What's the point of trying to maintain tight glycemic control?
What's the point of cutting down on carbs?
What's the point of cutting down on carbs?
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Tight Glycemic Control for Type 2 Diabetes
- Thread starter dosh
- Start Date
Chris24Main
Well-Known Member
Wow - talk about nailing an important question.
This is fairly contentious of course, but I do remember feeling enraged following my first delve into the likely outcomes of treating my T2DM diagnosis as I was being encouraged to, with meds.
The conclusion I came to was that even with a well controlled blood glucose level - the medical outcomes didn't seem to change..
so, that was the starting point for me trying to understand what "insulin resistance" was...
and the simple answer directly is that anything you can do to reduce carbs will lower your insulin and blood sugar - in the long term it's elevated blood glucose that the medical profession worries about - damage to all sorts of things from too much blood glucose doing what glucose does, glycating everything...
But - the issue is that most long term health issues are also associated with elevated insulin and elevated glucose, so as T2 (and absolutely the opposite of T1) we need to be looking at lowering insulin as well...
How do you do that? - by lowering carbs, particularly sugars and starches (which get turned into sugars)
So - I kind of agree - Glycaemic control is not the game you want to play, but lowering your blood glucose and insulin is..
... taking meds doesn't get in the way of doing this, but many of us here on the forum have found ways (different ways, there are no 100% sure methods, because we are all so different)
But the key take away is yes - it really does make a difference, and despite the stats, even the fact that you're here puts you on a better path, hope that helps...
This is fairly contentious of course, but I do remember feeling enraged following my first delve into the likely outcomes of treating my T2DM diagnosis as I was being encouraged to, with meds.
The conclusion I came to was that even with a well controlled blood glucose level - the medical outcomes didn't seem to change..
so, that was the starting point for me trying to understand what "insulin resistance" was...
and the simple answer directly is that anything you can do to reduce carbs will lower your insulin and blood sugar - in the long term it's elevated blood glucose that the medical profession worries about - damage to all sorts of things from too much blood glucose doing what glucose does, glycating everything...
But - the issue is that most long term health issues are also associated with elevated insulin and elevated glucose, so as T2 (and absolutely the opposite of T1) we need to be looking at lowering insulin as well...
How do you do that? - by lowering carbs, particularly sugars and starches (which get turned into sugars)
So - I kind of agree - Glycaemic control is not the game you want to play, but lowering your blood glucose and insulin is..
... taking meds doesn't get in the way of doing this, but many of us here on the forum have found ways (different ways, there are no 100% sure methods, because we are all so different)
But the key take away is yes - it really does make a difference, and despite the stats, even the fact that you're here puts you on a better path, hope that helps...
@dosh I feel that the report vastly underestimates the medical problems associated with high blood glucose for the following reasons:
1. It is only considering endpoints within 5yrs. - I've had T2D over 5 yrs and been in remission over 4yrs already and I intend to live quite a few more years.
2. Diabetic complications (usually) present themselves after many years of raised BG. But the common ones would not often result in any of the listed end-points within a 5 yr period. How long did I have pre-diabetes before my HbA1C got above 48 - I don't recall the date that a GP first said that my BG was raised, but at least 5 to 10 yrs before the T2D diagnosis.
3. It's not uncommon for people to have T2D symptoms and even complications well before their BG reaches 48. I think that @KennyA said he got some when his HbA1C was around 43 or 44. They are less common at lower BG levels, but even having an HbA1C of under 40 is no guarantee that somebody won't experience them.
4. The Harms just boils down to Hypoglycemia, which is not even a possibility for somebody (no matter how Low Carb) unless they are on Insulin or Glic or certain other actively Glucose lowering drugs.
I do understand that a low HbA1C is not a competition and that for some people, remission is just unrealistic. However, that is not a reason to give up! My opinion is that (rather like weight) we should aim for a sustainably low BG rather than struggling to get it as low as possible if even for a short time. This is a marathon, not a sprint.
www.diabetes.co.uk
edited to correct spelling and add the missing word 'some' in 1st sentence of last paragraph.
1. It is only considering endpoints within 5yrs. - I've had T2D over 5 yrs and been in remission over 4yrs already and I intend to live quite a few more years.
2. Diabetic complications (usually) present themselves after many years of raised BG. But the common ones would not often result in any of the listed end-points within a 5 yr period. How long did I have pre-diabetes before my HbA1C got above 48 - I don't recall the date that a GP first said that my BG was raised, but at least 5 to 10 yrs before the T2D diagnosis.
3. It's not uncommon for people to have T2D symptoms and even complications well before their BG reaches 48. I think that @KennyA said he got some when his HbA1C was around 43 or 44. They are less common at lower BG levels, but even having an HbA1C of under 40 is no guarantee that somebody won't experience them.
4. The Harms just boils down to Hypoglycemia, which is not even a possibility for somebody (no matter how Low Carb) unless they are on Insulin or Glic or certain other actively Glucose lowering drugs.
I do understand that a low HbA1C is not a competition and that for some people, remission is just unrealistic. However, that is not a reason to give up! My opinion is that (rather like weight) we should aim for a sustainably low BG rather than struggling to get it as low as possible if even for a short time. This is a marathon, not a sprint.
HbA1c conversion table
www.diabetes.co.uk
edited to correct spelling and add the missing word 'some' in 1st sentence of last paragraph.
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I guess I'd agree that I aim for tight glycaemic control. I have been diabetic for some time, but was only diagnosed in January 2020. I'd had diabetic symptoms for around ten years at that point. Low carb has almost completely removed the symptoms I did have (I have some mild but permanent neuropathy).
