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Maybe “Normal” BG Levels Aren’t So Normal After All


Apr 17, 2009

The author wondered why the bar for “normal” blood glucose (BG) levels for people with diabetes is so high and also what numbers truly constitute hypoglycemia. He set out to discover what constitutes typical fasting BG levels among non-obese Mexican children from one to five years old who do not have diabetes.

Read the more detailed clinical version of this article here.

In order to understand safe glycemic levels for children with type 1, it is important to know what constitutes a true “normal” glycemic range among similarly aged children who do not have diabetes.

The need to investigate and determine normoglycemia in Mexican children under the age of six begins with a lack of relevant published data.  Another motive for reviewing the currently recommended glycemic goals for children and adolescents with type 1 stems from the well-known observation that children and adolescents who do not have type 1 do not develop microvascular diabetic complications.  Today, thanks to insulin analogs and basal/bolus therapy regimens, children with type 1 have the option of achieving true euglycemia and of potentially benefiting from its advantages.

Clearly, diabetic complications are related to the principal marker of all diabetes:  hyperglycemia, specifically, chronic hyperglycemia(1)(2).  In order to recommend or suggest safe glycemic levels for children with type 1, it is important to know what constitutes a true "normal" glycemic range among similarly aged children who do not have diabetes.  Any reasonable clinical plan for the glycemic management and self-management of children and adolescents with type 1 depends on knowledge of the typical or "normal" nondiabetic values for the general infantile population of the same body weight.  These "normal" glycemic levels are not well defined or widely known. 

The information gained from the present study may help define a clinical goal of glycemic values equivalent to, or at least similar to, "normal" childhood values. It may also permit a comparison between the glycemic ranges currently recommended by the American Diabetes Association (ADA) and a pattern of hyperglycemic control that may be even more favorable and preventive than the liberal therapeutic recommendations currently in international use(1)(2). 

It is not known to what degree the current glycemic goals for Mexican children who have type 1, which are basically identical to those defined by the ADA, reflect the true glycemic values of Mexican children without type 1 and with appropriate body weight.  Precisely because the latter do not exhibit chronic or near chronic hyperglycemia, they will not suffer microvascular diabetic complications unless at some point they should develop type 1 or type 2, followed by similar chronic or near chronic diabetic hyperglycemia.  

Results

The results of the study indicate that for Mexican children from one to six years of age who have normal body weight and do not have type 1, the mean level of fasting BG is around 74.1 mg/dL.  This glycemic value is assumed to represent an approximate normal fasting BG for the children studied.  According to the official recommendations for children of the same age who have type 1, this "normal" level of BG is considered practically equivalent to therapeutic hypoglycemia (70 mg/dL or less).  Yet, at this level and at even lower levels, the children studied had no evident, self-reported, or other-reported hypoglycemic signs or symptoms.  Thus, it is probable that the low glycemic values seen in these children, although generally considered hypoglycemic, are asymptomatic and "normal" and do not indicate disease or malnutrition. 

The children's global mean BG in this study is almost exactly the glycemic mean (74.7 mg/dL) naturally maintained among pregnant women during the third trimester of pregnancy who do not have diabetes and are not obese(7).  It appears that after birth and for at least the first five years of extrauterine life, healthy Mexican children tend to maintain a glycemic state equivalent to that of their last three months of intrauterine life.

Hypoglycemia

Of the 303 children included in this study, 67.3% had BG levels of 79 mg/dL or lower.  The accepted definition of therapeutic hypoglycemia is any glycemic value less than 70 mg/dL(8).  In this sample, 35.6% of the children presented at least this degree of therapeutic hypoglycemia; 9% had hypoglycemia of 60 mg/dL or less, and 5% had biochemical hypoglycemia (less than 50 mg/dL)(8)(9). 

