Insulin for T2 and prevention of complications.

[Guest guest]

In a message dated 11/25/2005 9:34:45 AM Eastern Standard Time,

whimsy2@... writes:

> IMHO, if people saw their doctors more regularly, like for yearly checkups

> when they're feeling okay, more diabetics would be diagnosed BEFORE the

> problems occur.

This is true if the doctors are diligent in their examination. I had a

company physical every year, but it took another doctor to diagnose my Type 2.

Later

I acquired the blood results from my company physicals. The clue to Type 2

was evident in my fasting BG about 2 years earlier. Others have had similar

experience.

That was 16 years ago and I suspect there is a greater attention to the

possibility of diabetes today, but as always it's patient beware.

www.dapaice.com

" Click on Potpourri for diabetes tests. "

[Guest guest]

Hi Noble,

Once again - very valuable informaion for me...which leads me to more

questions :-) Below is part of your post I am asking about.

....in T2 about 20% may have complications at diagnosis. This is due to

the other components of the Metabolic Syndrome. Metformin can reverse

some of the complications related to IR. ACE inhibitors reduce

microalbuminuria and can reverse early nephropathy.

The best way to treat diabetic complication is to prevent through

achieving A1c less than 6.5 and BMI less than 23.

-----I need to be sure I am understanding what you are saying - you

talk about prevention of diabetic complications by keeping A1c less

than 6.5 and low BMI. YOu also say that in order to reverse some

complications - medication (Metformin) is required and also ACE

inhibitors. So, does this mean that reversal of complications can only

be achieved by medication and that prevention is acheived by keeping

bgs low?

With regard to testing - what does a neurological and an EKG show?

Thanks

Dawn - NC - T2 - diagnosed 5 weeks

D & E

[Guest guest]

Again, Dawn, I'm not Noble but I can definitely answer your next to

last question:

So, does this mean that reversal of complications can only

> be achieved by medication and that prevention is acheived by keeping

> bgs low?

Definitely, prevention is achieved by keeping BGs low. To do that,

determine what YOUR lab normal is for diabetes and whatever that is, aim

for it. (There is no standard for A1C tests but most seem to be around

6, from what I've read.)

As for the first part of that -- yes, reversal of complications can

occur. At the beginning of your diabetes, you might be able to control

with diet and exercise; many on this list have. ( -- you there?)

However -- diabetes IS a progressive disease and ultimately there may

come a time when diet and exercise don't work as well as it once did.

That's the time to go on pills. Or straight to insulin. There are many

studies showing that starting insulin earlier rather than later is more

beneficial to type 2s. I have saved some in my archives.

Whatever works to get your A1Cs down to non-diabetic numbers, do it.

A1Cs should be done every 3 months, so it's easy to keep pretty close

tabs on it.

Just in case doesn't pipe up here, he was diagnosed just about the

same time I was, in 1997.

Up until fairly recently he was controlled with diet and exercise only.

Now he's taking, I believe, Glyburide and metformin.

Our esteemed listowner, Rick, also controlled with diet and exercise for

a long time and is now on insulin.

(And if I'm wrong, someone is sure to correct me, smile.)

Vicki

Re: Insulin for T2 and prevention of

complications.

> Hi Noble,

> Once again - very valuable informaion for me...which leads me to more

> questions :-) Below is part of your post I am asking about.

>

> ...in T2 about 20% may have complications at diagnosis. This is due to

> the other components of the Metabolic Syndrome. Metformin can reverse

> some of the complications related to IR. ACE inhibitors reduce

> microalbuminuria and can reverse early nephropathy.

> The best way to treat diabetic complication is to prevent through

> achieving A1c less than 6.5 and BMI less than 23.

>

> -----I need to be sure I am understanding what you are saying - you

> talk about prevention of diabetic complications by keeping A1c less

> than 6.5 and low BMI. YOu also say that in order to reverse some

> complications - medication (Metformin) is required and also ACE

> inhibitors. So, does this mean that reversal of complications can only

> be achieved by medication and that prevention is acheived by keeping

> bgs low?

>

> With regard to testing - what does a neurological and an EKG show?

