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This is an old table with a new twist: the color code expresses an opinion... MY OPINION. ("Green" is good, but "orange" and "red" and "bright red" and "blood red" are progressively worse!)
It is different from all other tables you might find to convert Hb-A1c to approximate Median Plasma Glucose (MPG), because in this table "Optimal" Hb-A1c for diabetics and non-diabetics is 4.5% or less, and "Good" is less than 5.0 %... Diabetics don't get a break here... There is no forgiveness, and no special mercy for diabetics. You bend or you die, whether it is your fault or not, and whether or not it is more difficult for you than for non-diabetics.
The short advice of this table is: "Keep Your Glucose Levels Tightly Controlled Between 70 and 100 mg/dl all day long, everyday... or else you will pay the consequences." This is true for everybody: "Diabetics and Non-Diabetics Only"...
Use this table to find your average blood glucose when you know your HbA1c, and to interpret what that means to your health "according to Ellis." If you have checked your glucose levels several times per day for the past few months, you can also use this table to predict your Hb-A1c... (note: If your HbA1c does NOT come out in the vicinity of what was predicted by your average glucose levels, write to me to etoussier(at)hotmail.com and I will explore the reasons for this with you.)
Hb-A1c = 7.0% is "fine" according to the American Diabetes Association, but it is "Horrible" on my table... greater than HbA1c = 7.5% is either "Deathly" or it is "Suicidal"...
There is a bit of difference: "Deathly" means that high blood glucose will kill you "someday"... "Suicidal" means you are on a fast track to disaster. The difference is the number of years that it will take for high blood glucose to kill you... But rest assured, high blood glucose levels will kill you sooner or later.
Hb-A1c of 7.0 is the incredibly irresponsible, almost criminally negligent, guideline recommended for diabetics by the American Diabetes Association. They say they have an interest in the welfare of diabetics, but they seem to want to keep their patients in a state of chronic illness and dependence upon their member doctors...
If a patient dies in 10 or 20 or 30 years from a stroke or heart attack or cancer, or any other illness caused or aggravated by diabetes, almost nobody will blame a doctor for having caused the patient's death. It is difficult to see a cause and effect between high glucose levels today and cancer or a heart attack or stroke, or kidney damage tomorrow... 10 or 20 years later... Diabetes progresses so slowly that it is difficult to relate today's bad advice with death, 20 or 30 years later...
But I Accuse the A.D.A. of deliberately, or negligently, shortening the lives of millions of patients due to their bad advice, and of both causing and permitting the plague of diabetes on Earth today to grow worse because of their bad advice and leadership. It is obvious that bad health advice today will result in bad health results tomorrow, and there can be no doubt that to recommend blood glucose so much higher for diabetics than what we know is normal for healthy non-diabetics has to be terrible advice.
The only diabetics who can accept a higher HbA1c than normal 85 mg/dl are those who have a digestive problem called "gastroparesis," which makes controlling blood glucose levels very difficult. But higher than normal glucose levels will harm them just the same, whether it is difficult for them to control their blood glucose, or not, so they should do all that they can to keep their blood sugars as close to "normal" as possible. As I said, there is no forgiveness... high blood sugars will hurt you whether it is your fault or not, whether you can avoid it, or not.
The opinion expressed by the colors and the written portion of this chart is mine, based on the ideas I learned from Dr. Bernstein. But I caution you not to accept what I say because I am not a diabetic nor am I a doctor... Listen to your glucose meter.
Strict control of blood sugar, as taught by Dr. Bernstein, is the basis of my own theory of aging which I follow to slow down aging in my own body. I believe that aging is a direct function of average blood glucose levels, that is: the higher our glucose levels go, the faster we "cook" our body, and the faster we grow older...
Blood glucose is like a "fire within us" that gives us energy. We must keep the flame lit, but we also want it to be controlled, "a friendly fire," and not a blazing fire that is out of control.
