Guest guest Posted November 12, 2000 Report Share Posted November 12, 2000 Rob and I are veg-ing out this weekend. (I'll explain it all in a few weeks, when it's all over.) I just wanted to say that this was another excellent, thoughtful post from you. I'm going to repeat some of it because I found it so lucid. The only point I would add is that we should revert to using the GTT to diagnose diabetes: << So since the criteria are: 1. Symptoms of diabetes plus casual plasma glucose concentration of 200 mg/dl or more, OR 2. FPG of 126 mg/dl or more (fasting = zero caloric intake for at least 8 hours), OR 3. 2 hr PG of 200 mg/dl during an OGTT. If no unequivocal hyperglycemia is present then the test has to be confirmed by a repeat test on a different day. The symptoms of diabetes in criterion 1 being: polyuria, polydipsia and unexplained weight loss. So if somebody is tested casually in the middle of the morning and shows 195 mg/dl and claims to have none of the symptoms and then comes in the next day after 14 hours fasting and shows an FPG of 125 mg/dl then that person is not diabetic, right? (the OGTT is now no longer recommended for routine clinical use). <snipped> There are also the people who have symptoms of diabetes, including hyperglycemia, after exposure to certain medicaments or chemicals who revert to normoglycemia when that exposure is discontinued for some time. They are no longer diabetic but are presumably predisposed to diabetes so they could probably be usefully called half diabetic, too, I would imagine, why not? Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 Thank you, , for posting that clarification. Current US criteria call for a diabetes diagnosis if there are overt signs of the disease or after two successive fasting readings of/above 126 - even though fasting readings are not good indicators of diabetes. A diagnosis is called for also if 2-hr. postprandials are at/above 200 - even though many of us hit or peak at more like 1 - 1-1/2 hours. Postprandials are much more reliable indicators, but since people eat different types and quantities of foods, the best way to determine if there is a postprandial spike is a glucose tolerance test (using 75 grams of liquid glucose, I believe). And although labs fail to clarify this, the patient should be forewarned to prime him/herself with a minimum of three days of high-carb eating. Rob hasn't been diagnosed type 2 - partly because the lab lost some of blood specimens. Each of his symptoms is treated separately, by a different expert. No one has put the whole picture together. I have a sister who says she is not diabetic - that she has spilled glucose in her urine for 20 years because " I have a low renal thresshhold. " She worked in a medical lab, and recalls when they switched from GTT's to fasting glucose tests. Yet she thinks I'm pulling her leg when I say, " Normal people don't get up twice every night to pee. " She thinks it's normal to get the shakes and a headache when she misses a meal. The warning signs of diabetes posted by the ADA are so vague. They tell us to see a doctor if we are unusually thirsty or urinate frequently. How do we recognize " normal " ? We can go undiagnosed for years believing that " water tastes really good. " There is a proposal now to lower the fasting glucose threshhold for a diabetes diagnosis to 106, which still misses the point: It's our readings after ingesting carbohydrates that indicate the level of our disease. I was stunned that Teri was still under the impression that diabetes is somehow like a light switch or being pregnant. We have discussed this issue numerous times, but apparently the subject needs to be revisited. We are all at different levels of this disease, depending on how many years elapsed before we were diagnosed, whether we have a history of sulfonylurea use, obesity, genes, etc. Someone in another group said a workman she hired informed her that he is not diabetic - he just has high sugars. I suspect there is a lot of denial to overcome when first diagnosed. I hope that Teri recognizes that she is in the early stages of the disease, and that her pancreas will continue to deteriorate over time if it isn't rested. Susie Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 What I am concerned about, if you would have been following my statements correctly is that people who have been diagnosed not take it seriously. Often doctors are known to say " you have a 'touch' of diabetes " or " your sugars have been running a little high lately " . Statements like this are dangerous and can keep people that need medical treatment from obtaining it promptly. And I think you would agree that the longer treatment is not obtained, the more often and severe complications can be. Thornton wrote: > > > > I must say that I disagree