How aggressive are we type 2's in our treatment....

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desertdiabetic
Regular Member


Date Joined Dec 2005
Total Posts : 115
   Posted 6/26/2006 8:55 PM (GMT -7)   
I think that at the start I was like every other type 2 and wanted to avoid medications - and certainly not getting to the point of injecting insulin. I read and heard people who I respected in the field keep saying no matter where you are in your treatment it is no different than people who are not taking as much medications or not injecting insulin. I just did not understand how a person that is not taking any medications could be the same as someone that was taking several different medications and insulin and still not able to control. The more I read I began to understand what they are talking about. The disease is progressive, we all get diagnosed at different 'stages' of our particular disease. Handled aggressively enough we all might not have to progress at the same rate and might not progress as far into the different treatment options available. In the end we are all the same in that we have the same disease with the same treatment options and face the same complicatons if we progress to that point.

To the point. When I was diagnosed my fasting glucose was something like 150. Not all that bad in the overall scheme of things. My doctor put me on Metformin 500mg 3 times a day along with 2mg of Avandila twice a day. From what I hear this is rather aggressive to start with. Most people seem to start with just Metformin twice a day and don't progress to two medications until they are unable to control with jsst one. I actually cut back on mine some because I thought it was overkill, and it might have been. Now I am controlling very well and see the medications just as important as they were when I was not controlling as well. I lost 70 pounds - gained back 10 after starting a serious exercise program. I am right at the top of my weight range and just below the top of the BMI acceptable range. about 3 weeks ago my A1c was 5.2. I believe that I could maintain 5.5 easy with diet and exercise only.

Why would anyone take medications if they can control at 5.5 without medications? Good question. I do believe that we should shoot for the best and the most rormal range that we can acheive. That would be an A1c of 4.2 to 4.6. Higher is above where the body would control if it could. I believe that if you are in the 5's and above your beta cells are working very had to maintain those levels. Beta cell burnout is a major problem for type 2's. Avoiding beta cell burnout is paramount to me. To prevent this we have to maintain our blood glucose levels as close to mid 4's as much as we can. Most people will not agree with me on this. I don't think most doctors would agree either - but that is a completely different rant for a different time.

My question is how aggressive are you in controlling your blood glucose numbers? Most people seem to feel taht if you can control under the danger range of >7.0 you are doing ok. Well, that would be true if you did not think that your disease is progressive and it is the progression that will get you in the end. Changing the treatment after you are unable to control is following the curve - we should be ahead of the curve. While I do agree that medications are not natural I also believe that diabetes is not natural either and having the goal of no medications and no insulin is short-sighted and end the end will in most cases end up just where you don't want to be - on drugs and on insulin - Can you avoid medications forever - I don't think you can if you keep stressing your beta cells too much. Maintain a low enough A1c and probably you can avoid medication your entire life. That is not happening that often - in my opinion, anyway. Why am I still in the low 5's and not in the mid 4's? I did not say that I was successful as I want to be. I am normal in that respect. It is not the medications that are failing me, it is me that is failing me.

Boy, so long a post just to ask how aggressive are you in your own treatment program?
type 2 - dx 12/04
metformin 500mg 3x - avandia 2mg 2x


Jeannie143
Veteran Member


Date Joined Apr 2004
Total Posts : 6056
   Posted 6/27/2006 6:50 AM (GMT -7)   
Desert,

I don't think many people are as aggressive as you are to start... Most of us react in fear to our diagnosis because of the unknown aspects of the disease and the 'known' experiences of an Aunt or friend who had poor control and became blind or received an amputation. If a person is motivated by fear... eventually that fear-stress becomes more than can be coped with and sometimes the reaction is to revert to doing nothing (which adds more diabetic problems.)

It takes guts to face a life threatening disease and become pro-active, not reactive. And it takes time to reach that place in your steps to acceptance. Add to this the everyday stuff we all deal with, compounded by new meal plans, medication regimens, additional exercise plans, neuropathy, the technology of meters and testing, overcoming poking oneself with lancets and needles, additional costs and insurance (or lack of insurance) hassles... It can be overwhelming!

