Insulin for T2 and prevention of complications.

[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.

There must be thousands of them but I have never

seen one that used the words " well controlled "

or " poorly controlled " which is what we were

discussing.

I have been looking at some German studies that

define a treatment goal, in one case it was

a mix of patients on standard insulin treatment

(2 fixed doses per day), intensive insulin treatment

(many BG readings per day with insulin dose ajusted

accordingly), and those with insulin pump. The BG

readings, shown graphically, formed two separate

groups, one in which the patients kept more than

65% of their spot BG readings within that range

and another group of those who failed to make

the 65%; they clustered into those two groups, and

both groups had a mean HbA1c of about 7.5%.

Nevertheless, the first group (what we would call

the " well controlled " ) had an average spot BG reading

of 133 mg/dl and the other group (what we would call

the " poorly controlled " ) had a mean spot BG reading

of 156mg/dl. Yet judged on the basis of their HbA1c

they were equally what we would call " well controlled. "

The researchers then found that the first group had

a mean diabetes duration of 8 years and the second

group had a mean diabetes duration of 16 years.

There were other tests done but the conclusion drawn

was that after about 9 years from getting diabetes

(both Types 1 and 2 were included) the body acquires

a tolerance to elevated blood glucose concentration

(gets accustomed to it) and the HbA1c indication

(and hence the damage done by glycosylation) then

corresponds to a higher level of blood glucose

concentration than it did before.

The point is that the terms " well controlled " and

" poor controlled " were never used. Dianne said that

she would wait until she sees those terms used before

she pays much attention to studies. My reply was

intended to suggest that it might be a long wait

since those terms are subjective and do not appear

to be used by scientists writing for each other.

You asked me to find studies using " well-controlled "

diabetics but so far I had no success. That does

not mean that they are not used, just that they are

probably, as in this case, called something else.

Regards

[Guest guest]

> 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.

To me a whole year is a long time to go between

check-ups!

Before diagnosis, I was getting quarterly check-ups

for my work and my FBG was good right up to the

line but my HbA1c was increasing slowly. That was

the reason why I was put on diet and exercise which

I did not take seriously. I never had excessive

urination, probably because I was eating mostly

meat and dairy products. Between one quarterly

check-up and the next I got an even more sedentary

job, put on a lot of pounds and acquired a belly.

My HbA1c went through the roof to 13% and I was

put on Glucophage which brought it right down

within 12 months. Too late for the microalbuminuria

but in time for my eyes! My foot neuropathy values

are not perfect but they could have been worse.

So if I am typical then I would say that the kidneys

take the first hit before diagnosis, then the feet

and then the eyes.

I really cannot blame the physician, only myself

for not following his advice and reading his

pamphlets. He tried his best but there are none so

deaf as those who do not want to hear!

Thornton

[Guest guest]

> 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.

Diet is such a controversial issue that I have

decided to try to get back to a lower Glucophage

dose via weight loss by exercise if I can stick

to it but the future does not look very bright

in that direction, just a little brighter than

in the diet direction, that's all!

Thornton

[Guest guest]

and Vicki

I thought I posted this last night, sorry if this is a repeat.

Then there are situations like my daughter. From the age of 7 weeks

to 9 years I had her in for medical treatment so many times that

toward the end they were blaming her problems on me. By that time I

was literally a mess. I was 100% sure there was nothing wrong with

her, it was all my fault AND equally 100% sure that if her problem

wasn't found and treated she would die. Try that for a few years and

see what it does to you. If that were today I feel certain that I

would have been charged with child abuse. As an adult my daughter

remembered some of the questions that they had asked her out of my

hearing and concluded they were thinking child abuse. I agree that

was how it would look.

At age 9 she wet the bed. It disturbed her terribly and when it

happened the 2nd time in a few days that was just too much.

I usually was the one to take her to the doctor but that time my

husband took her. He asked me what I should tell them. I said check

her for urinary problems. And so they did.

