AC1 and confused - Page 3

Go Back   The Diabetes Forum Support Community For Diabetics Online > Diabetes Forum Community > Diabetes

Diabetes This section of the forum can be used to discuss anything and everything to do with Diabetes. Please use this general Diabetes section for any comments or discussions that don't fit into the more specific forum categories below. Please also ensure that all posts and threads are on topic, about Diabetes.


Like Tree18Likes

AC1 and confused - Page 3


Closed Thread
 
Shared Thread Thread Tools
Old 10-29-2011, 13:01   #21
Banned
 
Join Date: Aug 2011
Location: Kentucky, USA
Posts: 158

Member Type
Type 2
Diagnosed in 1998

62 likes received
132 likes given
Default

Quote:
Originally Posted by beefy View Post
ok, i just don't want to get into another internet argument over hypoglycemia or what each of us said, like what happened with salim a while ago...

But, i *did* mention medication (and so i do feel justified in explaining myself)... Exactly what i said was:


So yes, i did mention more than just insulin-dependence - mentioning medications specifically. I felt my statement should have implied, and i hoped people would infer, that what i mean was exclusive of those not on another glucose-lowering medication. However, you cannot always clearly state all your intentions and beliefs in one post.

As for hypoglycemia being "rare" among t2's ... I guess this depends on your definition of "rare". (although clinically, it's certainly rare, which i'll go on to show in just a moment if you continue patiently reading.)

to me, even though i can get hypoglycemic, it's rare. Usually i hit around a 4.0 - 4.5 mmol/l (about 72 - 81) and my liver releases more glucose. However, there are times it just keeps going down, especially if i don't eat at minimum of every 3-4 hours and i've been exercising a lot in addition to my low-carb diet. So it's not always happening to me, and i'm one of the t2's that is on a particular medication (not even diabetes-related) that makes it so i can experience it. If i eat properly, it will be a rare occurrence.

The research you link to just further proves my point. The first is specific to only certain segments of the t2 population - those "with limited health literacy". As such, it's a small segment of the t2 population - indicating the event is not commonplace among all t2's.

The second article clearly states...
"in type 2 diabetes, severe hypoglycemia appears to be much less common, but when patients with type 2 diabetes receive insulin they may become as susceptible to hypoglycemia as patients with type 1 diabetes."
...further proving my point. Also, the fact that they call it a "major clinical problem" doesn't make it "common" in type 2's, just perhaps common in a clinical setting (ie: Doctors offices, emergency rooms, etc.).

The third article states:
"one of the most common causes of hypoglycemia is injecting too much insulin. People with diabetes who inject insulin are at high risk of developing hypoglycemia. But anyone with diabetes using hypoglycemic (blood sugar lowering) medications needs to watch for signs of hypoglycemia."
... Again, proving my point. Also, nowhere on this article does it state hypoglycemia is a common condition among t2 diabetics.

Now here's why i state it's rare...

From this article:
"results: We studied 1055 patients. Prevalence of hypoglycemic symptoms was 12% (9/76) for patients treated with diet alone, 16% (56/346) for those using oral agents alone, and 30% (193/633) for those using any insulin (p,.001). severe hypoglycemia occurred in only 5 patients (0.5%), all using insulin."

*note, this is a cut/paste from the full article, not from the abstract linked to above. I actually go crazy and purchase full articles to read...
less than 1/2 of one percent of type 2's in their survey experienced severe hypoglycemia - thus making it extremely rare.

... Many people confuse hypoglycemic symptoms with hypoglycemia (a severe, dangerous medical condition), and they are not the same thing. Even if you choose to use the data for those that only experienced symptoms (12% and 16% for the two non-insulin groups), we're still looking at it not being a commonplace occurrence.

That report concluded with:
"mild hypoglycemia is common in patients with type 2 diabetes undergoing aggressive diabetes management, but severe hypoglycemia is rare. "
aggressive diabetes management, according to both the idf (international diabetes federation) and the aace (american association of clinical endocrinologists) is generally described as much lower targets than the current recommendations, and includes (especially in studies) multiple glucose-lowering agents as well as insulin therapy. (somebody needs to tell them to try lowering carbohydrate first ....)

another study (published by the aace) on hypoglycemia in niddm (non-insulin-dependent diabetes mellitus) goes on to say:
"results: Of the 262 study participants interviewed, 172 insulin-using and 90 sulfonylurea-using patients were asked whether they had ever had hypoglycemia severe enough to require the assistance of another person. Of the 90 sulfonylurea-treated patients with niddm, 3 (3.3%) reported experiencing severe hypoglycemia on one occasion only. Of the 172 insulin-utilizing patients, 13 (7.6%) had had severe hypoglycemic episodes"
and those are for those on both insulin-therapy and sulfonylureas. Those numbers are not what we'd call "common". The risk of severe hypoglycemia is still rare.

