BG under control but am I still at risk

[STEWBRU]

I am type 2 for a year now. The BG is under control, well most of the time. What confuses myself is whether there are still increased risk to developing heart disease, catching influenza, etc.
I know my body has changed since the diabetes attack. I don't sweat the same, in fact an absence of sweat. Dry hands and feet are most noticeable and I'm sure other things that I do not notice. Numb finger tips.

 

[pavlosn]

I am type 2 for a year now. The BG is under control, well most of the time. What confuses myself is whether there are still increased risk to developing heart disease, catching influenza, etc.
I know my body has changed since the diabetes attack. I don't sweat the same, in fact an absence of sweat. Dry hands and feet are most noticeable and I'm sure other things that I do not notice. Numb finger tips.

Even if well controlled diabetes increases your risk of developing this complications compared to a non diabetic person. This you can do little about. What you can do something about is to improve your own chances be keeping your diabetes as well controlled as possible.

 

[LittleGreyCat]

Perhaps you need to define "under control".

What were your last two HbA1c readings?
Do you test regularly?
If so what is your usual fasting glucose and pre-meal glucose levels?

Cheers

LGC

 

[STEWBRU]

Perhaps you need to define "under control".

What were your last two HbA1c readings?
Do you test regularly?
If so what is your usual fasting glucose and pre-meal glucose levels?

Cheers

LGC

Hi LGC. When first diagnosed HbA1c was 12.6. 2000mg Metformin and 2x Glyclacide then down to 6.5. Dropped out the Glyclacide and the last one was 5.9. I think this is under control? Test quite frequent. Morning before food around 6.5 on the Aviva. If fasting it goes down to less than 6.
What do you think? Is this OK?

 

[STEWBRU]

I'm not sure how this forum works. I thought I sent a post. But..
When first diagnosed my HbA1c was over 12 and I was quite ill. Lot's of symptoms. Was put on 2000mg Metformin and 2 x Glyclazide tabs. 3 months after this the Hb1Ac was down to 6.5? Monitored every month until stable. Stopped with the Glyclazide and the last one was 5.9.
DNS was pleased with progress. BMI is now 25.

Morning test before food is in the 6's. Fasting below 6.

What do you think? Is this OK.

 

[AndBreathe]

Even if well controlled diabetes increases your risk of developing this complications compared to a non diabetic person. This you can do little about. What you can do something about is to improve your own chances be keeping your diabetes as well controlled as possible.

Whilst, generally, I wouldn't challenge what you say Pavlos, I do disagree about heart disease etc., depending on where the controlled bar sits. For someone, like me, whose levels are now running in the non-diabetic range, I can't see that I would be at more material risk of CVD than someone who had never had that one diabetic set of bloods.

Of course, I'm being pedantic.

 

[Brunneria]

That is a great improvement! Well done.

HbA1cs measure your average bg over the last 2-3 months. so those are great averages.
But it doesn't mean you haven't been having highs and lows, which result in a good average.
Ideally, the fewer ups and downs, and the more stability, within the normal range, the better.
Perhaps try testing before eating, then 2 hours after, to see if you are having spikes in your blood glucose.

Regarding the symptoms you mention... lack of sweat and numb fingers. they are possibly a result of your blood glucose being high for some time before you got it under control. do you think you had diabetes for long before you were diagnosed?

Of course, they are also symptoms of other conditions. so the best thing to do is discuss it with your doc or nurse, and if they think it is appropriate, ask for a referral for peripheral or autonomic neuropathy to be investigated.

The good news is that by keeping your blood glucose as close to normal levels as possible, you are minimising the risk that further complications will develop. And you are giving your body the best opportunity to heal that you can.

Different people have different experiences of whether these things can improve. If you want to read a truly inspiring case, then read Dr Bernstein's book The Diabetes Solution. He is a Type 1 diabetic who has dramatically improved his health and reduced his complications by strictly controlling his diabetes for decades.

 

[pavlosn]

Whilst, generally, I wouldn't challenge what you say Pavlos, I do disagree about heart disease etc., depending on where the controlled bar sits. For someone, like me, whose levels are now running in the non-diabetic range, I can't see that I would be at more material risk of CVD than someone who had never had that one diabetic set of bloods.

Of course, I'm being pedantic.

I do so hope you are are right; for my own sake more than anyone else's.

When I used the latest UK online risk calculator to determine what my chances of a cardiovascular incident or stroke over the next ten years are, the risk jumped from 4% to 10,1% the moment I noted that I was t2 diabetic. It was interesting though that there was no field for me to record what my latest HbA1c score was - a "non-diabetic" 5,2% or 33 mmol, as it happens.

http://www.qrisk.org/

I believe the matter of how much of an additional risk of serious complications a diabetic faces compared to a non diabetic if the former maintains a non diabetic HbA1c has not been sufficiently studied.

A lot has been made of mortality rate statistics amongst diabetics but these are distorted by the large proportion of diabetics ( a shocking two thirds in the Uk as of October 2014) that do not maintain good control over their blood sugar, cholesterol and blood pressure levels.

Also, I know of only one study that looked at the benefit for diabetics to maintain a low normal hba1c and that came back that trying to achieve such low scores actually increased the risk of cvd. I believe this study was flawed however as it only considered massively increased medication doses as a means of achieving these scores not diet adjustment.


Sent from the Diabetes Forum App

 

[AndBreathe]

I do so hope you are are right; for my own sake more than anyone else's.

