November 9, 2014

Reflections on Life with Type 2 Diabetes

When I was diagnosed in October of 2003, I knew it was possible and that diabetes was in my family. I admit I knew very little about diabetes and that I needed to start learning.

What I didn't appreciate was a doctor calling me a liar about knowing I had diabetes, even after I had told him to check with my doctor. Then I asked my doctor if he had been contacted and the answer was no. Needless to say, things got tense and I demanded an apology in writing from the doctor. Never received one, and two months later the doctor was no longer employed by the hospital.

The reason the doctor was so upset was because I was on the operating table at the time of diagnosis.   The procedure was being done to balloon several arteries and implant a stent in another artery. And yes, healing the area where they started to procedure took longer, but it did heal.

I did have the internet, but was not sure where to start. In talking with my doctor, I did have the loan of two books from his library that were about diabetes. I also did a lot of talking to my pharmacist and she gave me some ideas of where to look – the American Diabetes Association being one of them.

I did learn fast that the teachings of the ADA were not for me. The booklet for recording my blood glucose readings was set for the readings of the ADA suggestions and this seemed overly high for what I was reading on the internet. Several of the diabetes forums also were careful to promote the ADA way and the moderators were busy keeping people from promoting non-ADA positions. Two of the forums are ghost forums today with very little activity.

Research is not backing either of the two schools of thought for blood glucose levels or even the idea that lowering blood glucose levels drastically is an invitation to cardiovascular problems. I remember the ACCORD study that was canceled because the death level was too high. Analyzing the data in hindsight has proven invaluable, proved some ideas, and refuted others.

While the jury is still out since there have been conflicting studies about the good or bad of tight management of blood glucose levels. Yet, the current recommendations for good A1c's still hovers at 6.5% for young people (generally under the age of 60) and at 7.0% for older people (generally over the age of 59). This means that the blood glucose levels look like this:

  • 7.0% A1c = 154 mg/dl (recommended by the American Diabetes Association)
  • 6.5% A1c = 140 mg/dl (recommended by the American Association of Clinical Endocrinologists)
  • 5.9% A1c = 123 mg/dl (this is near the top of the pre-diabetic range)
  • 4.5% A1c = 83 mg/dl (this is considered about normal)
  • 4.1% A1c = 71 mg/dl (readings below this level can be dangerous for type 2s)

Those first two numbers—154 and 140 mg/dl— are pretty high compared to the three bottom levels. In general, the two official levels are in the range that will promote gradual progression to complications. This is why those of us in our support group attempt to have A1c's at 6% or lower. Some even stay below 5% on a regular basis.

This blog from Diabetes Health makes the several statements which I do not believe in and will never promote, but it may be acceptable to some people, especially doctors.

2 comments:

Ila East said...

The A1c recommendation, to me, depends on the age of the person. A young person will have to deal with diabetes a lot longer than say someone who was not diagnosed until the age of 75.

The younger person should try for tighter control than a 75 year old. Again, the older person will benefit from keeping the BG as low as is reasonably possible.

One question I have, and as you can tell I have not researched it, how many years does it take for diabetes complications to be diagnosed?

Bob Fenton said...

I honestly don't think anyone has an answer. Too many variables such as age, ability to manage, blood glucose levels over time, and many others.

To do a study would require harm to people with diabetes.