November 3, 2006

What is a Normal Blood Sugar

Over the past year I've been tracking the searches that bring people to my web site What They Don't Tell You About Diabetes and have found that the single most popular search that brings in visitors is "What is a normal blood sugar?"

Much of my web site is devoted to answering that question with references to dozens of laboratory studies published in top peer reviewed journals which address various aspects of this question. If you want the details, that's the place to find them.

If you just want a quick answer to "What is a normal blood sugar?", here it is:

1. A normal fasting blood sugar (also the blood sugar you'd see before a meal) is 83 mg/dl (4.6 mmol/L) or less. Many normal people have fasting blood sugars in the mid and high 70 mg/dl (3.9 mmol/L) range.

2. A normal person eating the high carb typical American diet does not go over 120 mg/dl (6.6 mmol/L), ever, and many never go over 100 mg/dl (5.5 mmol/L).

3. A normal A1c is 4.6% or less. Heart attack risk starts to rise in a straight line fashion as soon as A1c goes over 4.6% and for each 1% of rise it is 2.3 times MORE frequent. That means that at a 5.7% A1c you have two and a third times more risk of a heart attack than a person has with an A1c of 4.6%

4. The reason that your doctor or lab might consider much higher numbers as "normal" is because there is a huge pool of people with undiagnosed diabetes and pre-diabetes in the "normal category" used by researchers in most studies because they used an arbitrarily chosen fasting plasma glucose of less than 110 mg/dl to define normal. An excellent study found that having a fasting blood sugar in the 90s was a very good predictor of diabetes 10 years or more down the road. So it is hard to defend it being truly normal.

5. People with diabetes CAN attain these normal blood sugar numbers. It takes the following to do it:

a. Education. You must learn how many grams of carb there are in every thing you eat, which includes weighing portions until you know what the "portion" listed in a Nutritional Information listing really looks like. Hint: It's MUCH smaller than you think. You need to learn in detail about what various drugs can and cannot do, and if you use insulin you must spend a lot of time reading about how to make it work. Bulletin boards and newsgroups are a good place to find people who have done this. Only take advice about how to get control from people with diabetes who have normal and near-normal blood sugars.

b. Cutting carbs. Carbs are what raise your blood sugar. Unless you are using insulin and are a genius at making it work, you are not going to be able to eat 100 grams of carbs a meal and control blood sugar. Somewhere between 12 and 30 grams a meal is the level most people with diabetes eat who maintain normal blood sugars.

c. Exercise. Some people find this helps greatly with blood sugar control. Others find it has no impact. It has a lot to do with what has made you diabetic. If it is mostly insulin resistance, exercise can usually help a lot. If it is insulin insufficiency, exercise is beneficial but won't necessarily normalize blood sugars on its own.

d. Meds. If you can't do it with carb restriction and exercise alone, it's time to check out drugs that lower insulin resistance, most notably Metformin.

3. Insulin. If diet and metformin don't do it, use insulin. Post-meal insulin works a LOT better for many of us than just Lantus, because Lantus can't bring down meal values to normal levels for most people. If you stress your beta cells at every meal, you are going to end up with non-normal blood sugars. It takes a lot of work and study to get insulin to where it gives you normal numbers. Most doctors can't be bothered and settle for numbers that won't keep you from developing complications. Read "Dr. Bernstein's Diabetes Solution" by Dr. Richard K. Bernstein to learn more about how to tailor insulin regimens so that they give you normal blood sugars.

That's it in a nutshell. Now get out there and get NORMAL!