They also concluded:
"on the basis of this study, we conclude that severe hypoglycemia is extremely uncommon in niddm. When it occurs, it is usually accidental and seldom recurs. Patients with multiple bouts of severe hypoglycemia have almost complete insulin deficiency. Thus, aggressive treatment of niddm to avoid diabetic complications is rarely associated with severe hypoglycemia and is usually well tolerated."
like i said, i don't really want to get into an argument here. I've spent a lot of time researching this disease, and i can provide article after article to back me up, whereas it's my opinion that what you've provided doesn't back up your statements.

You are entitled to your belief, but even if a primary side-effect of sulfonylureas is hypoglycemia, it doesn't change the fact that all the research and evidence states that severe hypoglycemia in a type 2 is rare. Even if they're on sulfonylureas or any other glucose-lowering agent.

Edit: Also, when you state...

Just because there are more type 2's than type 1's, it doesn't make it common among the type 2's. Hypoglycemia, even mild symptoms, is still rare, unless you consider 12% and 16% occurrence to be commonplace.

Another edit: And with that, i believe we've most certainly hijacked this thread on a1c targets enough, oops. I suggest if we want to continue a respectful debate, we do it in our own thread, if that's ok.


Last edited by MsTCB; 10-29-2011 at 13:04.
MsTCB is offline  
Old 10-29-2011, 13:03   #22
Banned
 
Join Date: Aug 2011
Location: Kentucky, USA
Posts: 158

Member Type
Type 2
Diagnosed in 1998

62 likes received
132 likes given
Default

Quote:
Originally Posted by beefy View Post
OK, I just don't want to get into another internet argument over hypoglycemia or what each of us said, like what happened with salim a while ago...

But, I *DID* mention medication (and so I do feel justified in explaining myself)... Exactly what I said WAS:


So yes, I did mention more than just insulin-dependence - mentioning medications specifically. I felt my statement should have implied, and I hoped people would infer, that what I mean was exclusive of those not on another glucose-lowering medication. However, you cannot always clearly state all your intentions and beliefs in one post.

As for hypoglycemia being "rare" among T2's ... I guess this depends on your definition of "rare". (Although clinically, it's certainly RARE, which I'll go on to show in just a moment if you continue patiently reading.)

To me, even though I can get hypoglycemic, it's rare. Usually I hit around a 4.0 - 4.5 mmol/l (about 72 - 81) and my liver releases more glucose. However, there are times it just keeps going down, especially if I don't eat at minimum of every 3-4 hours and I've been exercising a lot in addition to my low-carb diet. So it's not always happening to me, and I'm one of the T2's that is on a particular medication (not even diabetes-related) that makes it so I CAN experience it. If I eat properly, it will be a rare occurrence.

The research you link to just further proves my point. The first is specific to only certain segments of the T2 population - those "with limited health literacy". As such, it's a small segment of the T2 population - indicating the event is not commonplace among all T2's.

The second article clearly states...
"In type 2 diabetes, severe hypoglycemia appears to be much less common, but when patients with type 2 diabetes receive insulin they may become as susceptible to hypoglycemia as patients with type 1 diabetes."
...further proving my point. Also, the fact that they call it a "major clinical problem" doesn't make it "common" in type 2's, just perhaps common in a clinical setting (IE: doctors offices, emergency rooms, etc.).

The third article states:
"One of the most common causes of hypoglycemia is injecting too much insulin. People with diabetes who inject insulin are at high risk of developing hypoglycemia. But anyone with diabetes using hypoglycemic (blood sugar lowering) medications needs to watch for signs of hypoglycemia."
... again, proving my point. Also, nowhere on this article does it state hypoglycemia is a common condition among T2 diabetics.

Now here's why I state it's rare...

From this article:
"Results: We studied 1055 patients. Prevalence of hypoglycemic symptoms was 12% (9/76) for patients treated with diet alone, 16% (56/346) for those using oral agents alone, and 30% (193/633) for those using any insulin (P,.001). Severe hypoglycemia occurred in only 5 patients (0.5%), all using insulin."

*Note, this is a cut/paste from the full article, not from the abstract linked to above. I actually go crazy and purchase full articles to read...
Less than 1/2 of one percent of Type 2's in their survey experienced severe hypoglycemia - thus making it extremely rare.