>

> Thanks

> Dawn - NC - T2 - diagnosed 5 weeks

> D & E

>

[Guest guest]

The reason 20% of type 2s have complications on diagnosis is due to the

sneaky way diabetes comes on -- slowly, and generally diagnosis comes

only after some of the symptoms have appeared. The first ones are

usually blurry vision and/or painful peripheral neuropathy. And this

occurs after months to years of high BGs.

IMHO, if people saw their doctors more regularly, like for yearly

checkups when they're feeling okay, more diabetics would be diagnosed

BEFORE the problems occur.

As to Noble's statement that type 1 and type 2 are entirely different

diseases, from what I've learned, it's actually the CAUSE that's the

main difference; type 1 is autoimmune induced. Due to an immune attack,

the pancreas stops producing beta cells, which carry insulin throughout

the body. OTOH, in type 2s, there's plenty of insulin being produced;

it's just not getting to the cells appropriately (insulin resistance).

However, the results of poor BG control are identical in both type 1 and

type 2, and I'm not going to list them here, smile, just to say that it

takes a long time of poor control for complications to happen, generally

years. It may seem shorter for type 2s because many of them have had

high BGs for a long time before seeking medical care.

Vicki

Insulin for T2 and prevention of complications.

> Hi Rick, Dawn, Vicki

>

> Thank you Rick for the link to the CME for the Medical Profession. The

> article is aimed at those managing the usual diabetics.'An A1C < 7.0%

> is

> only achieved in 36% of patients.'. I am happy that most of the

> members of

> this list have achieved lower A1Cs with or without medicines .

> The statement that most will eventually end up on insulin is referring

> to

> those unable to maintain their A1c below 7 with diet, life style,

> exercise,

> Metformin + Glyburide. 25 years of experience in this field makes me

> confident in stating that less than 10%T2s with dedication to maintain

> their

> A1c below 7 and BMI below 23, need to go on to Insulin. I saw someone

> in the

> list with T2 over 8 years, initial A1c more than 10 maintaining normal

> A1c

> without any medication. I expect that if this person maintains the

> same

> tempo, he will not require insulin any time.

> I had also mentioned a study where majority of T2s on Insulin could

> come off

> insulin with diet, life style, exercise, Metformin + Glyburide. Stress

> relief is also a very important factor. In that study yoga was used

> to

> relieve the stress of everyday life.

> Type1 and Type2 are different diseases. Complications are not present

> in T1

> at diagnosis and develop due to high BG whereas in T2 about 20% may

> have

> complications at diagnosis. This is due to the other components of the

> Metabolic Syndrome. The important tests to detect complications are a

> good

> neurological and vascular examination, Fundi examination by an eye

> doctor,

> EKG and Urine for microalbuminuria. Metformin can reverse some of the

> complications related to IR. ACE inhibitors reduce microalbuminuria

> and can

> reverse early nephropathy.

> The best way to treat diabetic complication is to prevent through

> achieving

> A1c less than 6.5 and BMI less than 23.

>

> Noble

>

> Dr. Noble Zachariah,

> www.mdchoice.com/Dr_Noble/office.asp

> www.geocities.com/drnoblez1

> Key To Good Health www.geocities.com/key2gh

>

>

[Guest guest]

At 02:59 AM 11/25/05, Noble Zachariah wrote:

> Hi Rick, Dawn, Vicki

>

>Thank you Rick for the link to the CME for the Medical Profession. The

>article is aimed at those managing the usual diabetics.'An A1C < 7.0% is

>only achieved in 36% of patients.'. I am happy that most of the members of

>this list have achieved lower A1Cs with or without medicines .

That low percentage was shocking to me. I knew that " below 7 " diabetics

were the minority but not how rare we were. The worst part of this is that

many of these people WOULD try to gain more control if they only knew there

was a way to do it. Why isn't the medical profession telling folks that

they can do this? Why do they just assume that it's more work than most

would want to do rather than let the individual decide? Argh!!!

>The statement that most will eventually end up on insulin is referring to

>those unable to maintain their A1c below 7 with diet, life style, exercise,

>Metformin + Glyburide. 25 years of experience in this field makes me

>confident in stating that less than 10%T2s with dedication to maintain their

>A1c below 7 and BMI below 23, need to go on to Insulin.

" need to go on insulin " as in they have no choice, I hope. Because many

CHOOSE to go on insulin.