with the > > " half a diabetic " comment. Come on, > > you either have it or you don't. > > If that statement was true, , then diabetes would be easy to > diagnose but it is not. Hyperglycemia is a continuum and does not > have an absolute threshold but an arbitrary one. Between > normoglycemia and hyperglycemia is a band known as " impaired glucose > tolerance " or " impaired fasting glucose " . Those people are not yet > diabetic according to the currently accepted diagnostic criteria and > yet are manifestly not normoglycemic. So " half a diabetic " is not a > particularly bad non-medical description for them - they fulfil half > the diagnostic criteria but not all of them. > > Additionally, there is epidemiological evidence that retinopathy > begins to develop at least seven years before the clinical diagnosis > of Type 2 diabetes is made [1]. So the description " half a diabetic " > could reasonably be applied to people who in retrospect had diabetes > before they fulfilled the criteria for a secure diagnosis of the > disease. In effect, they had it but they didn't have it, i.e. they > half had it. > > In any event, , your claim that " you either have it or you > don't " is not supported by the literature. > > > [1] , M.I.: " Undiagnosed NIDDM: clinical and public health > issues. " 16 Diabetes Care (1993) 642-652 > > > > > eGroups Sponsor > > Public website for Diabetes International: > http://www.msteri.com/diabetes-info/diabetes_int > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 are you a doctor that you think yourself such an authority Thornton wrote: > > > > I have also heard the term type 1 1/2 > > used loosely to describe diabetics that > > are nearly type 1, IDDM, but still have > > some self generated insulin. > > Well, Sam, " nearly diabetic " might do instead of " half diabetic " , I > suppose but whichever way you look at it, there has to be some term > to describe the situation. Just because the diagnosis is still based > on hyperglycemia and because plasma glucose concentrations are > distributed over a continuum there have to be arbitrary limits set > and agreed upon. So if a patient fulfils the criteria, he or she is > diabetic, while a patient that does not fulfil the criteria is simply > not diabetic. > > So since the criteria are: > 1. Symptoms of diabetes plus casual plasma glucose concentration of > 200 mg/dl or more, OR > 2. FPG of 126 mg/dl or more (fasting = zero caloric intake for at > least 8 hours), OR > 3. 2 hr PG of 200 mg/dl during an OGTT. > > if no unequivocal hyperglycemia is present then the test has to be > confirmed by a repeat test on a different day. The symptoms of > diabetes in criterion 1 being: polyuria, polydipsia and unexplained > weight loss. > > So if somebody is tested casually in the middle of the morning and > shows 195 mg/dl and claims to have none of the symptoms and then > comes in the next day after 14 hours fasting and shows an FPG of 125 > mg/dl then that person is not diabetic, right? (the OGTT is now no > longer recommended for routine clinical use). > > There must be some medical term for someone in that condition but I > cannot find it anywhere. It seems to me that " half a diabetic " is a > possible lay description, I don't understand what people have against > it. > > There are also the people who have symptoms of diabetes, including > hyperglycemia, after exposure to certain medicaments or chemicals who > revert to normoglycemia when that exposure is discontinued for some > time. They are no longer diabetic but are presumably predisposed to > diabetes so they could probably be usefully called half diabetic, > too, I would imagine, why not? > > > > > > > > > eGroups Sponsor > > Public website for Diabetes International: > http://www.msteri.com/diabetes-info/diabetes_int > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 Oh my.. so , you think that all doctors are authorities?? Tisk. IMHO, has probably read more about diabetes than many GPs.. Doesn't make him an authority though, just well read. Perhaps you can accept that? Marr wrote: > > are you a doctor that you think yourself such an authority > > Thornton wrote: > > > > > > > > I have also heard the term type 1 1/2 > > > used loosely to describe diabetics that > > > are nearly type 1, IDDM, but still have > > > some self generated insulin. > > > > Well, Sam, " nearly diabetic " might do instead of " half diabetic " , I > > suppose but whichever way you look at it, there has to be some term > > to describe the situation. Just because the diagnosis is still based > > on hyperglycemia and because plasma glucose concentrations are > > distributed over a continuum there have to be arbitrary limits set > > and agreed upon. So if a patient fulfils the criteria, he or she is > > diabetic, while a patient that does not fulfil the criteria is simply > > not diabetic. > > > > So since the criteria are: > > 1. Symptoms of diabetes plus casual plasma glucose concentration of > > 200 mg/dl or more, OR > > 2. FPG of 126 mg/dl or more (fasting = zero caloric intake for at > > least 8 hours), OR > > 3. 