Pneu said:
Snodger said:
Personal targets aside, can anyone cite me some solid evidence for asking non-pregnant T1s to maintain an HbA1c of lower than 7.2% - ? (the level achieved for a short while by the lower-risk, better-control group in the DCCT).
I'm not stirring, I'm genuinely interested for my studies as well as for for me personally.
I don't have them to hand as I am at work.. but..
what I will say is that if your body could operate happily at an HbA1c of 7%, 8% etc... then why does a non-diabetic operate at 4-5% HbA1c? I don't think may people would argue that being over weight is unhealthy and that we should all try and maintain a 'normal' healthy weight.. yet saying you should try and maintain a normal HbA1c is terrible?
Would be great if you could find them, I'd be really grateful.
If you can achieve a normal hba1c without harming your health and quality of life, of course that's not terrible - it's fantastic, well done, and congratulations. But what I'm saying is that for type 1s (I know nothing about t2, none of what I say applies there) getting to normal bg is not as straightforward. We start to lose our hypo symptoms, which is
extremely disabling, and we get severe hypos, which are dangerous as well as terrifying.
In the DCCT the people who got to 7.2 (NB NOT normal, 7.2) got 3 x as many severe hypos - i.e. actual coma - than the control population. Severe hypos kill. Even in the 2002 DAFNE evaluation, where they said they had got people to reduce HbA1c without an increase in hypos, they only got HbA1c down to 8.4 AND they conveniently failed to include one of the study subjects who had died from unexplained 'dead in bed' syndrome. Dead in bed in a T1 usually means severe hypo (not me saying that, but 2003 NICE guidelines' comment on the DAFNE study).
We know from the DCCT that getting your HBA1c down to 7.2 for a few years can reduce your risk of long term complications. NB Few people in the DCCT trial could keep that up after the trial ended, and their risk of long-term complications remained lower - so actually it looks as though even a short term dip in HbA1c reduces risk of retinopathy, neuropathy and nephropathy. But as I say, they were
going into coma 3 times more than usual!
I can also find you trials which show that depression is higher in T1s with lower hba1c (presumably because it's so hard to get the bg down).
These are serious complications just as much as the -opathies. I find it so weird that the medical profession only really focuses on the long-term complications.
Incidentally, trials suggest that some bits of the body CAN thrive at a higher bg - for example, there doesn't seem to be much benefit in reducing hba1c below 8 when it comes to risk of neuropathy. And if you think about it, lots of other bits of the body are fine with moderately high bg; it doesn't affect every single cell. (Eg at hba1c of say 9, your hair and nails don't fall out, you still get periods, you probably aren't even thirsty). But yes, it looks as though retinas etc don't like high blood sugars, fair enough. Unfortunately, my brain doesn't like low blood sugars...
So in short, yes, it would be lovely if T1s could easily get their bgs down like T2s do, without suffering any bad effects. But what I'm objecting to is the fact that severely disabling and even lethal side-effects of low hba1c are just brushed under the carpet. Normoglycaemia is not this golden risk-free target for us.
Sorry for the long rant... I'll go off and look at owls again.