Therapeutic or biochemical hypoglycemia caused by excess or inexpert use of exogenous insulin routinely provokes terror and panic among parents of children whose diabetes is treated with insulin, and often among the children themselves.  In this study, however, almost 70% of the children had BG levels of less than 80 mg/dL, and they were fasting and were not allowed to eat breakfast until after the BG monitoring of all the children in their kindergarten (89 and 214, respectively) had been completed. Nevertheless, in this lengthy interval, no hint of the anxiety or urgency that often characterizes children who have type 1 and their parents when confronted with a hypoglycemic threat or episode was seen among these "normal" children or among their teachers.

Young people with type 1 who employ daily insulin therapy may be conditioned by the unpredictability and risk of further or rapid reduction in BG to levels below 71 mg/dL, which may be dangerous.  These "normal" children's response to real but asymptomatic hypoglycemia was not so conditioned.

As the study's results show, the symptoms of hypoglycemia and the physical and mental uneasiness that ordinarily accompany abnormally low BG levels can be absent in the child who does not have diabetes, even when the glycemic concentrations are in fact abnormally low (46 to 60 mg/dL).  For this reason, in children with or without type 1, the diagnosis of hypoglycemia solely by either a specific glycemic value or the presence of known symptoms is not tenable, although habitual BG monitoring of children with diabetes is necessary and prudent in order to assure timely discovery of the presence of infantile hypoglycemia.  

Illogically higher recommended levels

The ADA, in its glycemic recommendations for persons who have diabetes(3), recognizes that adults and children who do not have diabetes tend to differ in their fasting glycemic values.  In spite of the fact that various normative studies, including the present one, confirm lower glycemic levels in "normal" children than in adults without diabetes, the official recommendations champion glycemic levels illogically higher for children who have diabetes than for adults who have diabetes.

The significant glycemic differences between children and adults found in this study highlight the large discrepancy between the glycemic values of these children who do not have type 1 and those recommended (110 to 200 mg/dL)(3) as optimal during the night, when fasting, for children of the same age who have type 1.  These findings further suggest that "normal" Mexican children's fasting BG levels are far from the fasting values of 100 to 180 mg/dL currently recommended by the ADA for children from zero to 12 years of age who have type 1.

The appearance of diabetic complications in the childhood, adolescence, and young adulthood of those who have had type 1 from an early age are related to high levels of BG, including levels within the officially recommended ranges, which, in spite of being elevated above the normal ranges found in the current study, are frequently surpassed in everyday practice(1). 

Because young Mexican girls tended to have BG levels consistently lower than those of their male counterparts, the inevitable question is whether the glycemic levels officially recommended as optimal for children with type 1 should be identical for young boys and girls, as has long been the case. 

Summary

From the results reported here, complementary questions arise, still unanswered by the data:  Is there a positive or negative effect of BG levels below 80 mg/dL on the ability to learn in children who do not have diabetes?  Supposing that the fasting BG level represents the lowest daily BG level achieved: what is the highest typical or "normal" glycemic level reached after eating?  The response to these questions should inform the definition of the "normal" postprandial glycemic mean to be recommended.  Together with the data from the present study, the answers may help define the upper and lower limits of the normoglycemia typical of Mexican children without diabetes from one to five years of age. 

