"Tight Control"

[Erin]

I have read various medical pros and cons on "tight control" blood sugar control. From my experience I think that "tight control" is more dangerous, due to hypoglycemia than aiming for a normal number, expecially for seniors and for the frequency of hypoglycemia. I wonder what the forum here has similar opinions.

 

[Dude26]

I am a relative newbie but already I managed to lose my hypo awareness through tight control on blood sugar. I have been more relaxed about it since and my awareness has returned. Relaxed attitude seems the way to go.

 

[GrantGam]

Tight control does mean that you can find yourself dropping low with the smallest miscalculation of insulin dose.

There should be no issues with having tight control providing that you still have hypo awareness and aren't going below 4mmol/L regularly.

Grant

 

[Brunneria]

Have you heard of Bernstein's Law of Small Numbers?
He says that he wants his patients to keep very tight control, of both diet and medication, since the dietary control means that blood glucose never rises high enough for large doses of insulin, and by keeping insulin doses small, there is very little risk of hypos through excessive insulin.

Really, the central point is that we need a clear understanding that 'tight control' may come with a high carb, high insulin lifestyle, with a high risk of hypos. But it may also come from a low carb, low insulin, small standard deviation.

My personal circumstances do not involve injected insulin. However, I have Reactive Hypoglycaemia which is basically where my body over-produces its own insulin if I eat too much carb. The only way to control it (that I know of) is by utilising Bernstein's Law of Small Numbers. Low carb = no hypos. Works like a charm.

So, @Erin , are you talking about 'tight control' with moderate/high carb intake?
Or 'tight control' with low carb intake and 'small numbers'?

 

[Lamont D]

From everything I have read or gained personal knowledge of, good control gives you a rest from the symptoms of whatever your condition gives you.
This gives your body a better chance to reset your health.
It's akin to a machine switching back to a default setting.
The less you use your trigger to your symptoms of high blood glucose levels or high insulin levels in my case, the balance of your blood make up normalises.

Good control gives you less glucose and your insulin resistance drops, your visceral fat is lowered as you are using it for energy instead of carbs. You need less insulin to remove the higher glucose levels. And the cycle contributes to give you better all round health.
The worry of hypos diminishes because of the lack of insulin required to offset the glucose, so you don't trigger the need.

Good control in my personal journey, has corrected a fatty liver, liver and kidney function disease, heart disease, anxiety, sleep deprivation and lots of others.
I have great energy and I need it!
Wouldn't go back to any of my old diets!
Good control is the most important thing in my life now!
Next to my family and footie!

 

[Kristin251]

I follow exactly what brunneria said. Very low carb, very low doses of insulin and very few hypos. Bernstein also recommends small meals which I also follow. This is the only way I can keep steady. My deviations are generally between 70 and 100. I do get dawn phenomenon so after BF is a bit higher but 1/2 unit fixes that and I'm in the 80's all day.
I could never find a way to eat carbs and not roller coaster. What I do now suits my stomach better too

 

[Erin]

I am a relative newbie but already I managed to lose my hypo awareness through tight control on blood sugar. I have been more relaxed about it since and my awareness has returned. Relaxed attitude seems the way to go.

Dude26, in my eight years of diabetes with a minimum 80mg glyclazide and 3 Metformins per day, I have noticed a loss of hypo awarenes, and not only loss but nasty side effects and some time to recover. I wonder if doctors know why that happens.

 

[Erin]

Tight control does mean that you can find yourself dropping low with the smallest miscalculation of insulin dose.

There should be no issues with having tight control providing that you still have hypo awareness and aren't going below 4mmol/L regularly.

Grant

GrantGam1337, I agree with your possibiity of awareness of hypo, but I do not understand why it does not last. There must be a loss of pancreatis resistance or possibly an effect on the brain as time goes by, especially if there is a frequency of hypos.

 

[Erin]

Have you heard of Bernstein's Law of Small Numbers?
He says that he wants his patients to keep very tight control, of both diet and medication, since the dietary control means that blood glucose never rises high enough for large doses of insulin, and by keeping insulin doses small, there is very little risk of hypos through excessive insulin.

Really, the central point is that we need a clear understanding that 'tight control' may come with a high carb, high insulin lifestyle, with a high risk of hypos. But it may also come from a low carb, low insulin, small standard deviation.

My personal circumstances do not involve injected insulin. However, I have Reactive Hypoglycaemia which is basically where my body over-produces its own insulin if I eat too much carb. The only way to control it (that I know of) is by utilising Bernstein's Law of Small Numbers. Low carb = no hypos. Works like a charm.

So, @Erin , are you talking about 'tight control' with moderate/high carb intake?
Or 'tight control' with low carb intake and 'small numbers'?

Brunneria, I am referring mostly to the latter above. Tight control is a high probablity of hypogelycemia. and diabetic doctors must know if that is not something to be avoided, in comparison to some other clinics for example like ACCORD? or other doctors who think you will live longer if you maintain tight control.

 

[GrantGam]

GrantGam1337, I agree with your possibiity of awareness of hypo, but I do not understand why it does not last. There must be a loss of pancreatis resistance or possibly an effect on the brain as time goes by, especially if there is a frequency of hypos.