... many people confuse hypoglycemic SYMPTOMS with hypoglycemia (a severe, dangerous medical condition), and they are not the same thing. Even if you choose to use the data for those that only experienced symptoms (12% and 16% for the two non-insulin groups), we're still looking at it NOT being a commonplace occurrence.

That report concluded with:
"Mild hypoglycemia is common in patients with type 2 diabetes undergoing aggressive diabetes management, but severe hypoglycemia is rare. "
Aggressive Diabetes Management, according to both the IDF (International Diabetes Federation) and the AACE (American Association of Clinical Endocrinologists) is generally described as much lower targets than the current recommendations, and includes (especially in studies) multiple glucose-lowering agents as well as insulin therapy. (Somebody needs to tell them to try lowering carbohydrate first ....)

Another study (published by the AACE) on hypoglycemia in NIDDM (Non-Insulin-Dependent Diabetes Mellitus) goes on to say:
"Results: Of the 262 study participants interviewed, 172 insulin-using and 90 sulfonylurea-using patients were asked whether they had ever had hypoglycemia severe enough to require the assistance of another person. Of the 90 sulfonylurea-treated patients with NIDDM, 3 (3.3%) reported experiencing severe hypoglycemia on one occasion only. Of the 172 insulin-utilizing patients, 13 (7.6%) had had severe hypoglycemic episodes"
And those ARE for those on both Insulin-therapy AND sulfonylureas. Those numbers are not what we'd call "common". The risk of severe hypoglycemia is still rare.

They also concluded:
"On the basis of this study, we conclude that severe hypoglycemia is extremely uncommon in NIDDM. When it occurs, it is usually accidental and seldom recurs. Patients with multiple bouts of severe hypoglycemia have almost complete insulin deficiency. Thus, aggressive treatment of NIDDM to avoid diabetic complications is rarely associated with severe hypoglycemia and is usually well tolerated."
Like I said, I don't really want to get into an argument here. I've spent a lot of time researching this disease, and I can provide article after article to back me up, whereas it's my opinion that what you've provided doesn't back up your statements.

You are entitled to your belief, but even if a primary side-effect of sulfonylureas is hypoglycemia, it doesn't change the fact that all the research and evidence states that severe hypoglycemia in a Type 2 is rare. EVEN if they're on sulfonylureas or any other glucose-lowering agent.

Edit: Also, when you state...

Just because there are more Type 2's than Type 1's, it doesn't make it common among the Type 2's. Hypoglycemia, even mild symptoms, is still rare, unless you consider 12% and 16% occurrence to be commonplace.

Another EDIT: And with that, I believe we've most certainly hijacked this thread on A1c targets enough, oops. I suggest if we want to continue a respectful debate, we do it in our own thread, if that's ok.
Not all differences of opinion = arguments.

Hope you can relax a little.

MsTCB is offline  
Old 10-29-2011, 17:58   #23
Senior Member
 
Join Date: May 2011
Posts: 137

Member Type
Type 2
Diagnosed in 2011

53 likes received
19 likes given
Default

Quote:
Originally Posted by beefy View Post
First - I'm stunned that a physician would put you on Met, Actos and Glyburide WITHOUT trying insulin first... Considering insulin is a natural substance with no real side-effect (except possible hypoglycemia and weight-gain, obviously)... To pump someone so full of meds without trying insulin is kinda nuts, imho.
Insulin is an anabolic hormone. Anabolic steroids are 'natural' too. So are mercury and cyanide. Not saying insulin is any of those but it isn't without risks.

ScienceDirect - Medical Hypotheses : Insulin-cancer relationships: Possible dietary implication

That some would prefer to break the cycle of insulin resistance and make optimal use of any remaining functioning islet cells (not including medications to overstimulate and possibly burn them out) doesn't seem crazy in the least to me. It makes good sense. I'm not saying insulin use to address an acute or chronic situation is a bad thing but it isn't water either. To say someone is nuts for trying Metformin before going on insulin seems just a little over the top at minimum.

MsTCB likes this.
gphx is offline  
 
Old 10-29-2011, 18:11   #24
Senior Member
 
Join Date: May 2011
Posts: 137

Member Type
Type 2
Diagnosed in 2011

53 likes received
19 likes given
Default

Maybe the important definition isn't 'rare' but rather 'hypoglycemia'. The NIH defines 'hypoglycemia' as a bg of 70 or less. Surely a considerable percentage of our T2 population has hit that number?