2 hr PG of 200 mg/dl during an OGTT. > > > > if no unequivocal hyperglycemia is present then the test has to be > > confirmed by a repeat test on a different day. The symptoms of > > diabetes in criterion 1 being: polyuria, polydipsia and unexplained > > weight loss. > > > > So if somebody is tested casually in the middle of the morning and > > shows 195 mg/dl and claims to have none of the symptoms and then > > comes in the next day after 14 hours fasting and shows an FPG of 125 > > mg/dl then that person is not diabetic, right? (the OGTT is now no > > longer recommended for routine clinical use). > > > > There must be some medical term for someone in that condition but I > > cannot find it anywhere. It seems to me that " half a diabetic " is a > > possible lay description, I don't understand what people have against > > it. > > > > There are also the people who have symptoms of diabetes, including > > hyperglycemia, after exposure to certain medicaments or chemicals who > > revert to normoglycemia when that exposure is discontinued for some > > time. They are no longer diabetic but are presumably predisposed to > > diabetes so they could probably be usefully called half diabetic, > > too, I would imagine, why not? > > > > > > > > > > > > > > > > > > eGroups Sponsor > > > > > Public website for Diabetes International: > > http://www.msteri.com/diabetes-info/diabetes_int > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 NO! I do not think all doctors are authorities. I can accept the fact that other people are more well read than I am. If other people can accept my opinions as well. Just because a person is well read doesnt make them an authority. Likewise someone who doesn't read every article and journal they come across can have good viewpoints as well. I just am afraid that " newbie " diabetics will read some advice on here and dismiss their doctor's advice....and get into trouble with their illness. Maybe when we make our statements we should put a disclaimer on them. lol. Do you know what I am trying to say? DaveO wrote: > Oh my.. so , you think that all doctors are authorities?? Tisk. > > IMHO, has probably read more about diabetes than many GPs.. > Doesn't make him an authority though, just well read. Perhaps you can > accept that? > > Marr wrote: > > > > are you a doctor that you think yourself such an authority > > > > Thornton wrote: > > > > > > > > > > > > I have also heard the term type 1 1/2 > > > > used loosely to describe diabetics that > > > > are nearly type 1, IDDM, but still have > > > > some self generated insulin. > > > > > > Well, Sam, " nearly diabetic " might do instead of " half diabetic " , I > > > suppose but whichever way you look at it, there has to be some term > > > to describe the situation. Just because the diagnosis is still based > > > on hyperglycemia and because plasma glucose concentrations are > > > distributed over a continuum there have to be arbitrary limits set > > > and agreed upon. So if a patient fulfils the criteria, he or she is > > > diabetic, while a patient that does not fulfil the criteria is simply > > > not diabetic. > > > > > > So since the criteria are: > > > 1. Symptoms of diabetes plus casual plasma glucose concentration of > > > 200 mg/dl or more, OR > > > 2. FPG of 126 mg/dl or more (fasting = zero caloric intake for at > > > least 8 hours), OR > > > 3. 2 hr PG of 200 mg/dl during an OGTT. > > > > > > if no unequivocal hyperglycemia is present then the test has to be > > > confirmed by a repeat test on a different day. The symptoms of > > > diabetes in criterion 1 being: polyuria, polydipsia and unexplained > > > weight loss. > > > > > > So if somebody is tested casually in the middle of the morning and > > > shows 195 mg/dl and claims to have none of the symptoms and then > > > comes in the next day after 14 hours fasting and shows an FPG of 125 > > > mg/dl then that person is not diabetic, right? (the OGTT is now no > > > longer recommended for routine clinical use). > > > > > > There must be some medical term for someone in that condition but I > > > cannot find it anywhere. It seems to me that " half a diabetic " is a > > > possible lay description, I don't understand what people have against > > > it. > > > > > > There are also the people who have symptoms of diabetes, including > > > hyperglycemia, after exposure to certain medicaments or chemicals who > > > revert to normoglycemia when that exposure is discontinued for some > > > time. They are no longer diabetic but are presumably