[tony0611]

When I was diagnosed 5 months back my doctor gave me my targets Fasting (80-100), Post meal <150, HbA1c (<6.5), BP (<120/80) and BMI (<23) and normal cholestrol

On hearing these targets I asked if I manage these will I avoid complications ? He said we reduce the chances but cannot reduce the risk to zero.

I have been trying to do better than the targets he gave me but I keep reading articles like this

Diabetes Increases Risk of Many Infections

and this

Diabetes Exacerbates Cardiovascular Issues

And it makes me wonder. Can I really avoid complications ? Are complications inevitable no matter how strict the control is.

Do the articles above apply to people who keep a strict control (like hba1c's in the low 5s with very little standard deviation in BG values) or the standard ADA kind of control ?

I don't want to "reduce" the chances of complications but I want to "eliminate" the chances. Is that even do-able or am I kidding myself ?



.

 

[ThoseBackPages]

Since we have a disease, i cant see how anything would be able to be "totally eliminated"

 

[skb]

The answers to these questions has to be philosophical rather than technical. IMHO Life comes without any guarantees.
By taking all the steps towards tighter control we try to reduce/eliminate the chances of diabetic complications which otherwise are bound to catch up. That is all we can and should do, and leave the rest to the Almighty or destiny (based on one's beliefs).

I'm reminded of a couplet from Ghalib which would roughly translate as thus ;

If tension is life-threatening, how can my poor heart escape
Were it not the woes of love, it would have been the woes of employment

 

[WV Mom]

Are complications inevitable no matter how strict the control is.

According to my doctor daughter, if your control is so strict that your bg are ALWAYS normal -- i.e., if you have PERFECT control -- you will have no complications; diabetic complications are caused by elevated bg, nothing else. The question is whether or not you can achieve this control. The closer you come to it, the lower your chances of complications.

I choose to believe that this is attainable, and so I work toward it. Maybe a few years' experience will change my mind . . . ummmm . . . no it won't. I'm going to continue believing this kind of control is attainable and I'll hold it as a goal. No surrender!

 

[Shalynne]

All I know is, I'd already been dealing with several complications -- neuropathic numbness, blurry vision, blurrier brain -- before diagnosis. When my numbers went down to saner levels, all the symptoms faded, and most have disappeared.

That, plus the fact that several Forum members have lived with this dratted nuisance for decades, in good health.

So I'm hopeful for the future, and (fairly) confident that I can make those hopes real, with a reasonable amount of effort.

 

[smorgan]

Everything I've read and heard would agree with this. Complications are not caused by "diabetes" per se. They are caused by abnormally high glucose and/or insulin in the blood. I don't believe even "perfect" control if you are only looking at glucose is sufficient. To be sure, you need to have normal glucose AND normal insulin. Remember that your disease progressed for YEARS while you had completely normal glucose levels by only abnormally high insulin (prior to "diagnosis").

T2s are typically insulin resistant. That means that it takes an abnormally large amount of insulin to process glucose into your cells. So, if you only modify diet just enough to achieve "normal" blood sugar, you could very well continue to have abnormally hight insulin which can be harmful in and of itself.

I am very hopeful of zero diabetic complications going forward after taking the steps necessary to eliminate BOTH abnormally high glucose AND abnormally high insulin.

The only way I know of to accomplish this is to wean your metabolism OFF glucose as its main fuel and maintain nearly all of your cells running off of free fatty acids and/or ketones.

It's nothing new. Our species lived this way for over 99% of our time on the planet and there are a few peoples still living this way until today. It is blatantly "doable" - the scare tactics of the medical establishment notwithstanding.

According to my doctor daughter, if your control is so strict that your bg are ALWAYS normal -- i.e., if you have PERFECT control -- you will have no complications; diabetic complications are caused by elevated bg, nothing else. The question is whether or not you can achieve this control. The closer you come to it, the lower your chances of complications.

I choose to believe that this is attainable, and so I work toward it. Maybe a few years' experience will change my mind . . . ummmm . . . no it won't. I'm going to continue believing this kind of control is attainable and I'll hold it as a goal. No surrender!

 

[jwags]

The problem is many diabetics do not have good control. Many doctors allow diabetics to keep bgs way above normal levels for many years. All of these high bgs is what sets you up for complications. Also if you have a good HbA1c but lots of highs and lots of lows that also sets you up for complications. Unfortunatly keeping bg stable is the only way to limit complications. Even non diabetics suffer heart disease, strokes, kidney problems and blindness. There is no guarantees in life.

