Avoiding Diabetes Complications
Several years ago the Diabetes Health magazine published an article stating that diabetics should maintain a good BG average and A1c, and avoid a roller coaster type of control. The roller coaster control involves having many highs and lows. That would involve data widely scattered above and below the average. Blood sugars that rise and fall on the path of a roller coaster are traumatic to the body. Experiencing this trauma over and over again for a long period of time can lead to diabetes related complications, even if the A1c is good. I will demonstrate with two examples.
Patient A has test results 40, 55, 65, 100, 135, 145, and 200. The average is 106, but there are numbers that indicate unhealthy highs and lows.
Patient B has test results 72, 80, 94, 100, 106, 120 and 148. The average is 103, but the data is more closely packed, and none of the numbers are undesirable.
Patient B is experiencing better control, and is less likely to have diabetes complications. The "standard deviation" (SD) is a measure indicating how closely the data is distributed above and below the blood sugar average. Patient A had much larger deviations from the average of 106. Patient B had smaller deviations from the average of 103, so the SD was much better. I try to keep my SD as small as possible, but it is difficult to do. My A1c's have been in the 5.4-6.4 range for almost 20 years (The graph below shows my A1c's for the years 1980-2015). When I have too many highs and lows, my SD is higher and I can feel neuropathy symptoms. I used to have some spots of retinopathy in both eyes when I had a roller coaster control, even though my A1c was good. My using an insulin pump helped reduce the number of highs and lows.
The purpose of this discussion is to demonstrate the fact that a very good blood sugar average can still involve diabetes complications if there is a significant number of highs and lows over a long period of time. Don't rely solely on a blood sugar average and A1c. Try your best to avoid so many highs and lows. A good average accompanied by a stable control is the best way to avoid complications. Proper dieting and well chosen exercise routines can help very much in reducing the highs and lows.
I have had A1c's no higher than 6.4 for almost 20 years, but I had the beginning stages of neuropathy and retinopathy about 15 years ago. My control had been tight, but it was necessary to make it even tighter. I stopped having so many highs and lows. After a few months had passed, the retinopathy disappeared. The neuropathy is still present in my feet and legs, but I rarely experience any pain. If I have high blood sugar for many hours there is sometimes mild pain during the night. I have been a type 1 diabetic for 73 years, and have not had any serious complications. I want to keep it that way!!