Re: The Ticking-Clock Hypothesis?

Larry wrote: 
I just read carefully one of the San Diego ADA papers presented in June
2005. A good paper (Natural History of the Metabolic Syndrome and Type
2 Diabetes: The Ticking Clock) but could be misinterpreted as the focus
was primarily the natural history of Metabolic Syndrome leading to full
blown T2 Diabetes. Dr.Aaron Vinik did refer to one study ie. European
Prospective Investigation of Cancer and Nutrition/Norfolk cohort where
it states "..every 1.0% increase in A1C was associated with a 28%
increase in the risk of death, independent of age, blood pressure,
serum cholesterol, body mass index, or cigarette smoking habit".On the
whole Dr.Vinik's reviewed new "tools" to treat Diabetes that should
become available in the next couple years but unfortunately generalized
to the extreme case by focusing on the mortality of those diabetics who
start out with Metabolic Syndrome(ie.
hypertension,overweight,dyslypidemia)before developing Diabetes. What
about more information on study results for those diabetics who never
develope hypertension or obesity? I am suggesting that Dr.Vinik's paper
could be easily misunderstood since the independent co-morbidities of
obesity, hypertension, dyslipidemias were not clearly delineated and
lumped together under complications of Diabetes. His concluding comment
was "We need to learn how to modify behavior in order to make a big
dent in the incidence of macro- and microvascular complications of
diabetes. My problem is that I can lead a horse to water, but I have
not yet learned how to make it drink." (Does he have an attitude?) I
believe his comments showed his "agenda" and a slant in profiling the
normal history of T2 Diabetes to the more complicated class of Type 2
Diabetes.

Larry

The EPIC Norfolk statistics are particularly interesting because they were looking at a large population of all people, not just separating out diabetics. The straight line correlation between A1c result and mortality from heart attack and stroke was extremely impressive.

It is the basis of the "5% club" goal that many of us on this newsgroup pursue.

It looks like the only truly normal people are those with A1cs in the 4.7% range (as Dr. Bernstein has long argued.) But the really nasty stuff doesn't start happening until you get into the mid-6's and above, which means it is really worth doing whatever you can to get your Hba1c as low as you can safely get it.

For those who may not understand what an Hba1c measures and why it is so important, it is a measure of how much glucose has permanently bonded to proteins in blood cells. This is important not only for what they tell us about blood cells, which when they are "sticky" with glucose can clog up tiny capillaries like those in your eyes and kidneys, but also because of what they suggest about how other proteins in the body may be getting laden with permanently bonded glucose.

Glucose will attach to a hemoglobin molecule with a reversible bond which after some period of time becomes permanent. The higher your blood sugar, the more likely that these glucose molecules will permanently bond.

OTHO, it is worth pointing out that there are people who have abnormalities of their hemoglobin that mean they can get a very low A1c test result when their blood sugars are dangerously high. For people with this problem, there is another less well known test, the fructosamine test, which can show them the long term effects of high blood sugar on their blood.

If you continually run high blood sugars for prolonged periods according to your blood sugar meter but never see hba1cs over 5% it might be worth asking your doctor to run the other test.

Unfortunately, you occasionally will run into someone who has a fasting blood sugar of 160 mg/dl but a low hba1c who thinks this means they are fine. They aren't.
.

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