WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUGAR LEVELS

[REDLAN]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

While we could argue whether attaining "normal" HbA1C through intensive therapies leads to "normal" health outcomes. It doesn't.

Rather I think the issue is this

If by right to normal blood sugar levels we simply mean a normal HbA1C, and to achieve this I am having 14 hypos a week, then quite clearly the one thing I don't have are normal blood sugars.

The point of any diabetes therapy is to balance short and long term risks.

Firstly long term risks - the role of a good HbA1C while significant is often overstated. What we are really talking about is risk reduction not life time prevention. Except for an extremely small group of people who seem to manage to avoid getting any complications for some (unknown) reason, the vast majority of people will get complications in one form or another during their life time. Increasing the length of time that I keep complications to a minimal level is an important goal that has a significant impact on my quality of life.

Secondly short term risks. The main issue with frequent hypoglycaemia is the development of hypo unawareness. It increases your risk of accident, especially so if you drive. There are measurable cognitive impairments that appear once BG is down below 3.6, which become significant below 3.2, and severe below about 2.5. And if my hypo awareness starts at around 3.0 then I may be regularly experiencing quite severe cognitive impairments of which I am completely unaware.

Clearly the aim of the therapy to balance these two risks.

 

[Paul_c]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

If by right to normal blood sugar levels we simply mean a normal HbA1C, and to achieve this I am having 14 hypos a week, then quite clearly the one thing I don't have are normal blood sugars.

well then, perhaps you should consider changing your diet so that you can achieve good control with very little risk of hypos...

go get yourself a copy of Dr. Bernstein's Diabetes Solution...

http://www.diabetes-book.com/

you can read excerpts of it here:

http://www.diabetes-book.com/readit.shtml
especially chapter 7...

 

[AMBrennan]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

this is why we're upset... because these flawed studies are being used to allow them to cut the costs of treating diabetes by reducing the medication being prescribed to T2s or even changing the level at which people get declared to be diabetic

well then, perhaps you should consider changing your diet so that you can achieve good control with very little risk of hypos...

If diabetes can easily be controlled by diet then why do you worry about not getting medication, especially since we have established that drugs can have dangerous side effects?

 

[Yorksman]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

The majority of people who have type 2 don't make the changes that they should, despite early good intentions. These things are easily put off until tomorrow. That's why they deteriorate. A large number who take medication do so and believe that, because they are taking medication, they can carry on as before, and don't make the changes. They too get worse over time. I don't want to take meds because by not relying on them, I will make greater efforts to control it through diet and exercise. I fear, if I were to take meds, I'd get lazy about it.

 

[hanadr]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

AMBrennan
I don't pracice bad science, I know when something is a "link" or a cause. I hold by this. If low Hba1c in and of itself were dqngerous, non-diabetics would be at risk in the same way as diabetics.
If taking large dose of multiple medication is dangerous, it's likely to be more dangerous to those who indulge in it most.
No-one has looked at low HbA1cs kept low by diet and/or exercise.
I do know about Semmelweiss and how he was criticised for his belief that Puerperal fever was transmited on the hands of Doctors. I also realise that much of the prjudice against him was caused by his being Hungarian in Austria- Hungary,thus a member of the "Lower orders".
I also know how difficult it was for Doctor John Snow to get the authorities to admit that cholera was water borne.
there are dozens of ex\mples of where the medical profession has dismissed new ideas, based on evidence, because the person presenting that evidence was not one of their more highly regarded members. So what's changed there?Richard K. Bernstein is an MD and a Licensed practitioner in the USA. Why is the establishment against his EVIDENCE?
And WHY do so many people believe the 7 countries study on what constitutes a Healthy diet? Ancel Keys was not a nutritionist and he discarded at least 2/3 of the EVIDENCE he collected.
Evidence needs to be evaluated, corroborated, peer reviewed, understood. not just chosen at random.
Try the technique of "Reductio ad absurdam"
Hana
PS I think that despite much of his stuff being important, Lustig is mistaken about Glucose being a healthy carb.

 

[REDLAN]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

well then, perhaps you should consider changing your diet so that you can achieve good control with very little risk of hypos...

go get yourself a copy of Dr. Bernstein's Diabetes Solution...

http://www.diabetes-book.com/

you can read excerpts of it here:

http://www.diabetes-book.com/readit.shtml
especially chapter 7...