Hello, @Erin.

I'm afraid I don't know what you mean by this? I'm maybe not understanding it due to having had a few beers

Hypo awareness is lost due to the body adapting to the feeling of having low BG. It is entirely possible for a diabetic to retain hypo awareness with "tight control", providing that they do not have frequent hypos which result in their body perceiving this as "normal".

Regards,
Grant

 

[Lamont D]

Hello, @Erin.

I'm afraid I don't know what you mean by this? I'm maybe not understanding it due to having had a few beers

Hypo awareness is lost due to the body adapting to the feeling of having low BG. It is entirely possible for a diabetic to retain hypo awareness with "tight control", providing that they do not have frequent hypos which result in their body perceiving this as "normal".

Regards,
Grant

Hi Grant,

Whilst I was in my hypo hell period, my awareness was shot to pieces, I was totally unaware of the way my body was telling me to counteract the hypers and hypo symptoms. I was in total oblivion! I sometimes thought that I was napping, when I may have been unconscious. I still don't know!
Since being in really good control for over three years now, I now have really good awareness of my blood glucose levels coming anywhere out of my zone of between 4 & 6mmols. I know when I am coming out of ketosis, I know when my my bloods drop near a hypo. I have now an inbuilt alarm system that tells me, something has given me an imbalance in my good control.

I using this alarm to help me with my fasting regime.

 

[GrantGam]

Hi Grant,

Whilst I was in my hypo hell period, my awareness was shot to pieces, I was totally unaware of the way my body was telling me to counteract the hypers and hypo symptoms. I was in total oblivion! I sometimes thought that I was napping, when I may have been unconscious. I still don't know!
Since being in really good control for over three years now, I now have really good awareness of my blood glucose levels coming anywhere out of my zone of between 4 & 6mmols. I know when I am coming out of ketosis, I know when my my bloods drop near a hypo. I have now an inbuilt alarm system that tells me, something has given me an imbalance in my good control.

I using this alarm to help me with my fasting regime.

I'm glad to hear that everything is now back in line for you

It reiterates what I said about tight control not being hazardous; providing that there are not frequent hypos occurring.

I hope you keep things going the way they are

Grant

 

[Robbity]

I believe tight control means just that - you try to keep from going too high or too low. There's a happy medium and that's what I personally would call tight control. But I imagine this is probably more difficult if you're on insulin rather than being "diet conrolled".

Robbity

 

[Indy51]

What @Erin is describing is why I'm terrified of any drug that forces the body to pump out more insulin, especially if your body was already producing too much insulin to start with. I agree with the comments @chalup has made on other threads that no Type 2's should be prescribed these drugs (or insulin) unless they've had a c-peptide test first. Pretty sure Dr Bernstein doesn't prescribe sulfonylurea class drugs to his patients at all.

 

[chalup]

What @Erin is describing is why I'm terrified of any drug that forces the body to pump out more insulin, especially if your body was already producing too much insulin to start with. I agree with the comments @chalup has made on other threads that no Type 2's should be prescribed these drugs (or insulin) unless they've had a c-peptide test first. Pretty sure Dr Bernstein doesn't prescribe sulfonylurea class drugs to his patients at all.

Yes I absolutely believe that. Giving more insulin or drugs that force more insulin to be produced by the pancreas to someone who has hyperinsulinemia like me and many other type 2's is like pouring gasoline on a house fire to put it out. It may make your BG look better in the short term but it will make the disease worse in the long term and possibly destroy your beta cells in the process. One simple blood test can tell you if you have too much or too little insulin production and whether those drugs are indicated and yet doctors throw them at people without testing. Makes me angry.

 

[noblehead]

As a insulin user I would have to agree with your statement @Erin

 

[Kristin251]

I was on amiryl for a short period before DX and bs was all over the place and yes, it completely burned out my beta cells. It should be taken off the market as far as I'm concerned.

 

[tim2000s]

Let's remember, in all these statements, that Bernstein suffers from hypo unawareness.

 

[dbr10]

Have you heard of Bernstein's Law of Small Numbers?
He says that he wants his patients to keep very tight control, of both diet and medication, since the dietary control means that blood glucose never rises high enough for large doses of insulin, and by keeping insulin doses small, there is very little risk of hypos through excessive insulin.

Really, the central point is that we need a clear understanding that 'tight control' may come with a high carb, high insulin lifestyle, with a high risk of hypos. But it may also come from a low carb, low insulin, small standard deviation.

My personal circumstances do not involve injected insulin. However, I have Reactive Hypoglycaemia which is basically where my body over-produces its own insulin if I eat too much carb. The only way to control it (that I know of) is by utilising Bernstein's Law of Small Numbers. Low carb = no hypos. Works like a charm.

So, @Erin , are you talking about 'tight control' with moderate/high carb intake?
Or 'tight control' with low carb intake and 'small numbers'?

Bernstein suggests low carb for type 1s because errors in insulin dosage or timing are not as disasterous as they could be otherwise. On low carb you need less medication. Also, insulin makes people gain weight, making them insulin resistant, so they then need bigger doses to overcome the resistance.

Just met a man on holiday (T2) whose health has been affected by bad diet advice from HCPs. Such a shame.