Re: half diabetic

[Guest guest]

> I wrote:

>

> > Even diabetics who thought they had

> > good control, under the guidelines

> > previously set by the WHO, found themselves

> > that ooops, it wasn't such good control

> > after all... they changed their minds again.

> responded: , are you sure that the WHO uses the attribute

> " good " ?

If you read my post, I said the diabetics were thinking they had good

control. Guidelines are set by WHO.

> My

> impression is that only diabetics themselves use " good " and " poor "

Yes. And doctors tend to do the same things... perhaps not " good

diabetic/bad diabetic " but " good control/not good control/brittle " . I was

trying to convey the diabetic's perception. And this is an important factor

because of the denial that tends to go along with this disease. And their

perception has a direct impact on how they view and treat their own disease.

> I prefer to use the

> term " close control " which to me means nothing much more than that

> the diabetic is monitoring BG him/herself instead of just waiting for

> the quarterly HbA1c results and does not say anything about the

> improvement that has been achieved.

We are playing with words ... " close control " " good control " " good diabetic "

" pre-diabetic " " half a diabetic " (conjuring up the image of half a body),

that is how we perceive ourselves and/or the effectiveness of our control.

> In Germany, they tend to distinguish between 'standard' treatment

> and 'intensive' treatment, the difference being that with intensive

> treatment an attempt is made (by means of home BG monitoring) to

> steer the dosage a little closer to the hypo range

Why hypo range ? You mean the that the doctor's recommend that those

who are self-monitoring should be in the 60-80 range? I find this absurd. I

would imagine that they would be encouraged to steer the dosage to stay in

the normal range, most or all of the time.

> than is the case

> with the standard treatment in which home BG measurements are not

> made at all and the treatment goal is therefore set correspondingly

> higher (higher HbA1c, that is).

That seems to be a recipe for disaster.

> To me " good control " also says nothing about the numerical value

> measured but refers only to the amount of effort put into the

> monitoring and the effectiveness of the response to the information

> obtained from it. " Poor control " meaning that the diabetic is not

> really bothering, that's what the doctor is being paid for.

I find this very judgemental. I have had poor control. And it certainly was

not for a lack of trying! I may not have the wherewithal to test as much as

you, or even to test as much as I should, but I do " bother " !! I go to my

doctor whether I have good control or bad. I go to him to effectively

evaluate my condition, and help with solutions.

[Guest guest]

in Constable wrote:

> Half, whole, or bordered with pink polka dots, a person with diabetes or

> insulin resistance or hypoglycemia has a problem with sugar

> metabolism. Accept it and deal with it.

Yeah ! EXACTLY my point ))))) Thank you.

[Guest guest]

> said:

> The whole point of setting diagnostic limits is to ensure that the

> machine is NOT set into action for marginal cases. The resources are

> limited and it is most important to ensure cost-effectiveness.

This is where I personally think that the medical profession has got it

backwards. If they could prevent people from developing the advanced stages

of this disease, by catching it and monitoring it early, there would be much

less a drain on the system in dealing with all the diseases associated with

diagnosing it once it becomes full blown. If a doctor sees a trend of the bg

rising over a period of time, even if the bg's are still in the normal

range, the patient could be counselled, and have a much better handle on

things, than waiting to have heart disease, numbness, vision problems, and

the list goes on.

[Guest guest]

I am just saying like I was all along that people who have a medical problem

should be treated.

Period.

Thornton wrote:

>

>

> > And I think that we would all agree what

> > ever you call " half diabetic " " pre diabetic "

> > " bordeline diabetic " " glucose intolerant "

> > etc, that whatever term you use, there is

> > something obviously medically wrong and thus

> > the person should be watched closely and

> > tested frequently by their doctor and/or

> > be receiving treatment.

>

> , why do you think that we " would all agree " with your approach

> just because you have got that notion? Serious people are working on

> the problem all over the world for the very reason that there is NOT

> always " something obviously medically wrong " ! That is begging the

> question.

>

> The rule of thumb used by physicians is that on average (in developed

> countries) everybody can be found to have signs of one chronic

> disease for every 10 years of their life. So if a 60-year old new

> patient walks into my physician's office he can expect to find signs

> of around 6 chronic diseases straight off. Multiply that by the

> number of patients attending primary care physicians around the world

> (not to mention the vast majority that don't have any kind of access

> to regular health care) and you get some idea of what would happen to

> the global economy if they all had to be " watched closely and tested

> frequently by their doctor " . It would collapse.

>

> > I mean to just ignore a condition

> > or a developing condition just because

> > it does not meet someone's criteria is

> > ridiculous.

>

> The whole point of setting diagnostic limits is to ensure that the

> machine is NOT set into action for marginal cases. The resources are

> limited and it is most important to ensure cost-effectiveness.

>

> > People don't take this disease seriously anymore.

>

> One problem that you fail to mention is that many diabetics suffer

> from the crazy notion that diabetes is about the worst thing that can

> happen to them - but it just isn't true. There are many worse

> conditions and the physician is faced with all of them - he/she can't

> just go overboard when the 30th patient that day comes in with

> a " little touch of sugar " .