Well I was speaking figuratively, rather than describing my personal experience.

Well aware of Bernstein. What he advocates is a ketogenic diet. One of the main issues with a ketogenic diet is compliance. People generally speaking find them hard to stick to - drop out rates in studies can be as high as 1/3 after one year. Studies looking at ketogenic diets in epilepsy found that almost nobody stayed on one in long term follow up.

Also insulin requirements bottom out between 80g-120g per day - that is a ketogenic diet needs as much insulin as does a diet containing 80g of carbs, and an 80g diet is better tolerated than a ketogenic one.

The Bernstein approach is rather evidence lite. There is little evidence to support ketogenic diets in type 2 over any other kind of diet, and I don't think there is any research on ketogenic diets in type 1. Also is it just me, but doesn't the style of the Bernstein website scream quackology?

 

[MCMLXXIII]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

" doesn't the style of the Bernstein website scream quackology?[/quote]

You have inadvertently created a brilliant tongue twister!:grin:


Sent from my KFTT using DCUK Forum mobile app

 

[phoenix]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

Unfortunately this thread seems to have become a mixture
It's (I thought) about the 'right' to have normal blood glucose in T1.
This is a totally different ball game to people who are using diet and exercise or metformin alone. Hana, just like your husband, we have to take at least insulin.
Look at the DCCT graphs provided earlier.
Other evidence is scarce. We know that long term survivors with no complications show 'survivors with no complications having Hba1cs in the 7s (though quite possibly higher earlier in their history) but we also know of people with lower levels who do develop complications. (there is the Joslin study and smaller ones from the UK and France)We don't know why.
I'd love to know what is protective and so do the researchers which is why they are trying to find out.
I don't quite have Dr Bernstein's 'normal' glucose, though just before I started using a pump (another Bernstein no, no, he doesn't approve of pumps) I was diagnosed with background retinopathy. MY levels were at his approved levels.
I realised(or was convinced) that I was losing hypo awareness (and yes I functioned well at low levels) Since I deliberately raised my levels the background retinopathy hasn't gone away.
My HbA1c has been about 5.7-8 for the last 4 years .Maybe it's the something else (genes) but just maybe my problem was caused by trying to get too low a glucose level .At an Hba1c of 4.9 my average glucose levels were 5.2mmol/l It is in my opinion that if you are insulin deficient that to get such a low level then there will inevitably be a number of low blood glucose levels.
I'm still told I'm too low but at the moment I am able to recognise my hypos and accept the inconvenience which can occur when I'm exercising,(I'm not so concerned about performance as I might be if I were younger)
So my glucose levels are not Bernstein 'normal' but aren't high. If I begin to loose hypo awareness at this level then I would make efforts to raise them again.
Lastly lower carbs do not for me necessarily result in proportionally lower insulin to achieve the same results.
now which I didn't when I had lower levels.

]Hana (and I think this is off topic so I shall make it tiny print)
Evidence:

Not sure where A keys comes in but heres one for you Hana
The original paper (nothing to do with the seven countries study) that contains the famous graph.
http://www.epi.umn.edu/cvdepi/pdfs/Keys ... Health.pdf
You can check out the actual correlations for the 22 countries here:
http://rawfoodsos.com/2011/12/22/the-tr ... -it-wrong/
or maybe check out some of Keys actual papers.
here's one that might be interesting
Bias and misrepresentation revisited: "perspective" on saturated fat
http://www.ncbi.nlm.nih.gov/pubmed/4591426
You might also look up some of Keys laboratory experiments, his clinical trials as well as the data from the Seven countries study.
(and note what Keys advocated (not SAD, more Med) and how he refined (changed ) his hypothesis over the years.

Then look for the evidence from Bernstein.
There are a few papers on the diabetic foot but otherwise all his contributions seem to be comment on other articles. Where is the data?

 

[James12]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

It is unfortunate that you experience background retinopathy at fairly low levels, but at the same time it should also be expected, most non diabetics have a A1C of between 4-5. Think about it like this, would you put petrol in a diesel car?