References

  1. DCCT Research Group.  The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus.  New England Journal of Medicine, 1993, 329(14):977-986.
  2. Khan F, Green FC, Forsyth JS, Greene SA, Morris AD, Belch JF.  Impaired microvascular function in normal children:  Effects of adiposity and poor glucose handling.  Journal of Physiology, 2003, 551(2):705-711. http://jp.physoc.org/cgi/content/full/551/2/705.  Accessed 8 April 2009.
  3. American Diabetes Association.  Standards of Medical Care in Diabetes-2009. Diabetes Care, 2009, 32:S17-S25.
  4. American Diabetes Association.  Standards of medical care in diabetes:  Clinical Practice Recommendations 2007.  Diabetes Care, 2007, 30:S4-S41.
  5. Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA, Clark N.  Care of children and adolescents with type 1 diabetes.  Diabetes Care, 2005, 28(1):186-212.
  6. http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=6826&nbr=4193.  Accessed 8 April 2009.
  7. Parretti E, Mecacci F, Papini M, Cioni R, Carignani L, Mignosa M, La Torre P, Mello G.  Third-trimester maternal glucose levels from diurnal profiles in nondiabetic pregnancies:  Correlation with sonographic parameters of fetal growth.  Diabetes Care, 2001, 24(8):1319-1323.
  8. Pérez Pastén E.  Guía para el educador en diabetes.  Soluciones Gráficas, México, DF, 1997, p. 137.
  9. Stobo JD, Traill TA, Hellmann DB, Ladenson PW, Petty BG.  Principles and practice of medicine.  McGraw-Hill Professional, New York , 1996, p. 332.
  10. Tirosh A, Shai I, Tekes-Manova D, Israeli E, Pereg D, Shochat T, Kochba I, Rudich A.  Normal fasting plasma glucose levels and type 2 diabetes in young men.  New England Journal of Medicine, 2005, 353:1454-1462.
  11. Nichols GA, Hillier TA, Brown JB.  Normal fasting plasma glucose and risk of type 2 diabetes diagnosis.  American Journal of Medicine, 2008, 121(6):519-524.  http://www.amjmed.com/article/S0002-9343(08)00231-3/fulltext.  Accessed 8 April 2009.
  12. Bernstein RK.  Diabetes solution:  The complete guide to achieving normal blood sugars.  Little, Brown, Boston, 2003.
  13. LeRoith D, Taylor SI, Olefsky JM.  Diabetes mellitus:  A fundamental and clinical text.  3ra edición.  Lippincott Williams & Wilkins, Philadelphia, 2004, p. 1258. 

A Spanish version of this article was published in México, in Diabetes Hoy para el Médico y el Profesional de la Salud, 10(1), pp. 2179 - 2184, January 2009.


Categories: Blood Sugar, Diabetes, Diabetes, Health Research, Insulin, International, Kids & Teens, Low Blood Sugar, Type 1 Issues, Type 2 Issues



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Comments

Posted by Anonymous on 17 April 2009

Sorry, but I think this is a silly artilce. For one thing, children snack a lot more. Why? Because they are hungry. In the morning, children are not as active and that's why they don't complain about low blood sugar. but when they are active and reach for the nearest sweet that would seem to me as a reaxtion quite close to one of a diabetic.

You are looking in the mirror and then expressing surprise at what you see.

Posted by Anonymous on 19 April 2009

This dude has no freaking idea. Can't wait until he or a member of his extended family develops diabetes - then see him try and say we should be aiming for an A1c of 4.0. Get a clue, mate!

Posted by Anonymous on 22 April 2009

I am now able to tolerate bg levels of 100 or lower on human, or Lantus and Humalog. When I was on pig/beef insulins I was VERY sensitive to bg levels: sweating, anxiety, etc. If you've been on high carb diets and used to living with 180 bg levels with aftermeal spikes, and then tighten up control, you can feel like you're hypoglycemic though your bg is 130. It takes awhile for patients to get used to lower healthier bg levels according to a nurse wlho works at a large Seattle medical research facility in a diabetes clinic promoting tighter bg control.

Posted by Anonymous on 23 April 2009

Fasting BS of around 83 mg/dl and lower seems to be what a alot of the research points to as far as non-diabetic healthy individuals. Our ancestors probably had A1cs in the low 4.0s as they weren't stuffing there faces with carbohydrates 24/7 and sitting at desks all day long. Read the research mate, its extensive. The advent of high carbohydrate consumption came about with the agricultural revolution. Luckily while people were planting, harvesting, and generally very active they could avoid the pitfalls of increased carbohydrate consumption due to relatively high insulin sensitivity. We are still benefiting from this carbohydrate abundance but we no longer possess the same levels of insulin sensitivity to negate the negative impact of all these carbohydrates due our modern lifestyles. Insulin is a major culprit in many chronic diseases. Keep on bombarding your insulin receptors with pharmacologic doses of insulin and you will reap the adverse effects whether your diabetic or not (you will be eventually). Insulin regulates lifespan, regulates inflammatory actions, influences sodium retention, constricts arteries/blood vessels, builds/inhibits body fat, at the dosages most people use today. Use insulin as it was meant to be at physiologic (small) doses. Lower A1cs, longer life, less complications.

