September 23, 2014
The Questionable ADA
I do need to say that I do not follow the guidelines of the ADA. I did refuse for a couple of years to read what was happening on the ADA (American Diabetes Association) website, but that was a mistake. Even if a person does not follow the ADA, we still need to know what they are saying and what guidelines and research is published by them. Some of the research is behind a pay wall, but some is available to the public.
The reason I do not follow the ADA guidelines is that the blood glucose levels they promote are levels that result in the development of the complications. Knowing this is the reason doctors say that diabetes is progressive. When the ADA says they recommend an HbA1c of 7.0 percent is their guideline, this is also in the range for complications to develop. This also causes patients to only attempt to achieve this when an HbA1c below 6.0 percent is nearer normal and while complications can still develop, they will not develop as rapidly.
Having an A1c below 5.5 percent is better, but this is not achievable by everyone. I also admit I cannot attain this level without severe hypoglycemia. I would urge people to read this by David Mendosa, Normal A1c Level. He also discusses what Dr. Bernstein says about normal A1c levels.
Although the ADA has relaxed their food plans in the last two years and in October 2013 issued new guidelines for food plans that includes low-carb, the registered dietitians (RDs) still promote high-carb/low-fat diets even though many were on the committee that developed the ADA food plans.
The ADA is too lax in their guidelines for blood glucose levels two hours after first bite (they recommend not higher than 180 mg/dl) and this will promote complications. The guidelines also say at bedtime that our blood glucose level should be less than 180 mg/dl. Their one-size-fits-all standard is not a good thing and we need to realize this, as people are all different in the way we are capable of managing our diabetes.
The last time the ADA lowered the definition for diabetes was in 1997 that dropped the criteria for diabetes from fasting blood glucose of 140 mg/dl to 126 mg/dl or higher -- a change that increased the number of people with diabetes by millions. It is now 17 years later and a poorly named term of prediabetes needs to be changed. It is not an official designation by the ADA, but with research showing that damage occurs in the prediabetes range of 100 mg/dl to 125 mg/dl it is time to declare this diabetes and move on to having it treated.
Yes, this will add approximately 86 million people to the diabetes numbers, but if done properly, many should be able to stop the severity of diabetes for decades or at least years. Knowing the ADA, this is highly unlikely. The medical profession likes to have people to treat rather than practice any form of preventive medicine.
The ADA also needs to include in their guidelines the concept of moving insulin from the treatment of last resort, to prescribing insulin at the early stages. This has proven effective in allowing the pancreas to rest and partially heal, making oral medications effective for a longer duration. Read this by David Mendosa for further clarification. Many in the medical profession will not do this because of their overwhelming fear of hypoglycemia.
I hope this explains some of the more salient reasons for not following the ADA guidelines.