>I had also mentioned a study where majority of T2s on Insulin could come off

>insulin with diet, life style, exercise, Metformin + Glyburide. Stress

>relief is also a very important factor. In that study yoga was used to

>relieve the stress of everyday life.

I found it stressful and boring trying to stay low-carb enough to keep my

numbers where I wanted them to be. I did low carb, by the way, for about

5-7 years before diagnosis. I'm tired of it. I want to eat some pasta, some

bread, or a cookie once in awhile.

-=sky=-

Type 2 dx'd 9/04/04.

Low Carb, Metaformin XR (2000mg),

and sometimes Humalog.

Other Meds: HTZ, Lipitor, Cozaar,

Topcol, Armour Thyroid.

Supplements: B12, D, CoQ10, biotin,

Omega 3, L-Arginine, cinnamon,

and others.

[Guest guest]

On 25 Nov 2005 14:05:03 -0000 " Noble Zachariah " drnoblez@...>

writes:

> The statement that most will eventually end up on insulin is referring

to

> those unable to maintain their A1c below 7 with diet, life style,

> exercise, Metformin + Glyburide.

Sorry doctor but I have to disagree with you on this. If you believe that

there is a guarantee that there will be no complications solely based on

a type IIs HbA1c, plus D and E and pills or that D & E and pills with

keep a type II off of insulin then you have not been reading posts on

this list. Since DM is a progressive disorder as well as a highly

individualized disorder blanket statements like this have little value

for the patient.

> 25 years of experience in this field makes me

> confident in stating that less than 10%T2s with dedication to

> maintain their A1c below 7 and BMI below 23, need to go on to Insulin.

You are not the only medical professional with this sort of tunnel vision

as to the treatment of type IIs. Generally, they look at the patients

HbA1c, BMI (another way of saying not obese?) and automatically assume

that if the HbA1c is >7 then the patient is doing something wrong, not

that the treatment prescribed by the medical professional is not working.

You might consider the reasons why DMers are joining DM internet lists in

droves. Primary reason seems to be a lack of confidence in the

information/treatment results they receive from their medical

professionals. When I see a medical professional using words like

" confident " and " prevention " my reaction is that this is more of the same

old barrier that medical professionals put up in front of type IIs that

makes them feel like failures if they do what they are told and still

cannot get their HbA1c down to under 7 (which BTW is to most type IIs on

DM lists is still too high), and makes the patient lose " confidence " in

their medical professionals. IMHO most of that lack of confidence in

their medical professionals seems to be a conflict in the medical

professionals sticking to the party lines promoted by the ADA and an

understanding by the well informed patient that the ADA party lines in

re: WOE and treatment of type just don't work.

>I saw someone in the

> list with T2 over 8 years, initial A1c more than 10 maintaining normal

A1c

> without any medication. I expect that if this person maintains the

> same tempo, he will not require insulin any time.

How can you foresee the future if you understand that diabetes is a

progressive disorder?

> I had also mentioned a study where majority of T2s on Insulin could

> come off insulin with diet, life style, exercise, Metformin +

Glyburide.

> Stress relief is also a very important factor. In that study yoga was

used

> to relieve the stress of everyday life.

Could you give the cite for this one study and while you are at it check

medline for more than a dozen studies that say the complete opposite.

> Type1 and Type2 are different diseases. Complications are not

> present in T1 at diagnosis and develop due to high BG

Whoa, now you are in my backyard. Of course type Is do not present with

complications since it is a quick onset disorder but I challenge you to

prove to this list that " high BGs " are the sole reason for complications.

I know of several type Is who purposely keep their bgs in the 250's to

avoid hypos and have NO complications and several type Is who have

regular HbA1cs below 7 who have some complications.

> whereas in T2 about 20% may have

> complications at diagnosis.

I think that a more accurate statement would be that more type IIs

present with some form of complication than not. It is usually the

complication that sends the patient to the doctor in the first place. And

since type II onset is very slow (in most cases, years) the chances of

presenting with complications is high.

> The best way to treat diabetic complication is to prevent through

> achieving A1c less than 6.5 and BMI less than 23.

