Question for you all. I first joined a Diabetes forum on Reddit. The people there are crazy obsessed with this idea that your blood glucose should never go above 140. Even after eating. They have this little set of rules. <140 1 hour after eating and <120 2 hours after eating.

I really liked what I was reading. But I discussed it with my doc and he says absolutely no. He says studies suggest people who keep their blood sugars that low and tightly controlled do worse. He says they fall more, end up in the hospital more, get far too low more often, etc.

What do you guys think? Do any of you subscribe to the 140/120 idea? Do you think it's unreasonable?

I'm on of those who is crazy obsessed with never going over 140. in fact, I like to always be under 120 at 1 hour post-meal and back under 100 at 2 hours post-prandial.

The study your doctor is referring to is ACCORD, which was designed to see if lowering A1c to 6.5%, instead of the ADA's recommended 7.0%, could prevent heart attacks. The study was stopped early when analysis of preliminary data showed a slight excess of heart attack deaths in the subjects in the group who were striving to lower their A1cs.

However, many of the deaths were subsequently attributes to the use of Avandia, The ADVANCE trial showed no increase in mortality.

http://www.healthday.com/newsletters/diabetes.htm


http://diabetesupdate.blogspot.com/2010/05/accord-redux-its-high-blood-sugars.html

ACCORD was a very large study in which one group of people with diabetes were given a strong cocktail of diabetes drugs with the aim of lowering their A1c below 6.0. Those drugs included sulfonylureas, Avandia and Actos, all drugs known to increase heart problems. The other group of study participants kept their A1cs in 7% or higher range recommended by the ADA. The result was that the group of people shooting for the lower A1cs had slightly more heart attacks than those maintaining mediocre control.
For perspective, it is worth noting that another larger study, ADVANCE, pursued the same strategy with different drugs and found NO excess deaths in the tight control group.
And in both studies, the group with tight control had less classic diabetes complications most notably neuropathy and kidney disease. But because of that small number of excess deaths in the tight control arm of ACCORD, many family doctors are now telling patients that lowering blood sugar is dangerous.


Fortunately, a new study of the ACCORD data puts this into perspective. The study design of ACCORD is so sloppy, it is not likely we will ever know exactly what the problem with its protocol was.Before and after adjustment for covariates, a higher average on-treatment A1C was a stronger predictor of mortality than the A1C for the last interval of follow-up or the decrease of A1C in the first year. Higher average A1C was associated with greater risk of death as well as greater risk of diabetic complications
http://care.diabetesjournals.org/content/33/5/983.abstract


http://www.nejm.org/doi/full/10.1056/NEJMc1103669
Given unbalanced exposure, we think that the ACCORD trial is inconclusive and that the recommendation to abandon lower glucose targets is not supported and has unknown consequences for the long-term management of diabetes.


http://www.diabetesincontrol.com/index.php?option=com_content&view=article&id=7001
ADA - Low Glucose Levels Do Not Explain Excess Deaths in ACCORD Trial:A1c of less than 7% is not a predictor of mortality risk in Type 2 diabetes and the converse is true in that higher A1cs do increase the risk of mortality. For every 1% higher A1c level above 6%, the risk of death increases by 20%.

FWIW, my endocrinologist agrees with me and wants fasting readings NEVER higher than 100 and preferably below 95, before meal readings between 80-90, and peak (generally 60-75 minutes after a meal) less than 140, with 2 hour post-prandial readings lower than peak. My last A1c was 5.1

Here's some interesting information on why 140 is a magic number http://www.phlaunt.com/diabetes/14045621.php