Posted by Anonymous on 24 April 2009

Fasting BS of around 83 mg/dl and lower seems to be what a alot of the research points to as far as non-diabetic healthy individuals. Our ancestors probably had A1cs in the low 4.0s as they weren't stuffing there faces with carbohydrates 24/7 and sitting at desks all day long. Read the research mate, its extensive. The advent of high carbohydrate consumption came about with the agricultural revolution. Luckily while people were planting, harvesting, and generally very active they could avoid the pitfalls of increased carbohydrate consumption due to relatively high insulin sensitivity. We are still benefiting from this carbohydrate abundance but we no longer possess the same levels of insulin sensitivity to negate the negative impact of all these carbohydrates due our modern lifestyles. Insulin is a major culprit in many chronic diseases. Keep on bombarding your insulin receptors with pharmacologic doses of insulin and you will reap the adverse effects whether your diabetic or not (you will be eventually). Insulin regulates lifespan, regulates inflammatory actions, influences sodium retention, constricts arteries/blood vessels, builds/inhibits body fat, at the dosages most people use today. Use insulin as it was meant to be at physiologic (small) doses. Lower A1cs, longer life, less complications.

Posted by mjensentulsa on 24 April 2009

Without necessarily recognizing it, the author provides an interesting tidbit of knowledge to the body of diabetes research. To wit: Non-diabetic kids can have asymptomatic hypoglycemia, just like diabetic kids and adults do.

Unfortunately, the conclusion he seems to drive at -- that we should adjust our targets for Type 1 tots, is dangerous and misguided. It's based on the erroneous logic behind one of his initial precepts: "Any reasonable clinical plan for the glycemic management and self-management of children and adolescents with type 1 depends on knowledge of the typical or 'normal' nondiabetic values for the general infantile population of the same body weight."

Actually, there are some other metrics that matter much more, such as what glycemic targets keep Type 1 kids safe both from the hyperglycemic complications and the much more frightening consequences of hypoglycemia, a topic that researchers seem to overlook, as such consequences are harder to measure as they do not "stand still" (i.e. you can sample a population of diabetic patients, and count the diagnosis codes that represent neuropathy and microvascular because such chronic conditions persist; it is much more difficult to count the E/R admissions, the EMT visits, the glucose tablet interventions, etc., as these must be gathered from disparate points, including the parents themselves).

Those of us who deal with self-management ("inexpert" and otherwise) often refer to what we describe as "the tightrope" -- Trying to keep your BGs at an optimal level without those post-prandial boosts into hyerglycemic satiety, or pre-prandial hypoglycemic crises.

But for the parent of a small child, a better metaphor is the cliff. Imagine having a child that, because of their genes (the ones you gave them, perhaps), is constantly playing near the edge of a cliff. On one side is a drop off that could land them on sharp rocks below. On the other is a mountain where they might get lost in the forest or sustain a lifelong injury at the claws of fierce beasts.

Dr. De Loach seems concerned only about the forest and the beasts, and so urges parents to allow their children to play closer to the cliff.

The issues that I wish he and other researchers would pay attention to are the ones that really matters, for both children and adults dealing with Type 1.

First, please for heaven't sake understand what really matters to people living with -- it's not the A1C or any such "average" measurement. Those are fine for the "overall" indicator and line up nicely with your population statistics, at least in regard to long-term complications.

Instead, look at the Standard Deviation. Okay, I've got an A1C of X, which corrresponds to an average BG of Y. But how far from Y do I stray over a period of days or weeks? How does that metric rate against both long-term chronic complications and acute episodes of hypoglycemia?

