True. Its a bit like total cholesterol or BMI or only knowing total goals scored in a footie match! Not the total picture.Another reason why HbA1c in isolation is an overrated measurement of glucose control. Two people could have identical HbA1c but wildly different glucose regulation.
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.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.
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.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.
One has to ask how open minded doctors all over the world in general are.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.
Dr Bernstein's personal story is another great example of where exemplary BSL control paid dividends.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.
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.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).
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!One has to ask how open minded doctors all over the world in general are.
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).
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.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.
Do you use your diet to keep it tight or can you eat anything?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.
That is fantastic.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.
Diet, careful dosing and tech. I would have great difficulty doing it without those tools.Do you use your diet to keep it tight or can you eat anything?
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