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Confused

S

sheep

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22
I Was under the Impression that our aim was to achieve consistant Lowish and steady Bs levels in the hope of avoiding complications further down the road.

Just had my routine checkup from the neck down ( as opposed to a "check up from the neck up", which i no longer need lol ) and my doc was rather pleased that my HBA1c had gone up to 6,9 ( was 6.0 in Nov 2011). When i questioned this and told him i was hoping to achieve levels a lot lower he called me Crazy and suggested that if i fell below 6 at my next app he would take me off insulin in order to raise my numbers long term. Apparently a studies show that while non-diabetic ppl can have life long levels of 5.5 or less us diabetics have a habit of dying if we stay that low.
So this, added to initial advice to ignore any G.I references to food (they don't use that guideline here) and just eat what i like and dose with insulin to cover it has not helped me 1 year in, to have any more of a clue as to what i'm doing now than i did when diagnosed. :roll:

Rant over :D
Greetings to all from a wet and windy island in the north.

Russ
 
Hey Russ!

To put it bluntly, unless there are some overriding reasons why you should run your BGs higher, your GP is talking rubbish :evil: I had the misfortune this week to see a GP who told me I should always keep my levels between 8 and 9 to avoid hypos. This advice is absolute nonsense.

It CAN be dangerous to reduce your BG levels too low if you end up with lots of hypos, but your HbA1c of 6 was not too low. I try to get mine in the 5s.

I am flabbergasted at the rubbish these GPs talk. Make frequent visits to this forum if you can - there are some very experienced diabetics of all types on here who give very good advice. Also, consider changing your GP to one who has a clue or asking for a referral to a specialist.

Smidge
 
What your doctor was quoting was a study that showed people on insulin had a better morbidity rate if their HbA1c was higher than 7 rather than lower. There was a fairly long thread on here about it. Most of us felt the study was flawed. Providing the insulin user is "safe" from dangerous hypos, how can it be better to run that much higher than a non-diabetic? On the study, what were the people actually dying from? What other factors did they have in common?
Personally, rather than using "i'll take you off insulin" as a punishment, I'd consider "if I got my diet right and my HbA1c low enough, could I come off insulin onto other simpler meds?" as a reward! You may of course wish to be on insulin, and if so that's fine, but I know other type 2's that were on insulin that got themselves off it. Fergus Crawford was one I believe, Sid Bonkers was on insulin for a while and came off, I'm sure there are others. So maybe you have a choice.
Overall, every bit of common sense says that the lower the HbA1c the better. A higher acceptable level is better for the doctors; easier to get patients there, no danger of hypos so no come backs, less people troubling them asking how to get them lower, and so on. At a time when the NHS is saying should HbA1c's be higher, the rest of the world (USA, canada, Australia, new zealand) have lower targets than we do. USA endocrinologists say below 6.5, USA diabetes association say lower than 6.0 "if safe" (or might be the other way around, but you get the picture)
Good luck!
 
Hey sheep

Quote your totally out of date doc this..

A recent observational UK General Practice Research Database
(GPRD) study has reported increased risk of total mortality with
lower HbA1c with lowest risk for HbA1c 7.5%, and also a 49% higher risk of total mortality with insulin treatment versus oral agents .

However, this was not verified in the NDR study, showing no
J-shaped risk curve for total mortality in patients treated with insulin or oral agents, and that the increased risk of total mortality with
insulin was due almost exclusively to an increased risk of non-CVD
mortality, and that HbA1c was not at all associated with non-CVD
mortality
Click to expand...

Comes from a Swedish Healthcare doc drawn up last year as a basis for their diabetic care. It's the doc that I base all my personal healthcare targets on. Effectively it says the UK people who did the study badly mucked up the interpretation of the data they used.

Who do you believe? A healthcare service that's based on modern 21st century studies and advocates a diet near enough all of us on the forum knows to work (some form of low starchy carb diet) or a healthcare system that hasn't bothered to update its diet in 30 or 40 years.

The full doc in English is here:

http://www.healthcare-bulletin.com/...ascular_Disease__in_Diabetes_Care_-_2011_.pdf

There is (in another study) some evidence that survivability rates are slightly better in people who maintain stable BG's (not too peaky or spiked) over those who are less stable but have a SLIGHTLY lower HbA1c
 
As Grazer said, I am one who has escaped the clutches of insulin :D , and still got Hb1Ac in 5.s :D :D .
Now on tiny amounts of gliclazide as I cant have Met (wife says I'm windy enough :lol: )
 
Hi. I agree your GP appears to be saying some strange things. As for ignoring food GI and eating what you like its nonsense. Although you can increase insulin to match carb intake if, for example, you doubled both you would double your swing towards a hypo or the other way; not sensible. Eating Low-GI food is good advice for everyone let alone diabetics. It's amazing what the NHS can profer as good advice. As for insulin my GP won't let me have insulin 'cos it's a last resort yet other GPs offer it very early on; it's a lottery. The NHS Diabetes and NICE guidelines are very sensible on the subject so have a look at these if you haven't already. These are aimed at NHS Diabetes professionals so by definition it's what you should be hearing from them.
 
I was not planning to follow his advice to much TBH i'm happy to try and reduce it and keep it lower if possible. I do not put so much faith in his "study" reports either, while i am aware he is one of the leading experts in his field here i also know he is so overworked it's madness and i expect he wants less trouble from his patients lol. At the moment it suits me to be on insulin as i do have some food issues no fruit or veg ( a lot of it makes me physically sick) so it would be harder for me to maintain decent levels on just diet/Tabs. I did take Glucophage for 3 months but after spending most of that on the loo and then developing dizzy spells and passing out for no reason on a number of occasions i gave them up lol

I was reading that in the UK many diabetics are not getting tested for everything they should so it seems as bad as here, I have finally been given appointment for Opthalmologist and in June i will have test for kidneys and other things only 15 months after diagnosis so not so fast here either.
 
Daibell said:
Hi. I agree your GP appears to be saying some strange things. As for ignoring food GI and eating what you like its nonsense. Although you can increase insulin to match carb intake if, for example, you doubled both you would double your swing towards a hypo or the other way; not sensible. Eating Low-GI food is good advice for everyone let alone diabetics. It's amazing what the NHS can profer as good advice. As for insulin my GP won't let me have insulin 'cos it's a last resort yet other GPs offer it very early on; it's a lottery. The NHS Diabetes and NICE guidelines are very sensible on the subject so have a look at these if you haven't already. These are aimed at NHS Diabetes professionals so by definition it's what you should be hearing from them.
Click to expand...

Hi Daibell
I should just add that i'm in Iceland not the UK so I have no idea if the doctors here follow the NHS/NICE guidelines or Scandanivia. Either way they are talking rubbish it feels.
I Don't go mad with insulin despite their advice, i unsuccessfully try to limit my carbs daily..some good some bad for instance today will only be boiled egg, cup-a-soup and grilled chicken...yesterday started bad, got worse and finished with a nice big bowl of ice cream n choc sauce :oops:
More by luck than judgement as yet i have not had a Hypo the closest i came was a case of the shakes while out shopping, funnily enough i was right next to the bottles of coke so soon fixed that lol
 
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