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recent insulin study

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By non-compliance I meant that people didn't take the meds they were prescribed, yet didn't make any dietary changes that could have lowered their blood sugar.

Edit: I also meant people who didn't join a forum like this would probably never find out about different ways of controlling their blood sugar by eating less carbs as the standard NHS diet suggests that a Type 2 should eat starchy carbs with every meal.
 
I think Catherine has hit the nail on the head, the higher mortality rate is IMHO down to non compliance and the fact that rather than carb count and match the insulin to their food these poor soles are given a regime where they are kept artificially high to stop the likelihood of hypos. What the study calls good hba1c does not necessarily tell the whole story.

I was put on multiple daily injections (MDI) of insulin at diagnosis when my hba1c was 12.6% and my bg on entering hospital was 29.something mmol/L my next hba1c 3 months later was in the 5's and I have kept it in the 5's ever since and during the 12 months I was on insulin I lost over 4 stone in weight so its not a given that you will put on weight although I almost certainly would have if I had carried on my old lifestyle of overeating.

As has been said here many times that we are the enlightened ones who are being proactive in our care, people who are aware of the possible complications and doing our best to prevent them, unfortunately there are a lot of diabetics who simply bury their heads in the sand refuse to make any lifestyle changes and are happy to carry on with their poor nutritional lifestyle blindly believing that their medication will somehow allow them to eat and drink what they like.

The research shows a higher mortality rate it doesnt say that everyone on insulin is at higher risk and the hard facts are that if you dont make lifestyle changes or at least watch what you eat the chances are that as a T2 you will progress through a range of medications till you reach insulin and then if you still carry on as though nothing is wrong yes the outcome is unlikely to be a good one and you will almost certainly become another statistic of higher mortality associated with insulin treatment.

But it doesnt have to be like that and if you watch your diet and mange your insulin well then you are probably at no greater risk than a T1 I'm sure the same could be said of T1's who for what ever reason are not concerned over their own care is their mortality rate not higher than those who are well controlled?
 
Last night I went to bed really worried by what I'd read here about Insulin DepType2 diabetics..... I've been one since 2004. Reading your post Sid makes me feel a bit better. Since late October I've changed my eating habits to Low Carb 30g resulting in a weight loss of 17lbs, my insulin to humalog 25mix ( due to a gp error I was prescribed the wrong insulin for almost three years!) and by making those adjustments have successfully reduced my BGs to 5s and low 6s. My DN was happy with my BGs being in the 8s but I wasn't so I upped my insulin by a total of just 4 units and achieved my plan. I now inject 27 units pre breakfast and 22 pre dinner. Is this acceptable or am I increasing my chances of an earlier demise? I don't know.
 
What a great post Sid
 

That makes perfect sense to me.

It was interesting that one of my doctors was quite insistent that as my attempt to avoid progressing from pre-diabetes to full diabetes through diet failed, it is inevitable that I will be put on insulin sooner or later, and probably sooner. Of course at the time that I was trying to control with diet I was following the "eat starchy foods with every meal", so called NICE balanced diet she had told me to follow. Since I found this forum, read the various arguments for different diets and decided to go LC route everything has improved drastically (both Bg and especially cholesterol and trigs were rising to very bad levels on the not so NICE diet)so I am confident that the progression will be much slower than she seems to think will be the case. Fortunately her colleagues agree with me rather than her.



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Hi Sid,

Thanks for your thoughts. Unfortunately (for us insulin users!) I don't think that is the most likely interpretation of the study results, for the following reasons: 1). people in all comparison groups were 'incident cases' (that is, the authors used a criterion that to be included people had to be recently diagnosed and diagnosed for the first time), so in theory at least they won't have been people who had failed to comply with any therapy for years and gone through an escalation of medication, for whatever reason insulin for the insulin group was chosen as pretty much a first line therapy (we could query why). 2). Anyone with prior health issues of relevance to the study was excluded (so any health problem evaluated developed subsequent to the therapy of choice) 3) an extensive list of baseline characteristics was controlled for in multivariate analyses (meaning that these differences therefore did not impact on outcome (characteristics were: age, gender, HbA1C, blood pressure, smoking history, cholesterol, weight, duration of diabetes, LVD, creatinine levels, experience of antihypertensives, antiplatelets, aspirin, Charlston co-mobidity status and GP contacts in prior year. The outcomes therefore are given with all of these risk factors 'equal'. So, sadly, the clear implication made by the authors is that it is insulin as such that causes the reported higher rates of adverse events.

We could critiscise the study for being retrospective, but given the very large sample sizes, I am not sure we would see much difference with a prospective study.

I don't want to give people (including myself!) sleepless nights, but I think we need to at least assume for the moment that maybe insulin is dangerous and all try to cut down on it whilst keeping our BGs as good as possible - it is a balancing act for those who 'have' to have it, maybe 'better insulins can be developed if we press for that.
 
"but I think we need to at least assume for the moment that maybe insulin is dangerous and all try to cut down on it whilst keeping our BGs as good as possible"

This can be done with a L** C*** diet.

