Got diabetes questions? You came to the right place! Ask D'Mine is our weekly advice column, hosted by veteran type 1, diabetes author and educator Wil Dubois. This week, Wil has his eye on eye complications, and is waxing wise about the many different "ranges" for what might be considered ideal blood sugar levels.

{Need help navigating life with diabetes? Email us at AskDMine@diabetesmine.com}

 

Charlotte, type 2 from New Mexico, writes: I feel so old! Today I went for my annual dilated eye exam and the doc told me I have cataracts. I'm only 59! He said that diabetics get them sooner than "sugar-normal" people. Is this true? If so, why?

Wil@Ask D'Mine answers:  A few years back I got a call from a colleague who was on the eve of her 40th birthday. "Be straight with me," she said, her voice slightly slurred from one too many, "does your body turn to shit when you turn forty?"

Hmmmm.... Post-40: Diabetes; hypoglycemia unawareness; hypothyroidism; hyperlipidemia; osteopenia; degenerative spinal disease; depression; benign neoplasm; thyroid nodules; vitamin D deficiency; myopia. And that's just me.

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"It sure as hell does," I told her.

So we know age is the great eroder. Just as the wind and the waves turn mountains into molehills, so too does time erode our bodies. But does diabetes turbo charge the process? Is high blood sugar the other great eroder?

Ummm.... maybe so. I can see how it might be. Age has got nuttin' on glucose when it comes to being able to eff-up everything under our skins in our bodies. Well, and our skin too, come to think about it.  But I wasn't sure about cataracts. (See?—I don't know everything.) So I read up on it.

We all know that sugar is the enemy of sight. But what we generally worry about are various sorts of retinopathies: bleeding and/or jacked-up growth of capillaries in the back of the eyeballs that can cause partial or total blindness. In fact, raging blood sugars are the leading cause of "acquired" blindness in the U.S., so retinopathy is not to be trifled with.

Cataracts, however, are a horse of a different color altogether. Rather than affecting the blood vessels at the back of the eye, cataracts affect the lens at the front of the eye, causing it to turn cloudy, blurring vision. Retinopathy, by comparison, tends to make vision blotchy.

And sure enough, I found out that we D-folks have both a greater incidence and faster progression of cataracts than the sugar-normals. That means it's both more common and it gets worse faster. Sucks to be us. (Sometimes.) In fact, PWDs under 65 have three to four times the number of cataracts than sugar-normals of the same age.

Them's the facts. But why? Well, according to my sources, it turns out that "the enzyme aldose reductase catalyzes the reduction of glucose to sorbitol through the polyol pathway."  Uhhh.... Okay...

Even though I wrote that, I have no frickin' idea what it means.

It gets worse, because apparently, "intracellular accumulation of sorbitol leads to osmotic changes resulting in hydropic lens fibers that degenerate and form sugar cataracts." At least that's what the experts tell me.

Normally, I'd get out my medical dictionaries, look up all those words, call a few docs for clarification, try to get my head around it, then come up with a clever analogy so that all of you could understand how high blood sugar causes cataracts. But I'm so depressed about my friggin' health insurance denying my doctor's appeal of their denial of the coverage of my test strips that all I want to do is get drunk. So I'm going to take a short cut: Like everything else, high sugar does turbo charge the natural changes of age. Cataracts, generally a plague of the elderly, descend on us and our kind sooner and advance faster.

Any happy take-home points? Yes. Two. One is the same old song: Keep the sugar in check; keep the cataracts at bay. Quoting our good friend Dr. Bill Polonsky: "Well-controlled diabetes is the leading cause of nothing." It's un-controlled diabetes that is the harbinger of havoc. And if that doesn't work out for you, the second happy note is that, unlike retinopathies, cataracts are more easily treated and thus less likely to blind you.

Which is a good thing as I don't think we have a braille version of Ask D'Mine in the works. (No offense intended to braille readers.)

So just where should your sugar be to prevent trouble? It just so happens we have a question about that today, too....

 

Genevieve, type 2 from Nebraska, writes: I'm soooooooo confused. I don't know what my blood sugar should be! The American Diabetes Association website shows I should be between 70-130 before meals, and below 180 after a meal. Then I read somewhere else online that I should be below 140 after meals, while my test strip vial shows "normal" control range as being between 105 and 159, and "high" as being between 271 and 408. Can you help me understand where my blood sugar should be?

Wil@Ask D'Mine answers: You've been ambushed by the English Language. The ranges printed on the test strip vial, variously called "control range" (OneTouch), "glucose control range" (Accu-Chek), or sometimes more accurately "control solution range" (AgaMatrix, FreeStyle) aren't where you are supposed to be. They are where the strips are supposed to be.

Huh? Say what??

OK, here's the deal: every meter comes with a little eye-dropper bottle of either blue or red fluid called "control solution." You probably threw it out with the meter's manual, the crappy case meters always come with, the box, and all the warranty paperwork. Control solution is Halloween vampire blood with a more-or-less fixed amount of glucose in it. Its purpose is allegedly to provide you a way to test your meter to ensure it's working right. I say "allegedly" as I personally find control solution results less than reassuring. So my meter is supposed to read between 105-159 and I'm to sleep well at night knowing it's working right? Are you kidding me?

I never use control solution. Well. Almost never. I sometimes use it when training nursing, medical, and community health worker students. About two years ago I was training a block of 30 students on how to do fingersticks on patients. I figured to make it more realistic I'd just let each one of them poke one of my fingers. I was still bleeding two weeks later. So I haven't done that again. Now I use control solution for training.

Anyway, just ignore the numbers on the vial: that's not where your blood sugar should be. So just where the heck should it be? Well, no one agrees exactly. We talked about this a while back, but in a nutshell, as you mentioned, the ADA wants to see your sugar 70-130 before meals and sub-180 after eating. The other big group of American docs wants to see you at 110 first thing in the morning and under 140 in the afternoon. You can see all these confusing numbers in chart form here. And just to complicate things even more, the recently released global standards from the International Diabetes Federation are calling for 115 in the morning and 160 after meals.

I think a dartboard and a blindfold are in order here.

Why the wide range of targets? Well, not all PWDs are created equal. An appropriate target for a 39-year old male type 2 on metformin is probably not an appropriate target for a 14-year old female type 1 on an insulin pump; and yet the guidelines from all the big diabetes organizations seek to lump us all together into one set of standards.

Still, despite the lack of agreement amongst the collective experts, and the wide variety among PWDs, the take-home message here is pretty clear: everyone would agree that 200 or above after a meal is too damn high; and that somewhere around 100 in the morning is a pretty healthy way to start the day.

 

This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

 
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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.