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I came across this research which is quite confusing - to me anyway. My A1C is 6.4 and I'm doing my best to get it below 6. Perhaps this research was discussed previously but I would appreciate member inputs.

The conclusion of the research is:
In a large national cohort of patients with diabetes and
established HF, we demonstrate that the association between
levels of HbA1C and mortality appears U-shaped,
with increased risk of death at both higher and lower
HbA1C levels when compared with modest glucose control
(7.1%  HbA1C 7.8). It is estimated that approximately
20% to 30% (8), and perhaps up to 45% (9), of the nearly 5
million individuals with HF in the U.S. have coexisting
diabetes. Therefore, we feel that our data have significant
public health implications. We confirm that significantly
elevated HbA1C is associated with increased risk in this
population and efforts should be made to treat these patients
with proven HF therapies and consider glucose-lowering
therapy. Importantly, we also demonstrate an unexpected
hazard with normal or near-normal HbA1C levels in this
high-risk population of patients with diabetes and HF.

http://content.onlinejacc.org/cgi/reprint/54/5/422.pdf
 

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It's an interesting assertion, and I'm sure the media and health care community will jump all over it. We'll see our targets move up and our strip supplies dwindle even more.

So what are the characteristics of a veteran with diabetes and a low A1C? Is it someone that is pumped full of medications and insulin? Is it a newly diagnosed patient just under new found control? What are the confounding factors here? Understand that newly diagnosed elderly type 2's have a very high incidence of CHD BEFORE they are diagnosed. They are caused, IMHO, by the same thing, a metabolic imbalance of too much sugar. A newly dx'd veteran just under control for the first time may very well be at risk of a cardiac event. I know when my control suddenly improved, my eye hemmhorraged, a known pheenomenon. Is it the level or the change to the level?

What you can be sure that these people do not eat very low carbohydrate diets, at least not in numbers. IMHO this natural way of lowering an A1C bypasses all the health concerns this study implicates - heart disease, cancer, stroke, and diabetes complications.
 

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Keep in mind, HF and CVD are two different diseases.

Heart failure is not vascular in nature -- by which I mean, it does not involve the coronary arteries.
 

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I can give you my own personnel experience. The yr before I was Dxed my wife and I were walking 40-50 miles a week. I was in great physical condition for my age with no hint of CVD, I could do anything physical I wanted to do. My wife broke her foot, we stopped walking, my BG shot thru the roof, I was then Dxed with D, after several episodes of DKA. Once I knew I had D, I worked hard at lowering my BG level. I was Dxed at 350 after a week of zero carbs. The chest pain I soon developed came on quickly and seemed to be in direct relationship to the rapid reduction in my A1C. With in 18 mnths after Dxed I had to have a quadruple by-pass. In retrospect, it was just a short time before all of this that I was physically able to do anything I wanted to do. I believe it was caused by the rapid reduction in my A1C, my body just dumped all of that stored crap directly into my arteries.
 

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Mayo describes "Heart Failure."

Definition
By Mayo Clinic staff

Heart failure, also known as congestive heart failure (CHF), means your heart can't pump enough blood to meet your body's needs. Over time, conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently.

You can't reverse many conditions that lead to heart failure, but heart failure can often be treated with good results. Medications can improve the signs and symptoms of heart failure. Lifestyle changes, such as exercising, reducing the salt in your diet, managing stress, treating depression, and especially losing excess weight, can improve your quality of life.

The best way to prevent heart failure is to control risk factors and conditions that cause heart failure, such as coronary artery disease, high blood pressure, high cholesterol, diabetes or obesity.
 

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I think this is more a "reason" to sell us D folk on a higher A1C. I am constantly told that my 6.3% is "great control" despite knowing that a "normal" A1C is much lower.

What I am thinking the study is suggesting is that having an A1C that is super high vs super low is where the problem lies. I.E. At diagnosis, my A1C was 17.1%. Within 3 months, I had it down to 5%. I also had the eye problems after that, but I recall that my doctor and nurse were adamant that I NOT exercise during that period, and to just concentrate on getting my numbers down. I am sure it had to do with the posibility of perhaps having a cardiac event.
 

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I would still love to know how those of you who had a A1C higher than 15% got your number down within 3 months to 5%? I am following LC/HF WOE, exercising and I just tested my sugar after eating breakfast which consisted of coconut oil spread on a thin sandwich bread, with cinnamon and equal (which by the way usually does not spike me) and my bg was 280? This was after taking 16 units of Humulog and my supplements and meds (81 mg aspirin, crestor 20 mg, fish oil 1gram and Vitamin D3).
 

