The Cure for Type 2 Diabetes

alliebee said:

I would'nt waste my breath Grazer, No one has helped me more than you with your well informed advice and kindness to others on this site.

Alison x

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Thanks so much for the kind post alliebee. It's nice that some people don't just post to pick holes in others. The post preceding this one is obviously just rude and ignorant so I won't bother commenting on it, other than to say I think it defines the expression "sour grapes"

Errrr, pot and kettle spring to mind Grazer, just how personal do you have to make a post for it to be deemed unacceptable, as for snide remarks about comments on another thread, well as I said pot and kettle, I'm sure you know the rest

Oh dear, yet again confusion between the medical definition of a hypo and the ordinary Diabetes perseption of a hypo. I am diet controlled but have had hypos after too much exercise. I have dropped to below 3mmol/L and felt awful. Thankfully I liver dumped and all was well. If I had been driving however I may have caused an accident and the police would have taken a very dim view of my Bg status. If I operated machinery and dropped that low,again that would be dangerous. It is a large subject and not one to be treated by generalisations. We all need to keep the middle ground not too high or too low sos that we can function properly.

Incidentaly the OP of this thread is well known ,not only on this forum but also elsewhere on the internet , there is not cure, yet, even the OP is now on Byetta I seem to remember reading . I have read extensively over the years and NO-ONE not even the experts have a definitive answer to diet in Type 2. The best we can hope is to find a diet that suits us, keep our Bg levels stable and pray that we have picked the right choice.

I'd just like to add, for the two people who posted yesterday with questions about the subject of this thread, that the original thread is quite controversial and is in any case very old, so you might not get a reply from the Original Poster (OP).

Going back to today's discussion: I don't get hypos if I go below 4 - but I used to get night-time hypos quite frequently, pre-diabetes, from drinking too much. So I do know what they feel like. I certainly wasn't diabetic then - I've had my BGs tested every 6 months for the last 12 years, which is why I was caught so quickly.

I too used to carry glucose with me at all times, and over-treat if I went below 4. As I've got more experienced, I know I'm okay even in the mid-threes. Both my liver and my pancreas appear to be functioning quite well at present.

You sound just like one of our former Moderators, Angeleyes, who used to emphasise "4 is the floor" all the time in discussions like these. I think it's a good rule of thumb for newbies - but no need, either, to panic them into thinking something awful is happening to them right now. Getting stressed will only make things worse.

If you go below 4, test - then test about 15 minutes later, and if you're still dropping chew 2 or 3 glucose tabs, test again after 15 minutes to make sure you're going up, and then eat a small carby snack to stabilise yourself.

What people who aren't given testing kits are supposed to do I don't know.

Sorry, Grazer, I have a Type 2 friend (diagnosed for 9+ years) who has random hypos, paramedics and all, without any warning at all. She was diet-only to begin with, is recently on Metformin, and follows the NHS diet guidelines. She never tests. I am beginning to think there is more wrong there than the diabetes, or she's been misdiagnosed, but she won't discuss it at all. She is the exception - I've never heard of another Type 2 with exactly that problem.

For levels in general, HbA1c or daily, there is nothing wrong with a Type 2 aiming for non-diabetic levels unless there is another medical reason why they shouldn't. Discuss with your doctor.

Viv 8)

Good post, Bystander - this is getting slightly beyond helpful.

Hypoglycaemia is not limited to diabetics and under the right set of circumstances anyone can become hypo.

Medically 'normal' fasting blood glucose ranges from 3.3 mmol/l to around 4.5 mmol/l... healthy individuals normally present symptom of hypoglycaemia at around 2.4 - 2.7 mmol/l...

General advice is not to let your blood glucose go below 4 mmol/l as if you are being treated with medication then potentially your blood glucose can change more rapidly and therefore you are at greater risk of hypo. Any symptoms that you feel before you go much below 3 mmol/l are your body prompting you to eat in an attempt to avoid a hypo.. these feelings are generally felt as we drop below 4 mmol/l but can be higher in individuals that have poor blood glucose control.

As with anything however people are individuals and ranges are averages so you may be different...

Also not to sound dis-respectful to the type 2's out there but there are hypos and there are 'hypos!' feeling a little shaky and confused and bad is a mild hypo and obviously needs to be treated.. but then there are hypo's where you lose time, pass out, have fits.. and literally take days to recover from.. those are 'real' hypo's and not just your body prompting you to eat.

Just to add a bit more support to the 'below 4 is not neccessarily a hypo' arguement. I had a couple of reading in the high 3's last week and felt absolutely fine. I wasn't hungry, shaking or foggy headed at all (I'm diet and exercise type 2-as far as I know).

Also, in a channel 4 series I saw a while back, called the 'Food Hospita'l, a type 2 diabetic guy was given help to bring his bg levels under control, when he came back after a while to be retested he was at 3.8 and the doctor told him that was perfect! He didn't mention it being too low at all.

