"Rethinking A1C Goals for T2 Diabetes"

[KK123]

Same thing here, my mother in law is 89 and started having a sugar problem about 5 years ago. She's not on medication, just been told to watch what she eats. I think at her age it's not too much of an issue as long as she doesn't eat dessert all day.

Well if I got to 89 I would eat whatever I wanted, even if it was desserts all day!

 

[KK123]

She doesn’t really have the ability to make more complex decisions. She can say yes or no to biscuits. If you explain biscuits will increase her sugars and could lead to health risks, it just confuses her. The conversation would be something like.
Carer: do you want a cup of tea?
Gran: yes
Carer: do you want some biscuits?
Gran: yes
Carer: your diabetic, biscuits have lots of sugar and could make you ill, do you want to be unwell?
Gran: no
Carer brings in cup of tea no biscuits
Gran: where’s my biscuits?

It then becomes a what’s in her best interests debate....

Hmmmm….if a carer spoke to my Mum like that she'd get a mouthful! 'Do you want to be unwell'?, 'no, I'm 89 and I want a biscuit not a lecture'.

 

[Fndwheelie]

Hmmmm….if a carer spoke to my Mum like that she'd get a mouthful! 'Do you want to be unwell'?, 'no, I'm 89 and I want a biscuit not a lecture'.

My gran is in a fantastic care home, and they wouldn’t talk to her like that, it was me estimating what a conversation would go like, trying to show that my grandmother no longer has complex reasoning capabilities.

 

[KK123]

My gran is in a fantastic care home, and they wouldn’t talk to her like that, it was me estimating what a conversation would go like, trying to show that my grandmother no longer has complex reasoning capabilities.

Hi Fndwheelie, sorry, I was really remembering a care worker who said virtually exactly that to my Mum. x

 

[SaskiaKC]

I thought it was quite a thoughtful article. It says lifestyle rather than drugs should be the starting point for most people.
It also says
"There is no question that type 2 diabetes needs to be taken seriously and treated. But common sense should rule the day. Lifestyle changes are very effective, and the side effects of eating more healthfully and staying more active are positive ones. Every person with type 2 diabetes is an individual. No single goal is right for everyone, and each patient should have a say in how to manage their blood sugars and manage risk. That means an informed discussion, and thoughtful consideration to the number."

Many people on this site have changed what they eat and seen positive results. The article supports that (although it may have a different view of diet - but that is guessing ). It writes about treating people as individuals.

Thank you for posting it @SaskiaKC

Thank you for reading it and posting.

 

[Robbity]

I'm on my way to counting down towards 80 now and I'm d****d if I'm as daft yet as I'm stupid looking. If I want cakes, biscuits, etc I'll make myself some low carb goodies.

My biggest nightmare is actually getting to the point where I can't cope any longer and end up being forced to eat a high carb diet again just because what I eat no longer "matters" due to my age. I hope I'll still be able to enjoy a healthy diet rather than stuffing myself with carby treats.

Robbity

 

[Sirmione]

I just saw this 2018 article from the Harvard University Medical School:

https://www.health.harvard.edu/blog/rethinking-a1c-goals-for-type-2-diabetes-2018032613452

Makes perfect sense

 

[britishpub]

What a strange piece..

There's also an article on the same page Type 2 Diabetes: Value of home blood sugar monitoring unclear

https://www.health.harvard.edu/blog...-blood-sugar-monitoring-unclear-2017072411989

"After one year these researchers found that, compared with those not self-monitoring blood sugar, those who self-monitored had no improvement in the control of their blood sugar, and had no improvement in measures of quality of life"

Seems to go against many posters own experience, but what do we know

 

[ickihun]

Well I kinda agree with the idea of just manage symptoms in the elderly, my grandmother 80+ who is in poor health generally has just been diagnosed diabetic, now on top of even more medications the care home are helping her have a better diet before being retested, so she’s now miserable as she’s not getting her little treats she likes. It’s highly unlikely that she will live another 2 years, possible she won’t see 2020 is denying her daily biscuits with the tea trolley rounds, and her night time chocolate bar worth while?

