Industry Figure Tom Chappell

There are (relatively) affordable kits available nowadays to test your blood glucose levels at home, and anyone who has fat around their waist or who has been told that they are insulin-resistant or pre-diabetic should buy one, and use it. But what do the levels mean? What’s good? What’s bad?

Somewhere around blood glucose levels as high as 300 mg/dL, they like to hospitalize you. That’s bad. What about lower levels?

One of the standard definitions of full-blown diabetes is a fasting blood glucose level (after nothing by mouth except water for eight hours) greater than 125 mg/dL, for two mornings running. This level was chosen because it is here that you start to see patients developing diabetic retinopathy, i.e. blindness. That’s bad, too.

So, you might argue that we should strive for levels lower than this, and indeed, everyone agrees that this is so. The old definition of pre-diabetes (where you have to start taking action) was a fasting blood glucose of 110 mg/dL or greater, but in 2003, this was lowered to 100 mg/dL, because people just kept, you know, dying.

But is 99 a low enough target? A study of several thousand high-risk patients (who had non-diabetic glucose levels, but had other risk factors for coronary heat disease, such as bad cholesterol or blood pressure) divided patients into five groups:

    100-125 (the ‘pre-diabetic’ group that we already know is bad)
    93-99 (the group that contains me)
    87-92 (people who are better than I am)
    80-86 (smug bastards)
    <= 79 (people who are pointlessly healthier than they need to be)

After factoring out increased risk due to Framingham risk score, BMI, fibrinogen, Lp(a), and homocysteine, the top three groups still had an increased risk of coronary heart disease, and investigators concluded that there is a “continuous relation between glucose level and [coronary heart disease] risk across the range of nondiabetic glucose levels, independent of traditional and nontraditional risk factors, and that this relationship is similar for men and women” (quoting the National Diabetes Education Initiative’s synopsis of the study).

Interestingly (again quoting the NDEI), “Adjustments for [coronary heart disease] related medications (e.g. aspirin, statins, etc.) did not diminish the relative risks ascribed to glucose.” (i.e. the other medicines didn’t keep sugar from killing you just as much).

Also, note that they didn’t find any benefit from being in the bottom group, as opposed to the next-higher group. Those guys really are healthier than they need to be!

Hoogwerf BJ, Sprecher DL, Pearce GL, et al. Blood Glucose Concentrations <=125 mg/dl and Coronary Heart Disease Risk. Am J Cardiol. 2002;89:596-599.

Your mileage may vary, but I’m going to be shooting for a fasting blood glucose of 86 or lower.

Hey, put down that jelly doughnut! (It’s like eating a cigarette!)