 

[naynay]

Tony, there are no guarantees in life. We are all born into this world to die. That is the simple fact and truth. We of course have control as to what we do with our bodies that can help to keep the bad at bay; with that said however I cannot see fretting over if this or that is going to kill you. The fact is any one of us could walk out of the house today never to return. Now I am not a fatalist by any means, and I do not have a death wish. As I've stated before, my Mom died from diabetic complications (end-stage renal failure) at the tender age of 66 y/o. Do I want to go that route? Absolutely not. That is why I'm here on this forum and why I am trying to control my diabetes. However, do you know how many years I've been dealing with this? Since I was in my late 20's. I am now in my late 40's (actually I turn 50 this year). I cannot sit and dwell on all the damage that may have occurred inside my body to this point. All I can do is go forward and hope that I can repair some of it and avoid more. There have been other things I've done in my life that could have caused damage to internal things as well, aside from the diabetes. Live your life; don't sit worrying about even if I do this am I still going to die from a complication? Just live your life doing the best that you can for yourself and enjoy your life. I truly believe in fate, and whatever my fate may be it hopefully won't be for lack of trying to keep myself healthy to a ripe old age. There is a lot of bad in the world; don't let your mind dwell on the bad. Dwell on the good and the good you are doing.

Hugs to you Tony. I cannot put it any simpler than that. Look forward to the future rather than dooming yourself prematurely.

 

[tony0611]

Thanks Guys. Your comments have been all very nice. I think I just keep applying my mind where I really shouldn't be.

I really love this place and all of you guys !

Tony

 

[naynay]

Aw, shucks Tony, we all love you too! That is why we tend to get a little "motherly" with those who get discouraged. I get discouraged all the time, but I know I just gotta keep it up or what's the alternative?

Hugs, hugs, and more hugs! You can do this. No matter what, just stay on track.

 

[WV Mom]

Complications are not caused by "diabetes" per se. They are caused by abnormally high glucose and/or insulin in the blood.

The point about insulin is interesting, and I want to look into it further. I asked my doctor daughter about complications from hyperinsulinemia, and she says they weren't taught about that in med school -- only about complications from hyperglycemia. But then, she's not an endocrinologist; she's an OB/Gyn doing a fellowship in Maternal Fetal Medicine. So she does work with diabetic patients, but they're all young (child-bearing age) and relatively healthy.

Looking into my glass ball here, I predict that once I'll start looking, I'll find all sorts of conditions that are associated with hyperinsulinemia, but few that sort out what's the chicken and what's the egg. hwell:

 

[jwags]

I think the problem with hyperinsulmenia is it is not an easy thing to measure. We use the word Insulin Resistant alot. What that tends to mean is you still produce insulin but it is not accepted into our cells to be used for energy. So the pancreas just keeps cranking our insulin. All this extra insulin is what causes a lot of diabetic complications. That is why a low carb diet works so well. When you eat low carb your body doesn't need much insulin to process it. When you eat carbs your body needs to make a lot of insulin. So when you lower your insulin needs you address a lot of the complications of diabetes like heart problems, obesity and strokes. I'm surprised a doctor wouldn't know much about it, that is scary.

 

[smorgan]

Please report back whatever you find!

But, here's one easy one:

The typical T2 spends something like 5 to 10 years as insulin resistance develops, but high blood sugar has not yet happened. In spite of normal blood sugar, diabetes PROGRESSES, i.e., gradually gets worse and worse. By the time high blood sugar occurs, triggering the "diagnosis" of diabetes, on AVERAGE 50% of pancreas function has been lost. Thus, most of this initial damage occurred WITHOUT blood sugar being elevated. Only insulin was elevated during that period.

So what ailments could elevated insulin cause? DIABETES, for one.

The point about insulin is interesting, and I want to look into it further. I asked my doctor daughter about complications from hyperinsulinemia, and she says they weren't taught about that in med school -- only about complications from hyperglycemia. But then, she's not an endocrinologist; she's an OB/Gyn doing a fellowship in Maternal Fetal Medicine. So she does work with diabetic patients, but they're all young (child-bearing age) and relatively healthy.

Looking into my glass ball here, I predict that once I'll start looking, I'll find all sorts of conditions that are associated with hyperinsulinemia, but few that sort out what's the chicken and what's the egg. hwell:

 

[WV Mom]

I'm surprised a doctor wouldn't know much about it, that is scary.