With all due respect Noble, if you had said " forestall or put off "

complications I would not have responded to your post. Saying

complications can be " prevented " sounds like something a snakeoil sales

person says just before he/she tries to sell me something. I do not know

of a way you can guarantee that complications can be out and out

prevented any more than if you said if you don't smoke, regularly

exercise and eat properly you can prevent a coronary. A diabetic can

reduce their chances for complications or delay complications but there

is no way of predicting the future for ALL type IIs unless you have

another talent we are unaware of. :-)

[Guest guest]

Thornton wrote

> There is a thorough (but highly technical) explanation

> of the role played by genetics, age and obesity in

> beta cell dysfunction in type 2 diabetes at:

>

> http://www.medscape.com/viewarticle/514155_3

>

The article is really worth checking - even if you find it too technical -

the diagrams are very clear.

Bea

[Guest guest]

Well, I won't argue with you on that, , smile.

Using diet and exercise to control diabetes has to be the Most Important

thing in your life, IMHO, in order for it to work. Regular and frequent

BG testing and being in a support group such as this one also help keep

one motivated.

My only argument is with your final statement. Pills are not the only

next logical place to go after diet and exercise aren't controlling

diabetes adequately. Starting insulin early is cited as being

advantageous in several articles I have in my archives, and there are

people on this list who started insulin earlier rather than pills. And

some here tried pills but found insulin to be less odious and more

effective for good BG control.

Vicki

Re: Insulin for T2 and prevention of

complications.

>

>

>> If you can control with diet and exercise,

>> that's perfectly adequate.

>

> That was my downfall, Vicki! I started off with

> diet and exercise and I realize now that the

> " if you can " criterion really means: If you take

> it seriously enough!

>

> In other words, " if you can't " then that could

> well mean (as it did in my case) that you are

> not dieting severely and/or that you are not

> exercising strenuously or for long enough.

> (By " you " , I mean " me " , of course).

>

> It is really an argument in a circle because if

> you ask: " What is severely enough and what is

> strenuously and long enough? " then the answer

> has to be: " Enough so that you can control your

> T2 diabetes. "

>

> I now believe that the dieting has to be taken

> REALLY seriously and that the exercise has to be

> enough to result in a significant sustained

> weight loss (i.e. it goes down and stays down

> for ever). Both have to become just about the

> most important things you do!

>

> If you can control your diabetes with less than

> that then good, if you can't then you are just

> going to have to do more or eventually find that

> dieting and exercise do not hack it or no longer

> hack it!

>

> There may be reasons why you can't do " enough "

> even if it is only that you just do not have the

> stamina or the will-power in which case oral

> medication is the logical next step.

>

> Regards

>

>

[Guest guest]

And that's why God made insulin in those handy little vials. I found

the lifestyle restrictions imposed upon me by trying to it with d&e,

even with oral meds, just more onerous than I wanted to cope with on a

long-term basis. So, to return to a lifestyle that *I* want to live, I

chose insulin. Of course, now I have to lose some weight again, but

that would most likely be the case in any event.

CarolR

Thornton wrote:

> That was my downfall, Vicki! I started off with

> diet and exercise and I realize now that the

> " if you can " criterion really means: If you take

> it seriously enough!

>

> In other words, " if you can't " then that could

> well mean (as it did in my case) that you are

> not dieting severely and/or that you are not

> exercising strenuously or for long enough.

> (By " you " , I mean " me " , of course).

[Guest guest]

> The quibble is this: With type 1 the reason we

> " suddenly " do not produce enough insulin is

> cause of an autoimmune attack. In LADA, it's not

> sudden at all, as it is with type 1 in children -

> it can take months (like for me) or years (like

> for ).

Yes, you are right, Vicki, " suddenly " was not the right

word. " In a relatively short time " would have been

better, relatively short in comparison with the

10-15 years that it is said that a full-blown type 2

can take to develop from nothing.

Thornton

(I am getting confused myself now with some other

s on this list! Maybe the others could add their

last names, too?)

[Guest guest]

> My only argument is with your final statement.

> Pills are not the only next logical place to go

> after diet and exercise aren't controlling

> diabetes adequately. Starting insulin early is

> cited as being advantageous in several articles

> I have in my archives, and there are people on

> this list who started insulin earlier rather

> than pills. And some here tried pills but found

> insulin to be less odious and more effective for

> good BG control.