At the same time, seeing a person be as agressive as you are gives me a kick in the dupa to keep paying attention to my food plan and the rest of my regimen. It's encouraging to see someone fighting this disease tooth and nail. Kind of makes me want to get up to speed and be better with my testing and diet.

In answer to your question... I'm all gung ho for a while and then I become a slacker... kind of like a roller coaster. Wish I had your drive.
~ Jeannie

"People are like stained glass windows: They sparkle and shine when the sun's out, but when the darkness sets in, their true beauty is revealed only if there is light within."

- Elizabeth Kubler-Ross


Warren
Veteran Member


Date Joined Oct 2005
Total Posts : 534
   Posted 6/27/2006 7:17 AM (GMT -7)   

I think people should monitor their blood sugar to avoid future complications, because thats what diabetes does to you,

HOWEVER, I think advocating an A1c of 4.2-4.6 is not in a persons best interest!  That is an aveage blood plasma range of 60-75 mg/dl and the operative word is AVERAGE!!! that means you have some lower and some higher and already 60's is begining to flirt with Hypoglycemia and below that is definately hypoglycemic which has serious, deleterious even fatal consequences.  Low 5's (5-5.5= 95-105mg/dl) are just fine for an average and don't really have any serious long term consequences for a normal or diabetic person!  Lets just be a little careful about what we advocate to people here and not try to push them into a danger zone.

scool Warren
It's not that some people have willpower and some don't. It's that some people are ready to change and others are not. - James Gordon, M.D.
What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease. - George Dennison Prentice

I can only please one person per day, today is not your day...tomorrow doesn't look good either.


desertdiabetic
Regular Member


Date Joined Dec 2005
Total Posts : 115
   Posted 6/27/2006 7:37 AM (GMT -7)   
Warren - I think your concerns are shared by many people. I disagree with the average meaning that you have to go low to obtain that average. Anyone that averages anywhere near that range is doing so by having their individual situation in good control. You don't see the large peaks nor the hypo's. As you know most t2's don't go low very often. Getting down to lows is difficult as it is. If you are on meds that can drive you low and you maintain very low averages it is very unlikely that you will make drastic mistakes. Most people could not consider such a range because they live like they can eat anything and just add more insulin to cover or just are foolish. Anyone that believes that they can calculate how much insulin the body would have produced for something that has not even been consumed as yet is only fooling themselves. Something we all can do if we want. I choose not to. Well, being a type 2 that is really not an option for us anyway. I am referring to type 2's in this post, not type 1's. The scales I have found say that an average of 83 = 2.5. I have never advocated for anything lower. I stand very firm on my convictions that what the normal person can achieve we can too. If one cannot control what they eat then they should shoot for a higher number. I shoot for 4.5 but will probably never reach it, I don't have that absolute control it takes. Most people will probably just laugh it off because they will not, and I mean never, give up their favorite foods. And they probably don't have to if they do it correctly - but they will not achieve the best results.

Warren, you should read this sites 'other resources' and you will see that this site sells books that advoate just what I am saying. I think if you have a problem with it you should bring it up to Peter that he is promoting it also. There is plenty of information on what dangers there are for you heart at A1c's in the 5's. Impared Glucose Tolerance does have long term consequences for your heart. True, nothing compared to what >7.0 does, but still it is of some concern.
type 2 - dx 12/04
metformin 500mg 3x - avandia 2mg 2x


Warren
Veteran Member


Date Joined Oct 2005
Total Posts : 534
   Posted 6/27/2006 10:19 AM (GMT -7)   

Ok, for everyone that is wondering what in the world is an A1c number and how does that relate to my blood sugar:

