Re: Are complications still possible with non-diabetic resul
Sorry Hana, but once again, you have given potentially dangerous, life-threatening advice to a Type 1 diabetic. This person is probably having their honeymoon period (clue - slow onset, late diagnosis) and will possibly never again achieve an HbA1c of 5 point anything after the honeymoon ends. It would in fact be life-threatening of her to try do so anyway, as she/he is a Type 1 diabetic using insulin, overdoses of which can, and occasionally do, kill (or lead to brain damage). Research into Type 1 diabetes (real research, by real doctors, on real Type 1 diabetic people, and reported to me by real DAFNE specialists at the extremely real King's College Hospital) shows that an HbA1c lower than 6.0% will very likely bring the extremely dangerous problem of hypo unawareness with it. For Type 1 diabetics. Please refer to Cugila's post elsewhere about the serious consequences of that. For the record, to the OP, Type 1 diabetics should aim for, if possible, an HbA1c of 6.0% - 7.0%. If you go on the DAFNE course and work with the targets they set you for different times of the day and learn how to properly manage your MDI, sick days and hypos, you are much less likely to have any diabetes complications, and maybe none at all. I was told this at King's, and I have every reason in the world to believe them, because they know the real truth. If you want to aim lower, you need to discuss this with your team and be made fully aware of the risks of doing so.
Back to Hana, you are posting on the Type 1 forum. I do not even understand why you read this forum. I do not read the Type 2 forum, I could not care less, I do not have Type 2 diabetes and could say absolutely nothing valid to a Type 2 diabetic. Type 1 diabetes is a disease you do not have and clearly, from your ill-informed and occasionally dangerous posts, know very little about. You have Type 2 diabetes. They are completely different diseases. They are managed differently. Different rules apply in a million different ways. We live a different life from you. This is why the Type 1 forum was created - so that we can request and give relevant advice and support to people who understand, people who are living with the exact same problems.
Whereas you may well give amazing advice to Type 2 diabetics, I have seen you give dangerous advice not only here, but also before, in particular to a Type 1 diabetic to aim for a BG of 4.7. You did not state at which time of the day he should do this. Elsewhere, he has been querying what his pre-bed sugars should be. Not 4.7, that's for certain. Did you tell him to make sure he left minimum 4hrs after his last Novorapid injection before bed to be sure he was getting a near-true reading and would not go hypo in his sleep from too much bolus? No. Did you tell him how to make sure his basal dose was right? No. Did you tell him to take into account the exercise he's taken in the last 24 hrs, including how intense the exercise was, how long it lasted, or whether his arms were often above his head whilst exercising? No. Did you tell him to take into account his alcohol intake before his reading, as alcohol will very often induce a hypo later on? No. The reason you did not, is because you do not know what you are talking about, because you do not have Type 1 diabetes. I do not have leprosy for example, therefore, I do not post 'advice' to people with leprosy on leprosy forums.
To take issue with your point, as quoted below (and this is about Type 2 diabetics - about 48,000 of them, all of them quite real I'm sure):
hanadr said:
I have met people who've had diabetes for decades and have minimal complications. It probably is possible to avoid them altogether if your control is tight to the normal[5.0] and doesn't slip.
However, there isn't any data. People who have been diabetic for several decades, didn't have access to home blood glucose testing for a long time.[Sorry can't remember when it came into general use]. Even urine testing at home wasn't available a long time ago. In the 60s. people went to the hospital for "check-ups" once a month.
It will be a while into the future before sufficient data is available to completely answer your question. Even longer if medics continue to believe that tight control is dangerous.[they've no evidence for that either]
Hana
The emphasis below is mine.
http://www.library.nhs.uk/Diabetes/View ... sID=345735
This study generated two cohorts of patients aged 50 and over with type 2 diabetes from the UK general practice research database from Nov 1986 to November 2008. The first cohort was of 27965 people changed from oral monotherapy to combination oral therapy with metformin and a sulphonylurea. The second was of 20005 people changed onto regimes that included insulin. Mean follow up was 4.5 years in cohort 1 and 5.2 years in cohort 2. All cause mortality was the primary outcome. Confounding factors were identified and Cox survival models were adjusted for these factors accordingly.
The main result was that the 10% of patients with the lowest HBA1c values (below 6.7%) had a higher death rate than all but those in the top 10% who had a HBA1c of 9.9% or higher. Furthermore cardiovascular disease was more frequent in this low HBA1c group than in any decile. The results overall show a U shaped association with the lowest hazard ratio for death at an HBA1c of 7.5%. The hazard ratio for all cause mortality in people given insulin based regimes (2834 deaths) versus those given combination oral agents (2035 deaths) was 1.49. The U shaped pattern was sufficiently similar in the 2 treatment cohorts to suggest that risk of mortality with respect to HBA1c was independent of treatment regime. The commentary says that this study although it supports the results of RCT’s such as ACCORD cannot show as causal relationship between HBA1c and mortality. However the results are consistent with the idea that premature death may be related to hypoglycaemia.
This study supports the notion that in people with type 2 diabetes on insulin secretagogues or insulin itself the HBA1c target of 7.5% corresponds to the lowest death rate and the lowest event rate for large vessel disease. The comment says that priority should be given to insulin sensitizer therapy to lower HBA1c for as long as possible in people with type 2 diabetes because these drugs allow a low HBA1c to be targeted without any risk of hypoglycaemia.
I've wanted to say this to Hana for a really long time. The end.