Yes, I guess so but that is not the way the health

system works over here. We have progressive

" treatment stages " and a recent study showed that

of the 5.8 million diagnosed German diabetics:

16.4% are at treatment stage: 'Insulin'

11.2% are at treatment stage 'Insulin + oral meds'

44.4% are at treatment stage 'Oral meds'

28.0% are at treatment stage 'Diet and exercise'

I believe that the stages are arranged in order of

the direct cost of materials required in each stage

and it is usual to move up through the stages as

the physician determines the necessity (if the

state health insurance is paying, that is). That

is probably one of the reasons why some people are

shy of the " insulin stage " - it is clearly the " end

of the flagpole " in that way of looking at it!

Thornton

[Guest guest]

Hi ,

In so many studies of DM, people are treated as though there are no differences

in control. When they start doing studies on well-controlled diabetics (or

poorly controlled diabetics for that matter), I will pay closer attention.

One size doesn't fit all.

Hugs, Dianne

__________________________________

Yahoo! Music Unlimited

Access over 1 million songs. Try it free.

http://music.yahoo.com/unlimited/

[Guest guest]

At 08:33 AM 11/25/2005, Vicki wrote:

>Our esteemed listowner, Rick, also controlled with diet and exercise for

>a long time and is now on insulin.

>

>Vicki

Ya Sure You Betcha!

It seems that my 'carb tolerance' dropped considerably. In order to

have a diet consisting of more than steak and lard (JUST kidding!!!),

I decided to go back to insulin. I still need to watch my carb intake

to avoid having to wear an IV of Humalog , but using Lantus and

Humalog allows me to partake of nutritious low/lower glycemic carbs

and still maintain good control. Plus, I was able to enjoy a

reasonable Thanksgiving dinner yesterday with family and friends.

Rick

[Guest guest]

In a message dated 11/25/2005 9:12:24 PM Eastern Standard Time,

j459g@... writes:

> Thornton

> (I am getting confused myself now with some other s on this list! Maybe

> the others could add their

> last names, too?)

Good idea. Since there's another one with my full name, I'll try to be

/Dirk from here on.

/Dirk

www.dapaice.com

" Click on Potpourri for diabetes tests. "

[Guest guest]

Hi

I saw my GP(UK) Tuesday and he quoted a price of 30pence ( 51cents) for a

test strip and thought this expensive, but from the Dx put me on Metformin

and Glimepiride as they were cheap. He also said insulin treatment was

costly too - so it looks as though economics rule here in the UK too.

Each surgery has its own budget and they have to pay for the prescriptions

that they write out of that budget.

Rob

[Guest guest]

In a message dated 11/25/2005 9:05:27 PM Eastern Standard Time,

beapullar@... writes:

> Thornton wrote

>

> >There is a thorough (but highly technical) explanation of the role played

> by genetics, age and obesity in beta cell dysfunction in type 2 diabetes at:

> http://www.medscape.com/viewarticle/514155_3

>

It's an interesting article, and contains a statement that supports something

I speculated previously, namely,

. . . << it becomes apparent that the insulin levels in diabetic patients

are lower than in healthy controls and inadequate beta-cell function therefore

represents a key feature of the disease >>

If you couple that statement with,

<< Thus, in Type 2 Diabetes Mellitus, when amyloid separates the alpha cells

from their companion beta cells, the alpha cells also produce persistently

high and inappropriate glucagon levels in the blood. >>

found at http://academic.sun.ac.za/medphys/insulinresistance.htm

it makes me wonder whether a cure for Type 2 diabetes is feasible by removing

the amyloid which prevents proper operation of the beta cells.

I'd like to think it's possible and to that end remained determined to

preserve my beta cells by maintaining a normal A1c, primarily by means of diet.

/Dirk

www.dapaice.com

" Click on Potpourri for diabetes tests. "

[Guest guest]

In a message dated 11/26/2005 11:30:18 AM Eastern Standard Time,

j459g@... writes:

> Diet is such a controversial issue . . .

I assume the controversy is on how to achieve and maintain the eating goal,

rather than what the goal should be.

What helps me is to make a game of it. Predict FBG, BG after meals, A1c, you

name it, if it can be measured I'd like to try and predict it.