In a few hours the hospital called and said bring her back

immediately. She was hospitalized. The doctor that had seen her

that day had one year left in the military where we were getting all

our medical treatment. Then he was headed for the nearby Lilly Drug

Co. in Indianapolis about 60 miles away to work in the area of child

diabetics. That was his interest and so he saw what he was looking

at. Being military our medical records followed us so he had all her

records since her birth. He combed through them all and found not a

single, simple blood glucose test. He also said he saw symptoms that

should have alerted them to diabetes from the beginning. She had been

treated for vaginal yeast infections before her first birthday. He

gave us the connections to Lilly and their child diabetes studies.

And there we met another doctor who was a gem among gems. We were in

a situation that put us on the ground level with what Lilly was doing

at that time. That doctor lived with the kids, took them on 2-week

camping trips, supervised stays as an inpatient and in general was

more valuable than you could imagine. At first they did not believe

I was doing the urine test correctly, that was all we had at home.

Later they realized that was not the case and that she was as

difficult as any they had found.

In the light of today's knowledge I believe that a virus at age 7

weeks was the root of her problems but of course there is no way to

actually know that.

This brings up a couple important points. How did she live for 9

years without proper treatment? That is a mystery that there seems

to be no answer for. I think perhaps entering into that

considerations are the facts that she ate very little and was very

active. Most children that I have known did appear to have a fast

failure and therefore diagnosed. But perhaps some of them also went

undiagnosed for a while especially back in that time frame, 60s and

70s.

Diabetes knowledge and treatment have surely come a long way. When I

was first confronted with diabetes I knew absolutely nothing about

it. I had an outdated medical encyclopedia which I read that first

night. It said diabetic children die or spend most of their time in

a hospital. Since that time I have learned to never get serious with

outdated information even if it is outdated only a few years or

information from only one source. And to always consider the

source.

Shortly afterwards I read another book that seemed to make sense to

me at that time and I agree even more as the time goes by. That book

said that " long ago " there was a totally baffling disease called " the

fever " . Some sufferers were slightly sick, some violently, some

recovered soon without problems, others died or recovered over long

periods of time and still left with some problems. " The fever " was

diagnosed when the temperature was elevated. Enter the microscope

and they found they were not dealing with one disease at all as you

can well imagine. The writer speculated that diabetes, diagnosed

because of sugar in the urine, would someday be the same. That is

not one disease at all. I see that developing even now.

I am happy to now say inspite of being totally out of control for

several years she is well and has only minimal diabetic damage and

that is to her eyes.

BVan (Betty)

>

> Thanks, , for that clarification. It sounds right to me.

> However...I'm going to quibble about your last sentence

>

> " It seems to me that in Type 1 you suddenly do not

> > produce enough insulin while in Type 2 it happens very slowly -

that

> > is the real difference between the two. "

>

> The quibble is this: With type 1 the reason we " suddenly " do not

> produce enough insulin is because 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 ).

> Vicki

>

[Guest guest]

T, are you saying that you're going to cut back on your metformin

and increase vigilence to diet and exercise as a way to control BGs? And

you're concerned that you'll lose heart anyway?

If so, you're defeating yourself before you even start. As you said,

this requires a complete commitment. And by your statement, it sounds

like you're only half committed.

If I misread you, please set me straight.

Vicki

Re: Insulin for T2 and prevention of

complications.

>

>

>> 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.

>

> Diet is such a controversial issue that I have

> decided to try to get back to a lower Glucophage

> dose via weight loss by exercise if I can stick

> to it but the future does not look very bright

> in that direction, just a little brighter than

> in the diet direction, that's all!

>

> Thornton

>

>

>

[Guest guest]

Hi, Ray...your apprehension about insulin isn't irrational but I can

assure you that with today's very fine needles, shooting insulin in the

belly, where there are relatively few nerve endings, is practially

painless.

As for the risk of hypos, well, yes, it can happen - but not if insulin

is dosed properly. As I mentioned in another post, doctors generally

prescribe a " standard dose " insulin. Sometimes this works but more of

the time it's either too little or not enough. Since doctors are very

conservative, they generally prescribe a dose that practically

guarantees no hypos - but the opposite occurs, which is higher than

advisable BGs. This is why complications occur, even with insulin.