Hypoglycemia: MedlinePlus Medical Encyclopedia

MsTCB likes this.
gphx is offline  
Old 10-29-2011, 18:20   #25
Senior Member
 
beefy's Avatar
 
Join Date: Jan 2011
Location: Alberta, Canada
Posts: 1,491

Member Type
Type 2
Diagnosed in 2011

617 likes received
19 likes given
Default

Quote:
Originally Posted by gphx View Post
Maybe the important definition isn't 'rare' but rather 'hypoglycemia'. The NIH defines 'hypoglycemia' as a bg of 70 or less. Surely a considerable percentage of our T2 population has hit that number?

Hypoglycemia: MedlinePlus Medical Encyclopedia
... biting my tongue and not going to post as it's not what this thread is about

So I'm posting that I'm not going to post.

I will also state that I'm not impressed with the NIH - they ignore a great deal of relevant data. Plus they're source is the ADA. The ADA wants you to have HIGH BLOOD SUGAR. So they'll tell you to be scared at 70, which isn't normally medically serious, unless it's dropping fast - then the 70 never was serious.

__________________
47 yr. old Male
Alberta, Canada

Dx'd T2 Dec 19, 2010 - Fasting BG: 14.8 (267), A1c: 12.1, Wt: 290lb (over 320lbs at my heaviest)

As of Apr 23, 2013: 14-day Avg Fasting BG: 4.7 (85), A1c (Dec21): 5.1%, Stats: 230lb, 6'3" now with 37" waist

Low-Carb (Usually < 45-60g per day on a 3,000+ calories daily diet)

On Metformin only for meds. Exercise 6 days a week.
Supplement only with: Men's Multi-Vitamin, Vitamin D 2000iu/day, Aspirin 81mg, Cinnamon Extract and Fish Oil all 1x per day

beefy is offline  
Old 10-29-2011, 18:46   #26
Senior Member
 
Join Date: Jul 2011
Location: California, USA
Posts: 3,076

Member Type
Type 2
Diagnosed in 2009

4566 likes received
542 likes given
Default

Yeah, a lot of people are quoting that absurd 70 number and adding to this false panic about "lows" among non-medicated T2s. Suffice it to say that in the constant glucose monitoring trial which many of you have seen, within 2 SDs of mean in a NORMAL, non-diabetic population there were individuals who woke up at 58 and want right back to 58 a few hours after every meal! Gotta love the bell-curve.

If you look around for the actual diagnostic guidelines which doctors use to diagnose hypoglycemia it is quite a different picture. At minimum it must be below 55 (lower for women) AND accompanied by symptoms AND quickly reversible with administration of glucose. (Three required conditions.)

Note the "and" condition. A T2 with a long history of 300s can feel hypo symptoms at 120 (as many have reported) - that doesn't make it an actual "hypo". Likewise, some may feel bad at 70 or 65 also based on such a historical change - and might be well advised not operate dangerous machinery until they feel better - but that also does not make it actual hypoglycemia - it isn't. And it presents no danger to health in and of itself.

Has anyone heard of a non-medicated (and non-starving) T2 who had an actual hypoglycemic event with the three required clinical conditions mentioned above?

I haven't but I'm still looking every time this topic comes up.


Quote:
Originally Posted by beefy View Post
... biting my tongue and not going to post as it's not what this thread is about

So I'm posting that I'm not going to post.

I will also state that I'm not impressed with the NIH - they ignore a great deal of relevant data. Plus they're source is the ADA. The ADA wants you to have HIGH BLOOD SUGAR. So they'll tell you to be scared at 70, which isn't normally medically serious, unless it's dropping fast - then the 70 never was serious.

Patdart likes this.
__________________
Salim Morgan, T2
66 Years
DX: 9/2009 A1C=10.7
A1C 2/2010: 6.7 (DX + 4 months)
A1C 5/2010: 6.0 (DX + 8 months)
A1C 8/2010: 5.7 (DX + 11 months)
A1C 11/2010: 5.1 (DX + 14 months)
A1C 9/2011: 5.6 (DX + 2 years)
A1C 7/2012: 5.5 (DX + 2 years 10 months)
A1C 1/2019: 5.5
Diet: Approximately C:10;P:15;F:75 (as % calories)
Exercise: Not much. Stairs at home & work.
NO MEDS, No Highs, No Lows
Grandkids: 22
smorgan is offline  
Old 10-29-2011, 21:20   #27
Senior Member
 
Join Date: Dec 2009
Posts: 24,394

Member Type
Type 2
Diagnosed in 2009

23930 likes received
32255 likes given
Default

Quote:
Originally Posted by gphx View Post
To say someone is nuts for trying Metformin before going on insulin seems just a little over the top at minimum.
I'm pretty sure that isn't what Beefy is saying. He was objecting to the prescribing of met along with Actos and glyburide for a newly diagnosed type 2, who thereupon began having REAL hypos (as low as 39) every day. At least one and possibly both of the additional drugs were responsible for the lows - not the met.