That's just my way of putting fun into my way of eating. Others use different

methods, but a lot of them come down to making the conscious brain overcome

the subconscious brain which will persist in sending out hunger signals.

/Dirk

www.dapaice.com

" Click on Potpourri for diabetes tests. "

[Guest guest]

Hi

I can understand their reasoning, but I want the best treatment for me which

may not agree with their budgetary requirements. Surely they should also be

looking at what it is going to cost in the long term too?

Rob

[Guest guest]

> I can understand their reasoning, but I want

> the best treatment for me which may not agree

> with their budgetary requirements.

No problem, Rob, if you really want it, you can surely

get what you want any time you want it. The only snag

is likely to be that you might have to pay for it out

of your own pocket. If you want an insurance to pay for

it out of the pool then you usually have to accept

their rules.

> Surely they should also be looking at what it is

> going to cost in the long term too?

Yes, but the problem lies with the " going to cost " .

If you insure a million patients you can be pretty

sure that in 20 years' time you will be paying out

dearly for some awful complications that maybe 2/3 of

them are likely to be getting. What you don't and

cannot know is: Which patients are going to get

complications and which ones? There is a risk of

having complications, but not a certainty. If they

assume that everybody will get all possible

complications, that is one thing but to give

everybody the full treatment on the off-chance that

they will get them all is an expensive proposition.

The German health system knows that diabetes patients

cost twice as much on average as non-diabetic patients.

They also know that 5% of all diabetic patients are

responsible for 34% of all diabetes treatment costs but

they have no way of telling in advance for sure which

patients are going to end up in dialysis or with an

amputation and be amongst that 5%.

If they were to treat all patients initially on the

assumption that they need the maximum attention, the

works, just imagine what the total cost would be and how

much of it would have been unnecessary in the end.

Anybody who wants to be sure for themselves, can go

ahead and get the maximum treatment and pay for it

themselves, otherwise they have to accept that it is

handed out on the basis of a cost-effective economic

assessment.

Seems reasonable to me! As screening methods improve,

so will the chances of being able to devote attention

to where it is most needed. There is a genetic

predisposition to certain complications, too.

My guess is that as soon as detailed genetic screening

is possible, so will it be possible to get better

predictions of who is going to get what and when.

Regards

[Guest guest]

At 3:57 PM -0800 11/25/05, whimsy2 wrote:

> >>>>So, reversal can happen...by D & E or with D& E and medication?

>

>

>Most diabetics are reluctant to start insulin for various reasons. Many

>doctors assume all patients are reluctant to start insulin so when diet

>and exercise aren't doing the job, they start prescribing pills.

Good post Vicki.

Granted that insulin is probably the best control med I still have

two issues, both irrational. One is that I hate needles. Of course I

had to get used to the finger prick but I still hate it. The other

issue is that an overdose can kill you with a hypo. Thke irrational

part is that I am afraid because 60 years ago in the early days of

insulin injection my favorite cousin died of " insulin shock " .

I shocked a doctor and an educator a few years ago by saying that

insulin therapy might be a good alternative. My BGs were about 6.5

where 6.0 is about normal.

--

Ray B.

rbowler@...

Type 2 diet, Fortarmet

Live near Des Moines, IA

[Guest guest]

, what you say sounds quite reasonable from an insurance

underwriter's point of view. Unfortunately, that's the exact problem.

And if you're one of those unfortunately who suffers the consequences of

uncontrolled diabetes, it's absolutely no comfort to know that this

happened because it was statistically convenient for the insurance

companies.

Further, very few -- I haven't actually even heard of any -- doctors who

tell their diabetic patients that " well, you can avoid these potential

complications if you test frequently, use insulin and match your insulin

to carbs eaten, but if you want to do this, you'll need to pay for it

yourself. " This concept seems to entirely escape the medical profession

by and large, even though it's the way it's done for those on the pump.

So diabetics are denied even the opportunity to consider this option.

Also, sustained motivation to keep to the program is a very real

problem - not just in diabetes care but in health care in general.

That's why an online support group like this one is so important.

Vicki

Re: Insulin for T2 and prevention of

complications.

