control because sometimes the infusion site wasn’t good due to scar tissue, or sometimes the tubing would have air bubbles and thus give me higher numbers, I had to deal with keeping batteries with me for it, and also was too temped to not only snack too much, but also go out without my testing meter because my insulin was already with me. I also sometimes need just a half of a unit and with the pump, never knew if I was really getting that tiny amount. For me a syringe is more fail-proof. BUT, I know for a fact you can have better control than your average of 129 per 30 days with the pump and without the pump. I had a very good A1c with the pump and now maintain around a 5 % A1c without it. It is all about getting the dosing of your insulin just right and learning about all the things that affect your blood sugars. The pump is a great invention but, doesn’t click with everyone. Doctors will tell you the best thing to do is use the pump but this is narrowminded. I recomend working with your doctor to stabalize your glucose while on the pump and then choose whichever option suits you most. The point is you can do well with either. I have proven this and so have many others. Good luck to you
101 Jennifer // Jul 26, 2010 at 10:13 am
Thanks. Yes, I know I can get good, using low-carb, results using MDI.
I was hoping to be able to even out a bit more, when I do eat some carbs, potatoes particularly seem to really staaaaay with me, using a pump. Hence my hoop-jumping, and now way out of stable control due to the [dumb] nutritionist. And now that doc fired me bc, he said, I was rude to his receptionist (when neither the doc nor the nutritionist would call me back).
As such, however, I am exhasperated with this hoop-process, and am hence really, really curious to know the specifics of the Mendosa anti-pump theory, since I can easily give up these hoops if it really is bad somehow. ??
102 David Mendosa // Jul 26, 2010 at 10:28 am
Dear Jennifer,
What is “the Mendosa anti-pump theory”? I don’t remember ever hearing about it before.
Best regards,
David
103 Jennifer // Jul 26, 2010 at 10:30 am
Sorry, Bernstein! I just read this on a post 2-3 up from here, “Then I began turning everything around following Dr. Bernstein’s recommendations of eating low carb and not using the pump.”
I am wondering what this “not using the pump” theory is all about, the particulars, etc. Sorry I mis-stated!
104 David Mendosa // Jul 26, 2010 at 10:31 am
Dear Jennifer,
Thanks for clarifying your comment. For a moment I thought that my memory was failing!
Best regards,
David
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