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Discussion Starter · #1 · (Edited)
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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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.


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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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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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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180 2 hours after eating:eek: 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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Discussion Starter · #6 ·
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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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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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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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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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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What we have here is the usual drug company motivated (i.e. funded) observational study.
The rules are quite simple.

  1. Decide what you want the answer to be.
  2. Define the criteria for "success" - in this case a highly dubious and incomplete set of rules to define "control"
  3. Pick your population to support the result you insist on - i.e. folk who have already been pushed too far towards complications.
  4. Make sure that the subjects receive a good well balanced diet - i.e. high carbohydrate.
  5. Eliminate from the study those who for some reason can't deliver the "correct" result - e.g. folk who are careless enough to eat sensibly.
  6. Put an appropriate "spin" in the summary and ignore any conflicting data which the study is unfortunate enough to still generate.
  7. Make sure that the summary gets a good press and tuck the actual data away somewhere obscure just in case someone is unkind enough to want to look at it for themselves.
As jwags says, these results are based on the ACCORD study which is as he describes.

I saw another study discussing the benefits of full fat unpasteurised cheese. The data was clear - as was the benefit. So, what did the summary written by a representative of the Diabetes Association say: "Stick to low fat, pasteurised cheese" i.e. "let us destroy the beneficial elements first so we can continue to support the low fat rules".
 

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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.
Here's my very own [email protected]@@ experiment results. (just to clarify, I'm calling myself a [email protected]@@ for doing it).
I ran out of Truvia for my morning coffee. I Have to have my coffee in the am and it Has to be sweet and light soooo I started using real sugar again which I haven't done for some time now cause I was curious as to how it would affect me. My meals have stayed the same. Over the past week and a half or so my numbers have started creeping up . So much so that I've had to take my fast acting daily some days even twice which I usually don't have to do. Things I usually eat that don't spike me much are spiking me now beyond normal levels. Although I have corrected with the fast acting my fasting numbers (fastings have been higher every day today almost 200) have also crept up which tells me that crap is still floating around in my body and it's building which in my mind has to be causing damage.
Experiment over, I'm off to the store for more Truvia.
 

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Here's my very own [email protected]@@ experiment results. (just to clarify, I'm calling myself a [email protected]@@ for doing it).
I ran out of Truvia for my morning coffee. I Have to have my coffee in the am and it Has to be sweet and light soooo I started using real sugar again which I haven't done for some time now cause I was curious as to how it would affect me. My meals have stayed the same. Over the past week and a half or so my numbers have started creeping up . So much so that I've had to take my fast acting daily some days even twice which I usually don't have to do. Things I usually eat that don't spike me much are spiking me now beyond normal levels. Although I have corrected with the fast acting my fasting numbers (fastings have been higher every day today almost 200) have also crept up which tells me that crap is still floating around in my body and it's building which in my mind has to be causing damage.
Experiment over, I'm off to the store for more Truvia.
Sorry - but I have to agree to differ with you on "Has to be sweet". To expand on what you said in your earlier post, every thing we swallow has to be processed.
Sugar is simple and the body can cope with it, albeit in our case, badly. Artificial sweeteners and additives of all types still have to be processed by the body. How? A good question and when you know the answer tell me please.
It's my understanding that a sweet taste (however created) triggers an insulin response which means that your pancreas gets a push every time.
Healthy pancreas? No problem.
Not so healthy? A small push towards beta cell burnout.
The other point is that if the body does generate some insulin and there is no extra blood glucose to process, we go slightly hypo and the body responds in the usual way by signalling "hunger". So we're tempted to have another nibble.
Message: Lose the sweet tooth and live with unsweetened coffee/tea.
This is just my personal view based on my own reading. Food for thought? (which won't case weight gain)
 

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Discussion Starter · #14 ·
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.
Clarification:
Some time ago I made the statement that tight control does not necessarily mean you will avoid complications.
A member asked me where I got that information. I could not find it at that time. I Now, found the study in which I read this information.
I posted it to clarify my statement from months ago.
Tight control or not, type 1 or 2, you may consider that you may be in for some complications in the future. Each person is different.
Thirty years type 1, I have every complications known, except, to the best of my knowledge, retinopathy. I have found a treatment that has helped me, tremendously . This treatment will soon become commercially available. Do not discount treatment for complications, you may need it someday, hopefully not.
Hope and faith are wonderful things, we all need them.
I tend to lean more toward the scientific side. I believe in looking forward. For me, that means tending to the complications I now suffer and finding the most effective treatment to negate them.
Many of you have just started this journey. Because you are seeking more information, you are on the right track, good for you.
I am in a different catagory, uncontrolled type 1 over thirty years.
My prognosis was 2 to 3 years. I am working on changing that. My kidneys are now functioning normally. I plan to live to colect Social Security, and to die of OLD age.
Be blessed
 

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""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.""


This is what I'm referring to and agreeing with John.
Although the folks in this study were medicated how/what they eat does make a difference. You can inject insulin all day long but if you're eating habits are on the low end of desirable and still consuming loads of sugars and carbs damage is still being done to your body although the meter says OK.
 