Optimum glucose level for a non-diabetic is 70 to 85 mg/dl, and this is also the best glucose level for a diabetic according to Dr. Bernstein. In my opinion, everybody would be much better off in the long run if we would follow Dr. Bernstein's advice to be very strict with our blood glucose control, rather than follow the irresponsible recommendation of the A.D.A. to allow HbA1c of 7.0
My thanks to Dr. Richard K. Bernstein whose story, "My First Fifty Years as a Diabetic" shook me up and inspired me to seek better blood glucose levels in myself also. Now, with the use of Lantus (slow acting) and Humalog (fast acting) insulin, I am able to control my glucose levels all day, every day. - Ellis Toussier
________________________ Note: The table to convert Hb-A1c to Mean Plasma Glucose (MPG) is based on the following formulas:
HbA1c = (Mean Plasma Glucose mg/dl + 77.3) / 35.6
HbA1c = (Mean Plasma Glucose mmol/l + 4.29) / 1.98
Mean Plasma Glucose mg/dl = (HbA1c x 35.6) - 77.3)
Mean Plasma Glucose mmol/dl = (HbA1c x 1.98) - 4.29
(To convert from mg/dl to mmol/l, divide mg/dl by 18... or multiply mmol/l by 18 to get mg/dl)
The formulas were calculated by linear regression analysis, which is a mathematical way to predict a point based on known points. The data was obtained by analyzing the results from 1439 subjects enrolled in the Diabetic Control and Complications Trial (DCCT). Correlation between HbA1c and Mean Plasma Glucose (MPG) is not "perfect" but rather only .81 (1.0 would be a straight line, which has "perfect" correlation...) This means that to predict or estimate average glucose from Hb-A1c or vice-versa is not "perfect" but gives a good working ballpark estimate. Afternoon and evening results correlate more closely to HbA1c than morning results, perhaps because morning fasting glucose levels vary much more than daytime glucose levels, which are easier to predict and control.
The formulas are more accurate for adults than for infants or young children. They are not as valid for persons that have blood disorders or different hemoglobin composition other than what is "normal" for adults. If your average blood glucose results over a three month period do not coincide with the values above (plus or minus 15%) then you should get an additional blood test called Hemoglobin Electrophoresis which might disclose the presence of sickle cell anemia or other blood disorder.
Blood glucose measured in a laboratory spins red blood cells out of the sample, leaving only plasma. Blood glucose measured in a home glucose meter uses capillary blood, which has a different concentration of glucose. Virtually all new home glucose meters and test strips are callibrated to yield a plasma glucose value, so results should be close to lab readings taken at the same time, but can vary by up to 15%.
Therefore: Use the above table only as a useful tool to have a rough idea of what your average blood glucose was, if you don't already know it.
"It is helpful to measure HbA1c, but it is only a useful guide, very much like measuring the noise output of an engine. But what adjustment you make, and how you control your glucose level, is much more important than focusing on HbA1c or glucose level." - Dr. Jackson Liu
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But much better than a rough idea of your average blood glucose based on a single lab reading and a projection of HbA1c, is an exact knowledge of what your average glucose levels have been for the past few months, based on many blood glucose tests before and after every meal, every day.
My recommendation is that everybody, type 1, type 2, and non-diabetics, should test blood glucose several times a day, and then take corrective action when necessary to lower blood glucose. Do what a "Future Diabetic" like me has done for many years to stay healthy and young: check your blood glucose several times a day, every day, and take corrective action when your glucose levels are higher than optimal. There is only one way to know your blood glucose levels, and that is to test them with a glucose meter. 100 tests with a home glucose meter costs about $50 dollars, and the information you get from it is priceless for your health.
I know that I might convince some type 2 diabetics to test their blood glucose more often, but I am not going to convince many non-diabetics to test their blood glucose many times per day. But if you are not diabetic, and if you are interested in slowing down the aging process and thus prolong your good health, at the very least I recommend that you should own a home glucose meter and a box of test strips so that you can test your blood glucose whenever you are curious to see what your blood glucose might be after eating a heavy meal.