I know this isn't particularly scientific evidence, but anecdotally, it seems that below 4mmols, for a type 2 at least, is not much of a problem.

Aha ! Now what you are describing Sirzy is a lack of hypo awareness ! 4 is the floor was a good saying( I remember that too Viv) The original definition of hypo was below 3.8 but rounded up both for ease of remembering and also to give some leeway in avoidance treatment. I generally start feeling 'not right' about 3.9 ish.

I think all diabetics should be aware of the different perceptions of the word 'hypo'. To the medical profession it means a medicine induced condition usually requiring third party intervention and could be life threatening as the body will not be able to correct it on its own.
To most Type 2 diabetics it will mean the above mentioned 4 is the floor and you can usually avert going lower with a glucotab or something similar, you will ,if you are on diet only or Metformin probably liver dump as well to correct it. Testing is always the key to stopping it becoming a problem as Viv said.
We all need to be aware to keep ourselves in peek health no matter which type of diabetic you are or whether you are 'just' diet only or medicated.

All good stuff so thanks, but just bear in mind that the original purpose of this subject was to re-assure a new poster that she wouldn't risk dying by trying to reduce her HbA1C (not her BG) below 7.5. Still valid I think and wouldn't want the newbie to be led to believe otherwise.

With all due respect Grazer it is always better to re-read what you have written in terms of someone not knowing anything about diabetes reading what you have written. Hypos are always an issue for diabetics no matter how mild or severe they are and generalisation does not help. You also said

Pretty obvious really that she's more likely to die with an A1C of 7.5 than from going hypo on diet only.

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That is a very scary thought for anyone reading this forum who's HbA1c happens to be above 7.5 as many are when they are first diagnosed!

bystander said:

That is a very scary thought for anyone reading this forum who's HbA1c happens to be above 7.5 as many are when they are first diagnosed!

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You're right, and I probably shouldn't have phrased it that way. The intended point was that a person running with an HbA1C level at 7.5 or more is in more long-term danger from that than they are from suffering from a hypo IF they are on diet only, (which the poster is),and that point is valid. We don't want to scare new members, but I guess Diabetes IS pretty scary, and sometimes we need a bit of "Scare" to motivate us to do the right thing. I think being scared to go lower than 7.5 with our HbA1C is worse than being scared about the danger of NOT going below 7.5, which I think we all know is real. Nonetheless, your point is taken and it shows that you can give the wrong message if you're not careful.

bystander said:

Pretty obvious really that she's more likely to die with an A1C of 7.5 than from going hypo on diet only.

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That is a very scary thought for anyone reading this forum who's HbA1c happens to be above 7.5 as many are when they are first diagnosed!

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But it's true though isn't it?

Would you prefer that we spout the "yes a HbA1c of 8% is great, well done" line.

Everyone is different, and some people have health issues that prevent them getting lower HbA1c scores, the message is scarey, but the message is the right one. Not sure what anyone gains from sugar coating the truth.

7.5 is bad enough but I was told the other day by a doctor that 8 was fine! Not that mine is anywhere near that. I do not understand why NICE saw fit to up the anti on HbA1c when research points to more complications as your HbA1c increases. I can only assume that they feel that people will meet this increased target and make their statistics look better instead of educating diabetics better on the need to watch their diet, especially Carb intake and lower their HbA1c to below 7. I am in the 6's which suits my fine. 6 years on and no complications and a relatively healthy lifestyle.

BF, not sugar coating the truth but it is only by new diabetics getting good solid and correct information that they can learn about diabetes and not be undully frightened by random information.

bystander said:

Hypos are always an issue for diabetics no matter how mild or severe they are and generalisation does not help.

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This is also just not true. If Hypos are an issue for T2 Diabetics (on diet and metformin) how is it that most of us are not given testing equipment and many of us are advised not to test?

Forget "four is the floor", forget "hypo awareness"; your bog standard NHS T2 Diabetic doesn't have the means to know the difference between 4mmol/l and 10mmol/l. One of the worst things that can happen is if they knock back a couple of glucose tabs every time they get a small false hypo, because they're scared of a real hypo that they'll probably never get.

Just because the NHS service will not provide test strips due to cost does not make hypos not an issue! You know and I know that what diabetics need and what they actually get are two vastly different things!
Until the NHS realise that diabetics can control their diabetes in some cases by simply reducing carbs and watching what they eat they will continue to try and not issue test strips. There is a petition on here to that effect I believe.
When was the last time you heard a HCP use the word 'carbohydrate' to a new diabetic? They go on about 'sugars' instead muddying the issue altogether and causing untold harm to those who could have been better controlled if only they had the right information.
You are right that without testing most people cannot tell if the feeling they are having is hypo or hyper, even very experienced diabetics don't know.
As I said earlier the medical profession think only of a hypo as medicine induced so they think only in those terms for test strips. We know that is not so but then we are 'only' diabetics.

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Bystander, that last post of yours should be copied and sent to every single HCP in the country! I have seldom seen it put better!