While you're at it, check out the slope of that curve. My experience suggests that I get "hypoglycemic" symptoms when my BG drops sharply. That seems to explain why I can sometimes experience them when my meter reads 120 and I've just been exerting myself, but sometimes not get them when my BG is 45 and I've been sitting still for a long time.

Remember also that a diabetic's response is slower than that of the nondiabetic. Exogenous insulin injected into the subcute is slower to adsorb than pancreatic juice, which shoots directly into the bloodstream. Upsurges of BG are harder to bring down and downspouts are harder to head off. The parents are being extremely rational to keep their kids' targets out of your so-called "normal" range.

Back to that metaphor -- if you want parents to let their kids play closer to that cliff and farther from the forest, give them some tools to help them keep the kid's path from wandering into the dangerous areas on both sides. Give them a way to lower the standard deviation between the highs and the lows. Then they will worry less about bringing the average bg down.

Simply saying "shoot for a number that's closer to 'normal'" is absurd -- and reckless.

Posted by Pauline Barrett on 27 April 2009

I read the research article and of the several responses, mjensentulsa's response came closest to mine expressing the complicated results and implications of the project. Parents do not like surprises, especially in the middle of the night, and tend to over-react when their child's glucse level gets low. Though the scientific community now knows how low "normal" can be, is it truly normal for all? There are so many variations in day-to-day life.

Posted by Anonymous on 27 April 2009

Listen to the research. I like to hear this stuff. We as parents are scared into feeling like our kids are playing at the edge of a cliff. That is because we only use a tool that pushes them towards a cliff. Perhaps we should be thinking it really is a hill. Yes a steep hill but one we shouldn't be so scared about. That way A1c's could be lower. Our current management techniques have not seen average A1c's drop in 15 years. Studies have shown that someone has to be low for a number of hours at night before having a ceasure.

Perhaps we should really be thinking more as pancreases and readily usable measured doses of Gluagon be available to bump up lower BGL's as necessary just as the body does. Instead we store it in a difficult form that has to be reconstituted and put it in a special sealed orange case only to be opened in dire emergencies.

Just proposing an alternative way of thinking.

Posted by mjjensen-sutton on 29 April 2009

Yeah, this sure is a family disease! How strange to read this article forwarded to me by my excellent diabetes educator in Lake Havasu, Arizona, and to consider the congruence of the study results with my own observations using my BG meter (after 1982) with adult non-diabetic female friends (many having asymptomatic fasting BGs between 50-75), and then to discover a letter from my youngest brother among the responses (mjensentulsa on 4/24/09)!!
It may be useful to expand upon his creative images of the child playing between the Cliff and the Forest.

If the child goes over the Cliff, the Law of Gravity always applies and the child WILL FALL on the sharp rocks below, causing various degrees of bodily harm. When that Cliff is Hypoglycemia, the biochemical laws of brain survival apply and the child WILL FALL unconscious from low blood sugar, causing seizures, possible permanent brain damage, perhaps coma and then death.

However,when the child goes off the other side of the path into the Forest, the Laws of Probability apply and the child MAY BE ASSAULTED eventually by either a lion, a tiger, a bear, and/or a skunk, depending on when and how long the child spends in that territory. When that Forest is Hyperglycemia, the child MAY BE ASSAULTED eventually by serious coronary artery blockage requiring cardiac bypass surgery and/or by early-onset cataracts removed by a simple operation. The Wild Animals in the Forest may bite the child or simply pass by unnoticed. The long-term effects of elevated blood sugar may turn up in any of the body systems; they may be mild or they may "eat you alive." Over time, impaired circulation to the lower extremities may cause minimal numbness in the feet or tissue death and amputation.

