Change appears to be coming for diabetes care. The HbA1c test may not be the safest approach for diabetics to follow in preventing complications. Instead, experts are saying the average blood glucose level per individual will add clarity to diabetic patients looking to manage their disease.

A study supporting the change showed a close correlation between average glucose and HbA1c levels. So the myth, busted is: maintaining an average blood sugar is a safer approach for diabetes management -- NOT CHASING A UNIFORM HbA1c value. The fluctuation in blood sugar is what causes complications in the small vessels of the eyes, kidneys and peripheral nerve endings. For example - sustaining a blood sugar of 200 mg/dL is a lot safer than waking at 240 and ushering a boatload of sugar into your cells to drop your sugar to 80 mg/dL. It is the transfer of glucose into the cell that causes the injury to cell membranes and resulting complications.

Think of it like the movement of the ocean. High tide to low tide happens gradually, over the course of many hours throughout the day. When a storm hits - the waves become turbulent, crashing against the shore causing erosion. Is the human body any different? I'm not a doctor -- but I did stay at a Holiday Inn Express last week.

Guess what! If you're vehemently opposed to dieting (doesn't make you a bad person) here's an interesting study: a twice-weekly, 6-month, moderate, aerobic exercise program, without a concomitant weight loss diet, is associated with significant improvements in cardiovascular function in overweight, non-smoking, type 2 diabetic individuals.

The purpose of the study was to determine long-term cardiovascular changes when patients introduced moderate aerobic exercise. The study evaluated the effects on the vagal nerve applied to the heart rate in three different states: at rest, while lying, and while standing. Activation of the vagal nerve typically leads to a reduction in heart rate, blood pressure, or both. The study took place throughout a 6 month program where patients were evaluated twice a week. In a 10-min electrocardiogram recordings (EKG), Heart rate variability was measured by autoregressive power spectral analysis (PSA). This method allows a reliable quantification of the low frequency (LF) and high frequency (HF) components of the heart rate. The heart rate value before and after physical exercise were similar. In contrast, on standing, the heart rate was significantly higher whereas the LF component was significantly lower after exercise. Upon standing, the LF/HF ratio, reflecting the sympathetic vs. parasympathetic balance, was markedly lower. No significant exercise-related changes in these PSA components were observed on lying.

This study shows that the effects of short cardio events (for instance: 10 minutes on the treadmill) will enhance the ability of your heart to support sympathetic nervous system activities for homeostatic mechanisms in living. Furthermore, those same 10 minutes on the treadmill will enhance your parasympathetic nervous system - the internal organization also known as the rest and digest system. The parasympathetic system conserves energy as it slows the heart rate, increases intestinal and gland activity, and relaxes sphincter muscles in the gastrointestinal tract. Sympathetic and parasympathetic divisions typically function in opposition to each other. But this opposition is better termed complementary in nature rather than antagonistic. For an analogy, one may think of the sympathetic division as the accelerator and the parasympathetic division as the brake. The sympathetic division typically functions in actions requiring quick responses. The parasympathetic division functions with actions that do not require immediate reaction.

The Rule when it comes to managing diabetes is maintaining a blood sugar between 80 and 120 mg/dL by all means necessary. This does not take into consideration that some people might function better with a higher blood sugar. For all intents and purposes this is for safety reasons. Clocking in at no higher than 120 mg/dL is evidenced to delay the onset of long-term diabetic complications.

However, in my blog about Jeff the Trucker, in order for Jeff to be considered safe to drive -- the Federal Standards said that he must maintain blood sugars between 140 and 200. Whereas conventional medicine says the safest range for blood sugars is between 80 and 120. If Federal Standards say that you can function better with a higher sugar - why is it that we are encouraged to keep them lower? I understand this from a clinical perspective this is to delay the onset of complications. But in reality - the complications result from the fluctuations in blood sugar level and not so much the level at which it is sustained.

So herein lies my question for all diabetics out there - do you feel better or worse when your blood sugar is 80 compared to a blood sugar of 130? Compare being high and being low - what are the strengths and weaknesses of each?

