There is a perception out there in the online diabetic community that even slightly elevated blood sugar levels are dangerous. In spite of the science saying otherwise, some diabetics, out of fear of their condition presumably, hold these beliefs, where normal blood sugar is what we must all strive for, and beyond that, there be monsters, like people used to think when they looked at maps of yore beyond uncharted lands.
This is no way to approach diabetes though, it is important that we have a more accurate idea of this stuff than that. We not only want to be aware of where the real risks are, we also don't want to let ourselves get too paranoid about this and worry too much about things that really aren't that risky at all, especially since this needless worry causes needless stress which in itself can worsen our condition, by our own hands or hands or by the hands of those who may be confused about all of this.
Speaking of that, I want to reference an article on this by Jenny Ruhl, who runs a very popular blog on diabetes that a lot of online diabetics frequent and even speak highly of. Jenny means well but she takes a very simple minded approach to diabetes, just get your carbs from veggies and all will be well, and by all means don't let your blood sugar go over normal because she believes this to be dangerous.
So I've encountered this view from a lot of diabetics, in particular, Jenny says don't go over 140 so we better not, as if she was some sort of authority on this. Now the only authority here by the way is what the science tells us, and it does tell us that that the risks at this level aren't even significant, and this comes from doing studies which measure probabilities of damage at various blood sugar levels.
Jenny and her ilk also think that blood sugar targets followed by the ADA and the medical profession in general are the work of the devil and also dangerous, in spite of their not being any good evidence to believe that, but this isn't about evidence, it's really about fear, but we must be driven by knowledge here, not paranoia.
So here's the article from Jenny asserting that nerve damage occurs at blood sugar levels over 140. That's a ridiculous claim by the way but she claims that she can support this assertion, so let's have a look at how she does it.
I'll be looking at more of Jenny's articles in the future because they are indeed fun to look at and her logic does tend to be pretty amusing.
So she references a couple of studies that take people with neuropathy and see what their blood sugar runs at with an oral glucose tolerance test. What they did show is that out of the 73 patients that they looked at, all with neuropathy, 41 of them (56%) had either impaired glucose tolerance (over 140) or diabetes, with 26 of them being prediabetic and 15 being diabetic.
So there you have it, prediabetes, or being over 140 on an oral glucose tolerance test, causes damage. This is just plain hilarious.
That's actually a distribution that's not that far off from what a random segment of the population would provide, it does provide a little higher percentage of both than the average population but it's actually surprising that we didn't see a lot higher percentage of both here, especially with the diabetic number, since we do know that diabetes causes this, and does so quite clearly.
So she says that if you have neuropathy, you are much more likely (56%) to have at least impaired glucose tolerance, at best I'd say that it may be more likely but when we compare this percentage with the percentage of random people that are glucose tolerant then there really isn't that much difference as one might think, as prediabetes is rampant and a third or more of the population is now said to have this.
Not surprisingly, the extent of the neuropathy observed is correlated strongly with the degree of one's blood sugar problems, and diabetics with very high blood sugar suffer from more extreme versions, with those with normal blood sugar or only mildly elevated blood sugar being less severely affected generally.
The funniest thing about this article though is that if we are to take that impaired glucose tolerance causes neuropathy from this evidence, which is completely unsupported, we'd also have to say that normal blood sugar causes it too, because almost half of the patients did not have impaired glucose tolerance.
Neuropathy is a complex disease with many causes, and diabetes is just one of them, and even in diabetics there are multiple factors at work. The fact that prediabetics get this too doesn't even implicate blood sugar at all in its pathogenesis, you can't just say well since some prediabetics have this, prediabetes causes neuropathy, which is the claim she basically makes.
These studies actually speak against her claims, not for them, as in looking at them it's quite obvious that there's a lot more going on here than blood sugar. She also cites that prediabetics are 13% likely to get neuropathy, where people who are normoglycemic only get it 11% of the time.
So she claims that this "suggests" to her that that prediabetes causes neuropathy. This is a fairly meaningless difference by the way but this doesn't establish even a link to this very minor increased risk, as it very well may be the case that something else is causing both, and that's the more likely explanation I would say, because if the link was strong enough to talk about we'd be seeing a lot more difference than just the 2% increased risk that is being trumpeted.
Even if this is the case though, if being over 140 increases your risk of neuropathy by 2%, that's not even worth worrying about at all I'd say, particularly since people don't generally choose to have their blood sugar at a certain level, in other words there is a price to pay, and often this price involves medication or more medication and the costs here may be much higher than the benefits.
I do want to point out though that the higher insulin levels that we see in both prediabetics and type 2 diabetics are a concern to be sure, and high insulin can contribute to neuropathy, so it's not that we want to neglect this, and high insulin does a lot of harmful things including making our blood sugar control worse over time, although its contribution to risk of neuropathy is minor at best.
However if we focus on blood sugar at these levels, what we risk doing is making the diabetes worse, by seeking to elevate these levels further. The fear here is that the patient may be steered on a course that very often will lead to an accelerated progression of the disease, leading to a loss of control sufficient to make these risks very real indeed.
High blood sugar does play a significant role in microvascular damage, but we need to be clear on what levels of high blood sugar represent a significant risk, and it's quite a bit higher than 140, and prediabetics or diabetics whose blood sugar is maintained in a prediabetic range have not been shown to be at a substantially greater risk of these complications, the additional risk here is virtually nil actually, and that's what it really comes down to, regardless of how we may choose to hype the risks here.
There's enough things that happen to us that are actually dangerous, at levels that truly are dangerous, but those are the things that we really need to be worrying about. Managing diabetes is very often not a simple matter at all, and there are many factors to consider, but provided one has adequate control, well diabetes is a stressful enough condition without stressing over things that aren't warranted.