Like my brother, I have experienced the awfulness of "brittle" diabetes: sensitivity to tiny insulin doses, unpredictable highs and lows in reaction to any mental/emotional/physical experiences, severe hypoglycemic reactions, worry and fear in family members, the bizarre impact on my sense of self of having been incompetent or unconscious for periods of time, the body and headaches of seizure "hangovers." In the 43 years since Type1 onset in adolescence, I have even " burned out" my body's alerting system and can become scarily hypoglycemic (17-54 mg/dl) without getting shakey or sweaty or anxious and still go into a grand mal seizure.

Like my brother, I would not wish any of these conditions on my worst ADULT enemy, much less on a small person . A parent walks the path of diabetes WITH the child and is tall enough and old enough to see that the definite and immediate risks of low blood sugar outweigh the possible eventual hazards of some degree of high blood sugar.

When I was diagnosed at age 15, I was not expected to live to see 30. I was "educated" about all the terrible things that might happen to me. I tested the treatment mandates and was a "non-compliant, bad" diabetic. I learned that 'diabetic' was not a noun but an adjective, and only one of many that described me, along with 'intelligent,' 'warm,' 'creative,' 'loyal,' 'funny,' and 'patient.' Technology has developed while I have been outliving the odds: blood sugar meters and the insulin pump have given me information and tools to adapt to the realities of my daily life. Computerization that allows my meter to communicate with my pump has decreased the amount of math I need to do. Ultrasound has assisted me to give natural birth to two children. My parents have aged into their 80's and each developed Type 2 along the way, but the gene combination that led to my diabetes seems also to have given me longevity and resistance to the most severe complications. Science has developed alternatives to sugar and strict dietary rules. Human curiosity and compassion have led to research, and I do believe the current development of Continuous Blood Glucose Monitoring will provide the next step in answering my beloved brother's plea for a way to Stay On the Path of balanced blood sugars... until this disease can be completely prevented.

All of this does not mean that high blood sugars are alright. This article has made me want to try lowering the Blood Glucose Goal on my Cozmonitor pump system from 120 down to 100 mg/dl and see what happens.

It is good to know that research is being done in Mexico and that old beliefs are being questioned. Being diabetic is a lot of work one day at a time, one hour at a time, one minute at a time. My brother writes beautifully and thus his energy could be spent better for all of us.....

Posted by cde on 29 April 2009

THIS IS A RE-POSTING: The message I posted yesterday has been completely chopped up, with numerous spelling/gibberish errors added. Some malware computer glitch must have caused the problem, so I am re-posting my reply below.
----------------------------------------------------------

As quoted by Dr. Bernstein, Jean Martin Charcot said: "Theories, no matter how pertinent, cannot erase the existence of facts."

The article here reports data or facts derived from data. These data may or may not be useful to people who have DM1, but their usefulness (or not) is the result of a personal decision to take them fully or partially into account (or not) in understanding and applying one’s own management or self-management of DM1.

The data are not imperatives or prescriptions or even suggestions; they are merely facts, found in a given moment in time among a certain population of children.

In DM1 self-management, each person decides and implements the parameters of glycemic control that he or she judges best or that she or he can "live with." In that decision, which, in the case of DM1, must be made tens to hundreds of times each day, information and knowledge can be as determinant and influential as previous and current experience, success, or failure.

Perhaps there are personal reasons why for any individual any value above 100 mg/dL (180 mg/dL, for example) could be an attainable and personally acceptable nighttime BG goal, depending on parents' and the child's abilities and decisions. Part of the decision taken may relate to its intentionally contributing to the family's emotional well-being or “comfort level.” These considerations are also "facts," but of a different quality; they are more psychological or emotional or social than physiological. Psychological facts do not change physiological facts, though physiological facts (280 mg/dL, chronically, for example) can indeed influence psychological functioning (depression, for example).

Our glycemic decisions, for whatever motive, do not change the facts. The facts do not corroborate elevated glycemic levels as "normal" or "typical" in those without DM1, but we are not in this instance bound by facts to any course of action. We are only informed by them.

I am familiar with the many frightening, disturbing, infuriating, humilliating, exasperating, idiosyncratic experiences involved in self-managing DM1 to whatever glucose levels one decides or feels obligated or constrained to adopt.

