Complications - time to develop

[Red_Fox22]

Had an interesting discussion with my GP today about things other than my LADA for once.

He was of the view that it takes many, many years to develop any complications if you have elevated blood sugars.

Lets assume you have an A1C of maybe 51/52 - I would have thoughts things would start to go wrong withing maybe 5 years.

Views?

 

[EllieM]

Depends on the person. I've heard of some people having issues with eyes very soon after diagnosis, whereas others (including me) seem to be able to get away with less than optimal control for half a century.....

But let's be realistic here, 51/52 is actually not a bad hba1c by many T1's standards, my specialist is very happy with it as a level for me to aim at, as I actually am more at risk from loss of hypo awareness if I go much below 50.

Being realistic, my hba1c hasn't been at the 51/52 level for most of my 50 years as a T1, though it's been at that level for the last few years (and I have the hypos to prove it).

But I do sometimes wonder if T2s are more at risk than T1s of complications, or is it just that the NHS's mantra that they shouldn't do blood tests mean that they run higher hba1c's than T1s do....? Maybe it's just the fact that so many more diabetics are T2 mean that most of the complications happen to T2s?

 

[Dark Horse]

I've heard of some people having issues with eyes very soon after diagnosis

Those people are likely to have been people with type 2 diabetes who may have had the condition for years before diagnosis. The rule of thumb for people with type 1 is that they are very unlikely to develop any retinopathy within 5 years of diagnosis.

 

[LooperCat]

I can’t remember the exact percentage, but it’s a very small proportion of T1s that attain the guideline ideal of 50/7%. I think the people on the forum are much more engaged with managing their disease, so tend to run healthier levels. Before I joined I was in the 80s and 90s (for a long time) and from what I gather from my clinic, that’s pretty standard amongst the T1 population. Over my two decades I’d developed a little neuropathy and retinopathy but over the last 12 months I’ve been running pretty non-D levels, as you can see from my HbA1c in my sig. In that time, my eyes have healed and I’ve got the feeling back in my feet.

Tl;dr - I took 15 years of terrible control to develop complications, but reversed them in less than two.

 

[EllieM]

Tl;dr - I took 15 years of terrible control to develop complications, but reversed them in less than two.

That's an awesome and very encouraging result, particularly for those of us, including me, who don't always have the control we'd like to have.

 

[LooperCat]

That's an awesome and very encouraging result, particularly for those of us, including me, who don't always have the control we'd like to have.

Thank you The thing that jolted me into getting to grips with the D-emon wasn’t two near fatal-DKAs, the increasing pain and then numbness in my legs or the fear of losing my sight. In the space of a week I’d got out of the bath, looked down to see a couple of my toes bent back right under my foot - and couldn’t feel a thing. And then I had to call paramedics as I’d accidentally overdosed on insulin (got the raw and cooked weights of spaghetti mixed up). I joined the forum the next day and had a good read around. I realised it was mostly a T2 thing, but I thought I’d try low carb as I was fed up of the rollercoaster. It’s not for everyone, as it’s very restrictive (I’m allergic to meat and cow’s milk), but it works for me. I was practically disabled by how awful I felt with the swings in blood sugar - too ill to even hold down a job. A complete wreck, basically waiting to die. I felt Diabetes had ruined my life, it had certainly trashed my science career by arriving right in the middle of my PhD. But now I’m teaching full time, and I’m starting my paramedic training in September. I almost feel normal now!

 

[Red_Fox22]

Mel - that is indeed very impressive and you should be very proud of yourself.

I feel almost an amateur by comparison, as I "only" have LADA in the early stages (2.5 years) that I am treating with metformin and more recently Trulicity.

I have been on Trulicity for 8 weeks now and I find my BS are much better controlled so I suspect my A1c is likely to be in the mid to low 50s range when I next have this done.

I will then need to assess whether that is safe or if I need to top up the treatment with small amounts of basal insulin to get me down a few more points.

\My nurse seems keen to get me onto insulin sooner rather than later but I would prefer to stave that off if at all possible.

 

[ringi]

A few things makes it hard to know the time scales on complications:

• Few people have good records of regular A1c before diagnosis, and diabetes in adults often goes undiagnosed for a long time.
• There is no agreement on what the complications of diabetes are, for example should strokes and heart problems be considered? What about cansor?
• Some complications maybe due to high blood inslin levels, and clearly inslin resistance starts long before A1c increases enough for someone to be diagnosed with type2, and people with diabetes can still have very high inslin resistance even if BG are well controlled.
• Recovery from other health problems are often slower in people with diabetes, should that be considered as a "completion of diabetes"?

However I recall correctly, it is uncommon to get meaningfull eye or kidney problems within 5 years of poor BG control starting unless a person is old or already in poor health.

 

[SimonCrox]

I concur with @ringi above. In a way, it is affected by whether one has type 1 diabetes when one is diagnosed soon after onset in which case specific DM complications are almost unknown before 5 years of disease, or whether one has Type 2 DM when there may be a 10 year delay indiagnosis, and hence complications may be present at diagnosis.

I think that other risk factors such as smoking, hypertension and high total cholesterol also increase risk of complications:-

https://www.nejm.org/doi/full/10.1056/NEJMoa032782

best wishes

 

[JonBoy1199]

I can’t remember the exact percentage, but it’s a very small proportion of T1s that attain the guideline ideal of 50/7%. I think the people on the forum are much more engaged with managing their disease, so tend to run healthier levels. Before I joined I was in the 80s and 90s (for a long time) and from what I gather from my clinic, that’s pretty standard amongst the T1 population. Over my two decades I’d developed a little neuropathy and retinopathy but over the last 12 months I’ve been running pretty non-D levels, as you can see from my HbA1c in my sig. In that time, my eyes have healed and I’ve got the feeling back in my feet.

Tl;dr - I took 15 years of terrible control to develop complications, but reversed them in less than two.

That is fantsatic that you was able to reverse the complications in less than 2 years. I've had diabetes 22 years and Iwill hold my hands up, I've not had the best controlled blood sugars. I developed neuropathy 5 years ago and last year got into retinopathy teritory. That was the wake up call I needed. I now have very tight control with help of the libre. My neuropathy is improving and get mych less pain. Also now made it back to 6 monthly eye screening from 3 monthly after things improved and hopefully soon be back to annual screening.