How happy will she be in pain due to neuropathy or any of diabetes complications?
I'd want my grandparent to be weaned of carbs and die of natural causes than diabetes complications.
Nothing comes free. Not even luxury and contentment.

 

[ickihun]

There's also an article on the same page Type 2 Diabetes: Value of home blood sugar monitoring unclear

https://www.health.harvard.edu/blog...-blood-sugar-monitoring-unclear-2017072411989

"After one year these researchers found that, compared with those not self-monitoring blood sugar, those who self-monitored had no improvement in the control of their blood sugar, and had no improvement in measures of quality of life"

Seems to go against many posters own experience, but what do we know

They used carb eating subjects. Is my guess.

 

[HSSS]

There's also an article on the same page Type 2 Diabetes: Value of home blood sugar monitoring unclear

https://www.health.harvard.edu/blog...-blood-sugar-monitoring-unclear-2017072411989

"After one year these researchers found that, compared with those not self-monitoring blood sugar, those who self-monitored had no improvement in the control of their blood sugar, and had no improvement in measures of quality of life"

Seems to go against many posters own experience, but what do we know

That would be because monitoring consisted of a once a day reading so in which case I’m sure many would agree it achieves little. Structured readings during the day around food and activities are required for it to be useful

 

[ickihun]

I'II always remember one A&E doctor asking me how often I monitored for my excellent hba1c and no kidney problem on heavy insulin.
They are told the opposite to reality. My endo luckily keeps them right but not all teaching hospitals hv their own endocrologist who is as free with his knowledge as mine.

 

[HSSS]

They used carb eating subjects. Is my guess.

Yep only criteria wer as below

Eligible patients with type 2 non-insulin-treated diabetes were: older than 30 years, established with a primary care physician at a participating practice, had glycemic control (hemoglobin A1c) levels higher than 6.5% but lower than 9.5% within the 6 months preceding screening, as obtained from the electronic medical record, and willing to comply with the results of random assignment into a study group. Of the 1032 assessed for eligibility, 450 were randomized.​

 

[Fndwheelie]

How happy will she be in pain due to neuropathy or any of diabetes complications?
I'd want my grandparent to be weaned of carbs and die of natural causes than diabetes complications.
Nothing comes free. Not even luxury and contentment.

Whilst I can agree with you, I feel for some it’s too late anyway. If they were giving her a true low carb diet it might be a bit different their healthy eating is carbs on every plate. Cutting out biscuits, deserts and chocolate. Everything she looks forward to, she’s already in pain, unable to see or walk and waiting/wanting to die, is a few more months of cutting those little treats really going to make a big difference to her health now? Is having those treats going to psychologically improve her quality of life? Like I said earlier it’s a case of what’s in her best interests, my personal opinion is to allow her to be as happy as possible, but that’s not what’s happening.

I can see from both sides of the coin, for some elderly having a diet change and living well can be beneficial but there’s got to come a time (not saying it’s the same length for everyone) when it’s no longer worth it and just let them be happy.

 

[ShortStuff]

Well I kinda agree with the idea of just manage symptoms in the elderly, my grandmother 80+ who is in poor health generally has just been diagnosed diabetic, now on top of even more medications the care home are helping her have a better diet before being retested, so she’s now miserable as she’s not getting her little treats she likes. It’s highly unlikely that she will live another 2 years, possible she won’t see 2020 is denying her daily biscuits with the tea trolley rounds, and her night time chocolate bar worth while?

I hope if I was in her position, someone like you would be there to defend my right to squeeze whatever enjoyment I could out of my remaining days, not try to make me endure more miserable days. There comes a point where quality over rules quantity. I think your Grandmother has reached that tipping point. Make them see sense!