Blood Sugar Guidelines

llg, PhD, RN · Feb 11, 2007

I'm responding to this thread mostly to give it a "bump" in the hopes that someone with real expertise will see it and respond.

As a recently diagnosed diabetic, I have found the same thing that you have found. My impression is that the ADA guidelines (and other ADA materials) have been developed by committee. They are a big organization and need to develop a concensus before they make any "official pronouncements." That means that they might well be a couple of years behind the most current research and thinking as it takes a while to develop a consensus on that sort of thing.

I've also been skeptical of the ADA's dietary recommendations. They seem to recommend eating moderate amounts of foods with a high glycemic index (e.g. potatoes and pasta) and then take meds as needed. An amazing number of the recipes in their diet books, etc. include potatoes or pasta. Since my diabetes is borderline, I have been able to avoid meds by eating a low carb diet. If I were to follow the ADA diet, I would need meds. However, with a low carb diet, I don't need them. Their literature doesn't seem to reflect what we now know about low carb diets. They seem a little behind the times.

But ... I am new at this ... and certainly no expert. Let's hope someone who is a true expert gives us some insight.

nurseangel47 · Feb 11, 2007

I've also noticed the trend in my area of covering blood sugars as they occur rather than cracking down on what peeps eat. It's like, oh well, if they're gonna not stick to a diet conducive to tighter blood sugar control, let's just cover 'em when they skyrocket with peaked sugars!!! Oh my! Can we say organ damage? Blindness? Dialysis?!

llg, PhD, RN · Feb 11, 2007

I've also noticed the trend in my area of covering blood sugars as they occur rather than cracking down on what peeps eat. It's like, oh well, if they're gonna not stick to a diet conducive to tighter blood sugar control, let's just cover 'em when they skyrocket with peaked sugars!!! Oh my! Can we say organ damage? Blindness? Dialysis?!

I don't think it is a matter of "cracking down" on what people eat so much as it is about a philosophy of "encouraging" diabetics to eat foods that are not good for them with the expectation that meds will "take care of" the consequences. I believe it establishes false expectations and may prevent some people who WOULD choose voluntarily to follow a strict diet from making that healthy choice because the ADA literature never says that choosing to eat those foods is bad for you. They stress eating those foods "in moderation" rather than eating them only in very small amounts or not at all.

As is being discussed in another thread, everyone has a right to choose their own approach to managing their health. If some people choose to eat foods that raise the blood glucose to dangerous levels and then try to compensate with medication, that is their right to make that choice. However, they should be told about the other options as well, such as not eating those foods to begin with. Then let the people decide on which approach -- or combination of approaches work best for them.

Of course, it is also true that many people with diabetes will have an elevated blood glucose in spite of following a strict diet. A high blood glucose does not mean that the person was "naughty" in any way or even that they ate the "wrong" foods. Some people have no alternative but to take meds. For those of you who need meds, please don't think I don't realize that your disease necessitates that. I expect that I will need meds someday myself. It's just that while I am in this early stage of the disease, I am able to avoid them by maintaining a strict diet -- and I don't like the fact that the ADA doesn't encourage that more.

Finally, the expression, "cracking down on what the peeps eat" did not sit well with me. I found it a bit offensive. I recommend being careful about using such expressions -- particularly in front of patients.

Editorial Team / Admin · Feb 11, 2007

ADA Clinical Practice Guidelines are based on a complete review of the relevant literature by a diverse group of highly trained clinicians. After weighing the quality of evidence, from rigorous double-blind clinical trials to expert opinion, recommendations are drafted, reviewed, and submitted for approval to the ADA Executive Committee; they are then revised on a regular basis, and subsequently published in Diabetes Care.

Summary of Revisions for the 2007 Clinical Practice Recommendations :

http://care.diabetesjournals.org/content/vol30/suppl_1/

Diagnosis and Classification of DM

http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S42

Criteria for the diagnosis of diabetes mellitus
1. Symptoms of diabetes plus casual plasma glucose concentration $ge.gif$ 200 mg/dl (11.1 mmol/l).
Casual is defined as any time of day without regard to time since last meal.
The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss.
FPG $ge.gif$ 126 mg/dl (7.0 mmol/l). Fasting is defined as no caloric intake for at least 8 h.
2-h postload glucose $ge.gif$ 200 mg/dl (11.1 mmol/l) during an OGTT. The test should be performed as described by WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water.In the absence of unequivocal hyperglycemia, these criteria should be confirmed by repeat testing on a different day.
The third measure (OGTT) is not recommended for routine clinical use.

http://care.diabetesjournals.org/cgi/content/full/30/suppl_1/S42/T2

zacarias, ASN, RN · Feb 12, 2007

Siri, thanks for those links although I had already seen those. That's why I'm posting here. It says that the glycemic goals for fasting blood sugar is 90-130. That is not what I tought in nursing school and not what I've seen change over the years and certainly not what I've seen in practice. What gives?

Myxel67 · Feb 12, 2007

Siri, thanks for those links although I had already seen those. That's why I'm posting here. It says that the glycemic goals for fasting blood sugar is 90-130. That is not what I tought in nursing school and not what I've seen change over the years and certainly not what I've seen in practice. What gives?

Depends on who's setting the goals The American College of Endocrinology (ACE) and The American Association of Clinical Endocrinologists (AACE) tend to have stricter goals than the American Diabetes Association (ADA)

For example hemoglobin A1C goal set by ACE is 6.5% or lower, while ADA goal is

ACE has upper limit of FPG set at 110 mg/dl and 2 hr pp goal is

The goal set be ADA are higher--the ones you quote above sound close to ADA goals. ADA 2hr pp goal is

grammyr · Feb 20, 2007

My facility is changing our insulin protocol. Each MD has his own sliding scale and his own opinion of which insulin is best. Can anyone help with guidelines for SSI parameters and whether to use Humulog or Regular?????

neneRN, BSN, RN · Feb 20, 2007

In my facility, I only see the ICU patients being managed with the tighter parameters; our goal is between 80 and 100, and that is for virtually all ICU pts whether they are diabetic or not. A lot of research is out there showing intense glucose control reduces infection rates, as well as morbity and mortality in critically ill pts. I don't know how many studies have been done to test this with non-ICU pts in a hospital setting; and I don't know if its even feasible, given that the ICU pts are frequently on insulin gtts and at least initally getting accuchecks hourly to reach this goal. Can you imagine if you had to maintain this tight of a control on a med-surg assignment?

SCRN1 · Feb 22, 2007

I'm a newly diagnosed diabetic also and the diabetes educator at my doctor's office told me they go by ACE instead of the ADA. In the book she gave me, it says the ADA recommends for people with diabetes to keep their BG 90-130 pp,

SCRN1 · Feb 22, 2007

At hospitals I've worked, the sliding scales don't usually call for coverage until 150 either, unless the MD writes a different SS.

Barbie Lou · Feb 24, 2007

I am a CDE in an office,and I agree the the ACE guidelines will help keep people with prediabetes and diabetes more healthy. It does feel like the ADA is not keeping up with better care. As I work with people I try to have people use meters to experiment, like research. They will do blood sugars before and 2 hours after one meal per day to see how the body handles that food combination. If above the 140 guideline we look at how the glycemic index has affected the choice. This way help them accept ownership into their own care.

This is another subject....I also download the meter readings and we look for patterns and problem times. They really strive for the target area which is green on the computer. I really enjoy working with people with diabetes.