 

[pumppimp]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

James 12,
I don't quite understand the petrol in a diesel car analogy? I do agree with you though, that diabetics shouldn't be told off by their health care team for having a non diabetic HbA1c. If someone with type 1 can manage to achieve levels along those lines without having constant and dangerous hypos and still have very good hypo awareness then sure good for them I'm sure their health will be much better in the long term. Unfortunately that just isn't possible for the majority of people with type 1. I would love to have a much lower HbA1c (currently 6.9%) and be able to maintain it without losing my awarness and having a normal life, but I don't see that happening any time soon not for myself anyway.
At present I'm having a major disagreement with my hospital (everybody from the head of the hospital to the receptionist at the clinic) In that I complained about my consultant firstly, then did lots of digging to find that it has some of the worst controlled diabetics in Scotland! I tried to make my MSP and all the other MSPs aware of the situation and why it was so bad at this hospital. One of the examples I used was that the average HbA1c for 0-18 was something like 9.7%. Imagine somone being diagnosed when they are a baby then living with a HbA1c that high for nearly 20 years and of course you will have a lot of complications to deal with making it a lot more expensive in the long run for the hospital to deal with. The response from the hospital was that this was a perfectly acceptable level for somebody under 18 to have and they would be pleased if a paitent had that level at that age.
Should the battle not be just we have the right to normal blood sugars levels but the training for paitent and healthcare staff and the available technology and drugs that will help us get there. Not to keep on ranting but I've only ever had one consultant that I trusted and worked with really well and felt things were going in a positive way with. The rest have been very out dated in their treatment and the current one does not want to learn anything new from when he qualified. Should health care teams be better qualified and have regular training in new treatments and technologies? Often if the doctor or nurse is ill informed then the paitent who doesn't know any better and trusts their hcp will suffer in the long term with complications.
Rant over sorry!

 

[AMBrennan]

Re: WE HAVE THE RIGHT TO HAVE NORMAL BLOOD SUAGR LEVELS

I don't quite understand the petrol in a diesel car analogy?

Humans function well on low BG (4-5%, apparently) so higher BG will damage blood vessels much like using the wrong fuel will damage a car.
Of course, it's not surprising that he'd attempt proof by analogy.

If someone with type 1 can manage to achieve levels along those lines without having constant and dangerous hypos and still have very good hypo awareness then sure good for them I'm sure their health will be much better in the long term

You are begging the question.
The "right to normal BG" is about therapeutic thresholds - when should Alice be given more drugs, and when should Bob increase his insulin doses.

In that I complained about my consultant firstly, then did lots of digging to find that it has some of the worst controlled diabetics in Scotland!

Watch out for Simpson's paradox.

No-one has looked at low HbA1cs kept low by diet and/or exercise.

That's irrelevant to the question at hand - therapeutic thresholds. If you can achieve good control on exercise and diet alone, brilliant (although that does seem a bit unlikely in the t1 forum...) but the question is when the rest who are unable to do so should be given more drugs.
As you noticed, more drugs means more side effects, and the damage from those side effects may outweigh the benefits from better control. The question is where that balance is.

 

[James12]

Thank you Brennan for explaining my analogy, despite its simplicity.

Having normal HbA1cs is still something that most type 1 diabetics don't seem to find important. For many of us it is achievable with some self educating and hard work, yet being lazy about it increases our chances of developing devastating complications/ makes them almost certainly inevitable

 

[MCMLXXIII]

If life was a Grand Prix for Diabetics , then the hb1ac would be a pit stop.
If and how you finish the race all depends on how you drove the car

 

[James12]

If life was a Grand Prix for Diabetics , then the hb1ac would be a pit stop.
If and how you finish the race all depends on how you drove the car

i disagree, the hb1ac would be the lap time, the quality of your driving determines the lap time.

 

[Robinredbreast]

If life was a Grand Prix for Diabetics , then the hb1ac would be a pit stop.
If and how you finish the race all depends on how you drove the car

i disagree, the hb1ac would be the lap time, the quality of your driving determines the lap time.

The quality of 'driving' taking control, also depends on 'conditions' whether its wet conditions, using the correct tyres, heat, cold, has the car has a recent MOT, are there underlining problems with the mechanics that the person in control is unaware of, or a 'mechancial problem' just waiting to snap, losing control and the lap time goes out of the back window roblem:

" where we're going in life doesn't matter, its what happens along the way that counts"

This has become a very interesting thread :thumbup:

RRB

 

[Thundercat]

My driving instructor used to say "you are in control of the car it is not in control of you". Seems apt here.

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