No benefit to too tight a control of type1 diabetes?

[SueJB]

If this has been posted already I apologise.

https://www.medscape.com/viewarticle/917865?src=soc_tw_191011_mscpedt_news_endo_hba1c&faf=1

Thanks @ickihun it was new for me. The thing that struck me most is "time in range". I suspect that without a CGM or being a pump user, you wouldn't get any idea of this especially if you're a simple finger pricker like me

 

[KK123]

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

Well all I know is you look abut 12 you lucky lady! x

 

[KK123]

I sometimes wonder if it's just the hba1c test we should be looking at. No mention is made of the other hormones that work (or don't) in tangent with each other, ie one goes up so the other comes down to compensate, one is out of whack so another one adjusts accordingly. I 'worry' that by forcing glucose down artificially low or too low wherever the bar is set (not that we have a choice in our use of insulin obviously) it has an effect on those other hormones, could they also be responsible for this suggested rise in risk of CVD for example.

 

[JAT1]

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.

I totally agree. I wonder about the accuracy of the Hba1c in my case. Last test it was less than 4.2%. Measurements below that are not given here. And yet I have had only a couple of hypos since diagnosis on Aug 1 2018 and nothing I couldn't easily deal with by myself. All my readings are between 4 and 10, usually around 6 !! I finger prick. The endo is baffled and just keeps ordering more tests ! But I have had 3 now with under 4.2%. I think it's because I have gone from an extremely high carb diet before diagnosis to slowly working towards lower and lower carb, currently around 40 to 60 per day. The doctor wants to keep testing until she finds something wrong with me. I'm sick of her approach. "Seek and ye shall find." No thanks.

 

[JAT1]

Thanks @ickihun it was new for me. The thing that struck me most is "time in range". I suspect that without a CGM or being a pump user, you wouldn't get any idea of this especially if you're a simple finger pricker like me

If you stick to low carb (never more than 10 carbs every 3 hours, eaten with plenty of fat), so that essentially there is nothing within your control to push your bs up, it's my opinion that finger pricking is enough. I have to pay for all supplies out of my own pocket and with my budget I only measure my bs usually just once a day before bed. (I have a job but life is expensive here and I prefer to spend more on meat than using my last dollar on measuring my bs. Mind you, if I'm battling a cold or feel something "off" like routine exhaustion, I measure more, but the buck always stops somewhere.

 

[Grant_Vicat]

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!

I would guess you've come across some who have the grace to admit that you probably know more about managing your regime than them? I hope so!

 

[SueJB]

If you stick to low carb (never more than 10 carbs every 3 hours, eaten with plenty of fat), so that essentially there is nothing within your control to push your bs up, it's my opinion that finger pricking is enough. I have to pay for all supplies out of my own pocket and with my budget I only measure my bs usually just once a day before bed. (I have a job but life is expensive here and I prefer to spend more on meat than using my last dollar on measuring my bs. Mind you, if I'm battling a cold or feel something "off" like routine exhaustion, I measure more, but the buck always stops somewhere.

Thanks @JAT1 but I think you may have slightly missed the point I was trying to make. Monitoring BG at certain times by finger pricking, gives you exactish info on specific times but does not give enough 24hr coverage of time in range.
Not sure where you live but it must be hard to have to pay for everything. Goodluck

 

[EllieM]

I totally agree. I wonder about the accuracy of the Hba1c in my case. Last test it was less than 4.2%.

You may be one of those people for whom the hba1c gives an inaccurate result (certain blood conditions, blood cells that live longer or shorter than the standard 3 months, etc). If they are concerned, the could do a back up fructosamine test to see what that says.... (Not sure how it works, but it gives a measure of the last 2-3 weeks of control, typically used for pregnant women where you want to know the most recent history.)

 

[Antechinus]

Around the 29 minute mark of Ivor's interview with Malcolm Kendrick they discuss how high insulin levels in blood are bad for arterial health. Malcolm states that both high sugar and high insulin are bad. Need to get both down.

My understanding being that while you can manage high glucose intake with greater insulin use, preferably avoiding hypo's, in the long run your better off trying to reduce your insulin use.

 

[becca59]

I’m sorry. That is too simplistic. Many people need high levels of basal insulin. That is not dictated by food. Yes, you can reduce your bolus insulin if you eat less carbs. And that is the point. It is not reducing your insulin, it is reducing the carbs which then require the insulin.

 

[Member496333]

Around the 29 minute mark of Ivor's interview with Malcolm Kendrick they discuss how high insulin levels in blood are bad for arterial health. Malcolm states that both high sugar and high insulin are bad. Need to get both down.

My understanding being that while you can manage high glucose intake with greater insulin use, preferably avoiding hypo's, in the long run your better off trying to reduce your insulin use.

I also read somewhere that, given an equal level of sensitivity, exogenous injections result in higher blood insulin concentrations per x amount of cleared glucose when compared to those who produce insulin in the pancreas. I forget the exact mechanism but I believe it is something to do with the pancreas normally delivering the bulk of insulin directly to the liver rather than it circulating the whole body before it gets there.

I'm sure it's way more complex than that, though. Insulin doesn't just act alone in the liver, for one thing. I think someone here recently posted a link to a video or online literature that explains it far better than I'm able to.

 

[EllieM]

it has an effect on those other hormones, could they also be responsible for this suggested rise in risk of CVD for example.

I've wondered what effect c-peptide has on cardiovascular health (or health in general). I assume as T1s without insulin we're also without c-peptide, should we be injecting it with the insulin?