When I used the latest UK online risk calculator to determine what my chances of a cardiovascular incident or stroke over the next ten years are, the risk jumped from 4% to 10,1% the moment I noted that I was t2 diabetic. It was interesting though that there was no field for me to record what my latest HbA1c score was - a "non-diabetic" 5,2% or 33 mmol, as it happens.

http://www.qrisk.org/

I believe the matter of how much of an additional risk of serious complications a diabetic faces compared to a non diabetic if the former maintains a non diabetic HbA1c has not been sufficiently studied.

A lot has been made of mortality rate statistics amongst diabetics but these are distorted by the large proportion of diabetics ( a shocking two thirds in the Uk as of October 2014) that do not maintain good control over their blood sugar, cholesterol and blood pressure levels.

Also, I know of only one study that looked at the benefit for diabetics to maintain a low normal hba1c and that came back that trying to achieve such low scores actually increased the risk of cvd. I believe this study was flawed however as it only considered massively increased medication doses as a means of achieving these scores not diet adjustment.


Sent from the Diabetes Forum App

A while ago, I had a long discussion with my GP about the binary nature of the T2 flag on the qrisk site, and she agreed it would be better to have a form of discounting for a maintained HbA1c in the non-diabetic levels. On that day, we looked at the impact of halving the additional weighting the flag brought with it.

Personally, my with and without figures are 7.1% and 3.1%, so with the full flag applied I am scoring slightly abbout the average for my age/gender etc.

Looking at Professor Sikaris's presentation on interpreting blood panels for CVD risk, he considers the pivotal point for increased risk of complications to be an HbA1c of 5.5%. (I think it was his presentation, but the 5.5% is accurate.)

 

[phoenix]

The risk increase on that risk engine is even greater if you have T1. I suspect the assumption is that if you have T1 you have had it for far more years, with a greater average HbA1c than I have.
If I didn't have it I would apparently have a heart age of 59 (I'm 62 ) and a risk of 5.7% over the next 10 years. With T1, my heart age increases to 72 and I apparently have an 18% risk. ( smoking would put the heart 'age' into the 80s! )
(if I were T2 it would 'only' be 11.2% )
It's ( edit almost) enough to motivate me to do another marathon just to show 'them' that my heart is a bit better than the average 72 year old!
My doctor, does take the risk seriously though , even with a low HbA1c. she does insist on a stress test and arterial echo scan every couple of years so that she has a better indication of what's going on.

Unfortunately, I agree with Pavlov in that I don't think there are any guarantees, . The risk is hugely reduced with good control. But in both the DCCT , a type 1 long term trial, and the UKPDS(a long term type 2 trial) the risk didn't completely go away even with HbA1cs in the 5s . It was quite small for micro vascular complications but the risk reduction was less for macrovascular complications.

 

[STEWBRU]

That is a great improvement! Well done.

HbA1cs measure your average bg over the last 2-3 months. so those are great averages.
But it doesn't mean you haven't been having highs and lows, which result in a good average.
Ideally, the fewer ups and downs, and the more stability, within the normal range, the better.
Perhaps try testing before eating, then 2 hours after, to see if you are having spikes in your blood glucose.

Regarding the symptoms you mention... lack of sweat and numb fingers. they are possibly a result of your blood glucose being high for some time before you got it under control. do you think you had diabetes for long before you were diagnosed?

Of course, they are also symptoms of other conditions. so the best thing to do is discuss it with your doc or nurse, and if they think it is appropriate, ask for a referral for peripheral or autonomic neuropathy to be investigated.

The good news is that by keeping your blood glucose as close to normal levels as possible, you are minimising the risk that further complications will develop. And you are giving your body the best opportunity to heal that you can.

Different people have different experiences of whether these things can improve. If you want to read a truly inspiring case, then read Dr Bernstein's book The Diabetes Solution. He is a Type 1 diabetic who has dramatically improved his health and reduced his complications by strictly controlling his diabetes for decades.

Brunneria. I have thought about this and yes I now think that I had been having symptoms for at least a year before diagnosis. I remember cramps at night, itching till it bled in the lower leg area (during sleep). A little more frequent to the toilet at night. I thought perhaps it was an age thing but now it has become clearer what was happening. No telling how high the readings were and how damaging. A little scary really.

 

[Brunneria]

The risk increase on that risk engine is even greater if you have T1. I suspect the assumption is that if you have T1 you have had it for far more years, with a greater average HbA1c than I have.
If I didn't have it I would apparently have a heart age of 59 (I'm 62 ) and a risk of 5.7% over the next 10 years. With T1, my heart age increases to 72 and I apparently have an 18% risk. ( smoking would put the heart 'age' into the 80s! )
(if I were T2 it would 'only' be 11.2% )
It's enough to motivate me to do another marathon just to show 'them' that my heart is a bit better than the average 72 year old!
My doctor, does take the risk seriously though , even with a low HbA1c. she does insist on a stress test and arterial echo scan every couple of years so that she has a better indication of what's going on.

Unfortunately, I agree with Pavlov in that I don't think there are any guarantees, . The risk is hugely reduced with good control. But in both the DCCT , a type 1 long term trial, and the UKPDS(a long term type 2 trial) the risk didn't completely go away even with HbA1cs in the 5s . It was quite small for micro vascular complications but the risk reduction was less for macrovascular complications.
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There are never any guarantees. That's why they call it 'risk'.
And there are many other factors about which we have little knowledge and less control.

But I think that maintaining normal bg levels is a major, possibly main element of that risk, and it remains my goal.