Thursday, February 7, 2008

Deaths partially halt diabetes study

Ya know, I've had some problems with DH's doctor at the VA because of the way she kept changing his meds without seeing him (he's type 2 diabetic, she started him on insulin, and changed his dosages without having talked to us or seen us). But we made an appointment to see her, with a list of concerns he had, spent almost an hour showing her what we had done with dietary changes, and our adjustments to his insulin based on those changes, and got good explanations from her on why she had stopped one of his meds. She also explained why she didn't think it was necessary for him to get his A1c below 6.5 - 7. She said that the benefits of a normal (non-diabetic) A1c of 4.5 to 5 as relates to diabetic complications, are not that much better than at 6.5 to 7.
So when I saw the article about the ACCORD study, it made me appreciate the fact that she's not on the bandwagon of getting his blood sugar as low as it can possibly go (she said as long as he can keep it in the range of 80 - 140 the majority of the time, he'll be fine).
This study seems to be saying that diabetics have to struggle to get their A1c below 6, but from the diabetic lists I've been reading, that doesn't seem to be the case. Most of the posters have A1c's ranging between 4.5 and 6, and they work on having really tight control of it and getting their numbers as low as they can without having episodes of hypoglycemia.
The government abruptly halted aggressive treatment in a major study of diabetes and heart disease after a surprising number of deaths among patients who pushed their blood sugar to super-lows — findings that call into question a growing movement in diabetes care.
Wednesday's move doesn't affect health guidelines for most Type 2 diabetics, but it raises concern about a particularly vulnerable group: Patients at especially high risk of heart attack or stroke.
The 10,000-patient study, dubbed ACCORD, was supposed to answer a big question: Could pushing blood sugar to near-normal levels, below today's recommended target, help protect these high-risk patients' hearts?

There were fewer heart attacks than they expected to see, but more deaths from those heart attacks, and they don't understand why. The patients' weren't hypoglycemic, but their blood sugar was near the norm for a non-diabetic. There were also more unexplained deaths without clear evidence of heart attack.
So for now, the NIH's message: Diabetics with heart disease shouldn't strive for near-normal glucose, but to a level long described as optimal for all diabetics — around 7 on a measurement scale known as the A1C.

The goal for diabetics used to be 8 or 9, and was lowered to 7, each point drop means a 25 to 40 percent lessening of the risk for serious complications, such as blindness or kidney failure. It seems to me that they may have gotten carried away with the how low can you go in order to prevent complications. There seems to be a law of diminishing returns coming into effect here. The lower you go, after a certain point, the less good it's going to do you (gee, does that sound familiar to anyone?).
I'm all for treating diabetes, after all, I want my husband around for a good long time to come. With his family history of diabetes and heart complications, it's a really good thing that his doctor isn't one of those advocating he get his numbers to non-diabetic levels (and she didn't say anything about his weight this time, even though he'd gained back the 10 lbs he lost, and another 4 since starting the insulin). Weight gain can be one of the side effects of insulin, from what I understand (something about better utilization of sugar and storing it as fat instead of dumping it in the blood?).
This whole thing makes me wonder about the health establishment's habit of lowering the threshold for so many aspects of our health. For years, we were told that 120/80 was normal for blood pressure, now it's 110/70. We all know what they've done to the BMI, which is a bullshit measure for health anyway. Are they going to lower the standards so much that no one, thin or fat, is going to be able to meet any of them? I can see it coming...............


  1. In early 2006, when I started to seriously lose weight, my glucose level was 160+. I was well over 300 lbs at the time. Over the course of that year, I got my weight down to 235. At that point my glucose was consistently 120 - 130. I stopped my weight loss diet so that my skin could catch-up with my body. Now, a year later, I have started my diet again.

    Radcliffe at Radcliffe's Weight Journal

  2. And this is supposed to mean what? I weigh 377 lbs and my blood sugar is consistently between 70 and 110 (70 fasting and 110 after a meal). I'm not diabetic, not even pre-diabetic. DH is diabetic, taller than I am, and weighs less than I do by about 120 lbs, but his blood sugar, without meds and dietary changes, would be in the 300-400 range. With meds, and eating low-carb, it's now in the 80 - 140 range most of the time, and he's not losing any weight, in spite of having a physically challenging job.
    Glucose levels change when you make dietary changes, whether you lose weight or not.

