Not all HBa1c's are the same !

[CherryAA]

http://bjgp.org/content/67/657/158.3

"On the one hand, the epidemiological evidence shows a strong link between chronic hyperglycaemia (HbA1c) and adverse patient-important outcomes. On the other hand, the evidence from randomised controlled trial shows that lowering HbA1c by drug treatment is ineffective or harmful to patient outcomes. This contradiction is because we are using the wrong paradigm.

The current paradigm is that HbA1c has a causal relationship with adverse outcomes and that lowering HbA1c by any means must improve patient-important outcomes.

The alternative paradigm is that chronic hyperglycaemia is partly causal, but is only a late and easily measurable part of a more fundamental problem.

Our culturally ‘normal’ diet, based on carbohydrate, is biologically different from the diet the human species evolved to thrive on. A large proportion of people cannot tolerate a carbohydrate-based diet over years, even ‘healthy whole grains’. Eating starch is eating glucose, which requires a corresponding insulin response. An insulin response with every snack and meal for years can, in genetically vulnerable people, cause insulin resistance with variable expression among people and among different body tissues. The Hyperinsulinaemia and Insulin Resistance (HAIR) is the underlying problem driving disorders of glucose and lipid metabolism, characterised by pathological fat deposition as central and visceral obesity, metabolic syndrome, and, when the body’s compensatory mechanisms fail, type 2 diabetes mellitus (T2DM). The whole problem is the cause of the patient-important outcomes, not just the hyperglycaemia.

It is now easy to see: if drugs lower HbA1c by raising insulin and worsening HAIR, this can be ineffective or harmful to patient outcomes.

The standard treatment of T2DM, endorsed by the drug industry, is to base every meal on carbohydrate, which may worsen the underlying insulin response and HAIR, rapidly followed by multiple chronic drug prescriptions, which may be ineffective or harmful even while temporarily improving HbA1c.

A low carbohydrate, high healthy fat ‘real food’ diet can reverse the underlying dietary cause, offload the pressure on glucose and lipid metabolism, and allow the HAIR and T2DM to gradually recover."

Yet more confirmation for me, that the optimal approach is diet first THEN think about drugs.

 

[Bluetit1802]

The contents of this excellent article have been discussed previously on the forum (not the actual article, but the logic behind it)

It has often amazed me why the medical professions give T2s drugs to stimulate insulin production when they have little idea whether the patients already produce too much naturally, but insulin resistance prevents it from working correctly. I include insulin injections in this. There are tests to determine this, but none of them given routinely by the GPs, and anyone asking for them is likely to have much opposition. Far better to put them on low carb diets and thus lower insulin production rather than try to increase it.

Of course there are some T2s who do not produce enough insulin due to knackered beta cells.

Surely it would be better for all concerned to do the tests to see which category the patients falls in.

 

[CherryAA]

After 6 months on LCHF my own insulin is still registering 20 - my doctor says this is "Normal" range - its true its lower than ti was but truly normal would be about 5

The very idea of insulin injections to "help" me - which is what was discussed initially is just bizarre .

 

[Resurgam]

For decades I was lectured on my non compliance with the standard high carb but low calorie diets which simply did not work, but that was obviously my fault, for not doing them properly for cheating and lying about what I ate. The concept of a person who can put on weight whilst eating a 'proper' diet was just alien to my doctors and nurses.
Being able to lose half a stone in three days when I first tried Atkins was a great shock to me, after all the anguish - being able to reduce Hba1c from 91 to 47 in 80 days was also surprising. The reactions of my doctors - no comment.

 

[Bluetit1802]

After 6 months on LCHF my own insulin is still registering 20 - my doctor says this is "Normal" range - its true its lower than ti was but truly normal would be about 5

The very idea of insulin injections to "help" me - which is what was discussed initially is just bizarre .

http://emedicine.medscape.com/article/2089224-overview

This is an American website so the measurement units may not be the same. If you have a print out of your test results the reference range should be on there.

 

[CherryAA]

Thanks @bluetit, I have seen the fasting reference range of under 25 before, that is why my doctor told me I'm normal
However the normal range is 2.6 - 24.9 and as far as I can gather that is because a large proportion of the population eats a ****** diet that increases insulin. The ideal range is closer to 2.6- 5.0 ( or so I read somewhere amongst the plethora of research I seem to have accessed now.)

 

[douglas99]

"Our culturally ‘normal’ diet, based on carbohydrate, is biologically different from the diet the human species evolved to thrive on."

I evolved to catch a banana or possibly some wheat, if it wasn't moving too fast in the wind.
There is absolutely zero chance I could catch a wild boar.

So, unless evolution peaked at unwrapping the clingfilm packages from the meat counter at Tesco's on the modern Paleo diet, mankind is probably at a dead end anyway you look at it now.

 

[NatJS]

There are a couple of drugs that help to improve insulin sensitivity, metformin and Actos (pioglitazone). But yes, I agree that it's strange that the insulin resistance isn't generally more addressed by the medical profession.

 

[britishpub]

@douglas99 whilst it is patently nonsense to claim that the human species evolved eating a low carb diet, it seems to me that our brains have evolved far faster than our digestive systems, which is probably the root cause of most of our current health issues.