In June, I will have had DM1 for 40 years exactly. Starting long before home blood glucose meters or ultrarrapid or basal insulin analogues were even thinkable, I am able to know from experience how and why, given this past "life with DM1," what today is certainly possible (closer-to-normal BG levels through the implementation of dietary refinements and insulin analogue therapy) and conceivably safer (think Law of Small Numbers and its relation to feared hypoglycemia), may be quickly rejected or ridiculed.

The adept utilization of the marvelous new tools available and the proper information, education, and application to accompany their use may continue to seem impossible, dangerous, or "pie in the sky," but there are likely more than 100 persons with DM1 who employ them daily, without falling off any really high “cliffs.”

Empathy and commiseration may thus change recommendations or decisions, but they do not change facts.

The BG levels reported in this study were indeed obtained with physiologic secretion of insulin (that is, precise, minimal amounts of endogenous insulin, which is about 25 times more potent than injected commercial insulins, probably excluding U-500 formulations).

Each person with DM1 explicitly or implicitly decides whether this "normal" model of glucose management can or will work for him or her (through continuous infusion or basal/bolus insulin regimens, for example). The choice to disregard this possibility for BG control is always present and permitted.

Using longstanding, earlier, or familiar methods and standards of BG self-control is also an option (though, as in the cases of animal-based insulin and ultralente insulin, our options are sometimes unavoidably taken away, and new challenges and choices presented).

In my use of facts, I try to follow the wisdom of an 8-year-old boy who says (speaking to other children and adolescents with DM1 in the book "487 really cool tips for kids with diabetes"), "Always be open to try something new.... You never know what's going to work best for you and keep you feeling good." (p. 164).

Dr. Stan De Loach
México, Distrito Federal

Posted by Anonymous on 29 April 2009

Would mjjenson-sutton mind posting who your diabetes educator is in Lake Havasu? I am new to the Parker area and trying to find someone more local to see rather than traveling to Phoenix. Thanks!

Posted by Anonymous on 4 May 2009

The standard for blood sugar is between 70- 120 or 80-120 as of what I've been taught. Between is the keyword.

Posted by Anonymous on 9 May 2009

Unfortunately, for many of us, the management of D1 is not an exact science. I'm not sure we can even begin to know all the factors that come into play when we self-manage. What I think might be a predictable response to the insulin I've just injected, often isn't. And I do understand and mostly follow Bernstein's Law of Small Numbers.

I more than agree with mjjensen-sutton and the essence of what he writes translates (to me) into a quality of life issue.

Being called a diabetic is politically incorrect. I HAVE diabetes, but I think the experts truly want to turn me into a diabetic, having it consume my every waking moment. In reality it nearly does. Anyone who wants good control needs to test lots. It's SUCH a fine line between a normal BGL and a hypo. Judging by how many people have hypos every day, just proves that having really tight control is sometimes a hit and miss thing, even with expertly educated people who think they know what injected insulin will do. I'd much rather be a 120 mg/dl than 85 mg/dl and be a hairsbreath from sliding into a hypo.

How do we know that those Mexican children's livers don't release glucose in tiny doses to keep them at those levels, and stave off hypo symptoms? It's completely ridiculous to compare people with and without diabetes - their bodies work completely differently. I am positive we don't yet fully understand the mechanisms of insulin/glucose in healthy people, and yet those with D1 are supposed to mimic them with only insulin that doesn't work anywhere near as efficiently? Impossible!!!

Posted by mjjensen-sutton on 24 May 2009

For the person who asked for the name of my fantastic Diabetes Educator in northwestern Arizona, Sherri (who is also a Registered Dietitian and a long-time Type 1) can be reached at www.mydiabeteseducator.org/s.caddy -- That general website probably be helpful for anyone looking for a certified educator in their zip code. Lake Havasu City has a pumpers' focus group that she set up about ten years ago. "Pumpin' on the River" meetings at the public library are a great source of current information and interaction for us and our families.


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