incentive for good control

H

hanadr

Expert
Messages
8,157
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soaps on telly and people talking about the characters as if they were real.
I have thought for ages that it makes sense to keep TIGHT control.
After all not many non-diabetics get "Diabetic Complications". Although it has been shown that non-diabetics with above optimal HbA1cs do develop them.
This is where Bernstein's thinking is helpful. The space between normal BG and Hypo is narrow, so by minimising insulin doses, the risk of tipping over is reduced. This more particularly applies to T1
For me as a T2, using only minimal doses of Metformin, Hypo is a RARE thing. I developed one some weeks back, for no reason I was ever able to identify. I know what it feels like, because I used to use Gliclazide, which can cause it and in my case did a few times. Metformin is meant not to and my doses are small.
I have been jumped on a number of times by different people, because I always advocate reducing carbs, although I usually do say that increasing medication is an option. I am wary of side effects from any medication,so I chose not to use the "more medicine" option.
Since reading the recent studies on the effects of Leptin, I am more convinced that treating diabetes, need to tackle the causes and not just the symptoms.
( again this applies more to T2 than T1
Back to Bernstein: it seems that Bernstein patients are pretty free of complications, as is he.
 
C

cugila

Master
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10,272
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People who are touchy.......feign indignation at the slightest thing. Hypocrites, bullies and cowards.
I see the article is specifically about T1's but as Hana stated tight Bg control is effective and beneficial for ALL Diabetics whether T1 or T2. it makes no difference.

Ken
 
phoenix

phoenix

Expert
Messages
5,671
Type of diabetes
Type 1
Treatment type
Pump
I agree entirely that tight control is vitally important.but do not feel that Dr Bernsteins methods are necessary or good advice to most people, in particular most type 1s.
The DCCT (as included as part of the data set discussed above) has also recently produced a report on the diet of those characterised with good control..... ie those that had fewer complications.
Association of diet with glycated hemoglobin during intensive treatment of type 1 diabetes in the Diabetes Control and Complications Trial
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19106241

Conclusion
In summary, this analysis of DCCT participants who were randomly assigned to intensive therapy found that diets higher in fat and saturated fat and lower in carbohydrate were associated with worse glycemic control, independently of exercise, triglyceride concentration, and BMI but not after the baseline degree of glycemic control or insulin dose were controlled for. Contrary to commonly reported dietary practices of persons with diabetes who may restrict carbohydrate intake, these results support current recommendations regarding the limitation of saturated fat intake while promoting the consumption of nutrient-dense carbohydrates, such as fruit, whole grains, and vegetables, with appropriate insulin doses as needed. Future research needs to explore whether persons with diabetes inadvertently increase their saturated fat intake in their efforts to control carbohydrate intake and glycemia

It is worth reading the discussion section because as in all types of research like this there are some confounding variables. When iresearchers adjusted to take into account Hb A1c before the trial, the results were not significant.... They discuss the possible reasons for this ( better existing management skills at baseline, or possesing some residual insulin for example). It is perhaps possible that people who had higher levels at baseline are those (that for whatever reason) find control more difficult and may indeed cut their carbs and substitute with fat in their efforts to achieve control.
The researchers also suggest that carbohydrate content of the diet was less critical than the sat and monounsaturated fat content and discuss this.
 
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