HbA1c 4.0 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 4.9
Glucose 65 69 72 76 79 83 86 90 93 97
HbA1c 5.0 5.1 5.2 5.3 5.4 5.5 5.6 5.7 5.8 5.9
Glucose 101 104 108 111 115 118 122 126 129 133
HbA1c 6.0 6.1 6.2 6.3 6.4 6.5 6.6 6.7 6.8 6.9
Glucose 136 140 143 147 151 154 158 161 165 168
HbA1c 7.0 7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8 7.9
Glucose 172 175 179 183 186 190 193 197 200 204
HbA1c 8.0 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9
Glucose 207 211 215 218 222 225 229 232 236 240
HbA1c 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9
Glucose 243 247 250 254 257 261 264 268 272 275
HbA1c 10.0 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9
Glucose 279 282 286 289 293 297 300 304 307 311
HbA1c 11.0 11.1 11.2 11.3 11.4 11.5 11.6 11.7 11.8 11.9
Glucose 314 318 321 325 329 332 336 339 343 346
HbA1c 12.0 12.1 12.2 12.3 12.4 12.5 12.6 12.7 12.8 12.9
Glucose 350 353 357 361 364 368 371 375 378 382
HbA1c 13.0 13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9
Glucose 386 389 393 396 400 403 407 410 414 418

Now, with that being said I'd like to continue with the fact that there is NO correlation between Heart disease and an A1c number. 

Glycated hemoglobin (A1C) is a measure of long-term blood glucose control. Keeping A1C levels close to normal is an important part of diabetes care.

Some studies suggest that A1C levels may predict cardiovascular disease (CVD) and related problems of heart and blood vessels, such as heart attack or stroke, even in people without diabetes.  HOWEVER, a 2004 study among middle aged Type 2 health professionals (1500 of them for 7 years) found that the A1c level in these people was not a predictor of future heart problems. 

What they did find was that having diabetes was a fairly strong link to future heart problems.  Hmmmmm!!! could it be that high cholesterol, high blood pressure, associated weight problems, stress, smoking, drinking and a myriad of other factors all exacerbated by type 2 diabetes caused these heart problems??  Probably since they found there is absolutely no link between the A1c number and heart problems.

So for my 2 cents worth, keeping your blood sugar relatively normal is important since higher sugar levels in the blood can tend to do nasty things to a lot of your systems. By being myopic and focusing solely on this number to the exclusion of cholesterol, BP, and other very important "risk factors" just doesn't make much sense. 

I have a son with low blood pressure, normal blood sugar, thin as a rail and high cholesterol.  His Vegan diet has brought his cholesterol out of the 300's and into the 200's. Is that good enough? NO!...he's now on statins.  The point being here is someone with a "low" A1c who had a "significant" risk factor for heart disease - again, NO CORRELATION between A1c and risk factors.

Being "diabetic" of any type, means something is broken. You do the best you can to live a healthy lifestyle and use medication as an "intervention" to slow down and keep the disease at bay. If you want to be a zealot about lifestyle and numbers, be my guest; but I certainly choose "quality of life" and will have that chocolate chip cookie or ice cream once in awhile and if my blood sugar averages 95-100 instead of "83" I'm not going to get bent out of shape about it as long as the other "risk factors" in my life are normal.

scool  Warren



It's not that some people have willpower and some don't. It's that some people are ready to change and others are not. - James Gordon, M.D.
What some call health, if purchased by perpetual anxiety about diet, isn't much better than tedious disease. - George Dennison Prentice

I can only please one person per day, today is not your day...tomorrow doesn't look good either.

Post Edited (Warren) : 6/27/2006 12:25:34 PM (GMT-6)


desertdiabetic
Regular Member


Date Joined Dec 2005
Total Posts : 115
   Posted 6/27/2006 11:18 AM (GMT -7)   
Boy, you just struck a serious blow the the ADA and the American Heart Association. They both do believe that high glucose levels do have a direct relation to heart disease. That is what the A1c is all about - glucose levels over a period of time. I don't like the ADA anyway, so that doesn't break my heart at all.

There is good news here though - that qualty of live you refer to is reached by good control. Cholesterol and high blood pressure will be right in line with good glycemic control - and by the efforts it takes to get there. My numbers are fine. I have fallen down some on exercise this last couple months so my good cholesterol is a little low - I never said that perfection is obtained all the time. I just read somewhere where it said that diabetics should have the bad cholesterol below 70 and not 100 that is recommended for most people(not my numbers). Mine came back 68. I eat pleanty of 'good' fat and consume high protein. Just trying for low numbers willf improve your health.
type 2 - dx 12/04
metformin 500mg 3x - avandia 2mg 2x

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