BG Targets

[hanadr]

This is why I am so angry with the BG targets as set by the non-diabetic "experts" and the Healthcare professions.
A target is something to aim at, not something which is necessarily easily attainable.
Hence why such high targets?
NORMAL Bg is around or below 5mmol/l thus 7 is HIGH
normal HbA1c is around 4.6% perhaps as high as the average which is 5.1% Hence 6.5% or 7% are HIGH
The only people protected by these targets are the healthcare professionals NOT THE PATIENTS>
Subjecting the minor capillaries to elevated blood glucose is damaging, but the worst of these targets is that they lull patients into a false sense of security.
This is made even worse when the blood test results are given to patients as" You are doing Ok;That's good."etc.
Whatever the targets, some people will not or cannot attain them. If they understand the consequences and make a choice, that's fair for them.
If they think that attaining the targets is protecting them from "progression" or complications, they are being cheated and people who would or can attain normal blood glucose don't have the chance. Treatment should be based on "informed consent". Withholding the information is immoral
I understand that newbies might be scared by the truth, but they still have to live with the consequences. I understand that we are diabetics and that it's HARD and UNFAIR, but we can't change that.
However, I also understand that attaining normal or near normal blood sugars is POSSIBLE. It's HARD WORK and involves giving up things you like. Before insulin was available, there was nothing between life and death, but a very restricted diet. T1s died eventually , but I suspect that there were T2s who managed a normal lifespan.
Oral antidiabetic drugs came along and made things seem easier for T2, but now we are bearing the consequences of using these toxic substances. cf the AVANDIA debacle.
So now we live with a recipe for a short life "Eat what you like and take some more medicine, because progression and complications cannot be avoided"
instead of " Get as close to normal BG as you can and keep well."
Hana

 

[cugila]

I wondered when you would get around to posting this one on here Hana........ :wink:

Firstly, why does someone have to have a disease to be able to treat it properly ? Recommend levels etc. We wouldn't have many remedies available if we had to wait for everybody to experience a disease before we can consider them an 'expert' in that area. As for experts....too many people consider themselves experts, just because they have an opinion. That is one of the reasons the Ask the Expert section was renamed here. There aren't any here, just some knowledgable people who aren't afraid to voice an opinion.

Monitoring of HbA1c levels in type 1 and type 2 diabetes is fundamentally important because it provides an indication of glycemic control that guides therapeutic intervention to achieve glycemic targets. HbA1c levels can also be used to gauge whether or not a treatment intervention has had the desired effect of bringing blood glucose levels closer to the HbA1c target level. If not, the treatment program can be adjusted or advanced as required. The general HbA1c target for achieving glycemic control is around 7.0%; however, it may be necessary to consider individual patient history (or even the time of year as suggested in recent research) when setting HbA1c goals and adjust the target level accordingly. Healthcare providers may recommend lower HbA1c goals if they feel this is achievable without risking severe hypoglycemia or may suggest less stringent goals for patients with a history of severe hypoglycemia, limited life expectancy, or advanced microvascular or macrovascular complications. Indeed, the Australian Diabetes Society recently recommended a target HbA1c level of ≤6.0% in some people, or up to ≤8.0% in others. The algorithm proposed by the Australian Diabetes Society may assist healthcare providers in deciding the best management program for patients with type 2 diabetes because it recognizes the need for individualization of glycemic targets, while considering other factors such as type of therapy, class of medication, and the type of insulin therapy. However, setting lower targets must be viewed in the context of recent survival data in type 2 diabetes patients, which showed that low as well as high HbA1c values were associated with higher all-cause mortality and cardiac events. If confirmed, these findings could necessitate further revision to diabetes guidelines to include minimum HbA1c values. It is important for healthcare professionals to be aware of confounding factors, such as changes in diet or exercise that may influence treatment decisions.

http://www.hypodiab.com/uploads/article ... 345265.pdf

I think the highlighted parts say a lot........you have to take everything into account, not just the fact that YOU can get very low levels and that YOU don't think the levels should be what they are. there is much more to Diabetes than one individuals thinking, much more to control and quality of life...... The NICE guidelines also suggest that the targets (whatever they are) are tailored to each individual and their circumstances.

BTW, nice if you can achieve non Diabetic levels without causing problems, however as stated before we ARE Diabetic and the levels and the way glucose is dealt with are different in both groups.

A non Diabetic doesn't have the problem a Diabetic has in metabolising carbs/glucose/Insulin.......

 

[noblehead]

This is why I am so angry with the BG targets as set by the non-diabetic "experts" and the Healthcare professions.

You need to chill-out Hana and not get so uptight about things, the targets are only a guideline and its up to the individual from then on if they want to lower it further. As you know getting a normal a1c is extremely hard, wasn't your last one 5.6?