I don't know where I'd be otherwise - maybe 150kg, with knees and hips failing because of the weight? unable to sleep due to apnoea and the pain of neuropathy? kidney failure? massive lower leg oedema? I had all of these symptoms long before "official diagnosis". But how can I prove the negative - that I would otherwise have had a stroke or a heart attack or an amputation or kidney failure?
The issue with the number needed to treat thing above is that it only looks at the well-known extreme end-stage outcomes and only five years into the future. But if you look a little farther - eg 2035 - it is being estimated that by then the NHS will be spending 17% of its total budget on treating exactly those preventable tertiary diabetic complications listed. I do wonder if what we're seeing is an pro-medication argument being made here?
I don't know where I'd be otherwise - maybe 150kg, with knees and hips failing because of the weight? unable to sleep due to apnoea and the pain of neuropathy? kidney failure? massive lower leg oedema? I had all of these symptoms long before "official diagnosis". But how can I prove the negative - that I would otherwise have had a stroke or a heart attack or an amputation or kidney failure?
The issue with the number needed to treat thing above is that it only looks at the well-known extreme end-stage outcomes and only five years into the future. But if you look a little farther - eg 2035 - it is being estimated that by then the NHS will be spending 17% of its total budget on treating exactly those preventable tertiary diabetic complications listed. I do wonder if what we're seeing is an pro-medication argument being made here?
Having had a chance to read the NNT reference - it's from 2014.... it says some things that these days sound incredibly dated (my emphasis is in underline) :
There are no data to support the statement that tight glycemic control is lifesaving, and indeed these considerable data suggest that it is not. The median time for mortality outcomes was short, roughly two years, and perhaps over many years of using this approach there may be an identifiable mortality benefit, though if so it is likely to be very small based on the point estimates and sequential analyses performed by the Cochrane authors.
Hypoglycemia is a major problem for diabetics, and can in extreme cases be fatal or neurologically devastating. This problem did not, however seem to increase mortality which is reassuring for those at higher risk of limb amputation, or any others for whom this approach may be used or considered.
These data should not be interpreted to mean that any attempts to control glucose levels have been proven not to work. While it is true that glucose controls are not the cause of type 2 diabetes, but rather a symptom of an underlying metabolic disorder, treating this measurable symptom may have benefits. Unfortunately at this point even this remains unproven, despite being intuitively likely. Trials examining diet or lifestyle approaches versus directed glucose control are badly needed to determine the degree to which treating glucose levels is beneficial in comparison to other approaches.
Finally, we did not address microvascular complications here because we find these not to be patient-oriented. Nephropathy (protein in the urine) and retinopathy (retinal changes on exam) may both be harbingers of later problems, and both are reduced by tight glycemic control, however existing data argue strongly that clinically important outcomes like kidney failure and vision loss occur far less than cardiovascular outcomes....
It also assumes, I think, that "tight glycaemic control" can only be achieved by a drug regime, and therefore you have the hypo risk that they say is a "major problem for diabetics" - begging a question of their understanding of non-pharmacological interventions, and the differences between T1 and T2.
You might, for a different view, want to look at (for example) the David Unwin papers on his use of low carb in an ordinary GP setting.
Links: https://wchh.onlinelibrary.wiley.com/doi/10.1002/pdi.1835 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695889/
This is a similar paper, but from the USA.
https://drc.bmj.com/content/bmjdrc/8/1/e000980.full.pdf
There are no data to support the statement that tight glycemic control is lifesaving, and indeed these considerable data suggest that it is not. The median time for mortality outcomes was short, roughly two years, and perhaps over many years of using this approach there may be an identifiable mortality benefit, though if so it is likely to be very small based on the point estimates and sequential analyses performed by the Cochrane authors.
Hypoglycemia is a major problem for diabetics, and can in extreme cases be fatal or neurologically devastating. This problem did not, however seem to increase mortality which is reassuring for those at higher risk of limb amputation, or any others for whom this approach may be used or considered.
These data should not be interpreted to mean that any attempts to control glucose levels have been proven not to work. While it is true that glucose controls are not the cause of type 2 diabetes, but rather a symptom of an underlying metabolic disorder, treating this measurable symptom may have benefits. Unfortunately at this point even this remains unproven, despite being intuitively likely. Trials examining diet or lifestyle approaches versus directed glucose control are badly needed to determine the degree to which treating glucose levels is beneficial in comparison to other approaches.
Finally, we did not address microvascular complications here because we find these not to be patient-oriented. Nephropathy (protein in the urine) and retinopathy (retinal changes on exam) may both be harbingers of later problems, and both are reduced by tight glycemic control, however existing data argue strongly that clinically important outcomes like kidney failure and vision loss occur far less than cardiovascular outcomes....
It also assumes, I think, that "tight glycaemic control" can only be achieved by a drug regime, and therefore you have the hypo risk that they say is a "major problem for diabetics" - begging a question of their understanding of non-pharmacological interventions, and the differences between T1 and T2.
You might, for a different view, want to look at (for example) the David Unwin papers on his use of low carb in an ordinary GP setting.
Links: https://wchh.onlinelibrary.wiley.com/doi/10.1002/pdi.1835 and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6695889/
This is a similar paper, but from the USA.
https://drc.bmj.com/content/bmjdrc/8/1/e000980.full.pdf
Lamont D
Oracle
Low carb>glycaemic control>low insulin production>lower hba1c and fasting levels.
Because with T2 and other metabolic conditions, insulin resistance means over production of insulin. Which is not healthy for your liver or you. With low carb over time will reduce this output, and that must be healthier.
It works for me. And not on diabetic meds.
Because with T2 and other metabolic conditions, insulin resistance means over production of insulin. Which is not healthy for your liver or you. With low carb over time will reduce this output, and that must be healthier.
It works for me. And not on diabetic meds.
