Hi All

On a couple of other threads there is discussion of A1c and
BG goals, what are they, and who sets them. This reference
was noted:

http://www.diabetes.org/type-2-diabetes/tight-control.jsp
"Good control means getting as close to a normal
(nondiabetic) blood glucose level as you safely can.
Ideally, this means levels between 90 and 130 mg/dl before
meals, and less than 180 two hours after starting a meal,
with a glycated hemoglobin level less than 7 percent."

For the newbies, the ADA is not the only respected authority
out there. Nor do they seem to have the same concept of
nondiabetic numbers that the others have. Here are a couple
of other examples:

The American Association of Clinical Endocrinologists
Medical Guidelines for the Management of Diabetes Mellitus:
The AACE System of Intensive Diabetes Self-Management—2002
Update:
http://www.aace.com/pub/pdf/guidelines/diabetes_2002.pdf
extract:
"For each patient, therapy should be individualized to
maximize the likelihood of attaining and maintaining the
appropriate goal and reducing the frequency of side effects
or adverse reactions. To date, several studies have found a
significant advantage associated with a decrease in
glycosylated hemoglobin levels to 7.0% (normal, 3.8 to 6%),
or lower if possible (1,3-6). Both preprandial and
postprandial blood glucose targets are useful. The ACE
Diabetes Mellitus Consensus Conference in August 2001
established the following goals: HbA1c level of 6.5% or
less; preprandial glucose of 110 mg/dL or less; and the post
prandial glucose of 140 mg/dL or less.(6a)"

They reiterated this quite clearly in their 2005
Implementation Conference for ACE Outpatient Diabetes
Mellitus Consensus Conference Recommendations: Position
Statement:

"A1C <6.5%
Fasting/Preprandial plasma glucose <110 mg/dL
2-hr Postprandial plasma glucose <140 mg/dL"
and reinforced the need for SMBG:
"Self-monitoring of blood glucose (SMBG) is a critical
resource for the management of diabetes. When performed with
sufficient frequency, SMBG readings allow patients and their
healthcare professionals to make informed decisions about
lifestyle choices and adjustments in pharmacologic therapy.
SMBG can also provide ongoing feedback to patients about
their nutrition and physical activity. It is a very
important educational tool. A key obstacle, however, to
implementing effective interventions is a lack of supportive
healthcare systems."

That's a paragraph that many US insurance companies and the
NHS would do well to read. In my opinion, we could do with
the head of the AACE on the ADA board.

Or you could try the Joslin advice. It's still not as tight
as most here aim for, but they are just as reputable an
authority as the ADA:
http://joslin.org/Beginners_guide_523.asp
Goals for Blood Glucose Control

People who have diabetes should be testing their blood
glucose regularly at home. Regular blood glucose testing
helps you determine how well your diabetes management
program of meal planning, exercising and medication (if
necessary) is doing to keep your blood glucose as close to
normal as possible. The results of the nationwide Diabetes
Control and Complications Trial (DCCT) show that the closer
you keep your blood glucose to normal, the more likely you
are to prevent diabetes complications such as eye disease,
nerve damage, and other problems. For some people, other
medical conditions, age, or other issues may cause your
physician to establish somewhat higher blood glucose targets
for you.

The following chart outlines the usual blood glucose ranges
for a person who does and does not have diabetes. Use this
as a guide to work with your physician and your healthcare
team to determine what your target goals should be, and to
develop a program of regular blood glucose monitoring to
manage your condition.

(table modified to post here)
                   without diabetes  with diabetes
       
Before breakfast(fasting)       < 110     90 - 130
       
Before lunch, supper and snack  < 110     90 - 130
       
Two hours after meals           < 140      < 160
       
Bedtime                         < 120     110 - 150
       
A1C (also called glycosylated hemoglobin A1c, HbA1c or
glycohemoglobin A1c              < 6%       < 7%"

Unfortunately, nobody but us talks about 1hr PP targets. My
personal logic is that I treat their 2hr as my recommended
max peak for any post-prandial.

To summarise:

     pre-meal   2hrPP  A1c

ADA     90-130   <180   <7%
Joslin  90-130   <160   <7%
AACE     <110    <140  <6.5%

I doubt that anyone would consider the AACE, which is an
organisation of 5200 endocrinologists, as a bunch of
fanatical radicals. Nor would they be promulgating
guidelines impossible to be attained by the majority.

Make your own judgment on which of those guidelines you
think will lead to fewer complications.

Cheers, Alan, T2, Australia.
d&e, metformin 2x500mg