If the result scares you, as it sometimes scares me, take corrective action... I inject a small dose of insulin, even if I am not a diabetic, and I test more often. This keeps my blood glucose in a much narrower good range than if I try to control it only with correct diet and exercise, as most doctors tell their diabetic patients to do. There is no doubt that controlling blood sugar will prolong the healthspan of diabetics, so it makes sense that it will extend the life and health of non-diabetics, also.
if you are any type of diabetic, 1 or 2, you should definitely check your blood glucose several times each day, no matter what your doctor tells you the A.D.A. says is not necessary... (The A.D.A. actually say that diabetics type 2 do not need to check their blood glucose every day, for which reason test strips are not covered by many insurance policies... Can you believe the A.D.A. would say this?)
HbA1c, ("H-B-A-one-c" which means "hemoglobin type A, subtype 1c") is a simple blood test which measures the percentage of red blood cells that have been damaged because a molecule of glucose is stuck to the hemoglobin within the red blood cell. To find HbA1c, the percentage of red blood cells that are damaged are counted under a microscope.
The HbA1c blood test shows the average amount of glucose (or "blood sugar") that has been present in your blood over the last two to three months. I call blood glucose "the fire within you" because glucose is the energy that is used by our body. We don't want it to be too low, because we will die without energy, but we don't want it to be too high either, because it will cause a lot of other damage to our health. According to Dr. Bernstein, and also according to my "Glucose Theory of Aging" average blood glucose for diabetics should be the same as that of a healthy non-diabetic.
"Normal" blood glucose is 83 mg/dl. but it increases 20 minutes after eating almost anything. Different foods cause it to go up different amounts. ONE LARGE POTATO or ONE GLASS OF ORANGE JUICE or ONE BREAD ROLL will raise my blood glucose to 160 or 170. So it is not EASY to keep glucose levels below 100 all day long, everyday, as Dr. Bernstein and his students do, but it can be done if you learn to eat correctly. It takes up to two hours for blood glucose to come down in a non-diabetic, or much longer in a diabetic.
According to Dr. Bernstein, diabetes progresses whenever blood glucose is higher than 83 mg/dl... According to me, you grow older faster every second that your blood glucose is higher than the minimum at which it should be... As it goes up, your body temperature rises slightly. Higher body heat causes "an event" which might be the destruction of a Beta cell, and/or the ultimate flow and loss of heat from our body according to the Law of Thermodynamics (which says that heat flows from hot to cold)... and we slowly disintegrate, even if it is only a little, according to the Law of Entropy.
The higher our blood glucose, the more glucose can and does become attached to hemoglobin (the part of the cell that carries oxygen) in red blood cells. This process is called glycosylation (pronounced gli-kos-sil-LAY-shun). Once the glucose is attached to hemoglobin, the red cell is permanently damaged and cannot do its function to carry oxygen anymore. Glucose stays stuck for the life of the red blood cell, which is about 120 days. The higher the level of blood sugar, the more sugar attaches to red blood cells. The hemoglobin A1c test measures the amount of sugar sticking to the hemoglobin in the red blood cells. Results are given in percentages.
The problem in this world is to decide: Who Shall I Believe?
I recommend that you should not believe any "expert"... Don't believe Dr. Atkins... Don't believe Barry Sears, or Dr. Dean Ornish... Definitely don't believe the attrocious U.S.D.A. Food Guide Pyramid, or the American Diabetes Association (A.D.A.)... In fact, you should not believe any doctor or expert... not even Dr. Bernstein... Don't even believe ME...
You can ONLY believe the glucose meter. Check your glucose level before and after meals, and take corrective action to bring it down "by hook or by crook" to 70 to 85 mg/dl whenever necessary.- Ellis Toussier Bigio, June, 2002
IN DEFENSE OF MY VERY STRICT INTERPRETATION OF BLOOD GLUCOSE:
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A1c and diabetes
Date: Sat, 16 Jan 2010
Mr. Toussier,
I found your web page while looking at some A1c conversion charts.