predisposed to > > > diabetes so they could probably be usefully called half diabetic, > > > too, I would imagine, why not? > > > > > > > > > > > > > > > > > > > > > > > > > > > eGroups Sponsor > > > > > > > > Public website for Diabetes International: > > > http://www.msteri.com/diabetes-info/diabetes_int > > > > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 I am not saying I am right. It is only my humble opinion after all. But then, who says you are right also? We have differing opinions and I feel that you ought to respect that. However, I have known people (friends and family) where the doctor has made statements such as " you have a touch of diabetes " . They therefore were not concerned. Several years later the disease had progressed to alarming levels, such as very high fasting sugars, very high HA1C, etc. Whether that was their fault for not taking it seriously or the doctors fault for not ordering test periodically and following up with them I do not know. But it does happen. Also, not all people who are diagnosed are " country " people and would panic like you suggest. Some would I am sure, but not all. However, that does not give a doctor a reason for not telling someone something. Thornton wrote: > > > > Often doctors are known to say > > " you have a 'touch' of diabetes " or > > " your sugars have been running a little > > high lately " . Statements like this are > > dangerous and can keep people that need > > medical treatment from obtaining it promptly. > > , I don't have any data on what " doctors often say " but I > believe this is known as breaking the bad news gently, nothing more. > > This is normal medical practice - it would be very easy for doctors > to give their patients a terrible fright with unpredictable > consequences. When I was on a diabetes training some time back, we > had some very simple country people there and, although they were > accustomed to the idea of eating fat, one couple were very distressed > to hear that their metabolism converts fat into fatty acids and > protein into amino acids. > > I am willing to believe that if a man in a white coat had come in and > told them solemnly that their tests showed they were normoglycemic > they would have been just as distressed. > > You don't produce anything to support your statement that the > euphemistic approach is " dangerous " nor even that it results in poor > patient compliance - and I just don't believe it. There are many > reasons put forward for poor compliance and I don't recollect ever > having seen the practice " breaking the bad news gently " as one of > them. > > Sorry about that. > > > > > > eGroups Sponsor > > Public website for Diabetes International: > http://www.msteri.com/diabetes-info/diabetes_int > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 just because something is in writing, doesn't make it true you know Thornton wrote: > > > > are you a doctor that you think > > yourself such an authority > > Tut, tut, . I was doing what almost everybody does on this > list - quoting from the literature. In this case the Clinical > Practice Recommendations 2000 published recently by the ADA, price > $10. > > I didn't give the attribution straight away because those 3 little > letters are like a red rag to a bull (sorry, Susie) to some people on > this list and I didn't want to upset anybody (at least, I don't think > I did). > > If I was a doctor I wouldn't be hanging around this list but would be > back in the practice sending out my invoices. > > > > > > eGroups Sponsor > > Public website for Diabetes International: > http://www.msteri.com/diabetes-info/diabetes_int > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 Marr wrote: > > NO! I do not think all doctors are authorities. I can accept the fact that other people are more > well read than I am. I didn't mean you, I meant better read than some general practictioners. If other people can accept my opinions as well. Just because a person is well > read doesnt make them an authority. Likewise someone who doesn't read every article and journal > they come across can have good viewpoints as well. I just am afraid that " newbie " diabetics will > read some advice on here and dismiss their doctor's advice....and get into trouble with their > illness. Maybe when we make our statements we should put a disclaimer on them. lol. Do you know > what I am trying to say? Sure I do. Maybe a disclaimer can be incorporated into our closing statement that includes the website for Teri's web page. Newbie diabetics can get the wrong advice from " both sides " . While it's great to be enthusiastic about what works for you, it doesn't necessarily work for all. > > DaveO wrote: > > > Oh my.. so , you think that all doctors are authorities?? Tisk. > > > > IMHO, has probably read more about diabetes than many GPs.. > > Doesn't make him an authority though, just well read. Perhaps you can > > accept that? > > > > Marr wrote: > > > > > > are you a doctor that you think yourself such an authority > > > > > > Thornton wrote: > > > > > > > > > > > > > > > > I have also heard the term type 1 1/2 > > > > > used loosely to describe diabetics that > > > > > are nearly type 1, IDDM, but still have > > > > > some self generated insulin. > -- Dave -- Monday, November 13, 2000 t2 8/98 Glucophage ICQ 10312009 «» DavOr's daily aphorism: Some people approach every problem with an open mouth -- Visit my photo page @ http://www.dorcutt.homepage.