Re: What Creates CVD Risk In Diabetics?

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On Mon, 15 Oct 2007 08:56:49 -0700, Tim Shoppa
<shoppa@xxxxxxxxxxxxxxxxx> wrote:

The more I look into research about CVD risk in Type 1's, the more I'm
convinced that there's many factors beyond just glucose and insulin.
But I do not have the answers, just know that the risk is obscenely
elevated.

G'day G'day Tim,

Obscenely elevated is an excellent description and better than some
contrived numbers. For a poorly controlled T1 a figure I've seen
quoted was ten times that of a non-diabetic of the same age, lifestyle
etc. With tight control that factor was halved. The article didn't
define tight control though the values given for tight in the past
were quite loose compared with those routinely obtained by T2s posting
on asd. (For those unfamiliar with the asd phenomenon, posters here
thanks to common sense and high levels of encouragement regularly
achieve lower A1c readings than the average T2 thanks to the feral T2s
who disappear from the doctor's care after diagnosis.)

And it's possible that for type 1's the factors that are important are
different than for type 2's, but until I understand the factors for
either one then I think it's silly to try to draw fine lines between
the two.

Good point.

Doctors usually arrive at a risk assessment from ticking boxes for
various risk factors eg level of smoking, degree of sedentary
lifestyle, blood pressure, family history, blood lipids and then
consult a chart.

Though we use the word "factors" perhaps we should use the word
"terms" since each contributing term is ADDED not multiplied to get
the final score.

It is all a bit like those tests one comes across in magazines in
doctors waiting rooms where one can work out how good a wife or stud
you are etc
These have multichoice questions to which you pick a,b,c,d or e and
get a score depending on your choice. The scores are added up and
finally an interpretation is given. I particularly remember the "how
good a wife you are" one as I gained an ideal score thanks to them not
asking a couple of vital questions.

There is a delightful though undoubtedly apocryphal story of a famous
computer test using Artificial Intelligence, AI, to aid doctors make a
rapid diagnosis of patients brought into the Accident and Emergency
department. A wag put a bicycle through the set of test questions and
it was diagnosed as having high blood pressure thanks to the tires.

Certainly we have the tools to help limit the damage caused by high
glucose numbers but I am quite convinced that just controlling those
numbers will not remove all the elevated risks.

I'm sure you're right since some damage occurred BEFORE the blood
glucose levels became elevated. Some of that damage is irreversible.
The A1c measures damage done to a specific protein and ignores others.

Tim.

Best wishes Tim and thank you for stimulating interest in a topic
which should be considered important to all of us. IMHO our best
chances are arrived at by not being overly focused on a single issue
but making a checklist of healthy options and doing something about as
many of them as is practical. In the end though there is no promise.
Only the opportunity to make a bet with our lives as the stake.

--
Quentin Grady ^ ^ /
New Zealand, >#,#< [
/ \ /\
"... and the blind dog was leading."

http://homepages.paradise.net.nz/quentin
.

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