I'm finding out all sorts of stuff about hyperinsulemia, which makes me think she and I didn't communicate. Wouldn't be the first time.

Livestrong.com has an article (here) titled Why Is Too Much Insulin Bad? It says --

Persistent elevation of nutrients and insulin in the blood stream, a condition called hyperinsulinemia, eventually leads to type 2 diabetes. Eventually the elevated stress of perpetually trying to clear nutrients from the blood fatigues the beta cells that produce insulin. In addition, hyperinsulinemia greatly raises the risk for developing other diseases, including cardiovascular disease, obesity, metabolic syndrome and other endocrine disorders in women.

She's gotta know that -- especially the "endocrine disorders in women" stuff. As you say, if a doctor doesn't, it's scary.

Another fun thing I ran across is this page from Colorado State University about the physiologic effects of insulin. The animation half way down shows how insulin enables glucose to enter cells. It's a kick! I must've clicked "Add Glucose" a dozen times.

 

[Shanny]

It sure isn't her fault these things aren't being taught . . . med schools need to wake up & move into the 21st century. Keeping up with technical advances is one thing, but what's keeping them from teaching about the exploding epidemic of diabetes & its related conditions? If any profession ever needed to stay current, it's medicine!

 

[John.in.France]

I've been thinking about diabetes a lot over the last eighteen months. (Now that's a surprise, isn't it?)

This is my understanding (idiot's guide level):

Type 1 diabetes is caused by the body's failure to produce the insulin needed to process glucose.

Type 2 diabetes is caused by the body's inability to use insulin to process glucose.

I think the two conditions are quite distinct but that type 2 can develop into type 1 as the body burns out the pancreas trying to cope (red-line a damaged engine?). For that reason I distrust things like Prandin used to stimulate insulin production.

What the two conditions have in common is the symptom of high blood glucose - something we can test for. I don't think we can test (easily) at home for high insulin levels.

As has already been said, it is the presence of high concentrations of blood glucose that over time produce the side effects that we all wish to avoid.

Therefore our basic strategy has to be to keep blood glucose levels down to sensible values. This probably means that anyone with Type 1 needs to supplement their insulin in some way and that folk with Type 2 need to reduce their resistance (and perhaps supplement their insulin - especially if they are moving into the type 1 camp).

I don't really like the idea of using medication except when really necessary and then, I'm with Dr Bernstein and his "law of small numbers". If the glucose peak is kept small, then the medication dose can also be kept small (even as low as zero?)

A few times on the forum I have suggested to new members that their strategy should always be to cut carbohydrates only to be slapped down (normally quite politely) by older hands from the Type 1 camp who feel that medication is all they need. With respect to those involved I have to disagree - any strategy that reduces the glucose load is valid regardless of diabetic type. For type 2, it might eliminate medication entirely, and for type 1 reduce the level of dose needed.

I would like some method of tracking my insulin level directly but so far I've yet to find any method that doesn't involve enlisting a medical professional to assist - and we all know how helpful most of them can be ....

John

 

[deafmack]

When I was diagnosed 5 months back my doctor gave me my targets Fasting (80-100), Post meal <150, HbA1c (<6.5), BP (<120/80) and BMI (<23) and normal cholestrol

On hearing these targets I asked if I manage these will I avoid complications ? He said we reduce the chances but cannot reduce the risk to zero.

I have been trying to do better than the targets he gave me but I keep reading articles like this

Diabetes Increases Risk of Many Infections

and this

Diabetes Exacerbates Cardiovascular Issues

And it makes me wonder. Can I really avoid complications ? Are complications inevitable no matter how strict the control is.

Do the articles above apply to people who keep a strict control (like hba1c's in the low 5s with very little standard deviation in BG values) or the standard ADA kind of control ?

I don't want to "reduce" the chances of complications but I want to "eliminate" the chances. Is that even do-able or am I kidding myself ?

.

I am pretty sure we would all like to avoid complications related to diabetes. While those of us here have that as a goal and we work at it, I for one know that it isn't possible for all of us to avoid complications all of the time. Some of us are going to have complications related to diabetes, ie neuropathy, etc. At the same time, even when and if complications rear their ugly heads we still will strive to lessen their impact on our lives. My doctor put it right when she said, "Your goal is to be as healthy as possible even with diabetes riding your back." I think that was good advice.

