Comments on: Institutionalizing Frustration

By: Chris

Chris — Mon, 29 Oct 2007 21:18:13 +0000

Dear All:
I firmly believe the old saying that the cure should not be worse than the disease.
If diabetes are “guilted” into the “new” goal of 140 after meals and then suffer dangerous lows, one needs to use a little common sense and decide if they want to end up so low that they pass out or end up in a coma to “please” some endo. Keep in mind that your doctor will not be the one to leave a family without a mother because of some minimal effect of keeping the new 140 post-meal reading at the cost of passing out and cracking your head open or falling and injuring your spine for life. You’d be shocked if you do a little research on the internet as to how poorly some of these studies are conducted and how much the medical professiona is influenced by the drug companies. If you doubt me, look up how companies use “Relative” and “Absolute” statistics when they advertise how much their drugs reduce things like a heart attack — it amounts to fraud! I recently decided to drop my endo after his “nurse practicioner/educatord” bragged about how she could have a blood sugar level of 50-60 and be “just fine” and that it would just take some getting used to by me, implying that I should do the same. I love it when all these Minute Clinics spring up and the doctors come out blasting them saying “they’re just manned by nurse practioners and they might miss something important” yet, I make an appointment with my endo and they have me see only a nurse practioner, talk about talking out of both sides of your mouth.
My advise, reserach, research, research, and as one medical researcher in my family advise me,
you are your own best doctor, get second opinions, reserach a lot, and follow your heart and use common sense.
Chris

By: baddecisionmaker

baddecisionmaker — Wed, 03 Oct 2007 17:34:34 +0000

Yes. I agree (and already feel guilty!), thanks for writing this.

By: JC Jones

JC Jones — Tue, 02 Oct 2007 17:38:03 +0000

Fascinating information & great insight for us non-diabetic clinician types…Thanks.

By: John

John — Sun, 30 Sep 2007 17:16:22 +0000

A Type 1 diabetic does not produce glucagon. Targeting 140 post meal, without glucagon to compensate for the larger amount of insulin that’s required to hit such a low post-prandial target, is a dangerous endeavor.

First; product a closed loop system that both monitors BG in real time and delivers insulin and glucagon demand. All the technology is there, and has been for some time. Only thing missing is that Type 1’s don’t make up a large enough portion of the market, so only half our condition will be treated — the same half that treats a Type 2’s insulin resistance.

By: Dan Fahey

Dan Fahey — Fri, 28 Sep 2007 14:14:51 +0000

To Lauren:
Without commenting on teh credibility of a Type 1 to be virtually always below 130 [and a A1c of 5.3], let me just say it’s not helpful to the majority of diabetics to make statements like “if I can do this, anyone can.”
Most diabetics dedicated to good control CANNOT achieve those numbers, and trying to will only lead to a sesne of defeatism, which may lead folks to give us the effort.
I’d hope these blogs will be supportive of others, not a breast thumping session.

By: AmyT

AmyT — Thu, 27 Sep 2007 17:49:04 +0000

Hi Lauren,

I test a lot more than 8x/day. And if you can eat 95% carbs and achieve those kind of numbers, you must be in a very strong honeymoon phase, or something. That’s pretty incredible (as in hard to believe).

By: Lauren

Lauren — Thu, 27 Sep 2007 02:34:06 +0000

I try to never go above 130 unless I’m about to start a long jog or bike ride. My A1c is 5.3 and I test 10x a day. Yes, testing is a pain; but I cannot stand to see those high numbers on my meter. In my opinion there is no way to have an A1c under 6 without testing at least 8 times a day. (I’m Type 1 by the way.)

My goal is to come as close to normoglycemia as possible, which means 70-120 mg/dl pretty much all the time. I’m not a pumper; just taking good old fashioned Humalog and Lantus. AND I’m a vegan (no animal products) which means 95% of my diet is carbohydrate. If a starch eater like me can consistently smack down those high post-prandials, anyone can.

