National Organizations such as the ADA or Diabetes UK realized a couple of things
First the “one size fits all” doesn’t work for all Diabetics and in trying to reach the recommended range you could end up over medicating certain patients and “killing them”

High Blood Sugar kills you slowly over a decade or so, Low Blood Sugar kills you overnight so a “safer from immediate death, but will still kill you before your time” range of under 10.0 mmols/180 points was decided upon

And this is where the great “disservice” to many diabetics was born

Instead of dual standards such as:

For patients “not at risk” for severe Hypoglycemia the range should be Below 7.8 mmols/140 points and “at risk” patients Below 10.0 mmols/180 points, we all got tossed into the same guideline even though the experts “knew” that many diabetics would needlessly suffer complications

(the medical community is famous for treating patients like little kids that can’t handle the truth or make decisions for themselves – they “treat” they don’t “prevent”)

So why the lack of honesty?

If you target a PPG Range of Under 10.0 mmols/180 points you will delay diabetic complications for about 10 years

If you target a PPG Range of Under 8.7 mmols/154 points you will “save” your Eyes, Kidneys and Brain from Retinopathy, CKD and Vascular Dementia respectively

If you target a PPG Range of Under 7.8 mmols/140 points you add in normalizing your ASCVD risk (Heart Attack, Stroke and Congestive Heart Failure) and that nasty painful Peripheral Neuropathy which can lead to lower limb amputations

Just a couple of years ago the U.K. finally came out with revised guidelines

My (guess) would be they realized that if Diabetics had better control the nationalized medical system wouldn’t have to pay Billions to treat “preventable complications”

They lowered the PPG target to 8.5 mmols/153 points – that move could save millions of diabetics in the U.K. from losing their vision, prevent dementia and keep them from needing Dialysis – a great first step

Just have to ask – when will the rest of the Western Countries take the cue?

@A DiabetesTeam Member
I can’t help feeling that the medical establishment arbitrarily sets these limits and not just for blood glucose range.

There may be also other reasons that border on the politically correct. I remember asking a doctor why they don’t tell the truth re: complications and his reply was that they don’t want to discourage people.

I asked another doctor why they advised *all* people to cut down on salt and fats despite the fact that many/most people have no problem handling salt or fat and his reply was that they don’t want those that have hereditary issues etc re fats and salt to “feel left out”.

I wonder if there is a growing politicisation of medicine in this and other countries where agendas hidden or otherwise are distorting evidence based medicine.

My suggestion to those wishing to bring their bgs down is to do it in a stepwise fashion.

Awareness and management of diabetes should be at the heart of everything we do and the ridiculous idea “we should not let diabetes control us” should be thrown out the window.

Whether we like it or not, diabetes dictates how we eat and how we behave (including exercise).

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@A DiabetesTeam Member your foot dragging questions is valid

A "guess" on my part, since Diabetes Canada also has a set of guidelines for 'motivated' diabetic patients to keep their 2hr PPG "below 8.0" (144 points) which is my upper range, slightly more restricted than the U.K. is:

In the U.S. you have a "user pay" medical system - they don't make any money (doctors or pharma) if there is "nothing to treat"

In Canada and the U.K. the "Government" saves money if they Don't have to Treat

Financial motivation is likely at least a part of the equation, maybe a big part

(or maybe I'm just jaded ??)

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Diabetes does not take a vaca when you do!

@A DiabetesTeam Member that's where overall management comes in

We need to be "good" 75% of the time - that's about 40 weeks of the year

Of course even in those 40 weeks we are never perfect but certainly if you manage well it's probably pretty safe to say that you can have maybe 4 or 6 weeks a year of "somewhat less than ideal" sugar numbers, and if you are vigilant otherwise, you are not going to hurt too much

So now, no eating a whole chocolate cake everyday when on holidays, but if you are colouring a little outside the lines probably not harming much

And "pretending" you are (normal) for a week or two a couple times a year is great for the mental health - we still do have to live after all

The problem would only really apply to someone who is constantly struggling for control and a "mulligan week or two" would NOT be a good idea

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