What the doctors should tell newbies

I put this point in another thread and then thought it needs to be out on its own.
When someone is newly diagnosed, generally, they are given information and targets. ( at least after a while) And yes I have read all the horror stories that turn up here about those who don't :twisted: Often they are warned about possible complications.
What I think is, that a lot depends on individual patient needs.
Some elderly folks, who are very set in their ways, are unlikely to want to change their life by much, nor to test their own BG. For these folks, the targets suggested by DUK are probably fine and the annual or 6 monthly HbA1c is also probably sufficient.
complications develop over time and some people haven't got enough time left for that. There's no point in pushing them too much. They might think it sensible to give up taking sugar in their tea and coffee. Note I said "set in their ways"
For others and for younger people and hence most T1s, I feel they should know what non-diabetic numbers are and thus have a baseline so that if they are sufficiently motivated, they can strive towards non-diabetic levels.
It seems senseless to me to set control targets, almost double the levels of the non-diabetics.
Non diabetic BG hovers close to 5mmol/l at almost all times and when it varies, it tends to be for only a short time. thus a target of "below 8, 2 hours after meals" is actually demonstrably too high.
Non-diabetic Hba1cs average 5.1%, so "below 7%" is too high Many non-diabetics must have HbA1cs in the 4s and it's known thar people who are not diagnosed diabetic, who have elevated HbA1cs are prone to many of the problems that diabetics have, so the lower, the better.
All it needs is for the doctors to know these normal numbers and their patients

Type 1s and T2 on insulin have the problem of dealing with insulin doses and the potential for hypos. Bernstein covers this in his doctrine of small numbers. ie, you eat low carb, so you need minimal insulin and corrections require tiny doses, so you are less likely to hypo.
I think this is safer in the long term than the frequent advice to lessen the control by letting the Bg go up.
It's a balancing act. hypos versus complications. and only frequent monitoring of bg to help.
To me this is all theory, as I'm a T2, who 6 years after diagnosis is using only Metformin. Many T2s have gone onto multiple medications and/or insulin in that timespan. ( as I was warned I would have to)
My method is"If carbs put my BG up, I have a choice, don't eat them or take loads of medicines" I went with "don't eat them". I am not suffering from any deficiency diseases. I have a tasty and varied diet and have recently read John Yudkin's "Pure, White and Deadly". That book should ensure no-one even looks at a sugar crystal again.

Acron,
I am "Reduced" carb, not always LOW and I don't follow Bernstein to the letter, I use him as a guide and a target, but I still eat fruit, carrots and red and yellow peppers, which Bernstein forbids.


I am married to a T1 and have witnessed over 35 years, the effects of "loose" targets for BG control.( I didn't know then what I know now). I would like every T1 to avoid, retinopathy,laser treatment, eye surgery, neuropathy and Charcot feet with recurrent ulcers that take months to heal and NHS as the only possible shoe supplier, nephropathy and chronic kidney disease and gastroparesis.
Not to mention frequent trips to casualty and a 2 week stay in ITU, when A GP mistook DKA for a hypo and gave IV glucose.( thank heavens for home meters nowadays.)
Getting low HbA1cs is up to the patient and, whereas kids aren't always capable of thinking about the future, adults should be.
I have written a number of times that control can come from careful attention to diet and exercise OR from large doses of medication, which has attendant risks.
What is the point of setting a target, simply because it's attainable? which is what happens.Those targets were originally set by the ADA, so that people wouldn't get problems with employment and medical insurance which were common in the USA, before antidiscrimination laws. They have been modified recently, still on the "easy to attain2 basis.
Even non-diabetics with above 5% Hba1cs have been found to be at risk of "diabetic type" complications. So NO there isn't a gap between non diabetic numbers and unsafe ones.On the contrary, It's been shown that it's the HbA1c level rather than the diagnosis of full blow diabetes, which brings the risks.

Motivated diabtics need to know the non-diabetic numbers if they are to know what target to aim for, because the ones given by DUK, the ADA and other medical authorities. Are based on the premise that Diabetes is progressive and inevitably leads to complications and death.
Setting "easy" targets, ensures just that. the death certificate doesn't say "diabetes" it names the final complication. that DUK poster was right.

Obviously there are some diabetics who cannot achieve non-diabetic targets, perhaps because of further clinical factors, but there are more, who tell me and others like me that we are wrong. Simply because they are not prepared to take the difficult road for themselves.
If anyone shows me a way of maintaining my membership of the 5% club without killing my pancreas off completely, gaining weight or risking hypos with strong medication, whilst allowing me to indulge in all the foods that I still like,but deny myself, I'll give it a try.