Getting to ‘normal’

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Sidebar article to Doctor’s patience yields new diabetes treatment and approach

by Ms. Margaret C. Roth

Just as “normal” is no absolute in any context, it varies somewhat among medical professionals providing guidance to diabetics on target blood sugar levels. And that’s where Dr. Richard K. Bernstein differs vehemently with the U.S. medical establishment.

Bernstein’s persistent insurgency against conventional thinking in diabetes treatment, grounded in a difference of numbers representing desirable blood sugar levels that in turn mean the difference between good health and life-threatening illness, is akin to Army leaders now doing their insurgent best to fight the standard approaches to acquiring and fielding the best equipment and materiel for warfighters in a timely manner while it can still save lives. Disciplined experimentation is a key to success in both cases.

At high levels, blood glucose can be essentially a slow-acting poison for virtually every part of the body, including the cells of the pancreas that make insulin. High levels of blood sugar can stunt growth and impede brain development in children. They can also cause changes that lead to atherosclerosis, a hardening of the blood vessels, as well as a host of other complications.

“Normal” blood sugar is the holy grail of diabetics, especially Type 1 diabetics, whose bodies make very little or no insulin at all because their immune systems attack and destroy the cells in the pancreas that produce the hormone. They cannot survive without taking insulin every day, and their blood sugar levels can fluctuate wildly with the food they eat and their bodies’ responses to the insulin they take.

For those with Type 2 diabetes, the most common type, these fluctuations are less likely to be as intense; their bodies do not make or use insulin well, but they are not as dependent on supplemental shots, if they take them at all. In all, 9.4 percent of the U.S. population, or 30.3 million people, have diabetes, according to 2015 figures, of whom the vast majority of the adults—more than 90 percent—have Type 2 diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Type 1 diabetics need to test their blood sugar as many as 10 times a day—before meals and snacks, before and after exercise, before bed and sometimes during the night—or even continuously using a sensor worn under the skin. Type 2 diabetics who take insulin are likely to test just two or three times a day, depending on the type and amount of insulin they use.

There are two primary measures of blood sugar for diabetics monitoring themselves. One calculates the milligrams of blood glucose per deciliter of blood (mg/dL) at a particular point in the day, while the other, called the A1C or glycated hemoglobin test, measures the average blood sugar level over the past two to three months. The A1C blood test looks at what percentage of the body’s hemoglobin—a protein in red blood cells that carries oxygen—is coated with sugar (glycated). The A1C percentage is convertible to average mg/dL. Doctors treating diabetics typically do the A1C test every three to six months, but A1C test kits are also available for home use.

For someone who doesn’t have diabetes, a normal A1C level is below 5.7 percent, according to the Mayo Clinic. As the standard for diagnosing diabetes, an A1C level of 6.5 percent or higher on two separate occasions indicates diabetes. A result between 5.7 and 6.4 percent is considered prediabetes, which indicates a high risk of developing diabetes. For most people who have previously diagnosed diabetes, Mayo’s website says, an A1C level of 7 percent or less is a common treatment target, while higher targets of up to 8 percent may be appropriate for some individuals. Someone who has had uncontrolled diabetes for a long time might have an A1C level above 8 percent.

According to the American Diabetes Association, a desirable blood sugar level for diabetics to achieve is 70 to 130 mg/dL before meals, and less than 180 mg/dL after meals, with an A1C of less than 7 percent, the “common treatment target” cited by the Mayo Clinic.

In sharp contrast is Bernstein’s vision for a healthy life of normal, steady blood sugars, day in and day out: 83 mg/dL for adults (equating to an A1C of less than 5 percent), in the 70s for children before puberty and 65 mg/dL for pregnant women.

On at least one point, diabetes specialists agree: Any sugar levels higher than normal are unhealthy.

MARGARET C. ROTH is an editor of Army AL&T magazine. She has more than a decade of experience in writing about the Army and more than three decades’ experience in journalism and public relations. Roth is a MG Keith L. Ware Public Affairs Award winner and a co-author of the book “Operation Just Cause: The Storming of Panama.” She holds a B.A. in Russian language and linguistics from the University of Virginia.

 


This article is published in the July – September 2018 issue of Army AL&T magazine.

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