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I would still love to know how those of you who had a A1C higher than 15% got your number down within 3 months to 5%? I am following LC/HF WOE, exercising and I just tested my sugar after eating breakfast which consisted of coconut oil spread on a thin sandwich bread, with cinnamon and equal (which by the way usually does not spike me) and my bg was 280? This was after taking 16 units of Humulog and my supplements and meds (81 mg aspirin, crestor 20 mg, fish oil 1gram and Vitamin D3).
I know in my case, it was a combination of NCH, Novo-Rapid, and a low-carb diet that got me down so quick. The problem is, once I started taking the basal doses, my belly started to grow, and the weight came right back.

As for your "low carb?" Try having some scrambled eggs with spinach and a bit of salsa. That is more low carb high fat. The thin sandwich bread will still have carbs.

Also, depending on the exercise (if it is intense resistance) that can also increase your blood glucose as well.

You are on Metformin right now, and it's job is to suppress the glucose dumping of your liver. You might even find that you have better results working out first, then eating to recover.
 

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There is a lot more involved with having a high baseline BG level than just not enough insulin. Inflammation is a big culprit and your body while subjected to high BG levels still has some there. Your body responds by telling your liver to excrete more glucose, your body's defense to all things wrong with it, release glucose. Hormone levels, illness, stress, etc all effected my BG level directly or indirectly.

The biggest improvement for me was getting my digestion in order, then testosterone injections, then the aspirin therapy. Went from a mid 90's baseline to mid 80's baseline.


I would still love to know how those of you who had a A1C higher than 15% got your number down within 3 months to 5%? I am following LC/HF WOE, exercising and I just tested my sugar after eating breakfast which consisted of coconut oil spread on a thin sandwich bread, with cinnamon and equal (which by the way usually does not spike me) and my bg was 280? This was after taking 16 units of Humulog and my supplements and meds (81 mg aspirin, crestor 20 mg, fish oil 1gram and Vitamin D3).
 

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Hi, Renee ...

I don't know how to get to normal in 3 months, either. I started out with an A1c of 13.5 this April. Still waiting! (Must schedule an exam next month or so.)

As for the 280 BG, I suspect the sandwich bread might be your culprit here. I know that I tend to spike higher and harder on starchy foods than sugar alcohols -- especially if they're wheat-based. And this was especially true when I first started on insulin, before I got my numbers down.

Now that I'm closer to normal levels, have lost some weight and am exercising more, I find I can eat nuts and legumes (former no-nos) in moderation, and that I'm better able to cover starchier carbs with my Novolog ... IF I don't try that trick too often or go (literally) hog-wild on portion sizes.

As for the report ... yup, it will definitely be used as an excuse to keep our numbers dangerously high.
 

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I know that the sandwich bread has carbs, but it is one carb my body seems to do well with. I have eaten this before with the coconut oil and cinnamon with no spike, or minimal spike. I just checked my bg again and it is 222. Shouldn't be that high. I have had a problem with another humulog pen during Thanksgiving week that was not acting right, so this one is from the same box. I just wonder if it is a bad batch of Humulog? I mean the other night, I had half a baked potato with full fat sour cream, asparagus with hollaindaise sauce, and a bit of venison steak and I ended up with a low that I had difficulty bringing up. That was another pen that seemed to be working just fine obviously. I just don't get it sometimes. :?
 

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Oh, and by the way, just so you all know...I don't typically eat starchy carbs ever. Just thought I'd have a little of what I know doesn't spike me. Otherwise it is no-no with starchy carbs at all. I do not typically eat bread, pasta, potato, rice...nothing. Usually the only carb I am eating is what is in veggies. I don't even eat fruit with the exception of an occasional honey crisp small apple (maybe 1 every 2 weeks). I have been trying to get more high fat in the diet as this seems to be key.
 

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Oh, and by the way, just so you all know...I don't typically eat starchy carbs ever. Just thought I'd have a little of what I know doesn't spike me. Otherwise it is no-no with starchy carbs at all. I do not typically eat bread, pasta, potato, rice...nothing. Usually the only carb I am eating is what is in veggies. I don't even eat fruit with the exception of an occasional honey crisp small apple (maybe 1 every 2 weeks). I have been trying to get more high fat in the diet as this seems to be key.
Good decision. I think if I were you, Renee, until I could get this thing under control, I'd ditch every one of 'em, every time. Thin sandwich bread, half a potato, tart apples . . . anything that remotely resembles a double fourteenth cousin to a carb - avoid it like poison. Yes, it may be that it hasn't spiked you in the past, but I've had to retest a few things after many months of safe usage, when the numbers just weren't adding up. Once you get your numbers down & stable, you can always begin adding back. It's just that right now, every little thing is suspect. I wouldn't run the risk, if it were me.
 