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 13, 2000 Report Share Posted November 13, 2000 : can you tell that I sometimes suffer from anxiety disorder? haha. About drs not explaining and patients not asking.........I suppose I must have been different then, because I wanted to know everything immediately! So I got right on the internet and starting doing research. But that's me. I wonder what that says about doctors in general though. My doctor was sort of like that, but when I moved out of the area, I found an endocrinologist who is very patient with my questions. So that worked out for me, because I have many questions! Thornton wrote: > > > > I am not saying I am right. It > > is only my humble opinion after all. > > But then, who says you are right also? > > We have differing opinions and I feel > > that you ought to respect that. > > Calm down, , I do respect your opinions, OK? But you are > arguing with the obvious - everything we say here is our opinion, > that is what the list is for: so that we can express our opinions. It > would be a real mess if everybody had to tack " in my opinion " onto > every single statement! > > > However, I have known people (friends and > > family) where the doctor has made statements > > such as " you have a touch of diabetes " . They > > therefore were not concerned. Several years > > later the disease had progressed to alarming > > levels, such as very high fasting sugars, very > > high HA1C, etc. Whether that was their fault > > for not taking it seriously or the doctors > > fault for not ordering test periodically and > > following up with them I do not know. > > No, and I don't know either but I don't believe that it is any part > of a primary-care physician's responsibility to " follow up " high-risk > diabetics if they don't show up in his waiting room. None of what you > are saying is peculiar to diabetes - there are hundreds or even > thousands of tests that could be performed if the patients insisted > on them but very few do, except the very rich, maybe. Take that to > its extreme and we would have more of a problem with hypochondriacs > than hyperglycemics! > > > Also, not all people who are diagnosed > > are " country " people and would panic like > > you suggest. Some would I am sure, but not > > all. > > Now hold on! I didn't say " all " , did I? I was just giving an example > of what can happen. For example, there are far more simple people in > the world who know what fat is, but have a really hard time > understanding what a protein is, far less a carbohydrate, than there > are people who have done at least first-year organic chemistry. > > > However,that does not give a doctor a reason > > for not telling someone something. > > But it sure does! Even if you get them to begin to understand basic > nutrition, the moment that you tell them that insulin is a protein > they are lost again. > > I am pretty sure that the only way for a working physician to survive > is for him/her to tell his/her patients no more than they ask about. > I read somewhere that the majority of patients who turn up and report > diabetes symptoms ask only three questions: How is this going to > affect my job? Can I still go on vacation? Do I have to eat anything > special? > > And I put myself in that group without hesitation - in fact I seem to > remember that I didn't ask my physician anything, not even what > diabetes was, and he didn't volunteer the explanation either. Next > patient, please! > > > > > > > eGroups Sponsor > > Public website for Diabetes International: > http://www.msteri.com/diabetes-info/diabetes_int > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted November 14, 2000 Report Share Posted November 14, 2000 In a message dated 00-11-13 19:42:22 EST, you write: << By the time my first complications appear in 5 - 10 years time, I should have a grasp of the bare essentials! >> Yeah, but, , if you'd low carb you could probably avoid those " inevitable " complications. (Vicki, ducking and running)...boy, you're a stubborn cuss! Quote Link to comment Share on other sites More sharing options...
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