Re: What's different about Jennifer's Advice?

On 7/26/2011 7:32 PM, Chris Malcolm wrote:
The previous discussion about this has got rather polluted by
cross-posting trolls so I'm restarting it here.

Kurt has claimed that Jennifer's "test test test" Advice is nothing
new or special, it's the pretty standard advice that medical
professionals have been giving out (or should have been giving out)
for for years if not decades before Jennifer started polishing her
summary advice to newbies in asd and mhd.

But her advice is more than the advice to test your BGs. It gives
advice about when, what to do with the test results, etc. Here it is.

"Jennifer's advice"

Note the advice about when:

* Upon waking (fasting)
* 1 hour after each meal
* 2 hours after each meal
* At bedtime

Here's the advice about what BG targets to aim for:

* FBG under 110
* One hour after meals under 140
* Two hours after meals under 120

Those are substantially lower target values than those advised by the
ADA or Joslin. The method she advises of trying to get to those target
values is also rather different from the general treatment plans of
the ADA or Joslin. She gives more detailed dietary advice, shifting
more strongly in a low carbing direction, than do ADA or Joslin.

Of course it is true that the ADA& Joslin don't say that aiming for
and achieving such targets is bad, nor is that kind of low carbing
bad. They would be quite happy for an individual doctor to give such
advice to an individual patient based on their needs and
capabilities. But generally speaking they don't expect it.

For example the ADA's general Type 2 post mean BG target is to be
under 180 at one or two hrs post meal, and if you're failing to meet
that then the primary intervention is intensification of
pharmacological treatment. See for example:

"Medical Management of Hyperglycemia in Type 2 Diabetes: A Consensus
Algorithm for the Initiation and Adjustment of Therapy"

"A consensus statement of the American Diabetes Association and the
European Association for the Study of Diabetes"

I think these differences in emphasis are important.

Jennifer's advice has helped many many people. I am one. After three months I looked like a pincushion but had a good understanding of how my damaged metabolism handled different foods in many different situations.

The politics of why someone would ever devalue what she has done no longer interest me.