Tight Control T2 not effective

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Tight Control T2 not effective


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Old 12-17-2011, 19:05   #1
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Smile Tight Control T2 not effective

I have read about this some time ago. WHen asked to provide the the background, I could not find the article.
Here it is:
People with type 2 diabetes are often urged to get their blood sugar as close to normal as possible. But several studies have not shown that such tight control has advantages. Now, an analysis of 14 clinical trials including more than 28,000 participants confirms that intensive blood sugar control does not save lives. Complications involving the kidney or the retina were less common under intensive blood sugar treatment, but the difference was not significant. Patients in the intensive blood glucose treatment groups were, however, at significantly higher risk of having their blood sugar drop to dangerously low levels. The fact that there was no obvious benefit to outweigh this potential harm might spur doctors and patients to think twice about this approach to diabetes treatment.


[BMJ, online Nov. 24, 2011]
British Medical Journal; it can be found online


Last edited by D4Hope; 12-17-2011 at 19:10. Reason: spelling
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Old 12-17-2011, 19:38   #2
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The problem wasn't "tight" control - which in most of those studies wasn't even what most of us would call tight in any case - but about serious over-medication. This has nothing to do with "tight" control done intelligently and naturally, i.e., by diet which by the way is completely incapable of producing "lows".

As far as eating badly and attempting to force BG down with massive amounts of oral meds and insulin - yes, BAD IDEA definitely for multiple reasons. That's all they tested. No profit in intelligent BG control.


Quote:
Originally Posted by D4Hope View Post
I have read about this some time ago. WHen asked to provide the the background, I could not find the article.
Here it is:
People with type 2 diabetes are often urged to get their blood sugar as close to normal as possible. But several studies have not shown that such tight control has advantages. Now, an analysis of 14 clinical trials including more than 28,000 participants confirms that intensive blood sugar control does not save lives. Complications involving the kidney or the retina were less common under intensive blood sugar treatment, but the difference was not significant. Patients in the intensive blood glucose treatment groups were, however, at significantly higher risk of having their blood sugar drop to dangerously low levels. The fact that there was no obvious benefit to outweigh this potential harm might spur doctors and patients to think twice about this approach to diabetes treatment.


[BMJ, online Nov. 24, 2011]
British Medical Journal; it can be found online

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Old 12-17-2011, 19:53   #3
 
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This article from the Mayo Clinic says that tight control is:

Blood sugar level before meals: 70 to 130 milligrams per deciliter (mg/dL), or 3.9 to 7.2 millimoles per liter (mmol/L)

Blood sugar level two hours after meals: less than 180 mg/dL (10 mmol/L)

Hemoglobin A1C (glycated hemoglobin, an indicator of your blood sugar control for the past few months): less than 7 percent

I don't consider that to be tight control by a long shot.

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Old 12-17-2011, 20:59   #4
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Many of these studies are based on a flawed study called the ACCORD Study. The particiipants in the ACCORD Study were older, sicker Type 2's who had very poor control for many years. They attempted to get their bgs and HbA1c's by any medication possible plus insulin. So many of these D's were on all sorts of drug combos including Avandia + insulin to get tight control. When people on D forums talk about tight control we talk about bgs that are stabalized in a narrow range. We do it with low carb diet, exercise and medication only when necessary. Since we eat low carb we don't get the spikes that a lot of D's get and we don't get the lows , either. My bgs stay about 100 most of the day give or take 10 -15 points. I feel that achieving normal bgs for me is not a risk. But if you are getting low HbA1c's by balancing out highs and lows, that is not good. My HbA1c comes from evenly balanced bgs.

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Old 12-17-2011, 22:40   #5
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180 2 hours after eating what was the 1 hour OVER 200

damage starts at BG over 140 so no there "tight control" wont help

Gee I wonder why there was not a significant improvement.

Thats like going on a diet, 3000 calories instead of 3500 calories and saying there is no significant difference, so dont diet.

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Old 12-18-2011, 02:25   #6
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Default Tight Control

Everyone defines tight control differently, that is okay.
In reviewing the studies, what astonished me was that even Type 2s with tight control (as they define it) were not able to avoid the complications that come with long term diabetes.
Did anyone else, in reviewing the studies, find this?

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Old 12-18-2011, 02:46   #7
 
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Quote:
Originally Posted by D4Hope View Post
Everyone defines tight control differently, that is okay.
In reviewing the studies, what astonished me was that even Type 2s with tight control (as they define it) were not able to avoid the complications that come with long term diabetes.
Did anyone else, in reviewing the studies, find this?
That study reminds me of my brother-in-law who says he has tight control of his bgs. His idea of tight control is eating a lot more fruit and dry cereal. Other than that, he eats anything that isn't chained down. No, the test results didn't surprise me at all.

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Old 12-18-2011, 04:07   #8
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As I've gone into elsewhere, my current understanding is that diabetes progression and complications come from TWO things, only one of which we measure:

1) excess blood sugar - because it doesn't get processed and/or takes too long, and
2) heavy glucose "throughput". We don't/can't measure this with our meters. It produces intra-cellular methylglyoxal which several researchers claim is tens of thousands of times more potent a glycating agent than excess glucose in the blood.

So, aside from this so-called "tight control" involving excess BG over 140 which has been confirmed to be a level at which damage occurs, there is something else even more important.

If these folks are scarfing multiple oral meds in large doses and/or shooting insulin and STILL having such bad numbers, just imagine how terribly they are eating. This means they are continuing to process large amounts of glucose, only somewhat suppressing the "spillover" in the blood with tons of medications.

So, the far more potent agent of glycation (and diabetic complications are all about glycation) is still running rampant or even increased under this ridiculous treatment regimen.

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Old 12-18-2011, 12:36   #9
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Quote:
Originally Posted by D4Hope View Post
Everyone defines tight control differently, that is okay.
In reviewing the studies, what astonished me was that even Type 2s with tight control (as they define it) were not able to avoid the complications that come with long term diabetes.
Did anyone else, in reviewing the studies, find this?
first you say the definition is usles then you go on to say yor supprised at complications.

So your surprised that people with BG routinely over 200 develop complications.

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Old 12-18-2011, 14:20   #10
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Quote:
Originally Posted by smorgan View Post
As I've gone into elsewhere, my current understanding is that diabetes progression and complications come from TWO things, only one of which we measure:

1) excess blood sugar - because it doesn't get processed and/or takes too long, and
2) heavy glucose "throughput". We don't/can't measure this with our meters. It produces intra-cellular methylglyoxal which several researchers claim is tens of thousands of times more potent a glycating agent than excess glucose in the blood.

So, aside from this so-called "tight control" involving excess BG over 140 which has been confirmed to be a level at which damage occurs, there is something else even more important.

If these folks are scarfing multiple oral meds in large doses and/or shooting insulin and STILL having such bad numbers, just imagine how terribly they are eating. This means they are continuing to process large amounts of glucose, only somewhat suppressing the "spillover" in the blood with tons of medications.

So, the far more potent agent of glycation (and diabetic complications are all about glycation) is still running rampant or even increased under this ridiculous treatment regimen.
I can eat what I want, take a shot/orals and all's well is a misconception that even many Diabetics have and quite frankly makes me want to shake some people.
Just because the readings on the meter have come down to a good level after medicating them doesn't mean all those sugars are magically gone in your body. They are still there, lurking and doing damage and in my opinion just keeps collecting if you keep piling it in.

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