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Why do some diabetics escape complications?

  • Thread starter Thread starter catherinecherub
  • Start Date Start Date
It will be interesting to see what the outcome is, I was quite surprised that two thirds of the veterans (over 50 years with diabetes) had no complications! :shock:

Nigel
 
noblehead said:
It will be interesting to see what the outcome is, I was quite surprised that two thirds of the veterans (over 50 years with diabetes) had no complications! :shock:

Nigel
Click to expand...

I'm not surprised Nigel. Most of us who developed diabetes back in the 60's were taught to count carb through 10gm exchanges and to look after ourselves with insulin by eating regularly in smaller amounts. Lots of people still use twice daily insulin now with success. The only difference for people now is that they probably test their bg levels a bit more frequently. It can be good at times to practice a bit of self discipline over the food you eat and when you eat it, as you get rewarded later on in life.

When I lived in Essex, I asked a consultant why I was lucky in the fact that diabetes had caused me very little problems, his reply was that luck doesn't come into it. :roll: You either do things right or do things wrong. He then proceeded to give me a good talking to and told me that I was being too hard on myself.
 
viviennem said:
At last, somebody thought to ask the question! I wonder if the answer will be - "kept tight control of their bg levels"?
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Not if it reflects previous studies which have studied the survivors of 50 years with T1. Not until relatively recently was Hba1c tested and the tools for strict control weren't available when these people developed diabetes. The studies done to date though are all on T1 and don't necessarily apply to T2.
I don't know if the study mentioned in the link will cover T2 either as until recently you wouldn't have found many people diagnosed with T2 at an age to have a life expectancy of more than 30 years.
In the Joslin study, there was no difference between the HbA1c and previous control history of those with and without complications (average was 7.6%) at time of testing. In the Paris study, the survivors had had an average of 35 years before any complications had developed (and even then very few had 'severe' ones. Their mean Hba1c was 8.6% and only 10% were below 7%. In a small UK study of 10 people (1993)who had had diabetes for an average of 67 years , 4 had some evidence of complications but none had lost sight, needed dialysis or suffered amputation. These people had an average HbA1c of 10%!

In the Joslin study the survivors had normal BMI (average 25), high HDL (average 1.84mmol) and low insulin doses(average 0.52 u per kilo).
When they looked at factors that correlated with complications :age, diabetes duration, age at onset of diabetes, A1C, BMI, total cholesterol, and LDL cholesterol did not differ significantly between groups or for each microvascular complication.
Those people with complications tended to have higher triglycerides,take higher doses of insulin and strangely in the case of nepthropathy have lower hbA1cs.
The Paris study also found that their survivors had normal BM1s, higher HDL, and took an average of 0.52 u insulin. They also tended to be active with most doing at least 30 min of exercise a day, had social lives (visits to theatre, restaurants etc) and had worked full time .. 40% were still working.
In the UK study only one subject was obese (over BMI 30)


Recently the Joslin study has shown that 67% of it's survivors have some residual insulin production and that there is evidence of continuous beta cell renewel and death.

So my take on the results I've read (and summarised only briefly) is that a low HbA1c is probably a good thing(from other studies) but its equally important to keep a healthy weight, be active and have a good lipid profile with higher HDL and lower triglycerides... and be lucky enough to have some residual insulin production.


http://onlinelibrary.wiley.com/doi/10.1 ... 029.x/full
http://onlinelibrary.wiley.com/doi/10.1 ... 8/abstract
http://www.springerlink.com/content/221 ... lltext.pdf
http://care.diabetesjournals.org/content/30/8/1995.full
 

I concur with what you are saying iHs, I too was taught in carbohydrate exchanges but found it impossible to manage my bg until blood meters came widely available. My control vastly improved when I made the change to a bolus/basal regime, I once thought about pump therapy but have since tightened my control and if I can keep achieving near-normal control I see no need to change.

Phoenix....good post as ever and those studies prove that other factors such as exercise and quality of life are just as important as good control in living a long and complication free life.

Nigel
 
I've been a Type 1 for 52 yrs now with no complications. You would think - looking back to the good old days (not) and the way we tested would have given us massive probs now. The colour was orange for high sugar when you tested your urine, but how high was high anyway? I must have spent most of my diabetes life with high sugars without even knowing it, and back then of course there was no such thing as a low carb diet.
I have my own thoughts on the reason long term diabetics (or the majority of them anyway), have few or no complications, and I'm almost sure it was because of the insulin we had then. It wasn't synthetic like it is nowadays. I think if it was investigated they would discover the old insulins had something in them to reduce complications.
What do you think about my idea?
 

Time will tell April!

The trouble was with the old animal insulin was my control was hit and miss, since moving onto the modern analogue insulin's my control has vastly improved which I am sure will help my long-term prospects, although I do accept their are problems with these insulin's for some people as there was on pork/bovine insulin's.

Nigel
 

April, are you suggesting that youthink that complication rates will be higher, with those diagnosed in the 90's, than with people diagnosed in anaimal insulin days?

That is interesting, and as Nigel says, time will tell. Myself, based on nothing more than gut instinct, suspect, if that does prove to be the case, it is less to do with the synthetic insulins, and more to do with the "eat what you like" attitude that was prevalent back then. I think I went a full 25 years of (T1) diabetes care without anyone discussing carbohydrates with me. I am so pleased that things have changed, and I curious to see if that is reflected in peoples prognosis...I just hope that I can live long enough to see!
 
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