We're all pretty much in agreement that met is not like all the other oral diabetes drugs. It works in the liver and leaves our delicate beta cells alone to do their work at their own pace. If my doc were to start prescribing sulfonylureas & other pancreas-busting drugs, I would be requesting insulin myself.

Diabetes Drugs - Quick Summary

Now if this discussion is to continue, one of you needs to open a new thread somewhere else, and leave this A1c thread to revert back to the OP.





Last edited by Shanny; 09-08-2013 at 18:12.
Shanny is offline  
Old 10-29-2011, 23:11   #28
Senior Member
 
Join Date: May 2011
Posts: 137

Member Type
Type 2
Diagnosed in 2011

53 likes received
19 likes given
Default

Quote:
Originally Posted by Shanny View Post
I'm pretty sure that isn't what Beefy is saying.
That could be. I was reading in the wee hours and beefy usually comes across as pretty smart.

gphx is offline  
Old 10-29-2011, 23:32   #29
Senior Member
 
beefy's Avatar
 
Join Date: Jan 2011
Location: Alberta, Canada
Posts: 1,491

Member Type
Type 2
Diagnosed in 2011

617 likes received
19 likes given
Default

Quote:
Originally Posted by Shanny View Post
I'm pretty sure that isn't what Beefy is saying. He was objecting to the prescribing of met along with Actos and glyburide for a newly diagnosed type 2, who thereupon began having REAL hypos (as low as 39) every day. At least one and possibly both of the additional drugs were responsible for the lows - not the met.
That is what I meant, yes. And I also agree maybe a new thread should start on hypoglycemia if people WANT such - it might be time to close this one, imho, (since it was on A1c stuff) before it gets out of control.

__________________
47 yr. old Male
Alberta, Canada

Dx'd T2 Dec 19, 2010 - Fasting BG: 14.8 (267), A1c: 12.1, Wt: 290lb (over 320lbs at my heaviest)

As of Apr 23, 2013: 14-day Avg Fasting BG: 4.7 (85), A1c (Dec21): 5.1%, Stats: 230lb, 6'3" now with 37" waist

Low-Carb (Usually < 45-60g per day on a 3,000+ calories daily diet)

On Metformin only for meds. Exercise 6 days a week.
Supplement only with: Men's Multi-Vitamin, Vitamin D 2000iu/day, Aspirin 81mg, Cinnamon Extract and Fish Oil all 1x per day

beefy is offline  
Old 10-30-2011, 00:42   #30
Banned
 
Join Date: Aug 2011
Location: Kentucky, USA
Posts: 158

Member Type
Type 2
Diagnosed in 1998

62 likes received
132 likes given
Default

Quote:
Originally Posted by beefy View Post
That is what I meant, yes. And I also agree maybe a new thread should start on hypoglycemia if people WANT such - it might be time to close this one, imho, (since it was on A1c stuff) before it gets out of control.
Glad you clarified what you meant because I interpreted it the same way several others did, i.e. that you were saying Insulin should be used BEFORE trying oral meds.

MsTCB is offline  
Closed Thread

Thread Tools

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are On
Pingbacks are On
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
New and confused glitch New Member Introductions 7 11-17-2010 00:37
HELP....Confused? tantoria2 Diabetes 4 09-16-2010 09:35
Confused momtohail Diabetes Symptoms 8 09-05-2010 16:30
Well, I'm confused! Corkyp New Member Introductions 15 08-25-2010 01:07
Confused MinisMom Diabetes 2 04-22-2010 19:53

LEGAL NOTICE
By using this Website, you agree to abide by our Terms and Conditions (the "Terms"). This notice does not replace our Terms, which you must read in full as they contain important information. You must not post any defamatory, unlawful or undesirable content, or any content copied from a third party, on the Website. You must not copy material from the Website except in accordance with the Terms. This Website gives users an opportunity to share information only and is not intended to contain any advice which you should rely upon. It does not replace the need to take professional or other advice. We have no liability to you or any other person in respect of any content on this Website.


All times are GMT +1. The time now is 19:05.




Powered by vBulletin®
Copyright ©2000 - 2020, vBulletin Solutions, Inc.
Search Engine Optimization by vBSEO
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2020 DragonByte Technologies Ltd.
User Alert System provided by Advanced User Tagging v3.1.0 (Pro) - vBulletin Mods & Addons Copyright © 2020 DragonByte Technologies Ltd.