 

[canadiandude]

I think many of us in this thread (thanks Tony for bringing up a great conversation topic lol) have already said what I would have also posted. So rather than restating everything, I'll just agree that we should be working hard to avoid any spikes in our BG levels even though we can't always succeed in that regard as infections and illness will take their tolls on our levels on occasion.

What hasn't been mentioned in either article posted by Tony or in this thread is the role that exercise can play in helping to keep your levels stable. That's not to say that exercise, in and of itself is an effective BG level reducer (in fact, for some of us, exercise increases our levels) but together with a proper diet (in my case, LCHF), exercise can provide that extra " je ne c'est quoi" that allows us tighter control.

@WV Mom - You're such a nerd! I only clicked "Add Glucose" twice.

Now, with all that said, I think we, as low carbers, also set ourselves up many times. We actively seek out either 1) excuses to eat something we shouldn't or 2) a low carb replacement for things we used to enjoy but now can't). I can, in some repeats, understand the need to do 2) but at the same time, I wonder if one of the reasons why so many regard an LCHF diet as unsustainable is because we strive so had to find excuses for a cheat or fill our low carb diet with artificial sweets that will oftentimes only serve to keep sweet foods a priority in our diets.

This is not a judgement. I am possibly one of the most guilty persons on here for both 1) and 2). In fact, I have avoided posting my Bg numbers in the morning numbers thread because I have cheated so much on my diet this month and my haven't bothered to check my numbers except once or twice all month. I know they are higher than they should be and I have been too embarrassed to post them.

It's enough that illnesses wreak havoc on our tight control levels, we shouldn't also be doing it to ourselves. (at least, I don't). I think Eric has been right all along in his strict diet and, as a result, he has very tight control over his BG numbers to the point where it often astonishes many of us when he gets upset over a 5.2.

@ Smorgan - I particularly enjoyed what you said here:

"The typical T2 spends something like 5 to 10 years as insulin resistance develops, but high blood sugar has not yet happened. In spite of normal blood sugar, diabetes PROGRESSES, i.e., gradually gets worse and worse. By the time high blood sugar occurs, triggering the "diagnosis" of diabetes, on AVERAGE 50% of pancreas function has been lost. Thus, most of this initial damage occurred WITHOUT blood sugar being elevated. Only insulin was elevated during that period.

So what ailments could elevated insulin cause? DIABETES, for one."

I found it very easy to picture this process as it happened. Yet, at some point, a Type 2's pancreas becomes damaged from too much insulin. So something happens to the body during that time which results in it insufficiently using the insulin it produces. That, in turn, starts the pancreatic damage process and eventually, the high levels of insulin cause diabetes. So... is what happens to cause the body to stop using insulin efficiently something that develops at that time or is it the hereditary component that we are born with and which eventually affects us? Am I making sense?

 

[John.in.France]

Basically the bottom line is that complications will develop - if we let them. We stop them by making sure that our BGs stay "normal".

And yes, that takes discipline and attention to detail.

It also pre-supposes that your diagnosis is early enough to allow you to do as I did (I hope) - grab the problem by the throat and nail it at once.

Staying low carb - and fighting your way through the "carb flu" symptoms is a price that has to be paid. If you decide to make excuses for falling off the wagon regularly, then you have to accept the price - complications!

John

 

[Shalynne]

LCHF is definitely sustainable and healthy. But several factors can make it difficult, to varying degrees:

1. Many of us find that our medical teams oppose LCHF. For some of us, it's difficult-to-impossible to question authority.

2. LCHF is expensive. In some areas, whole-foods may be darn near inaccessible. I personally know of several large urban communities where this is so.

3. Carbs are the centerpiece of all cuisines and most social activities. Healthy travel can be a challenge. This is why so many of us posted confessions this month.

4. Carb addiction -- like addiction to alcohol, nicotine or caffeine -- is real.

I believe it's unfair to ask anyone to cater to our way of eating (I'd love to see 'em switch, but scolding gets us nowhere). But at the same time, many of us find direct opposition at nearly every turn.

Of course -- with the exceptions of steep economic or locational barriers and, possibly, severe cases of medically-induced brainwashing -- none of the above are an excuse.

Still, a less diabetic-hostile world would be healthier for humans in general.

Change starts with Forums like this one, where real diabetics get together to share problems and solutions. And out in the real world, every time we order a burger without the bun or share low-carb foods at a potluck, we move the culture forward, one nano-micro-fraction of a Planck length at a time.