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The following information comes from a study published in the July 27, 2009 issue of the Archives of Internal Medicine.

The percentages of complications in well controlled type 1s were very impressive.

"The demonstration that near-normal glucose control substantially lowers microvascular and cardiovascular complications has heralded a new era of Type 1 diabetes care," says lead author David M. Nathan, M.D., of Massachusetts General Hospital. "The remarkable improvement in long-term outcomes achieved with intensive glucose control should encourage clinicians and patients alike to implement intensive therapy as early in the course of Type 1 diabetes as possible."

The authors compared overall rates of eye, kidney, and cardiovascular complications in three groups of people diagnosed with Type 1 diabetes an average of 30 years earlier.

"After 30 years of diabetes, fewer than 1% of those receiving intensive glucose control in the DCCT had significantly impaired vision, kidney failure, or needed a limb amputation due to diabetes," noted Saul Genuth, M.D., of Case Western University, who co-chairs the EDIC study. "Tight control is difficult to achieve and maintain, but its benefits have changed the course of diabetes." Intensive treatment meant trying to keep hemoglobin A1c readings at 6% or less with at least three insulin injections a day or an insulin pump.

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The following information comes from a study published in the July 27, 2009 issue of the Archives of Internal Medicine.

The percentages of complications in well controlled type 1s were very impressive.

"The demonstration that near-normal glucose control substantially lowers microvascular and cardiovascular complications has heralded a new era of Type 1 diabetes care," says lead author David M. Nathan, M.D., of Massachusetts General Hospital. "The remarkable improvement in long-term outcomes achieved with intensive glucose control should encourage clinicians and patients alike to implement intensive therapy as early in the course of Type 1 diabetes as possible."

The authors compared overall rates of eye, kidney, and cardiovascular complications in three groups of people diagnosed with Type 1 diabetes an average of 30 years earlier.

"After 30 years of diabetes, fewer than 1% of those receiving intensive glucose control in the DCCT had significantly impaired vision, kidney failure, or needed a limb amputation due to diabetes," noted Saul Genuth, M.D., of Case Western University, who co-chairs the EDIC study. "Tight control is difficult to achieve and maintain, but its benefits have changed the course of diabetes." Intensive treatment meant trying to keep hemoglobin A1c readings at 6% or less with at least three insulin injections a day or an insulin pump.

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Hi Richard,

I have a few questions. I understand that the research is based on Type I, but do you think that 6% is a reasonable number for Type II's, too? Or is Type I so different from Type II that there is no good comparison? I mean, I know type I is different from type II, but the question applies to the general principle.

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Type 2 diabetics who take very good care of themselves are not as likely to have these complications because they still produce their own insulin and C-peptide. That helps protect against complications. Research is being done in Boston on long term Type 1's. A significant number of the 550 participants examined thus far have C-peptides of 0.6 or more. That is actually quite low but these old timers do not have complications after 50 years or more of diabetes. Type 2 diabetics have much higher C-peptides than that, assuming they are producing insulin. Many Type 2 diabetics eventually produce less and less insulin until they become insulin dependant. At that stage they are very much like a Type 1. I have a few Type 2 friends who no longer produce any insulin or C-peptide so they are now more likely to have complications than before. I should have pointed out that the Type 1's without complications have typically taken good care of themselves. If a Type 2 has an A1c greater than 6.0 it is not as likely to lead to complications as it might be for a Type 1. I do, however, believe that A1c's well above 6.0 are very dangerous for ALL diabetics.

I am sorry that I cannot do a better job answering your question. You asked a Type 1 to answer a Type 2 question. Lol! Maybe some Type 2 diabetics will answer your question now and give their opinions.
 

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That's good news. I have been working towards an A1C of 4.5 or so. My control over the last month has been excellent for the most part. My rare spikes hit 120 or so briefly, but I have been averaging 90-100, with lows ranging from 70-85 on average, with the lowest 64. most of the time I am pretty stable in the 80's to 90's.

I stick myself way too much, but I am paranoid of a spike, which ends up causing me to use 8-10 strips a day. I thought about a CGM device, but I doubt I can get insurance help with that. If I could, it would be even easier to adjust diet.

Thanks for the update.
 

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That's good news. I have been working towards an A1C of 4.5 or so. My control over the last month has been excellent for the most part. My rare spikes hit 120 or so briefly, but I have been averaging 90-100, with lows ranging from 70-85 on average, with the lowest 64. most of the time I am pretty stable in the 80's to 90's.

I stick myself way too much, but I am paranoid of a spike, which ends up causing me to use 8-10 strips a day. I thought about a CGM device, but I doubt I can get insurance help with that. If I could, it would be even easier to adjust diet.

Thanks for the update.
Warren your control is better than mine, congratulations! I am 70-120 about 80% of the time but still have a few highs as high as 160 and some lows as low as 50. A CGM would help me see those highs and lows coming before they happen and I could correct them quickly. That would cause me to lose less insulin and improve my health and A1c.

I have found an endo who has worked to get my insurance company to cover my CGM. I was accepted a week ago and my Dexcom CGM is being mailed to me. A really convincing letter from an endo carries a lot of weight. She even asked me to fax her my BG numbers for the last 6 months. The insurance people were able to see my highs and lows scattered all over my pages. That may have been the convincing factor.
 

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Discussion Starter #7
C - "continuous". It gives you a BG number every few minutes.
 
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