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I think a lot of the research that goes into some of these studies came from the ACCORD Study. First off many of the participants were older, poorly controlled diabetics for many years. They threw every kind of medication and insulin combo at them to get their HbA1c's down. They even used the drug Avandia which has now been taken off the market in a lot of places. Many of these poorly controlled D's ended up going low because of all the drugs they used. So yes they got HbA1c under 7, but they did this by having lots of hypos which we know is not good. I think we all have to know our own bg profile. I have an HbA1c in the low 5's but my bgs are extremely stable. I rarely go below 90 and rarely over 120. Most of the time I stay in the 95-110 range. I think achieving good bg control is very individual. There are certain drugs like sulfyurea drugs like Glipizide that I avoid like a 10 foot pole because of the hypos. I really think keeping HbA1c above 7 like recomended is much more dangerous for your heart.
 

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Now I didn't read this article carefully in its entirety but I did read enough to get this from it:

1) Nowhere (and forgive me if I overlooked it) did it mention anything resembling any kind of exercise. So it appears these people all were junked up with meds as their only means of lowering their Bg levels and then they were expected to survive longer than two years. Please!

2) Notice that all of the subjects have BMIs in the low 30s. Go back to my first point. Now, we have a number of Type 2s that are highly obese and not exercising (from what we can tell, and if they are, it's not done as part of the treatment programme). These subjects are also pumped full of meds and it's highly likely that they are following ADA dietary advice. Their lipid levels are probably all over the place. To me, it doesn't matter what their BG levels are at any time... they are all in for serious problems!
 

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Oh, and by the way, just so you all know...I don't typically eat starchy carbs ever. Just thought I'd have a little of what I know doesn't spike me. Otherwise it is no-no with starchy carbs at all. I do not typically eat bread, pasta, potato, rice...nothing. Usually the only carb I am eating is what is in veggies. I don't even eat fruit with the exception of an occasional honey crisp small apple (maybe 1 every 2 weeks). I have been trying to get more high fat in the diet as this seems to be key.
Yep ... natural fat will help fill you up while keeping levels down.

Sounds like you don't have my problem with wheat (unpredictable BGs), but something else is going on.

I don't use pens, but have acquired some self-inflicted experience with insulin bottles gone past their prime. I spiked on everything and nothing. I also possess a certain degree of paranoia about new bottles starting out bad. So, personally, I go super light on the carbs until I know my current supply is good.

It appears your insulin may be OK, but the pens in that box are iffy. Is there a way to inspect/test them before using? (I hope that's not an ultra-ignorant question. Please pardon me if it is.)

Hope the rest of your pens are reliable!
 

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Interesting discussion, I did have a Heart Attack Oct 6, 2011, 3 stents inserted, was in CCU three days then in the Heart Institute the rest of the week and I am still recovering, they took me off of Humilin N and R and put me on Lantus and Novorapid never been in such poor control of my sugars, usually my A1C are 7.1, but I spiked to 8.2 could be I was having min heart attacks since February, doctor blamed the A1C and me for my Heart Attack IDIOT, seems my sis had a Heart Attack at 40 so it runs in the family, there is a strong push out there that if your Diabetic you will have Heart problems, everybody that goes into the Heart Institute with heart problem will automatically be tested for Diabetes, I saved them a step
 
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I believe this is exactly the answer. The lessen learned from ACCORD and other like it is not the evils of normal A1Cs, but the evils of heavy medication and insulin use to get there. It is well-known that lows are more harmful (and more quickly) than highs. Given a choice between 7.0 on no meds vs. 5.0 on several pharmaceuticals plus insulin, I'd take the 7.0 any day. Yes, I believe it would be healthier in every way. But I'm much more at peace with my low-5s with zero meds or insulin. Why doesn't anyone want to test that?


I think a lot of the research that goes into some of these studies came from the ACCORD Study. First off many of the participants were older, poorly controlled diabetics for many years. They threw every kind of medication and insulin combo at them to get their HbA1c's down. They even used the drug Avandia which has now been taken off the market in a lot of places. Many of these poorly controlled D's ended up going low because of all the drugs they used. So yes they got HbA1c under 7, but they did this by having lots of hypos which we know is not good. I think we all have to know our own bg profile. I have an HbA1c in the low 5's but my bgs are extremely stable. I rarely go below 90 and rarely over 120. Most of the time I stay in the 95-110 range. I think achieving good bg control is very individual. There are certain drugs like sulfyurea drugs like Glipizide that I avoid like a 10 foot pole because of the hypos. I really think keeping HbA1c above 7 like recomended is much more dangerous for your heart.
 

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Later studies of the accord data reached the conclusion that the aggressive treatment one group received was risky, but only to people who had type 2 for more than 20 years, without good control.

Can you say "Damage already done?"

-Lloyd
 
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