Welcome back to our weekly diabetes advice column, Ask D'Mine!

In case you were expecting on this fine Feb. 2 morning to open your browser and see a certain friendly groundhog emerging from a burrow to predict this winter season, no dice. No Punxsutawney Phil here.

Instead, what you get is veteran type 1, diabetes author and educator Wil Dubois, forecasting some real down-to-earth D-advice on out-of-range blood sugars...

With a Happy Groundhog Day to y'all, of course!

News nuggets from around the diabetes community

State of the Union: It's Time to Cure Diabetes
President launching new precision medicine initiative to better treat, cure diseases like diabetes.
'Robotic Pancreas' Appears On American Idol
Carlos Santana's nephew Adam Lasher shows off Dexcom G4 during live performance.
Metformin: A Great Lakes Disaster?
Wisconsin researchers find diabetes drug being discharged into Lake Michigan, affecting fish.

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{Got your own questions? Email us at AskDMine@diabetesmine.com}

 

Erik, type 1 from California, writes: I have a question about blood sugar targets. My doc gave me guidelines saying I should be at 150mg/dL two hours after a meal.  I am pretty sure that I could push it to a peak of 350 and still have it back to 150 in two hours, but that seems wrong on so many levels. What are the realistic downsides of dancing over 200 for a short while and then back to normal, not just on occasion, but pretty regularly? I understand the hypotheticals, but look to you for the real story. I really appreciate your frankness and willingness to tell it like you would to a friend, not as a "by the guidelines" educator.  

Wil@Ask D'Mine answers: That's me, Mr. Real! Thanks for the feedback.  I haven't seen the guidelines that say you should be at 150 mg/dL yet. The endos want 140, the IDF wants 160, and the ADA wants 180. Am I surprised someone else has chosen a different number? Not really.

But I think you or your doc might have missed the fine print, and I can see how that could have happened, as most guidelines are petty vague in their wording. Our blood sugar guidelines aren't like a party invitation telling us to be at a certain place at a certain time—they're more like a speed limit. ADA says it clearest: our peak postprandial reading is to be 180 mg/dL or less. They don't really care when the peak occurs, they even put in a little footnote saying that most folks peak 1-2 hours after the start of a meal, so check it then.

If you take the time to read the endos—and I don't recommend it—they say, "In subjects without diabetes, blood glucose levels typically peak approximately 1 hour after the start of a meal and return to preprandial levels within 2 to 3 hours; 2-hour postprandial blood glucose levels rarely exceed 140 mg/dL. Therefore, the consensus panel recommends a treatment-targeted 2-hour postprandial blood glucose level of <140 mg/dL." They are more time focused, but again, they are really after the peak, and in their case they are advocating using meds and technology to control us to the level of sugar-normals.

The IDF also uses the 1-2 hour vague language, so it becomes clear that all three outfits are seeking the high ground, and it's the blood sugar level that's important, not the time we take it.

If you can hit a 350, you just blew through your doc's guidelines by 200 frickin' points.

And actually, it's shocking to me that you could rocket all the way up to 350 in an hour or so. I rarely find that my sugar peaks much before two hours, but I know we are all different. Even more shocking is the fact you can get it back down to 150 an hour later. Holy cow, what are you eating? Not beef, that's for sure.

Target-busting aside, is this a dangerous dance? Yeah, I think so. Although there's quite a bit of debate about the subject of "glucose variability," more and more research is making it look like the more variable you are, the greater your risk of the microvascular variety of diabetes complications—the eye and kidney stuff.

The cutting-edge thought is that we should pay the most attention to the standard deviation (SD) of our numbers. It's important to note that in this case being deviant is not the same as being a pervert. Deviant means different. When it comes to blood sugar, it's the spread between the highest and lowest readings. The greater the spread, the more deviant you are, so to speak. There's no shortage of complications involved in this approach to avoiding complications, and Ãœber-smart type 1 endo Dr. Irl B. Hirsch talks about it in detail here.

Exactly where your SD should be is something the experts are still arguing about, but most agree that the lower the better. And if you dance with a 350 you'll have a sucky SD.

But all hypotheticals aside, the body just doesn't like rapid change of any sort: temperature, pressure, or sugar. It breaks the first law of homeostasis: the body keeps everything on an even keel by making constant little changes. Big changes usually leave us feeling like crap. I find crazy changes in sugar generally leave me feeling like I've been beaten up by drunken sailors. That can't be a good thing. Our bodies can tell us when we are hurting them. It pays to listen.

That's as real as I can get.

 

Leslie, type 1 from Colorado, writes: Should I be proud of my A1C, which is 6.2, if I know it included a bunch of lows to counterbalance the numerous highs? When you look at it that way, it's not such a great achievement.  My screw-ups just happen to be balancing out my screw-ups! "Lucky" me. How should I be thinking about this? It's like getting an A, and knowing you cheated.

Wil@Ask D'Mine answers: Proud is probably the wrong word. It's too bad we don't have a test of glycemic variability we can run along with the A1C. Oh. Wait. We do! It's called GlycoMark. It's one of those new designer lab tests, similar to the type 2 predicting Pre-Dx we covered here. So what is it, and what does it tell us? It's a test for, I kid you not, 1,5-Anhydroglucitol (1,5-AG).

WTF is that?

1,5-AG is a monosaccharide, a distant cousin of glucose, that our bodies get from food. In sugar-normals, the 1,5-AG levels are constant. But in us less-than-perfectly controlled D-folk, the more spikes we have, the lower our level of 1,5-AG is. By measuring the level in our blood, the makers of the test claim that they can detect all postprandials above 180 mg/dL over the previous couple of weeks. How?

OK, think of your kidney as a fork in the road. The left fork goes to Bloodtown, and the right fork goes to Bladderville. Normally, the 1,5-AG goes to Bloodtown when it hits the kidney fork—it's reabsorbed, and a constant amount is maintained in your blood. But when your blood sugar is over 180, it's like road construction. The normal route is blocked, so the 1,5-AG turns right. Crap! This is no detour! It's a one way street!

And so the 1,5-AG finds itself in your toilet when your blood sugar is high, rather than back in your blood. How high is too high for 1,5-AG? Anything above 180 mg/dL, as it turns out.

Hmmmmmm.... so in a sense, above 180 our kidneys don't work the way God and Nature intended them to. Something to think about.

Anyway, it's the lack of 1,5-AG that shows too much sugar has been in the system. When sugar returns to normal, the kidneys go back to recycling the 1,5-AG and the levels in the blood rise at a predictable rate.

But can you still cheat? Sure. As it serves as a marker of short-term variability, you could beat the test by being really careful the week before you took it.

So you could have sucky control but still get an "A" on both the GlycoMark test and the A1C exam.

But you'd still know you cheated, so you couldn't be proud.

 

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.

 
Disclaimer: Content created by the Diabetes Mine team. For more details click here.

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.