You do have some good points on health, but I disagree with your
hypothesis regarding A1c levels.
I am 53 years old and have been an insulin dependent diabetic since
November 1970 (39 yrs 2 months). My A1c used to run in the 7's.
I changed my eating habits in November 2003, lost 40 pounds and my
A1c now run in the 6's.
This has caused my to suffer from low blood sugars more frequently.
As additional information I have not shown any signs of retinopathy,
neuropathy, or heart problems. My eye doctor actually doesn't
believe I have been a diabetic as long as I say.
I just thought you should know that your "opinion" on A1c levels
is just an opinion. You should make that more clear on your web
site so diabetics are not "scared to death" by your chart.
I will say, it was interesting reading. - A Diabetic Type I
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Ellis: I will have to answer "in defense" of my very strict
interpretation of blood glucose, which translates to my table of
HbA1c which the writer refers to above.
In short: my interpretation of Blood Glucose is as follows:
50 and less: Hypoglycemia - too low.
60 Very low
70 to 85 Optimal
100 High
110 Very High
120 Bad
140 Terrible
160 Horrible
180 Deathly
200 and more: Attempted Suicide.
So... my HbA1c table says the same thing: 4.5% which corresponds
to 83 mg/dl is Optimal; less than 5.0 is "Good"; 5.0 to 5.4%
(100 to 115) is "High"; 5.5 to 5.9 (118 to 133) is "Bad"; and 6.0 to 6.9 (136 to 168) is "Terrible" or "Horrible"...
So... The 53 year old diabetic type 1 writes to protest that
my table is too strict. He doesn't say where he is on the
6's scale, but he is in the 6's so he is between 136 and 168,
and this, he protests, is NOT "terrible" or "horrible"...
So I am "scaring diabetics to death" when I tell them it is
"terrible" or "horrible".
Let's see what we know from his e-mail:
He is 53 years old. His HbA1c is somewhere in the 6's so it is
between 138 and 168 AVERAGE...
According to him, dropping his average blood glucose has also
caused him to suffer from "low blood sugar" more frequently...
He says he does not have retinopathy (eye problems), neuropathy
(loss of neurons), or heart problems... And his eye doctor
thinks the condition of his eyes is not as "bad" as others he
has seen, so he told him that he doesn't appear to have had
diabetes for 39 years.
He obviously LIKES to get a pat on the back from his eye doctor.
But a pat on the back isn't doing him any favors to his health.
If I was his eye doctor I would tell him to try to get his
average blood sugar lower. I would NOT tell him how well he is
doing, because he can do better. And he would probably CHANGE EYE
DOCTORS if I was his eye doctor and I told him this.
I DON'T EVEN GO TO AN EYE DOCTOR.
So... the implication is that MY TABLE is wrong because HE
is 53 years old, HIS HbA1c is in the 6's and he says he has
no complications from diabetes, and his EYE DOCTOR probably
agrees with him, also...
So... In defense of my table... I AGREE that it is "just my
opinion"... In fact, the very first sentence of my page says
"This is an old table with a new twist: the color code expresses
an opinion... MY OPINION."
So... this is as if I tell you that IN MY OPINION it is safer
to drive no faster than 40 miles per hour, and HE SAYS that he
drives at 70 miles per hour and HE HAS NOT HAD an accident...
and a policeman has told him he thinks he drives very well.
THAT DOES NOT MEAN MY OPINION IS MISTAKEN... it just means that
we are talking of different levels of risk, and he is willing to
take more risk.
I point to the following:
1. 83 is LESS THAN 138... That is a FACT.
It is FIFTY FIVE POINTS less than 138 and it results in
an A1c of 4.5% instead of a 6.0%. THAT IS A HUGE DIFFERENCE.
I HAVE NO DOUBT that persons with 4.5% A1c have less chance of
heart attacks, cancer, and senility than persons with much higher
blood glucose... And this is the reason why I think that 4.5%
is OPTIMUM, 5.0% is GOOD, 5.5% is HIGH, 6.0 - 6.9 is Terrible or
Horrible, and 7.0 and above is DEATHLY or SUICIDAL.
