You must Sign In to post a response.
  • Category: Health

    Changes in Blood sugar standard limits


    Are you having a query regarding blood sugar standard limits and how will it impact diabetic patients? Searching for detailed information about the standards and its sanctity here? Find responses from experts for your questions on this page.

    Blood sugar standard limits are being reduced thereby increasing the number of diabetic patients.
    Wants to know the scientific basis and justification for these changes.
    Who is the competent authority to decide and are they unbiased in making these changes?
    Any experts in that field are included in the panel and the decision is taken after thorough study.
    Are we following any international standards or our own Indian standards?
    Request experts to dispel doubts on the sanctity of these changes creating more and more diabetic patients.
    Also, wish to know additional qualifications and expertise acquired by Doctors to declare themselves as Diabetologists and specialist in treating this problem.
  • Answers

    7 Answers found.
  • There are many agencies in the world which are time to time suggesting the blood sugar limits for diagnosing the diabetes. Some of these agencies are World Health Organisation (WHO), American Diabetes Association, European Association for the Study of Diabetes etc.

    There is already a lot of research going on in the field of diabetes and after a lot of medical data the limits are changed slightly if so required. Medical science is still under developing stages and there are lot of grey areas which are yet to be resolved. The subtle changes in the limits or tolerances in medical measurements is only helping in that resolution.

    Medical science and its measurements are not like mathematics. The wide range of the permissible variations in these measurements is itself signifies that. So the measurements falling at the boundaries are to be taken with a pinch of salt.

    Most of the countries are following the guidelines as given by WHO or western medical associations. We are also following that except local changes if any proposed by the leading medical research institutions in the country like AIIMS or the other Govt Medical Colleges.

    As per WHO, if the Fasting plasma glucose levels is greater than 7.0 mmol/l (126 mg/dl) and the 2-hour Plasma glucose is greater than 11.1 mmol/l (200 mg/dl) then Diabetes is indicated. Now this boundary is based on a large number of medical data set and may not be exactly fitting in case of every individual. There can be subtle changes this side or that side. This is the uncertainty which sometimes, with the new data sets available, forces the medical institutions to suggest a new range or limit. This is then seen by the research agencies worldwide and based on the feedback it could continue or remain unchanged.

    Let me give an example to understand this wide range of medical measurements. Sometimes people go for tests to determine deficiency of Vitamin D in their body and get some result and then the doctor compares it with the current limit being followed. Sometimes the limit will be different with different type of machineries used also. The limit (Normal range) for Vitamin D in human using Electro Chemiluminescence method is as follows -

    Deficiency of Vitamin D if test gives less than 20 ng/ml.
    Insufficiency of Vitamin D if test gives in the range 20 to 29 ng/ml.
    Sufficiency of Vitamin D if test gives in the range 30 to 100 ng/ml.
    Potential Toxicity of Vitamin D if test gives more than 100 ng/ml.

    For a layman such a long range is confusing and not understandable but it is the limitation of the medical sciences at this juncture.

    Now above limits are based on the previous research and medical data acquired by the medical institutions and they may change a little bit when new data comes in the picture associated with new research. The uncertainty and ambiguity in this aspect will remain and the Govt regulatory bodies should ensure that we are only following the reputed research institutes or having our own research in the country.

    Knowledge is power.

  • The changes in the blood sugar levels and standard limits are decided by the following statutory bodies around the world. The main agencies are.
    1.World Health Organisation (WHO)
    2.European Association for the Study of Diabetes
    3.American Diabetes Association
    These organisations will be constituting various committees with the experts in the concerned people to study the various cases reported around the world and based the actual incidents studied and the results, the permissible levels will be decided. Naturally based on food habits and other factors the tolerance and chemistry of the body will be changing. Keeping these issues in mind the permissible levels may be changed. These changes will be made only after an elaborate study and proper case studies.
    Many of the countries are following the standards given by WHO. India is also following the same. Based on the local conditions and food habits if any changes are required they may be considered only after a thorough investigation and studies by the experts in India and Institutes in India.
    Diabetologists should first earn an undergraduate degree followed by a master's degree in medicine. Then, they must complete a residency in internal medicine and choose an endocrinology sub-speciality. There is a certificate course in diabetology. After MBBS, Doctors can do this certificate course to become a Diabetologist.

    drrao
    always confident

  • The thread has not been reviewed by Editors yet. Readers are advised to use their best judgement before accessing this thread.
    This thread will be reviewed shortly.
    If you think this thread contain inappropriate content, please report to webmaster.
    Thanks for the informative responses.
    As per WHO norms which India is adopting permitted limits for Fasting plasma glucose is 126 mg/dL
    and 2Hrs after food plasma glucose level is 200 mg/dL.
    So only people with glucose levels beyond that levels are diabetics requiring medication/ treatment.
    Now with reduction of these limits, non-diabetic people are subjected to treatment without any necessity.
    In addition, this unrequired introduction of chemicals into our system every day will surely have an effect on our body.
    Simply branding them as diabetics itself causes unwanted mental tension and financial burden to the patient as well as their family.

    Secondly, these people for none of their fault will be denied health insurance coverage for diabetes and connected diseases that may develop due to diabetes for a certain period (2-4 years) terming it as a pre-existing disease (PED). Further charged with higher premiums and co-payments.
    On the pretext of protecting the health of maybe 10% of people near the upper limits of WHO permitted standard limits ( borderline cases) victimizing and penalizing balance 90% of non- diabetics, is it justified?
    It seems more like a lobby working to benefit medical community, Pharma companies, and health insurance companies at the cost of poor patients.