>

> I understand what you are getting at, , but we really ought to

> keep the game in the ballpark.

>

>

>

>

>

>

> eGroups Sponsor

>

> Public website for Diabetes International:

> http://www.msteri.com/diabetes-info/diabetes_int

>

>

>

[Guest guest]

Amen!

wrote:

> > said:

> > The whole point of setting diagnostic limits is to ensure that the

> > machine is NOT set into action for marginal cases. The resources are

> > limited and it is most important to ensure cost-effectiveness.

>

> This is where I personally think that the medical profession has got it

> backwards. If they could prevent people from developing the advanced stages

> of this disease, by catching it and monitoring it early, there would be much

> less a drain on the system in dealing with all the diseases associated with

> diagnosing it once it becomes full blown. If a doctor sees a trend of the bg

> rising over a period of time, even if the bg's are still in the normal

> range, the patient could be counselled, and have a much better handle on

> things, than waiting to have heart disease, numbness, vision problems, and

> the list goes on.

>

>

>

>

> eGroups Sponsor

>

> Public website for Diabetes International:

> http://www.msteri.com/diabetes-info/diabetes_int

>

>

>

[Guest guest]

wrote:

<< Why hypo range ? You mean the that the doctor's recommend that those

who are self-monitoring should be in the 60-80 range? >>

The problem with the UKPDS and the DCCT studies, as well as with many modenr

diabetics, is trying to hold blood glucose close to 100 much of the time

while on the high-carb Food Pyramid diet. There's too much bouncing - too

much overcorrecting. Even the best-controlled of the DCCT test subjects

couldn't manage better than an average of 7.6 hbA1c ... and that had climbed

to 8.1 in a two-year followup. These were special subjects, hand-picked for

their diligence, and intensively trained and monitored, at great cost.

Susie

[Guest guest]

> Why hypo range ? You mean the that

> the doctor's recommend that those who are

> self-monitoring should be in the 60-80 range?

> I find this absurd. I would imagine that they

> would be encouraged to steer the dosage to stay

> in the normal range, most or all of the time.

I didn't mention being IN the 60-80 range, . I think I said

nearer to. The few tests that have been made with the proposed

continuous glucose monitoring devices are reported to have shown that

most diabetics have hypos far more often than had previously been

supposed, especially in the night.

I am a type 2 on Glucophage 2 x 500 mg a day. My last HbA1c was 5.2%.

It has been around 5.4% - 5.6% for about 6 months now. When I asked

my physician if I would be even better off if I could get down to

4.8%, he said no, definitely not, you are at the bottom of the safe

range. If you go any lower you will be exposed to a much higher risk

of hypos and nobody knows for sure what the long-term effects of

repeated hypos are, not much work has been done on it but the

sensible thing is not to go to 5.0% or below.

I read somewhere that Type 1's are advised to keep their HbA1c up in

the 7's for the same reason because they have a significantly higher

hypo risk, especially night hypos, than NIDD type 2's. I can search

for the reference if you are interested.

That is what I meant by steering nearer to, and away from, the hypo

range.

As to the words (poor, good, close, etc.) I didn't mean to be telling

you anything, I meant to be asking. I have no real interest in

persuading anybody else to use a particular terminology, I just want

to get mine right (and be able to document it, if possible). Although

I would hazard the guess that most of the time we argue here, we are

arguing about the terminology without knowing it! I know it sounds

trivial to you but I happen to be a member of the German Terminology

Group (DDT) and I need to watch my words!

[Guest guest]

> Message: 13

> Date: Tue, 14 Nov 2000 00:57:27 -0000

>

> Subject: Re: Digest Number 1154

>

> I just jumped in to defend it because the

> notion that the diagnosis of diabetes is a yes-no decision is

> completely untenable.

I can admit that there might be some problem drawing a line.

> You missed the point about the 7 years, I submit. There is no known

> convenient way to successfully screen presumed healthy people for

> diabetes at that time, I understand. So they have diabetes but they

> don't know it and there is no way that practicable routine screening

> tests could show it up.

Unless the statistic you cited was 7 years before hba1c or post-prandial

bg showed problems, I disagree. The doctor sends the blood to the lab

anyhow (as opposed to using a meter in the office). Why not an HBa1c

instead, which would probably catch more of these 'latent diabetics' (I do

like that term, )? How much more inconvenient would that be? Or

else, on alternate years, instead of a fasting blood glucose, use

post-prandial test - after a meal of pancakes, french-toast, cereal -

whatever (most breakfast foods being a carbo bonanza).

> Thus they have an invisible, undetectable diabetes but they DO have

> diabetes and so, in retrospect, they were diabetics for all that

> time.

I just think if they are sustaining damage to their eyes, it ought to be

visible elsewhere too, it's just that a fasting blood sugar isn't that

place. The disease must progress much farther before it shows up there.

> I am going back to the previous terms: " latent diabetic "

> and " manifest diabetic " . I suppose nobody will have any objections to

> those?

I actually like those. No denial of the presence of the disease, just

that's it's not known yet.

- Bob N.