  3. For a good analysis of this report (not by me) see: Jenny points out that all of the people in the study were taking many strong medications and that medication interactions are a likely cause.

  4. Vesta, I like your new flowers but I loved the Dragon....dragons are loyal creatures...much like you.

    Now, about the lowering of the Hgb A1C. Yes, they have found through research that lowering A1C can result in lowering complications related to diabetes. Lowering the A1C for the most part is a good thing UNLESS the lowering is due to a very low period during the night when the blood sugar drops to dangerously low levels and the patient isn't even aware of it. Since the Hgb A1C is based on the average blood sugars over a 3 month period, these dangerously low blood sugars at night contribute to the A1C number. I wonder if that is one of the things that are contributing to the deaths when the A1C is too low. The blood sugar falls too low at night....unable to correct it....then by the time it is corrected .... the damage is done.

    And yes, you are right; weight does not necessarily have any direct correspondence to blood CAN, but it doesn't always.

  5. Jenny (Blood sugar 101) posted on this yesterday.

    She also has an interesting article on the correlation between A1c and heart attack in even non-diabetic people.

    I've actually kept my A1c under 6 for over 3 years and it hasn't been hard at all. But then, I'm not on many drugs, insulin and a metric buttload of carbs like the people in the study, just Metformin (which has a protective effect against heart attack) and an ACEi (blood pressure.) I started out with an A1c over 12 and fasting glucose of 341.

    Dr Bernstein has something he calls the law of small numbers. A 20% miscalculation in a 50 unit insulin dose can kill you in your sleep, a 20% miscalculation in a 5 unit dose probably won't get the chance. If they had asked me I would have told them they were going to kill someone.

    You have to die of something, though. I'm aiming for a bizarre sex related accident in my 90s.

  6. Next thing you know they're going to be encouraging all of us to keep our body temperature at 97.1.

  7. my own woman - I think the only way they would know if blood sugar went really low at night is if the participants were using those continual blood glucose monitors that have a sensor implanted under the skin and a monitoring unit is plugged into that (it's new and not widely available yet, I think). the monitoring unit can be unplugged and the information downloaded to a computer so the data can be graphed and deciphered. The only other way to know would be to wake them up every so often and check blood sugar, but even that is no guarantee that they'd catch the low (not to mention what being woke up several times a night would do to one's health and mental well-being).

  8. You know, when they lowered the blood pressure standards, my immediate response was, "This is for the sole purpose of selling more medication."

    They change a number, and suddenly millions of people are in the "omg need pills" category. Now, I wonder who could benefit from that? Hmmmm.

  9. Oh, and I think radcliffe up there is a spammer

  10. rio - every time some health standard is lowered, I get the same thought. Who has pills that are going to help us meet that new standard and who is going to make more money doing so?
    And, yeah, he might be a spammer, he has a website promoting diets, all kinds of diets, which is why I told him weight doesn't necessarily have anything to do with what your blood sugar is at any given moment.

  11. Vesta44: I guess we are made of different stuff. I ate low carb for the 10 months I was dieting in 2006. I ate mostly the same foods all the time. I measured my glucose every morning before I took food, water or even brushed my teeth. My glucose steadily dropped over the course of the initial 6 months until it stopped dropping at about 140. My weight continued to drop during this time. When my weight got to about 240, my glucose suddenly dropped to 120. Over the past year, my glucose is between 120-130. For some reason, my glucose numbers do not relate to my intake as much as my weight.


    I hope I'm not a spammer.

    Radcliffe at Radcliffe's Weight Journal

  12. radcliffe - low carb is going to make your blood glucose drop, carbs turn into sugar, and when you decrease the amount of carbs you eat, you have less sugar in your blood. It's how diabetics help control their blood sugar, and not all of them lose weight doing it (my husband is a case in point). I eat low-carb with him, and I have lost 15 pounds in 12 months without trying (no additional exercise, no counting calories, nothing). If it continues, fine, if it doesn't, fine. I've been this weight, within 40 lbs or so for 30 years, and my health hasn't suffered much (just my mobility, and that's due to arthritis and fibromyalgia, which aren't caused by fat).

