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Ask
Dr. Bernstein
How
Dangerous Are BG Swings?
Richard
Bernstein, M.D., F.A.C.N., F.A.C.E., C.W.S.
New
York Diabetes Center
Mamaroneck, New York
Question:
I have been unable to find information on the effects of having
short-term spikes in my blood sugar.
For example 115 mg/dl before breakfast and 180 after
breakfast. I don’t take any medications and would like to control my
blood sugars with diet and exercise.
I am 6’2” tall and weigh 179 pounds and I walk 3-4
miles at least 5 times a week. Is there a hazard associated with
these blood sugars and what do I need to do to keep my blood
sugars in the normal range
Answer:
Your question brings up
two points.
The first is
whether there is a long-term hazard in pre-breakfast (i.e.,
fasting) blood sugars of 115 mg/dl? The American Diabetes
Association (ADA) appears to have answered this when it created a
new diagnostic category known as "impaired fasting blood
glucose" for individuals who display fasting values greater
than 110 mg/dl on two occasions.
Your second
point relates to transient spikes. I see many “non-diabetic”
obese people whom I help to lose weight. A number of these
individuals have normal fasting glucose levels (about 90 mg/dl)
but HbA1c values that are slightly elevated at around 5.5%. This
corresponds to a four-month average blood sugar of about 120 mg/dl
at my lab.
I
suspect that such mild elevations have been present for years.
Inevitably,
when I examine patients, I'll find some early diabetic neuropathic
complications.
These may
include:
-
somewhat diminished heart rate variation on deep
breathing (parasympathetic neuropathy)
-
dry skin on the feet (sympathetic neuropathy)
-
the intrinsic minus foot deformity with claw toes
and high arch (motor neuropathy)
-
diminished sensation in the feet (sensory
neuropathy)
-
double vision in one or more directions of gaze
(motor neuropathy).
Usually, more
than one of these signs is present.
I suggest that
you have your HbA1c checked. Normal values are probably below the
midpoint of the normal range of your laboratory, since most labs
tend to set their normal ranges too wide. Using my lab, I find that non-diabetics have HgbA1c values in
the range of 4.2% to 4.6%.
To
address the problem of controlling your blood sugars, I would
advise a lower carbohydrate diet. If you are in shape and
exercise, it is likely that you might be consuming too much
carbohydrate.
If
a lower carbohydrate diet does not normalize your blood sugars,
the next step would be insulin, which must be administered in a
physiologic manner as determined by blood glucose profiles.
Although
sulfonylurea oral medications might work initially, they are not
long-term solutions. Since
you are not obese, it is unlikely that the newer medications which
reduce insulin resistance will be of value.
My
book, Dr. Bernstein's Diabetes Solution, goes into great
detail on all of the above.
Richard
Bernstein, M.D., F.A.C.N., F.A.C.E., C.W.S.
New
York Diabetes Center
Mamaroneck, New York
For
more information check out Dr. Bernstein’s corner at
http://www.diabetesincontrol.com/bernsteinarchive.htm
To
view other advice from Dr. Bernstein go to www.diabetesincontrol.com/bernsteinarchive.htm
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