FB
 
Would maybe better to say misusing insulin to combat eating too much food is dangerous, as is those who do not take it properly from fear like this or to loose weight inappropriately. DWED, diabetics with eating disorders.

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"Would maybe better to say misusing insulin to combat eating too much food is dangerous"

Would maybe better to say misusing insulin to combat eating too much of the wrong type of food is dangerous.

FB
 
For me its all about getting the balance of my foods eaten right .

Portion control too , little snack size meals suits me best .
This is in my signature also !
Know what foods spike me and stay well clear from all of these .

NEED my insulin as tablet medications FAILED to make a ' dent ' in my
previous too high BS levels .
Always been skinny and was cocky with this when young too !
 

Even if a type 1 was to low carb, I really don't think it would effect those figures. Why, because as type 1, still need to inject basal which in itself is a nightmare to get right, and does need regular adjustment and a good knowledge, sadly lacking through education from some healthcare pros. There have been many posters asking about basal testing. Even then, protein converts into glucose which is more difficult to "predict" on levels and would still need the same education to learn to count for protein instead of carbs. Then theres the danger of ketoacidosis, if levels rise through not enough insulin, much quicker than someone who does produce some insulin naturally. Whatever your diet, testing, adjustment, and an element of predictability is required, and the same knowledge for type 1s needed as counting for carbs or counting for protein. Thats a personal choice.
Obviously limit insulin to suit your diet, and if following a healthy one, need to inject what you need, so insulin harmful,less harmfull than not having it.

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"Even if a type 1 was to low carb, I really don't think it would effect those figures."

Oh but it does Brett. I know lots of type one diabetics holding non diabetic HbA1c numbers. Some are members of this forum.

FB
 
fatbird said:
"Even if a type 1 was to low carb, I really don't think it would effect those figures."

Oh but it does Brett. I know lots of type one diabetics holding non diabetic HbA1c numbers. Some are members of this forum.

FB
Click to expand...

Yes, and they have the knowledge and confidence to adjust basal, count for protein and predict through testing how different activities can effect their sugars. Ive read their posts. Not saying it can't be done at all, just same knowledge needed. Exactly the same as myself just counting carbs, and eating the right ones.

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I think those that post regulary here are a different breed to the majority of diabetics. We've made a conscious effort to educate ourselves and others. Most diabetics unfortunately are not interested in this or any other forum and go through life struggling quite often.


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We agree Brett-it can be done-this is very interesting.

BACKGROUND
Intensive diabetes therapy aimed at achieving near normoglycemia reduces the risk of microvascular and neurologic complications of type 1 diabetes. We studied whether the use of intensive therapy as compared with conventional therapy during the Diabetes Control and Complications Trial (DCCT) affected the long-term incidence of cardiovascular disease.

METHODS
The DCCT randomly assigned 1441 patients with type 1 diabetes to intensive or conventional therapy, treating them for a mean of 6.5 years between 1983 and 1993. Ninety-three percent were subsequently followed until February 1, 2005, during the observational Epidemiology of Diabetes Interventions and Complications study. Cardiovascular disease (defined as nonfatal myocardial infarction, stroke, death from cardiovascular disease, confirmed angina, or the need for coronary-artery revascularization) was assessed with standardized measures and classified by an independent committee.

RESULTS
During the mean 17 years of follow-up, 46 cardiovascular disease events occurred in 31 patients who had received intensive treatment in the DCCT, as compared with 98 events in 52 patients who had received conventional treatment. Intensive treatment reduced the risk of any cardiovascular disease event by 42 percent (95 percent confidence interval, 9 to 63 percent; P=0.02) and the risk of nonfatal myocardial infarction, stroke, or death from cardiovascular disease by 57 percent (95 percent confidence interval, 12 to 79 percent; P=0.02). The decrease in glycosylated hemoglobin values during the DCCT was significantly associated with most of the positive effects of intensive treatment on the risk of cardiovascular disease. Microalbuminuria and albuminuria were associated with a significant increase in the risk of cardiovascular disease, but differences between treatment groups remained significant (P≤0.05) after adjusting for these factors.

CONCLUSIONS
Intensive diabetes therapy has long-term beneficial effects on the risk of cardiovascular disease in patients with type 1 diabetes.

http://www.nejm.org/doi/full/10.1056/NEJMoa052187

Of course -it is how good control is achieved that makes all the difference.

FB
 
Keep taking sentances from a paragraph and ignore what else ive said lol.
If insulin is needed not alot you can do about it if type 1. Even low carbing proper education is needed for dosing basal, protein will need to be insulated for. The same factors apply if using insulin on any diet, the need to adjust for excercise,stress,illness, quantity of carbs or protein,time of meals eaten and im sure ive missed a few. If you need it you need it. Its the education on adjusting the insulin for the above which is lacking for alot of individuals, along with what mo sarid about people not taking a big interest in it such as regular posters here, which is why I think it would not effect those previous figures, and not stop the fact type 1 require the stuff

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This thread couldn't have come at a worse time for me...
 
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