Diabetes Viewpoints

Concrete Goals

By Travis Grubbs

I have a confession to make: I am a “Building Code Nerd.” This is a good thing since I am a building inspector, but sometimes I go to extremes. I can’t go into a home or a store without noting code infractions. While driving down the road, I will point out code violations to my wife. Bless her heart; she plays along by saying things like “oh” or “okay.” Fortunately, I am not facing her so I don’t see her rolling her eyes.

One of the things that I like about the building codes is that they tend to be precise. Let me give you some examples, I don’t mind. All references are from the 2006 International Residential Code (IRC) and do not include any state amendments.

Doors: Section R311.4.1 of the IRC requires that every dwelling unit have at least one exit door that is a minimum width of three feet and a minimum height of six feet and eight inches. This door cannot lead into a garage, but it does not have to be on the front of the house. Did you know that you don’t have to have a front door?

Hallways: Section R311.3 of the IRC states that the minimum width of a hallway is three feet. This requirement makes it a lot easier when you are trying to move that big sofa down a hallway.

Toilets: Figure R307.1 of the IRC states that the center of the toilet bowl must be a minimum of 15 inches from the wall, tub, vanity, etc. This is to prevent the toilet from being placed to close to these objects. You ever try to sit on a toilet that is too close to a wall?

I realize that by now you are probably totally enthralled with the building codes and are ready to purchase your own copy, but it is time that I move on and get to the point. After recovering from the shock of getting hit by that Mack truck called type 2 diabetes, I sought out the standards for controlling my diabetes. Due to my background and orientation, I expected to find uniform standards.

My doctor told me that my blood sugar range before meals should be 80 to 120 mg/dl, and that my blood sugar should not go up more than 70mg/dl two hours after starting a meal. For me, that would have my range after meals at 150 to 190 mg/dl.


I then compared my “goals” with the standards promoted by the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). The ADA recommended a pre-prandial (Fasting blood sugar, before meals) of 90-130 mg/dl and the AACE recommended a pre-prandial of <110 mg/dl. My doctor recommended pre-prandial (80 to 120 mg/dl) would put me 10 mg/dl below the ADA recommendation, and would allow me to exceed the AACE recommendation by 10 mg/dl.

Why was there a difference in the values recommended by my doctor, the ADA, and AACE? Was it OK for me to exceed the AACE recommendation? What’s the big deal of maintaining a prolonged difference of a postprandial 10mg/dl? I don’t know about with pre-prandial, but I know that “10” can make a big difference in other respects.

My normal body temperature is 98 degrees. If it were 108 degrees my brain would be fried, or at least close to it.

Driving to work I have passed “the law” while cruising along at five to eight miles over the speed limit. Going ten miles over the speed limit has resulted in me being pulled over to the side of the road and having a conversation with a nice sheriffs deputy about the evils of speeding. Oh yeah, I got to pay for his time too.

I was really disturbed when I read the recommendations for the postprandial (blood sugar two hours after starting a meal). The ADA postprandial is <180 mg/dl, the AACE postprandial is <140 mg/dl (7.8 mg/dl), and my postprandial is 150 – 190 mg/dl. My prescribed “goal” would have me exceeding the ADA recommendation by 10 mg/dl, and the AACE recommendation by 50 mg/dl! I am not a medical professional, but I am going to estimate that a prolonged postprandial difference of 50mg/dl equals “You are screwed!”

I am used to dealing with solid numbers, and now I am supposed to choose which glucose ranges I wish to apply to my life? Is it too much to ask for the medical establishment to get together and agree on a common measurable standard for blood glucose ranges? I wonder how many of these “experts” have diabetes.

Take your prescribed ranges and see how you compare to the ADA and AACE recommendations. I, on behalf of the type 2 diabetic population, request that the medical community produce one uniform standard in which to measure the daily control of our diabetes. Such a standard would be then be “set in concrete.” *

*IRC Section R506.1 states that the minimum thickness of a house foundation concrete slab is three and one half inches.

Disclaimer
dLife's Daily Living columnists are not all medical experts, but everyday people living with diabetes and sharing their personal experiences. While their method of diabetes management may work for them, everyone is different. Please consult with your diabetes care team to find out what will work best for you.