  13. You can find out how low you go at night by testing at 2-3am a few nights, that's usually the lowest point. I've seen 70s and some 60s then. Also if you wake with a start in the middle of the night, it may be from a sudden drop in BG so you can test then and see.

    My BG, and other numbers, dropped big time when I cut back on carbs. I lost a lot of weight after that, really effortlessly (still clinically obese,) but the weight itself has not made any more difference in BG, A1c or cholesterol after the initial carb cut back. (All I did at first was cut back on the things that I saw made my BG go up above a certain number and substitute other things I like that don't affect it as much.) My weight or my set point, though, seems to depend on what carb level I stay at. I don't think I'm interested in doing Atkins level carbs all the time just to be thinner. I'm comfortable with what I'm eating and like it all and don't really miss a lot since I do have times when I eat some of anything that I really like but don't see often.

  14. nonegiven - that's one of the reasons DH and I are eating fewer carbs. We haven't cut them out completely, and we are looking at which ones spike his BGs and then eating fewer of them and more of the ones that don't seem to bother him. We've added more veggies too, which seems to help some. Most of what we've done relates to what he snacks on, we went from cookies and chips to meat and cheese. That has helped a lot. We still have the cookies and chips in the house, he just doesn't eat them as often, or as much of them at one time. I'm still tracking everything on a spreadsheet I created (compares insulin dosage to time of day to what he ate and when he ate it to blood sugar numbers). His doctor was impressed with it when we showed it to her. We're still learning, but his control is getting better, and I think the fact that he's only had 4 or 5 lows in the last 4 months is pretty good (and the lows have been between 50 and 70, so I don't think that's too bad either).

  15. It is going to be up to each individual to monitor their own health. The body may in the near future become the most reliable source of infomation to determine what is working and what is not. If we just listened most of the time, we would probably be better off. I think that reading online reviews of people who have found success in these health situations is one of the best sources we can use. I really like places like that bring what is going on in the community right to your finger tips instead of relying on a doctor who set standards that keep evolving.

  16. luis - the way I see it, most of us in the fatosphere are taking charge of our health and listening (or learning to listen) to our bodies. A lot of people have gotten cynical over the years about the hype of this is "bad" for you this year, and then in a year or two, it's not bad for you, it's actually good for you and something else is "bad". As far as supplements and such are concerned, what works for one may not work for another, it's very much a Your Mileage May Vary type of situation. I tend to look at it from the standpoint of who's going to make money off this advice if I decide to follow it? How long do I have to follow it to see results? Are the results worth the money/effort/possible side effects?

  17. Hello,
    IM 35, Female My sugar level threw out the day runs on average between 400-500,sometimes as high as 525 , the doc put me on metformin, but a very low dose, and it hasnt helped at all, the lowest i have seen it since then was 389 and that was not having eaten in like 5 hours. Seems like no matter what i do it stays up there, Ive been watching what i eat, but even the littlest things seem to make it go up alot. Im in nursing school, so ive studdied it, and seen plenty of the effects of it, but what do you do when your doc just doesnt think it matters when its that high. I just dont get it, and she did the 3 month test on me and it was at 10%, depending on where you read it or study it from, its suppose to be between 6-7%. any comments would be helpful.

  18. Gayle0530 - DH is type 2 diabetic and his A1c 6 months ago was 9.9 and his doctor at the VA was having a hissy fit over it. He was taking Metformin (1000 mg twice a day) and glyburide (7.5 mg twice a day). So he's now on insulin twice a day, and we're eating low-carb/high fiber, his A1c 3 months ago was 8.4, and a couple of weeks ago, it was 8.1, so it's coming down slow but sure. All I can recommend is checking your blood at least twice a day, cut down on carbs, and there are a couple of books that will give you some good ideas on how to go about taking care of this. Gretchen Becker's The First Year: Type 2 Diabetes and Dr Bernstein's Diabetes Solution. I think, if I were you, I would be raising holy hell with the doctor and telling her/him that this is totally not acceptable, that the complications from uncontrolled blood sugar are not something you want to deal with. And if they won't deal with it, I'd look for another doctor. That kind of treatment (rather, lack of treatment) can be dangerous.


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