>

>

>> I saw my GP(UK) Tuesday and he quoted a price of

>> 30pence ( 51cents) for a test strip and thought

>> this expensive, but from the Dx put me on Metformin

>> and Glimepiride as they were cheap. He also said

>> insulin treatment was costly too - so it looks as

>> though economics rule here in the UK too.

>

> Yes, I am sure that it does everywhere! The idea of

> putting everybody on insulin right away sounds good

> - if you don't have to pay for it! And a lot depends

> on the accounting method and which budget it comes

> out of. We are only talking about cents but if those

> are several times a day for life and multiplied by

> millions of patients, the bottom line is usually

> quite a lot of money.

>

> I imagine that putting all diabetic patients directly

> onto the most expensive treatment with the object of

> reducing the risk of them getting complications in

> 20 years' time would break the back of most health

> care systems. And telling a mother that it is best if

> she pays out money she does not have now for a treatment

> that might or might not help to prevent complications

> that she might or might not get in the remote future

> has to be weighed against the certainty that her children

> might have to go without school lunch right now, and the

> whole family without a vacation, to pay for it.

>

> And a physician can tell all his/her patients that an

> intensive treatment with many BG readings a day plus

> insulin doses matched to readings is the best for them

> but if most of them are not going to have the patience

> or the interest or the time to comply with his treatment

> then it is going to be a shocking waste of money.

>

> The graduated system in which the treatment goal is

> matched to the present severity of the disease and

> the physician prescribes the least expensive treatment

> to enable that goal to be achieved seems to me to be

> a more reasonable way to handle the situation.

>

> Regards

>

> Thornton

>

>

>

>

>

[Guest guest]

I believe you're not correct there, -- as I recall, there are

several studies in my archives which do exactly define the A1Cs of the

diabetics used in those studies.

I know, you'd like me to post the cites. Well, I'll look later when I

have time.

Vicki

Re: Insulin for T2 and prevention of

complications.

>

>

>> In so many studies of DM, people are treated

>> as though there are no differences in control.

>> When they start doing studies on well-controlled

>> diabetics (or poorly controlled diabetics for

>> that matter), I will pay closer attention.

>

> Yes, I know what you mean but there is the point

> that " well-controlled " and " poorly-controlled "

> are really a matter of definition and depend on

> the criteria adopted by the researcher.

>

> Naturally, it is going to be more difficult to

> get sensible results from a study using subjects

> whose diabetes is all over the place. A lot will

> depend on the object of the study.

>

> All this mentioned just to suggest to you that you

> won't see the terms " well controlled " and " poorly

> controlled " in study reports because they are not

> clearly defined terms, they are subjective terms,

> and you have to look at the way that the subjects

> are classified into groups numerically in terms

> of their treatment targets and their compliance

> with the treatment.

>

> One person's " well " could easily be another persons

> " poorly " !

>

> Regards

>

>

>

[Guest guest]

> IMHO, if people saw their doctors more regularly, like for yearly

> checkups when they're feeling okay, more diabetics would be diagnosed

> BEFORE the problems occur.

Not necessarily, because people can go high after meals for years when their

fastings are normal.

> However, the results of poor BG control are identical in both type 1 and

> type 2

Yes, but the treatment can be different.

Gretchen

[Guest guest]

> I'm not clear what progressive means as regards well controlled diabetes.

> Does it mean that if BG control is maintained in the normal range, say

4.8%, by

> diet and exercise, that factors other than aging are expected to cause

> deterioration in the diabetic condition?

No one really knows, in part because so few type 2s keep their BGs that low.

Gretchen

[Guest guest]

> > IMHO, if people saw their doctors more regularly, like for yearly

> > checkups when they're feeling okay, more diabetics would be diagnosed

> > BEFORE the problems occur.

>

> Not necessarily, because people can go high after meals for years

when their

> fastings are normal.

That's the big problem. My husband gets a rather thorough physical

every year yet last spring he went in because of excessive urination

and had a fasting glucose of 344 and an A1c of 10.3. Silly me, I know

his family history and I thought the fasting glucose test was

sufficient. He would no doubt be in better shape if we had known

earlier that although his body was able to get his glucose down by

morning it was not low most of the time. On their side, they should

flag dubious glucose levels because I doubt his FBG was truly normal

in recent tests.