By: CB

CB — Wed, 26 Sep 2007 18:50:01 +0000

Well Amy, you’ve got us going on this one, congrats. As a brittle T1 pumper who’s been D for over 52 yrs, I’m all for keeping in “good BG control.” I still stick with what I said in my early post yesterday, that “guidelines” will only become stricter as time passes. However after re-reading the IDF Guideline document more carefully, I think this IDF guideline is more than meets the eye.
First, the IDF appears to be recommending very tight BG control. At the very end of the Guideline document, Table 2 “Glycaemic Goals for Clinical Management of Diabetes”, states that the IDF wants us to keep our A1c’s below 6.5% (not 7% as the ADA and other US D groups recommend), our fasting BG’s less than 100mg/dl and our post-meal BG’s less than 140mg/dl. [It’s this 140 recommendation, not the others that we’ve been focused on in our blogs. I’ve summarized their recommendation as 6.5/100/140.]
Second, the Guideline presents some interesting (but disheartening) results from a number of clinical experimental studies, including the following from page 16 (that’s p. 18 of 36 of the pdf): “… SMBG [self-monitoring of blood glucose] showed a reduction in HbA1c of 0.4% compared with interventions without SMBG. When regular medical feedback was provided to people, the HbAlc reduction more than doubled… The recently published DiGEM study failed to show SMBG significantly reduced in HbA1c, which was only 0.17% lower in the group using intensive SMBG compared with usual care WITHOUT SMBG.” [Emphasis added.]
The Guideline document talks a lot about the various all too-well-known complications of D that can be mitigated by good control. But the IDF nowhere states that if we move to 6.5/100/140, we’ll reduce our risks of complications any more than my staying at say 6.99/120/160. They can’t because there are NO empirical studies I’m aware of that have measured the consequences (presumably benefits) from following very stringent control protocols versus “regular,” good control protocols (e.g., the difference between 6.5/100/140 v. 6.99/120/160). Despite following stricter controls personally, I don’t really know (nor does the IDF) how much better/longer my life will be as a D because of these stringent controls – it’s merely my assumption that there’s some linearity involved in the benefit.
What the IDF appears to be recommending as new BG guidelines is that we Ds should implement SMBG-based control of their BGs (even though, paradoxically the studies cited in the Guideline show very marginal benefit from SMBG, even after getting a few words of “feedback” from our doctor) to levels that are VIRTUALLY THE SAME as people with “normal glucose tolerance” (I take this phrase to mean non-D folks). This is a big deal. Keeping my BGs to 100/140 on average would likely have my endo telling me it’s too risky – unless I want to show up at the ER as a hypo more often. Maybe this guideline was pushed by Lily (who makes glucagon) or by Amylin Pharmaceuticals (who makes Symlin), as Suzi mentioned. If far more Ds really follow this new guideline (which of course is unlikely), I’ll bet hypoglycemia will become a word known to far more people.

By: Bonny C Damocles

Bonny C Damocles — Wed, 26 Sep 2007 17:21:23 +0000

Amy,

I have been living with type 2 diabetes since July 1991 when I was diagnosed based on a sky-high fasting sugar reading of 468 mg/dl and fortunately have never been frustrated.

How can I say that? Very easy.

Our family physician then was Dr. Adelto Adan, a cardiologist at Mid-Michigan Medical Center, who believed that my problem was diabesity. Please understand that this has nothing to do with type 1 diabetes nor does it have any similarity to it.

This being the case, the best course of action I had to take was to exercise. So exercising I did and have been doing it for 2 hours total every day in the first 6 months of my diabetes life and have since reduced it a little bit to 80 minutes/day in 4 sessions of 20 each, 1 session before each of my 3 full meals and 1 session before bed.

What have I been eating? Only heart-healthy foods, mostly carbohydrates from fresh fruits, vegetables, grains, beans, nuts. For protein, I have been eating fish.

Of course my pp sugar levels are always high but 2 hours before my next meal, they are always in the normal range. I have been learning that temporary and short-lived sugar highs are harmless to me.

I am not supposed to say this but as far as I am concerned, it works wonders: after-meal sugar highs should never be controlled. What I am actually saying is that my exercise routine is so effective that my body has been learning, altho very slowly but surely, to operate like a normal one.

I would think that when it comes to treating type 2 diabetes (I am making it very clear that type 1 is a very different beast), the frustrating part is the impossible task of keeping pp sugar levels to a fixed safe level, like 140 mg/dl 2 hours after a meal.

By: AmyT

AmyT — Wed, 26 Sep 2007 15:10:31 +0000

Hey Jayne and Bernard,
Yes, it’s about living life and not being crippled by guilt! Thanks for your affirmations on that.