Viv 8)

The NHS's position on diabetes both type 1 & 2 is a total joke... in my local diabetic clinic the advice on the plasma screen was and I quote "make sure your 2 hour post meal readings are below 12.5 mmol/l". When I questioned this the consultant said that they didn't want to set unrealistic targets and dis-hearten people... I pointed out that surely they will be more dis-heartened when they lose a limb or their sight in 10 years?!?

The medical fact is that for every 1% increase in HbA1c over 5.5% you increase your chance of diabetic complications... worse still this increase is linear.. so an hbA1c of 12% is not 5% more likely to get complications over someone with 7% but more like 8 times or 800%.. Now I know this is scary but how are people to make an informed decision when the general guidance from the NHS is so lacking in information...

Finally reference hypo's....
Hypo's are dangerous in two situations:

1. You rapidly fall below 3mmol/l - this can only be induced by insulin I do not believe that you can drop your blood glucose quick enough via any other measure that's not going to give you warning.

In any person once you start exercise or start to fall low your body will stop producing insulin and your liver will start dumping glucose.. At that point you are more likely to fatigue before you drop below a dangerous level... you would practically have to ignore your body screaming at you to eat.. which in a sub 3 mmol/l hypo situation is an uncontrollable urge to stuff your face.. to do yourself real harm.

2. You have repeated hypos (multiple in the same day) - meaning that you have no glucose reserve to dump from the liver..

Feasibly if you are type 2 and you drop below 4 mmol/l enough in the same day without eating anything then you might have a problem due to no liver dump.. but in reality that is not going to happen..

Frankly, I'm amazed that there are so many supposedly 'sensible' people who seek to ignore the fact that as has been mentioned before '4 is the floor'. This isn't my opinion, its a well established medical fact. Not a figure plucked from thin air. Whoever it was that used to say that before, viviennm, obviously knew what they were talking about.

Anybody here who seeks to propogate the idea that there is no such thing as '4 is the floor' or 'ignore hypo awareness' because you are a type 2 quite obviously doesn't know what they are talking about IMO. They are obviously far more knowledgable than all the medical experts in the world. Well isn't this forum lucky to have such people on board giving out advice?

Pneu said:

1. You rapidly fall below 3mmol/l - this can only be induced by insulin I do not believe that you can drop your blood glucose quick enough via any other measure that's not going to give you warning.

In any person once you start exercise or start to fall low your body will stop producing insulin and your liver will start dumping glucose.. At that point you are more likely to fatigue before you drop below a dangerous level... you would practically have to ignore your body screaming at you to eat.. which in a sub 3 mmol/l hypo situation is an uncontrollable urge to stuff your face.. to do yourself real harm.

2. You have repeated hypos (multiple in the same day) - meaning that you have no glucose reserve to dump from the liver..

Feasibly if you are type 2 and you drop below 4 mmol/l enough in the same day without eating anything then you might have a problem due to no liver dump.. but in reality that is not going to happen..

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Thanks Pneu, good summing up. I think the reality is that a lot of people talk about "hypos" but are at cross purposes as to what a DANGEROUS hypo really is. As I've agreed a number of times on this thread, anyone (including non diabetics) can get low blood sugar, which we often refer to on this forum as a "hypo"; my daughter gets them and it's a bit unpleasant. It's quite common amongst non-diabetics that work hard and skip lunch. But it's not a medical emergency. I've had one (3.2) and felt dizzy, bit weak - I'd played 18 holes of golf in the burning sun with no food. But I wasn't about to get taken to hospital. I do think that BECAUSE we're diabetic and have knowledge that non-diabetics don't, we refer to things like low blood sugar in the diabetic "hypo" way rather than the way a non-diabetic would - felt a bit rough so had a mars bar (Lucky swine!) As Pneu said, a true dangerous hypo is insulin induced, and can lead to collapse, coma and hospital treatment. Metformin simply doesn't do that; it can't given the medical way it works on our bodies; - diet only certainly doesn't. SOME diabetic drugs that stimulate our own insulin production (metformin doesn't) can in some circumstances according to medical info induce a hypo, although it would normally be mild. Of course there will be medical conditions that can inflict hypos on people not on insulin I'm sure, but that would probably apply equally to non-diabetics.
As Borofergie said, if you knock back a glucose tab as a T2 on diet only (or Met) everytime you think you've got low blood sugar, you're probably doing yourself a dis-service.
Perhaps we need a new word for non-diabetic type hypos - "non insulin (or similar) induced low blood sugar" doesn't really trip off the tongue, but using the same term for it as you do for insulin induced hypos is, in my opinion, misleading, unpleasant though I'm sure they can be.

Angeleyes said:

This isn't my opinion, its a well established medical fact.

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Excellent. Then you won't mind backing it up with some references.

I have often seen the statement 4 is the floor but never seen it backed up by reliable references I would be interested to see them .Although for me to see 4 would be great!
CAROL