So now we live with a recipe for a short life "Eat what you like and take some more medicine, because progression and complications cannot be avoided"

Never ever been told that! :?

instead of " Get as close to normal BG as you can and keep well."

That's exactly the advice I have been given throughout my 30 years of type 1 diabetes!

Hana

 

[catherinecherub]

Who are these non diabetic "experts that you scorn? Are they the Endocrinologists? We all know your views on Health Care Professionals and it does get a bit tiresome when you keep calling them into question. Sitting in judgement on others is a pointless exercise.

Whilst you may have confidence in your opinions, yes opinions nothing else, you are not an expert and can only manage your diabetes and not everyone elses. Confidence is generally productive but it should not be overestimated. Someone may have confidence that they can fly and jump off a tall building with disasterous consequences. Someone may be confident that they are going to pass their driving test and fail.

Targets are an individual thing and there are too many variables to consider for diabetics. Someone may have difficulty getting below 7 but that does not mean that they are eating anything they like. Their restraint may be equally as good as yours but they are not you and so you will never know, The only alternative for them would be near starvation, would you recommend that?


I often wonder if you are seeking vindication for the way that you manage your diabetes.

 

[Robbie1968]

guide lines are just that "Guide Lines" not every one can be perfect,, I for one am sure, I eat what I Should, stick to all the rules, Yet never seem to be able to get below That 7, so I'm happy just knowing that when I get close to the 7, then I'm close to the guide lines and that makes me feel good,,,,

Hope every one is having a good weekend,,,,,,


Robin,

P,s 2.10 today I became a Granddad,,,,,, congraits to my baby girl,,,,,,,

 

[daisy1]

Congratulations Grandad. Best wishes to Mum, Dad and baby girl

 

[CollieBoy]

Hi, sorry to but in on this argument but as an ordinary T2 diabetic, I would like to give a few thoughts. Targets are just that, targets. they should be individual, achievable/realistic and measurable. So this means that there should be an elemnt of discussion between the HCPs and the diabetics. In my case at consultant/hospital level this is sadly lacking.
Individual ? NO- there was no discussion, targets were imposed from on-high!
Achievable ? In my case - yes but not realistic as no-one asked what was realistic for me.
Measurable - only in retrospective Told you have achieved Hb1aC X/ you have dropped too low (no aim for Y) and how can there be Targets if in 2 years you never see the same consultant twice.
They need to aspire to the professionalism of the surgery HCPs in communicating targets .
Sorry about the rant folks but I am expressing MY opinion here, my experience, My results may not tie with yours so you might think I push my target too far but I expect to try to push the envelope as far as I can.

 

[phoenix]

Those non diabetic experts use evidence , not anectdote, including that the normal reference range . As I've mentioned before the range is tested regularly at the NGSP, the institute heading up international standards in Hba1c testing . When asked by Rick Mendosa they said that it doesn't vary much from year to year and is '4.7 to 5.7 — at plus or minus 2 standard deviations. This includes about 95 percent of the values.'
Lowe levels undoubtedly have less risk of complications but in T1 there is a trade off of the risk of serious hypoglycemia. That is hypos that need assistance. The graphs from the DCCT show this very clearly. The risk curves for other complications are similar.
Personally, I've had an HbA1c down at 4.9% and agreed with my doctor that it was far too risky, inspite of the fact I have never had a hypo that I couldn't deal with quickly by myself.
Reducing Hba1c levels from 8% cuts risks immensly, the risk reduction at levels below 6.5% is much less.
For T2s who may be diagnosed much later in the development of diabetes lowering HbA1c too aggressively with medications may be counterproductive. Again the risk reduction at HbA1cs below 6.5% is not huge.

Generalised targets are just that, as even the NICE guidelines say quite clearly that they should be individualised and the result of discussion with the patient taking all factors into consideration

 

[cugila]

Fergus.
It is a discussion.....not an argument and anybody can join in, it's an open forum for all.

Glad to see that you are not accepting things either. Some of the medical profession do seem to think that they dictate to us. Not in my book they don't ! They think we know nothing much about our condition......not so, at least on this Forum anyway.

Targets SHOULD be agreed, I was lucky, my Endo (with him for 9 yrs) discussed the targets and the methods to achieve them. I gave my input, the SDSN (with her for 4 yrs) was also involved and we all came away happy with what was agreed. My targets, my methods, my choices.

I suppose I am one of the lucky ones really, my care is excellent and I know it is not the 'norm' for everybody.........I really wish it was different and everybody got the best treatment and were listened too.

That's why we push this Forum at every opportunity, knowledge is power and Dr's need to realise we are not all devoid of intelligence ! Pity some of them are not on here. Might do them good to see pro-active people who do care what happens and want a say in their health and treatment.

 

[Sid Bonkers]

This is why I am so angry ...

Merry Christmas Hana