I'll start - I prefer my blood sugar to be higher (<120 mg/dL) rather than lower (<80 mg/dL). When I am higher I know I am never on the verge of being disoriented, uncoordinated, or likely to lose my ability to think clearly. Having a higher blood sugar allows me to continue on without worrying if I'm too close to having a reaction. My weakness of being high is the inconvenience of needing water - ice, cold water. Now how do you all feel about your highs and your lows? It's okay. I know it's frustrating as H-E-double hockey sticks to test, treat, and repeat - only to find that your numbers aren't always perfect. Tell me about it. No, really -- please, do!!

DexCom has developed a continuous glucose monitoring ("CGM") system that could be the next generation of aggressive control. The DexCom GCM is a device that measures glucose trends throughout the day, providing up to 288 glucose measurements every 24 hours.

A traditional glucose monitoring test -like finger sticks - leave gaps in time where you are uncertain as to your blood sugar reading. Continuous monitoring is different from traditional blood glucose monitoring because it affords a comprehensive picture of where your blood sugars are throughout the day and night. The trend reveals times throughout the day where your sugar may increase or decrease, as well as how fast it is happening. This trend information together with the glucose value shows you patterns and problems that traditional finger sticks cannot cover as thoroughly. CGM allows you to set a target range for your desired glucose. When your glucose goes above or below this range, an alert automatically lets you know.

A 2006 study showed that people who used this device were able to achieve a 23% decrease in time spent high and a 21% decrease in time spent low. After speaking with Dianne on the DexCom customer support line - she advised me that they are offering a $375 startup kit that has everything you need to get going. The Rechargeable STS Receiver has a sleek rounded design that can easily be carried with the carry case on both your belt or in a handbag. The STS Transmitter is lightweight and fits comfortably underneath clothing. The STS Sensor & Applicator is easy to insert and safe to use with no visible needles or exposed sharps. With this wireless system, no cables or wires will get in your way allowing you to Take Control and Live Uninterrupted.. Each sensor lasts for 3 days. A set of 5 sensors costs $175 and will last you approximately 15 days.

The annual cost of continuous glucose monitoring averages a ballpark figure of $4,258. Okay, sounds a little steep - but lean on Uncle Sam to offset the cost of the best control. Sounds like it might be time to open up a Flexible Spending Account and write-off the yearning for glucose precision.

The Center for Disease Control announced that they will run a study to examine the cost-effectiveness of treatment interventions for type 2 diabetes. "People with diabetes are at considerable risk for heart disease, strokes and other serious health complications," said David Fleming, M.D. acting CDC director. "This study confirms that aggressive treatment interventions aimed at reducing the risks of cardiovascular disease increase life expectancy and, at the same time, may reduce lifetime health care costs," The footer of the Press Release where I got this story says:

CDC protects people's health and safety by preventing and controlling diseases and injuries; enhances health decisions by providing credible information on critical health issues; and promotes healthy living through strong partnerships with local, national, and international organizations.

Here comes my spiel, so grab a seat. Remember that huge event back in 1993? I'm talking about the announcement of the DCCT study that proved tighter control reduces the complications of eye, kidney, and nerve diseases caused by type 1 diabetes. And 5 years later the UK reiterated these results for type 2 diabetes. The $2.5 billion question is (yes, diabetic complications cost the United States $2.5 billion in 2005): why are we still relying on an antiquated test that can only be administered every 3 or 6 months to tell us how well we are controlling our diabetes? If more accurate testing and earlier therapeutic intervention result in less diabetic complications - where is the holdup?

To those concerned at the CDC, in an effort to protect people's health and safety by preventing and controlling diseases and injuries why haven't we seen a new test that can monitor our overall diabetes control on a monthly basis, rather than waiting to test every 3 or 6 months? This would, in effect, allow tighter control, which has been proven to reduce the potential of diabetic complications. (Please note: the original issue of the sited press release was May, 2002). Just a thought - you could use that extra $2.5 billion for something else like promoting healthy living through strong partnerships with local, national, and international organizations.