I agree that I might be mistaken. We'll see if the person
who wrote the e-mail is well at age 80, and we'll see if I will
be well at age 80... I DON'T KNOW YET.
I KNOW THAT I AM VERY WELL at age 64, going on 65.
2. Dr. Bernstein's A1c is 4.5% and Dr. Bernstein has been a
diabetic more than 50 years...he has been on insulin since he
was age 12 and now he is about age 75.
Not only is he ALIVE, but he is still working and practicing as
a very good doctor.
So if Dr. Bernstein who has zero help from his pancreas can do it,
every diabetic and every non-diabetic can do it.
3. If he has gotten more hypoglycemia trying to keep his HbA1c
lower than 7.0 it is BECAUSE HE HAS USED INSULIN incorrectly, ie,
too large a dose of insulin will cause hypoglycemia. It was
not caused by eating low carbs or exercising too much, his hypo
glycemia was caused in every instance from TOO MUCH INSULIN,
at the wrong time.
He doesn't say it in his e-mail, but this is the ONLY cause of
hypoglycemia in a diabetic type 1, so it is HIS FAULT, and it does
not mean that my table is mistaken for saying that 6's is
TOO HIGH.
Driving at 70 miles per hour is more dangerous ipso facto than
driving at 40 miles per hour, and this is true whether you are
diabetic or not diabetic. As it is true that 6's is too high
"according to Ellis" whether you LIKE IT or DON'T LIKE IT.
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About Me: My name is Ellis Toussier Bigio. I will be 65 years of age in August, 2010, and I think I look better at age 64 than I did at age 52... I honestly think I might be the healthiest and youngest 64 year old man in history, because nobody before in history has ever been able to do what I have been doing since I was 20 and even more so what I have been able to do since I was 52 to stay young and healthy. I DON'T think I am aging very slowly because I have "superior genes" or "good skin"... I think Time stops for me because of my 8 point anti-aging program which I follow to stay young, and which I invite you to learn... The fantastic hormones which I am now using and many of the anti-aging therapies that are so good for my health simply did not exist before 1985.
I live in Mexico City, where I am free to buy and sell and teach others around the world to use legal and good hormones. I do this under the supervision of my good doctors. I am not a doctor, but many doctors think I know my topic so well that they have flown to Mexico City to consult with me and to learn from me... Some doctors call me "colleague"... and other doctors call me "The Madman in Mexico..." (I like "The Madman in Mexico" best of all... whoever does not use the hormones I use and still thinks I am really mad has to be very ignorant, even if he is a doctor...)
I like to think of myself as "the King of Growth Hormone," and... "the Father of EPO to prevent loss of muscles and mobility" and... "the Father and the Mother of using Insulin for non-diabetics to prevent diabetes and aging." I hope you will think I am "The King" and not "The Madman in Mexico"... but if you do, that is fine with me... It makes me laugh, and he that laughs last, laughs best. I have no doubt in my mind that I will have the last laugh.
I am the owner and moderator of "Rejuvenation," a forum to which you are invited to subscribe (free) , where we discuss the use of "The Major Leagues" hormones: injectible human growth hormone, EPO, testosterone, and insulin, as well as many other anti-aging therapies such as EDTA chelation, hyperbaric oxygen, laser therapy, various procedures in plastic surgery, skin treatments, Botox, and many others. There are more than 4000 anti-aging doctors and patients subscribed to Rejuvenation, and nearly 10,000 posts in the Archives, almost all of which are annotated and commented by me, personally.
Related Links:
Dr. Bernstein: Why a Low Carb Diet?
The Amazing Carbohydrate Thermometer
Rejuvenation, My Amazing Anti-Aging Program (it works!)
The Glucose Theory of Aging
The Non-Diabetic Use of Insulin to Avoid Diabetes and Slow Down the Aging Process
How to Save a lot of Money Buying Authentic Growth Hormone In Mexico and be happy with your purchase.
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