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No benefit to too tight a control of type1 diabetes?

Discussion in 'Type 1 Diabetes' started by ickihun, Oct 10, 2019.

  1. ickihun

    ickihun Type 2 · Master

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    • Informative Informative x 1
  2. HSSS

    HSSS Type 2 · Well-Known Member

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  3. Grant_Vicat

    Grant_Vicat Don't have diabetes · Well-Known Member

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    All I can say is that tight control with an HbA1C of between 6 and 7 for many years slowed down my kidney deterioration appreciably. Put it another way, I was passing proteins at the age of 15 in 1973. I would have undergone dialysis in 2013 had not a donor come to my aid. I agree with what @HSSS has pointed out, but I wonder what might have happened had I not been so stringent.
     
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  4. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Thanks as I'd missed that 1 and I am a type one who feels terribly guilt for not having a normal HbA1c.
    As the article points out, the latter measurement may mask a rollercoaster of highs and lows whereas the new tech should help us achieve better and more even blood sugars - there's hope! I think it was this pregnancy related rollercoaster that probably led me to have retinal bleeds.
    It confirms the 2008 studies (Accord) re the correlation of much less complications with a 7% and under result.
    Anyway this article has made me feel better so thanks again for thinking of us type 1s....
     
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  5. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Another reason why HbA1c in isolation is an overrated measurement of glucose control. Two people could have identical HbA1c but wildly different glucose regulation.
     
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  6. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    True. Its a bit like total cholesterol or BMI or only knowing total goals scored in a footie match! Not the total picture.
     
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  7. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Yes, doctors almost have a mantra about this: if you are having to use lots of insulin to get and keep BSLs down then hypos are more likely.
    But see Pediatrics March 2018 Management of Type One Diabetes On Very Low Carbohydrate Diets authors Lennerz, Ludwig et al you can see average HBA1C around 5.6%, low BSL variability and very low hypo rate.
    As the author of the Swedish study notes, the statistics are not as clear when looking at the lower HBA1C levels. How many TIDs did the study find say, at HBA1C of 5.5 % or lower? How can you compare the HBAIC and complication rate them if there were not many sub 5.5%?
    Is this study really just proving the obvious? If you use a usual diabetes diet and try to achieve low HBA1Cs you are at increased risk of hypos?
    The ADA would applaud as they have set upper limits for recommended acceptable BSLs for TIDs of 10 mmol/l. Why? Anecdotally US physicians are worried they will get sued if a patient of theirs suffers from a hypo, never mind that the recommended BSL ranges may lead to their patients being at risk of diabetes-related complications later on when it may be more difficult to prove what caused the complications to occur.
    The ACCORD study did show increased risk of CVD in T2Ds and TIDs for HBA1C below the 6 to 7% HBAIC range but not why. Other similar studies showed lower risk as HBA1C was progressively lower. The difference between the studies depended on how you divided up the HBAIC intervals vs the CVD occurrence. So 2 studies (ACCORD and one other) showed the U type curve, (higher risk at low and high HBAIC) whereas 2 showed a line with lower risk as HBAIC became lower. So what to believe? It sounds like statistics may be born liars, but which pair of studies do you believe? And intuitvely, if CVD is lower in non-diabetics (with their normal HBAICs) than TIDs with higher HBAICs, I know what I am going to go with.
     
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    #7 kitedoc, Oct 10, 2019 at 8:20 PM
    Last edited: Oct 10, 2019
  8. ickihun

    ickihun Type 2 · Master

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    I only lose weight, even 4mths after my bariatric surgery on bgs lower than 6.5mmol/ml. Anything higher I stay the same or add.
    I'm still classed as obese.
    GP has me noted as Type1(Insulin dependent) and Type2 (IR).
     
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  9. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    I find it awful that clinicians other than Richard Bernstein do not consider the benefits of lowering insulin by eating low carb and therefore reducing dosage errors, but rather are still fixated upon the idea of balancing insulin doses with carbs as if diabetes was all about maths rather than biology. That's my experience in the UK where the life of a diabetic consultant must be frustrating given the lack of success in getting patients to achieve the target numbers without going hypo a lot.
     
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  10. kitedoc

    kitedoc Type 1 · Well-Known Member

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    One has to ask how open minded doctors all over the world in general are.
     
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  11. kitedoc

    kitedoc Type 1 · Well-Known Member

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    Dr Bernstein's personal story is another great example of where exemplary BSL control paid dividends.
     
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  12. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    You are doing so well on the weight loss. Have you noticed reduction in the insulin needed to get your bgs in that range? You'd assume that losing fat around the liver and pancreas would help a lot with insulin sensitivity. Having said that although I am not big, my insulin needs vary dramatically at around week 4 of my cycle so it is hardly straight forward.
     
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  13. NicoleC1971

    NicoleC1971 Type 1 · Well-Known Member

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    Not very given that they have to learn a vast quantity of knowledge from tablets of orthodox stone, half of which is reckoned to be out of date within 5 years. You'd have to be a brave doctor to step out of line but there are some heroes. At least the experience of type 1 gives us a healthy scepticism about the art of medicine!
     
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  14. Jim Lahey

    Jim Lahey I reversed my Type 2 · Well-Known Member

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    Looking good there though. You look healthier and happier than in previous avatars. Not that I spend my time on here stalking people's avatars, you understand, but in my opinion the improvement is clear to see.
     
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  15. ickihun

    ickihun Type 2 · Master

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    Thanks @Jim Lahey. I have some lovely tops I bought when I lost on low carb eating so they are back out. I'm always the optimist regarding one day being an average size. I did it with heavy exercise in the 80s. Got married and trained with a footballer in 90s. Divorced in 00s and exercised til I couldn't walk well in this decade. This decade is by far the hardest on my health. Scared to predict what turning 50 has in store for me in just over a years time.
    I'll be delighted to grow old, the older the better. However no plans on doing it quietly. Ha ha
     
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  16. LooperCat

    LooperCat Type 1 · Well-Known Member

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    I think time in range is far more important than HbA1c. Used together they can be a powerful indicator of control; I’m usually around 80-90% in my 3.8-7 range with less than 2% below - and even then only slightly. Combined with an HbA1c of 35 (5.4% in old money) I’m confident I’m at minimal risk of both complications from hyperglycaemia and serious hypoglycaemia.
     
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  17. ert

    ert Type 1 · Well-Known Member

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    It's all about time in target now. Or so my Specialist says. It didn't concern him that my HbA1c was 5.3% (which my diabetes nurse was apoplectic about as she wanted it above 6%) as I have spent only 1% time below 3.9 mmol/l over the last 3 months.
     
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  18. ickihun

    ickihun Type 2 · Master

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    Do you use your diet to keep it tight or can you eat anything?
     
  19. ickihun

    ickihun Type 2 · Master

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    That is fantastic.
    I'm back to see my specialist in March and will hv loads of data with food references. I'm wondering if I need to start using my novarapid on carb and protein counts. I'll ask what he thinks and take his advice. I'm losing weight after an operation so we are giving priority to that. I'm slowly reducing both insulins but without Novarapid I get bgs numbers raised as a knock on effect. So I'm correcting. Constantly at mo.
     
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  20. LooperCat

    LooperCat Type 1 · Well-Known Member

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    Diet, careful dosing and tech. I would have great difficulty doing it without those tools.
     
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