As I mentioned also in another post, I belong to another list whose

moderator has devised a method of dosing that is very exact. It's based

on personal parameters after lots of testing. With this method, minor

hypos can happen but in my 7+years of using it I've never had a hypo

that I'd consider dangerous.

Vicki, diabetic since 1997, A1Cs consistently under 6, no complications,

planning on no complications, EVER!

Re: Re: Insulin for T2 and prevention of

complications.

> 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]

> T, are you saying that you're going to

> cut back on your metformin and increase vigilence

> to diet and exercise as a way to control BGs? And

> you're concerned that you'll lose heart anyway?

> If so, you're defeating yourself before you even

> start. As you said, this requires a complete

> commitment. And by your statement, it sounds

> like you're only half committed.

>

> If I misread you, please set me straight.

No, you are quite right, Vicki. That other half is

really giving me some trouble at the moment, especially

as the winter has now set in. One look out of the

window and I have to fight the urge to jump back

into bed instead of doing my 60 minutes fast walking.

No signs of depression at the moment so my only excuse

is just plain old-fashioned laziness (and the ice!).

Thanks for firing me up a bit, here goes!

T.

[Guest guest]

Okay, then, good luck.

May I suggest something more?

If I remember correctly, in the past you've been eating a lot more carbs

than most of us here consider advisable, and you've defended this

approach most vigorously. However, those of us who have tried it knows

it works very well, not only for controlling BGs, but for weight loss.

Let me restate it briefly: Eating lower GI carbs helps to control BGs

as well as aid in weight loss. Avoid high GI carbs High GI carbs

include anything made with grains, such as breads, pasta, cereals, as

well as rice and potatoes.

The following 6 paragraphs are excerpted from my " standard newby letter "

so if you've already read this, skip to the concluding 2 paragraphs of

this post.

For further information about the glycemic index (GI) check out

Mendosa's most excellent website. URL is

www.mendosa.com

Here's my own list of pretty lowcarb veggies:

Spinach

Cauliflower

Broccoli

Summer squash (zucchini, crookneck)

Spaghetti squash

Mushrooms

Asparagus

Greenbeans

Cabbage

Sauerkraut

And of course lettuce and avocados which aren't a veggie but a

fruit, but they're definitely lowcarb. I have a large mixed lettuce

salad with avocado every night with dinner.

You can eat a reasonable portion (4-6 ounces) of meat, chicken, fish

without problem; it's all protein, no carbs.

Berries are the lowest carb fruit but even so, you should eat them very

sparingly. Here's the website of the USDA, which you'll find very

helpful. It has carbs, calories, protein, etc.

http://www.nal.usda.gov/fnic/cgi-bin/nut_search.pl

It's helpful to have a food scale. A cup measure isn't nearly so

accurate. I use a Salter scale. It weighs in both grams and ounces and

cost me somewhere around $35. I got mine at a local gourmet shop but

they're available online too. Just do a Google search for " Salter food

scales " .

Now, I don't want to argue with you about whether this method works

better than your method. Just give it a try for 2 weeks - checking your

BGs an hour and 2 hours after meals, as well as before -- so you can

actually see the proof.

Oh - and if you're doing this, be sure to check your BGs before and

after your exercise too. This may be the time to carb up, otherwise you

may find yourself low at the end of the hour.

I think you'll find the pounds melting off too. And you'll be a happy

camper, smile.

Vicki.

Re: Insulin for T2 and prevention of

complications.

>

>

>> T, are you saying that you're going to

>> cut back on your metformin and increase vigilence

>> to diet and exercise as a way to control BGs? And

>> you're concerned that you'll lose heart anyway?

>> If so, you're defeating yourself before you even

>> start. As you said, this requires a complete

>> commitment. And by your statement, it sounds

>> like you're only half committed.

>>

>> If I misread you, please set me straight.

>

> No, you are quite right, Vicki. That other half is

> really giving me some trouble at the moment, especially

> as the winter has now set in. One look out of the

> window and I have to fight the urge to jump back

> into bed instead of doing my 60 minutes fast walking.

>

> No signs of depression at the moment so my only excuse

> is just plain old-fashioned laziness (and the ice!).

>

> Thanks for firing me up a bit, here goes!

>

> T.

>