• Guest - w'd love to know what you think about the forum! Take the 2025 Survey »

What the doctors should tell newbies

H

hanadr

Expert
Messages
8,157
Dislikes
soaps on telly and people talking about the characters as if they were real.
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
 
i was told to keep mine between 4 and 7. Which i am doing. My average was 4.5 but after chatting to my dns he suggested and i agreed to raise it to 6. Thus i would not hypo when i exercise. Is that correct info? If you keep it below 5 is there more a risk of i hypo?
 
I'm new to all this (the website I mean) but yes I thoroughly agree that newbies are given little , none or poor info , and I feel aggrieved about it.
My Doc was a little sketchy about BS numbers, and having bought a meter, the instuction leaflet was even less help.
I tend to have more Hypos than high BS episodes, and whilst I agree about the numbers you are talking,and the reasons you're using, I dont know how I could ever hope to remain within such a tight range.
As an engineer, I thought the answer was to look for a Continuous BS monitoring device, when first diagnosed 2 years ago, and though there were peeps trying to produce them (some Armenian guy I think) I cant wait to re-google this cus it would I'm sure be a big step towards better control and tighter tolerances.
 
Irrespective of specific numbers, I think the newly diagnosed teenager who is prepared to just take it all on board and deal with it appropriately is a rare find indeed. Younger teens are going to live forever and complications are only a very distant maybe. Until of course you get there. I was 14 when diagnosed.
 
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.
 
Marky74 said:
i was told to keep mine between 4 and 7. Which i am doing. My average was 4.5 but after chatting to my dns he suggested and i agreed to raise it to 6. Thus i would not hypo when i exercise. Is that correct info? If you keep it below 5 is there more a risk of i hypo?
Click to expand...

There will always be some slight variations in your bs, so in theory the lower you are the less margin for safety you have.

Instead of running higher levels all the time, why not simply eat something before exercising to prevent a hypo?

If you maintain a low level most of the time there's a risk of losing hypo awareness. But if you test frequently you should see if this is happening (and can then maintain higher levels just for a week or two until hypo awareness returns).
 
Hanadr, whilst I agree with the essence of what you're saying in this thread, it just seems like this has turned into yet another one of your low carb evangelisms. And again, while I agree with the low carb sentiment, I don't know if anyone else feels the same but, I find myself skipping over the threads you start because I know exactly what the tone of them is going to be. We know you're low carb, we know you follow Berstein to the letter and we know you believe that every other diabetic should be doing it your way. Anyway, now that's off my chest...

I'm not a scientist so I wouldn't know, but do you think there could be a gap between "non-diabetic" numbers and "un-safe" numbers? An HbA1c of < 6 is difficult for a T1 (please don't start about low carbing!). That's a fact. There was a thread recently stating the average T1 HbA1c of 7.something in a particular PCT if I remember correctly. However, maybe as long as you're under 8 then the difference, or "damaging" effect to your body is negligable or even non-existant. All this does it widen the goal posts for T1s, rather than giving the newbies an extremely harsh target that realstically, they will struggle immensely to meet. That's just asking for more condition-related depression etc.

If a diabetic takes their condition seriously enough to want to obtain decent levels then they'll research. If they research then they'll find out about low GI and low carbing and then, with any luck, they can make the decision as to whether they want to change their ways and achieve good numbers.
 
colecraft said:
I'm new to all this (the website I mean) but yes I thoroughly agree that newbies are given little , none or poor info , and I feel aggrieved about it.
My Doc was a little sketchy about BS numbers, and having bought a meter, the instuction leaflet was even less help.
I tend to have more Hypos than high BS episodes, and whilst I agree about the numbers you are talking,and the reasons you're using, I dont know how I could ever hope to remain within such a tight range.
As an engineer, I thought the answer was to look for a Continuous BS monitoring device, when first diagnosed 2 years ago, and though there were peeps trying to produce them (some Armenian guy I think) I cant wait to re-google this cus it would I'm sure be a big step towards better control and tighter tolerances.
Click to expand...
Hi colecraft, What do you mean when you say that you "have more Hypos than high BS episodes"? My GP says that as a Type 2 on diet and metformin only I will not have an hypo. I do know that I go below 4.0 on some occasions and even as low as 3.4 - but that has never caused me any problems. In fact, I wouldn't have known about it without testing. I must say you seem to be on the right track. Best wishes - John
 
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.
 
