MarcoRiveira
Well-Known Member
- Messages
- 105
- Type of diabetes
- Type 2
- Treatment type
- Tablets (oral)
Sometimes, his experiences can be scary ...
"I have seen “nondiabetics” with sustained blood sugars averaging 120 mg/dl develop diabetic complications." (120 is 6.67)
http://www.diabetes-book.com/nondiabetic-versus-diabetic/
Yes, you are absolutely right. In the book, he talks about trying to normalise Hba1c to the average for non-diabetics. (Then my doctor tried to tell me that was dangerous and I might have a heart attack. How more likely to have a heart attack could I be than a non-diabetic with exactly the same Hba1c. Another blow to my trust in the treatment)My mistake, the better word is that "proper" should be "ideal", which is the title of the video. Ideal for him because non-diabetics he tested, in his experience, had 4.6.
Your doctor was referring to the ACCORD study that stopped part of its study programme as a result of too many people dying of heart attacks when undertaking intensive type 2 therapy with a target Hba1C of <6.5%.Yes, you are absolutely right. In the book, he talks about trying to normalise Hba1c to the average for non-diabetics. (Then my doctor tried to tell me that was dangerous and I might have a heart attack. How more likely to have a heart attack could I be than a non-diabetic with exactly the same Hba1c. Another blow to my trust in the treatment)
Brilliant. Thank you so much. I think Jenny Rhule criticises the methods used in the study and also points out many patients had heart problems to start with, they did not follow LCFC, and some were on Avandia, later discovered to increase the risk of heart attacks.Your doctor was referring to the ACCORD study that stopped part of its study programme as a result of too many people dying of heart attacks when undertaking intensive type 2 therapy with a target Hba1C of <6.5%.
It wasn't corroborated by a similar study at the time, the ADVANCE one, and there were questions asked about the predisposition to CVD amongst the participants and the impact of lowered glucose levels on them specifically.
It certainly raised many professional eyebrows and has affected the approach that is taken with T2 diabetes and tight blood glucose control. I suspect hat there may be a risk of increased coronary events with low blood glucose amongst those with higher risk of CVD, but there's not a lot of data to prove or disprove that theory.
All this goes to show you is that there's more to life than spending your entire time worrying about complications. I think it comes down to minimizing risk, rather than eliminating completely. We know that minimizing risk is keeping Hba1C levels below 6,5. No that won't eliminate completely, but you are much less likely to get them. You personally have to weight the risks off against each other.
One might also argue that complications aren't really "Diabetic Complications", they are simply issues that anyone could get, it's just that Diabetics are more likely to as a result of elevated blood glucose levels. Genetics will also play a large part in susceptibility. If your family already has a genetic predisposition to CVD, no amount of having a normal glucose level will eliminate it, just reduce the risk.
And even with his marvellous techniques, and approach, I don't see how it's possible to use any of the basal insulins and avoid dawn or getting up phenomenon. Low carbing helps, but doesn't eliminate it. Doing proper high intensity training is also not really that easy under his regime, as keeping your bg low can be really tough.
So while I applaud his excellent approach that has kept him going for so long, I struggle with it, because it doesn't always fit what I want to do, and if I'm going to live my life, I'd rather enjoy it than worry about it lasting forever. So I'll take the <6.5% relative risk over the 4.5% minimal risk.
However in the UK, you don't get sued, so that's not a good argument out of the US (and coincidentally describes why health care in the US costs so much...)I aim for Bernstein blood sugar and HBA1C targets , don't always get there but am close. Never had a HBA1C of 4.6 % but will keep trying. Don't low carb anymore but can still achieve non-diabetic targets.
I liked this passage from an interview with the Dr on ADA......................
Now, why do they advocate elevated blood sugars where the A1C is 6.5 or 7? I’ve asked a number of the ADA presidents over the years. Not recently, because I haven’t been in touch with them recently. But back in the old days before I became a physician, I knew a lot of them, including my own physician. And he gave the same answers that the other presidents gave.
If a diabetic goes blind, dies of congestive heart failure, dies of kidney disease, that’s to be expected. That goes with the disease. If a patient of mine dies of hypoglycemia, it’s my fault and I get sued. So, I’m going to keep my patients as far from hypoglycemia as I can.
Now, if you have them on high carbohydrate diets, where the blood sugars can vary by plus or minus 150 in a day, you want to keep their blood sugars certainly above 250. And 200 is an A1C of 7.
Thats telling it like it isI aim for Bernstein blood sugar and HBA1C targets , don't always get there but am close. Never had a HBA1C of 4.6 % but will keep trying. Don't low carb anymore but can still achieve non-diabetic targets.
I liked this passage from an interview with the Dr on ADA......................
Now, why do they advocate elevated blood sugars where the A1C is 6.5 or 7? I’ve asked a number of the ADA presidents over the years. Not recently, because I haven’t been in touch with them recently. But back in the old days before I became a physician, I knew a lot of them, including my own physician. And he gave the same answers that the other presidents gave.
If a diabetic goes blind, dies of congestive heart failure, dies of kidney disease, that’s to be expected. That goes with the disease. If a patient of mine dies of hypoglycemia, it’s my fault and I get sued. So, I’m going to keep my patients as far from hypoglycemia as I can.
Now, if you have them on high carbohydrate diets, where the blood sugars can vary by plus or minus 150 in a day, you want to keep their blood sugars certainly above 250. And 200 is an A1C of 7.
However in the UK, you don't get sued, so that's not a good argument out of the US (and coincidentally describes why health care in the US costs so much...)
I aim for Bernstein blood sugar and HBA1C targets , don't always get there but am close. Never had a HBA1C of 4.6 % but will keep trying. Don't low carb anymore but can still achieve non-diabetic targets.
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But for what I'd lose in terms of quality of life wouldn't be worth it.
and honestly I'd love to know how if you are not low carbing.
I don't understand what you would lose in terms of quality of life by having a lower HBA1C ?
Well driving licence and hypo awareness symptoms would be two @Wurst,
I exercise most days and honestly my control would be much easier if I didn't!I don't understand what you would lose in terms of quality of life by having a lower HBA1C ? Do you mean the extra effort ?
Daily exercise !
Honestly, why do we get so bothered about it? Sad to say it, but for the majority of people, Bernstein's approach isn't doable.I live in Germany who are also a bit 'sue happy', so there is another good argument 'out of the US'. UK and US appear to have similar BS guidelines, so who is copying who ?
Good point , I'm not aware of the HBA1C limits for a UK driving licence disqualification , what are they exactly?
In Germany you have to be over 5 mmol to drive which if averaged out would be ~ HBA1C of 4.8 % or 29 . I've yet to experience a problem with hypo awareness running in non-diabetic levels.
Same in the UK, you have to be above 5mmol/l which would make it impossible to get a HbA1c of 4.6 as Bernstein would like.
Isn't Bernstein hypo unaware anyway, sure I read he was, I know of other people who have tried to get their HbA1c <5.0% and have lost their hypo awareness symptoms, if you lose them then your automatically disqualified from driving in the UK which is a heavy price to pay if you rely on a licence for work and recreational purposes.
I'm no mathematician but you would only need to be 5 mmol to drive not for an entire 2-3 months 24/7 , unless driving was your profession. If you were only driving 1 hour per day @ 5 mmol you could still hypothetically attain a 4.6 HbA1C. I was at 4.2 mmol for most of the weekend and perfectly happy.
I understand the argument for avoiding non-diabetic levels as it is not possible for everyone, nor am I saying I am right and others are wrong but while I can attain these levels I intend to continue
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