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Discussion Starter · #16 ·
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.
That is the beauty of the treatment I am attending. It causes the liver to metabolize, like a non-diabetic person. It activates the liver metobolism, to work like that of a non-diabetic.
People can red a zillion studies, what I know is my personal experience,and it has been working for me now for a year. My energy level is up. My neuropathy almost gone, depending on my activity level, at least I can sleep at night. My kidneys are back to normal function, GFR up and A1c down. I lost 20 pounds, without trying. A little over a year ago I was housebound and nearly bedridden, did not drive a car in 7 years. That has alll changed. I ride my bike dailly now.:)

It concerns me that you assume uncontrolled diabetes means poor diet, lack of discipline, not true. Some people are not textbook diabetics. Those are the people this clinical study can help, among others.
 

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D4? Tell us what kind of foods you eat. Does your diet include fruit and grains and all the ADA recommended foods? What parts of your 30-year routine have you changed since you were accepted for clinical trials?
 

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Discussion Starter · #18 ·
D4? Tell us what kind of foods you eat. Does your diet include fruit and grains and all the ADA recommended foods? What parts of your 30-year routine have you changed since you were accepted for clinical trials?
Hi Shanny,

I gave up red meat 8 years ago. I eat no bread, or pasta, have not for 4 years. Ieat more now of what I have been eating, fresh and raw. Nothing processed. Lots of fruit. I make a smoothie at least once a day, it consists of nuts, usually amonds or walnuts, kale and other greens, always some parsley, 2 tablespoons flax seed, and celery, then what ever fruit is the flavor of the day.

I have eaten 5 small meals a day since 2000. I try never to eat more that 30 carbs at a time.

I walk extensively and ride my bike. ( before this trial I was not able to walk much, due to neuropathic pain, and I certainly did not ride a bike back then.)
NO JUNK food what so ever. I drink ONLY water, plain.
I have coke and peanut butter crackers on hand for hypo events, only. (Doc recommended coke because the pulp in orange juice inhibits sugar absorption)

Just the fact that this trial has freed me from the pain (totally dropped pain meds, last May) so that now I can lead a normal life is wonderful. I have gotten my energy back. I am getting fit and trim. Everyone in the trial is loosing, or has lost weight.
I have also been able to totally drop two blood pressure medicines.
Latest bloodwork shows GFR up, creatine normal and A1c down. At the clinic they keep reminding me that it took thirty years to get where I am. I am impatient, I want it to change overnight, that is not the way it works.
My creatine has come down .2 and .3 at a time, but it is 1.3 and stable.
What else whould you like to know? Happy to share.
The type 2 patient they started with came in a wheel chair, now walks unassisted and says he has no pain in his feet and legs.
 

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Don't tell me what the trials have done for you, just tell me what you were eating before you gave up red meat, bread & pasta. Where now do you get any protein in your diet? Thirty grams of carb five times a day is a sizable amount of carbs.

You have been insisting that tight control is not effective against complications - that you had good (tight?) control and still got serious complications. I'm just trying to figure out how you were eating 26 years' worth of bread, pasta, etc., and you still eat lots of fruit . . . totaling about 150g of carb per day. Why have not your scientific leanings told you that further reducing carbs might be acceptable management for your brittle diabetes?
 

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A straight water extract of the stevia plant is NOT an "artificial" sweetener nor something new and alien to the human metabolism like sucrose with a chlorine molecule attached (Splenda), etc.

It has been found to have actual BENEFITS for diabetics in particular beta cell preservation and alleviation of insulin resistance. Putting this in the same category as actual "artificial" sweeteners cooked up in a chemistry lab (in many cases producing entirely new molecules which no prior exsitence in the environment or the human metabolism) is not correct and will only confuse the issue.

However, there may be 2 problems with Truvia and similar products:

1) Instead of using a simple water extract which produces "steviosides" (the ones for which benefits for diabetics have been found), the food processing giants somehow thought it advisable to extract and refine just a single chemical from the many found in the stevia plant. It is called "Reb A". No longer the natural food used by South American natives for 1500 years nor (I believe) the same product used by tens of millions of Japanese for 30 years without a single case of adverse health effects. It is an extract, so still not "artificial" but now really looks like a highly "procesed" and unnatural food. Much different than just dissolving some leaves in water like making green tea! (The way steviosides are made)

2) Most commercial "stevia" products contain a tiny amount of Reb A mixed with a much larger amount of a "filler" or artificial sweetener (from the chem lab) like erythritol, etc.

Some additional reading about Stevia:

Skullduggery?

Anti-Diabetic Action?

Helps Insuling Resistance?

Anti-Hyperglycemic?

Post-Prandials Better than not just sucrose (duh!) but also better than aspertame

My impression is that other tasting sweet, this substance is not even in the same universe as the chemical artifical sweeteners and lumping them together is not accurate or productive. It is a completley natural food, albeit non-nutritive.


Sorry - but I have to agree to differ with you on "Has to be sweet". To expand on what you said in your earlier post, every thing we swallow has to be processed.
Sugar is simple and the body can cope with it, albeit in our case, badly. Artificial sweeteners and additives of all types still have to be processed by the body. How? A good question and when you know the answer tell me please.
It's my understanding that a sweet taste (however created) triggers an insulin response which means that your pancreas gets a push every time.
Healthy pancreas? No problem.
Not so healthy? A small push towards beta cell burnout.
The other point is that if the body does generate some insulin and there is no extra blood glucose to process, we go slightly hypo and the body responds in the usual way by signalling "hunger". So we're tempted to have another nibble.
Message: Lose the sweet tooth and live with unsweetened coffee/tea.
This is just my personal view based on my own reading. Food for thought? (which won't case weight gain)
 
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