Hi Wallycorker,
for more than 25 years I have had hypos, but never tested pos for Diabetes.A range of different Docs kept telling me I didnt eat enough, and that nothing else could be wrong, ....well what a joke, I've always had a great appetite,.....and now I'm told I'm overweight, and that may have contributed to my T2, THANKS.
Nowadays my hypos are , not more frequent but, - more unexpected, more severe, and recovery from them takes longer, I just got into the edge of one yesterday, noting that for example my Bs ranged from 3.7 to 10.2.
I also think that since I started testing 2 yrs ago (tho not as fastideously as I should have) my hypos occur at higher Bs levels than they used to, though I cant prove that. At 4 now I get wobbly, and If I ever get to 3 its bad news and I need wifeys help cu I'm on the floor.
I just started the food diary and more frequent testing, (knew I should have done it before !), my 3 highs yesterday were down to some currants in my bowl of fibre breakfast,a peach, lunchtime, and a far-too-late Thai green curry.(so that wont happen again)The low happened exactly 3 hours after breakfast and 2 hours after the biggest spike.I believe I can help my spikes by altering my diet .But I'm not confident I will ever master the hypos, because I feel like I get em in increasingly inconsistant circumstaneces.
regards
John
 
Hi again Colecraft,

I don't feel any different whether I am 3.4 or 10+ - most people cannot understand that. My GP insists that I am in no danger from hypos so long as I am only taking metformin. Because of that I'm quite casual about my lower results and concentrate only on reducing my higher blood glucose levels. All I do is have something to eat if I find that I am under 4.0
 
I don't understand why doctors and specialists have such different interpretations. All health professionals should be given the same information.
My HBa1C is 5.9 and my Dr told me to get this higher as it's too low - I still feel this is too high for my liking, and yes I have a mild hypo practically everyday, but surely it's better to have one blood reading at 3.5 every other day than to have constantly high bloods which may result in liver failure, going blind and amputation (obviously extreme circumstances). My specialist praised me and said if you could get it a little lower it would be ace...why is there so much confusion?
My boyfriend tests his bloods with my BG tester and often comes up at 4.2 after a meal, and I know that I could only ever wish to be this low after a meal (although after two hours they have always dropped to appropriate levels).
The Dr actually said to me that a HbA1c of below 9 was acceptable...I think he is asking for me to have my legs chopped off to be honest...I was also told this information when I was first diagnosed by the speicalists...Not impressed now that I have unearthed the serious complications from high bloods and what a non-diabetics bloods are...It's a stupidly difficult condition to control at times and it would make life much easier if they told us straight exactly the facts.
My friend is a babysitter for a 5 year old type 1 diabetic who had a Hba1C of 14% and she was told it is normal to have a Hba1C of under 20%. What a load of tosh, it's riduclous and that child is likely to take the condition less seriously when she is older, in my opinion as she will grow up thinking that this is acceptable or why should they be lower when they could be that high as a child...It's a ridiculous system.

I feel I am quite lucky to be able to judge what my bloods are. I can tell fairly accurately what my bloods are and know in an instant if I am low or high or have ketones. Sounds like not everyone is blessed with this gift :(
 
Hi Rebecca.

What Sue says is spot on. Specialists/Endocrinologists are trained for far longer and to a far higher standard than any GP. Listen to your GP, but always trust the experts.

Any confusion arises because some GP's are just trying to impress but not knowing anything about Diabetes other than what they might have picked up in training and after attending a couple of
seminars over the years. They might have read an article somewhere. They are not experts, they are general practitioners. A little of most things does not an expert make. Of course there are GP's who have taken the time to study and are very well informed about Diabetes. If you have one of those then you are very lucky. Not many about.

There is far more expertise and information about Diabetes on this site than you could ever hope to find in a GP's head unless he/she is a member here of course ?

Ken.
 
cugila - what you say is true. But as with the opinions of most experts, there is a fair amount of diagreement.

It is still diffiult to pick your way through conflicing, and sometimes impassioned, advice to find the best course for yourself.

The trouble with T2 is that there is not a one size fits all solution.

Trial and error using a meter seems a very sensible way to go about things. Although I wonder if it is necessary to continue to test as often as some people think they should, once you have found an eating regime that works for you.
 
Romola said:
cugila - what you say is true. But as with the opinions of most experts, there is a fair amount of diagreement.

It is still diffiult to pick your way through conflicing, and sometimes impassioned, advice to find the best course for yourself.

The trouble with T2 is that there is not a one size fits all solution.

Trial and error using a meter seems a very sensible way to go about things. Although I wonder if it is necessary to continue to test as often as some people think they should, once you have found an eating regime that works for you.
Click to expand...
I've cut back quite drastically on my testing now that I've established an eating regime. Tending to test on rising and very occasionally one hour after meals.
 
Back
Top