  • Two answers above have dealt with the technicalities side of your question.
    So I do not want to go on that side.
    If your question is for the academic and knowledge sake, then okay.
    But if it is from the angle of a diabetic patient, then I may add a few points.
    Ye, it is true that the earlier standards(thresholds) have been revised downward.
    In the early days it was diagnosed by urine test. That is one is diagnosed as diabetic by testing the glucose level in excreted urine. Butglucose manifests in excreted urine quite later than one becoming diabetic. I have heard my grandfather say that in villages they used to diagnose diabetes(prameha) if ants collect at the place where they passed urine. But those stages were quite late after diabetic has onset. By the time the body could have suffered lot of damage.

    Any disease can be managed and controlled if it is diagnosed well early and treatment started.T hat is why modern standards are better in early diagnosis. Modern standards are based on the glucose level in the blood immediately after food intake and after a long gap after food(fasting).
    Though it is true that many more persons come under a category when the threshold is lowered,like more diabetics being diagnosed when the glucose level threshold standard is lowered.
    Modern standards give a window as 'border cases' whereby a person is warned that he/she may become diabetic if the signal is ignored and no precautions preventive care is not taken.

    Many people are benefited by lowering of the threshold levels because they get sufficient time to take care and prevent or revers the onset of diabetes by simple lifestyle changes and even avoiding starting medicines.
    The lowering of threshold standards actually help in preventing to some extent the pace of worsening situations because people get more window time and warning to have proper care. Thus many serious consequences of acute or chronic diabetes get prevented, managed or at the worse delayed.

    The lowering of standards is like signalling for applying brakes within safe distance between two vehicles nearing collision rather than on coming bumper to bumper when damage is more probable..

  • TThis response is marked as DELETED by the admin.

    We have to take with a pinch of salt that all developments in the medical and diagnostic field are being exclusively used for the benefit of patients only.
    Any development will have pros and cons and they are all double-edged swords.
    There is every possibility of misuse and there should be enough precaution and protection to prevent misuse.

    We all will welcome technological developments by means of the latest types of equipment in the diagnostic field.
    But can we accept all the costly unwanted and unnecessary diagnostic, invasive tests being done as a routine?
    Shall we support the trend of" Unwanted and indiscriminate" use of
    i) Cesarian section for the majority of deliveries,
    ii) exposure to radioactive rays for various tests and
    iii) Angiograms, angioplasty and connected surgeries.
    Corporate hospitals set up with hundreds of crores of investment and costly medical education spending crores at
    corporate colleges have abnormally increased the cost of treatment for minor health problems also.

    We all agree that family doctor tradition used to have a soothing and confidence restoring effect on the patient.
    Now the scene is reverse and patients are scared to approach a doctor or hospital.
    Not only the financial burden but also the psychological impact is scaring the people.
    We all have high regard for real doctors with a human touch but their percentage is decreasing day by day.

    Let us all have a realistic analysis of the situation and find a way out.
    Any development which doesn't care for common man's welfare is a retrograde step.

  • Any change in the threshold limits of a medical measurement will have certain business implications also and it is difficult to find out whether a lobby is behind this or it is being done in the usual spirit of medical research because what we get information is mainly from scientific journals and hospitals.

    Whenever a change is there, these questions will pop up to intrigue us in finding their real motives. Still, I believe that as these things are being checked and verified at so many levels of Govt and private reputed medical colleges or research institution that simply to doubt them as the malefide intention of some business people or lobby may not be a wise thing to do at this stage until unless some whistle blowers bring these intentional uncertainties to the surface.

    Knowledge is power.

  • The earlier standard of the fasting glucose levels were in the range of 70 - 110 and the post prandial sugar levels were 120 - 140. Even the diabotoligists do support these figures. Random blood sugar tested any time of the day should remain below 200.
    Again there is a test known as Hb1 AC which gives a positive clue of the status of Diabetes. If the percentage is in the range of 4.5 to -5.8, it could signify the well being of the patient means that the person is devoid of diabetes. Any percentage beyond 6.5 is indicative of Blood - sugar patients. HB1AC beyond 9.0 percent indicates the poor control of the sugar and is suggestive of proper treatment by the Diabologists.
    All these norms were in consistent with WHO norms and later it was modified by American Diabetic Association where the range of diabetic/ non diabetic were revised with an upward movement of the figure.
    According to American Diabetic Associarion, the FBS up to 140 is accepted as normal figure and also after meal the blood sugar limit is 180 thus giving the patients mental relief in relation to presence of sugar.

  • I feel doubting the figures decided by qualified and experienced professionals in the field may not be advisable. But these days we can't assure anything. There may be something behind in deciding the limits. But we can't protest it as the people who decide will come up with their own theories.
    When the blood sugar limits, post lunch up to 200, may be acceptable based on the age of the individual. But anything above 200 needs some action. So it is the choice of the individual to go for medication or not. But we require a control in food habits if the sugar levels post lunch are touching 170 also.
    Coming to insurance, definitely, the insurance companies will try to take advantage of these limits and they will charge a higher premium. We can't make them accept as they will go by WHO standards.

    drrao
    always confident


  • Sign In to post your comments