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A comparison of the guidelines for control; NICE, ADA, etc.
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<blockquote data-quote="phoenix" data-source="post: 203374" data-attributes="member: 12578"><p><strong>Re: A comparison of the guidelines for control; NICE, ADA, e</strong></p><p></p><p>The IDF guidelines referred to by Grant are T2 guidelines, they don't seem to have a T1 guideline.</p><p>I've just been searching for any other than the NICE guidelines.</p><p>So far I've found this one from ISAPD and aimed at children and adolescents but I think its quite relevant to adults with T1 as well since much of the evidence they used was from the DCCT which was a study of adults and adolescents..</p><p>First it says quite clearly</p><p>.</p><p>It then has levels of control from ideal (non diabetic) to high risk (action required)</p><p> <strong>ideal control ie non diabetic</strong> </p><p>neither raised nor low blood glucose levels</p><p> Fasting or pre prandial 3.6-5.6mmol/l</p><p>post prandial 4.5-7mmol,</p><p>bedtime 4.0–5.6 </p><p>nocturnal 3.6–5.6</p><p>HBA1c >6.5%</p><p><strong>Optimal </strong> ie for someone (in the case of this guideline a child or adolescent with diabetes)</p><p>no symtoms of raised BG</p><p>Few mild and no severe</p><p>hypoglycemias</p><p>fasting or preprandial 5-8mmol/l</p><p>post prandia:l 5–10</p><p> Bedtime :6.7–10</p><p>nocturnal 4.5–9</p><p>Hb A1c <7.5 (in the text it suggests for older adolescents <7%)</p><p></p><p>The next 2 categories are suboptimal and High risk so for example it is sub optmal to have symptoms of high BG levels ( Polyuria, polydipsia,) suboptimal to have episodes of severe</p><p>hypoglycemia (unconscious and/or convulsions) and suboptimal to have an Hba1c 7.5–9.0. It is High risk (just included those that apply to adults, there are others for children) to have symptoms such as Blurred vision, skin or genital infections, and signs of vascular complications. A high risk HbA1c is >9.0</p><p></p><p>I very much doubt if any type 1s could safely achieve non diabetic control in every aspect because even rapid acting insulin lasts up to 5hrs so a normal post prandial level may well result in a hypo later. Basal insulins are also not flexible enough to cope with large overnight flutuations. No doctor would want someone with T1 diabetes aiming for lower non diabetic fasting/nocturnal levels, we can't switch off the cirulating insulin in the same way as a non diabetic so there has to be a margin for safety. </p><p> My HbA1c has been in the 5s for a number of years but I certainly have occasional post prandials of above 10mmol and relatively frequent mild hypos.</p></blockquote><p></p>
[QUOTE="phoenix, post: 203374, member: 12578"] [b]Re: A comparison of the guidelines for control; NICE, ADA, e[/b] The IDF guidelines referred to by Grant are T2 guidelines, they don't seem to have a T1 guideline. I've just been searching for any other than the NICE guidelines. So far I've found this one from ISAPD and aimed at children and adolescents but I think its quite relevant to adults with T1 as well since much of the evidence they used was from the DCCT which was a study of adults and adolescents.. First it says quite clearly . It then has levels of control from ideal (non diabetic) to high risk (action required) [b]ideal control ie non diabetic[/b] neither raised nor low blood glucose levels Fasting or pre prandial 3.6-5.6mmol/l post prandial 4.5-7mmol, bedtime 4.0–5.6 nocturnal 3.6–5.6 HBA1c >6.5% [b]Optimal [/b] ie for someone (in the case of this guideline a child or adolescent with diabetes) no symtoms of raised BG Few mild and no severe hypoglycemias fasting or preprandial 5-8mmol/l post prandia:l 5–10 Bedtime :6.7–10 nocturnal 4.5–9 Hb A1c <7.5 (in the text it suggests for older adolescents <7%) The next 2 categories are suboptimal and High risk so for example it is sub optmal to have symptoms of high BG levels ( Polyuria, polydipsia,) suboptimal to have episodes of severe hypoglycemia (unconscious and/or convulsions) and suboptimal to have an Hba1c 7.5–9.0. It is High risk (just included those that apply to adults, there are others for children) to have symptoms such as Blurred vision, skin or genital infections, and signs of vascular complications. A high risk HbA1c is >9.0 I very much doubt if any type 1s could safely achieve non diabetic control in every aspect because even rapid acting insulin lasts up to 5hrs so a normal post prandial level may well result in a hypo later. Basal insulins are also not flexible enough to cope with large overnight flutuations. No doctor would want someone with T1 diabetes aiming for lower non diabetic fasting/nocturnal levels, we can't switch off the cirulating insulin in the same way as a non diabetic so there has to be a margin for safety. My HbA1c has been in the 5s for a number of years but I certainly have occasional post prandials of above 10mmol and relatively frequent mild hypos. [/QUOTE]
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