Re: Normal Blood Sugar Values??
- From: Alan Mackenzie <acm@xxxxxx>
- Date: Sun, 3 Jul 2005 19:22:57 +0000
Alan S <loralweightandcarbs@xxxxxxxxxxxxxxx> wrote on Sun, 03 Jul 2005
12:25:42 +1000:
> On Sat, 2 Jul 2005 18:03:45 +0000, Alan Mackenzie <acm@xxxxxx> wrote:
>>Alan S <loralweightandcarbs@xxxxxxxxxxxxxxx> wrote on Sat, 02 Jul 2005
>>21:40:52 +1000:
>>> On Sat, 2 Jul 2005 08:37:18 +0000, Alan Mackenzie <acm@xxxxxx> wrote:
Hi, Alan.
I think we're talking at cross purposes, to some extent. T1 and T2 are
different problems, even if they do have things in common. So I'll skip
some the things you've said, even though they're important and sensible,
in the interests of having a bit of time left to do other things. ;-)
>>> We hear scare stories - ....
>>Exactly my point in this thread. They're dangerous, even when there's
>>nothing much to be scared of.
> again ?????? What's dangerous? The scare stories? I agree.
Saying "Eye damage starts at 120" is a scare story, a bit like saying
"nuclear reactors can go critical and blow you to smithereens" is. (The
latter killed quite a few people at Three Mile Island in 1979.) Why is
it dangerous? Because it causes people to get minor things blown out of
proportion, diverting their attention from important ones. It can make
them scared and depressed.
[ .... ]
> I have had hypos (from other's analysis, reactive hypos) and am one of
> those who reported them. They were never as severe as a type 1 hypo,
> and the way I minimised recurrence was by achieving tight control - not
> by avoiding it. When I stopped going so high, I stopped going so low.
Hmmm. You can have tight control around an average of 80, or tight
control around an average of 110. I'd not recommend the former.
>>> I can provide plenty of cites of the consequences for those who
>>> didn't achieve it.
>>Yes, but can you get a sense of proportion round them?
> How do you measure that?
You don't measure it, you sense it. When your reaction to something is
"Get real!", you're sensing a lack of proportion in somebody else. Rabid
anti-smokers going on about "passive smoking", governments saying how
fingerprint databases of the entire world's population will protect us
from "terrorism", people telling me "behave the way I say or else you'll
roast in hell" and people here saying "BS > 120 is dangerous" all provoke
the reaction "Get real!" in me.
> All I can use is my own judgement and analysis of the worth of the
> cites.
Yes.
[ .... ]
> But, as you have implied repeatedly that I am ignoring type
> 1's, try browsing through the many references here (other
> type 1's have indicated that the DCCT has a reasonable sense
> of proportion):
> http://diabetes.niddk.nih.gov/dm/pubs/control/
> Diabetes Control and Complications Trial (DCCT)
> First, to answer your fears, they are cautious:
> "What Are the Risks of Intensive Treatment?
> In the DCCT, the most significant side effect of intensive treatment
> was an increase in the risk for hypoglycemia (low blood sugar) episodes
> severe enough to require assistance from another person. Because of
> this risk, DCCT researchers do not recommend intensive therapy for
> children under age 13, people with heart disease or advanced
> complications, older adults, and people with a history of frequent
> severe hypoglycemia. Persons in the intensive management group also
> gained a modest amount of weight, suggesting that intensive treatment
> may not be appropriate for people with diabetes who are overweight.
> DCCT researchers estimate that intensive management doubles the cost of
> managing diabetes because of increased visits to a health care
> professional and the need for more frequent blood testing at home.
> However, this cost is offset by the reduction in medical expenses
> related to long-term complications and by the improved quality of life
> of people with diabetes."
Yep: "increase in the risk of hypo". But no figures cited in your post.
I'm sure there in the original report though. You know that original.
Does it attempt to balance the damage (psychological, social as well as
physical) caused by these hypos with the benefits due to lower BS? If
so, how?
Are you aware of what a full-blown T1 hypo does? If your lucky, at home
at the time, and there's somebody around to give you a helping hand, you
end up with a splitting headache, and BS levels bouncing to >400. If
you're less lucky, you end up being carted off to hospital and detained
there. If it happens at work, more than once or possibly twice, you end
up being treated as an invalid (which, in fact, you are), missing pay
rises, promotion, possibly being dismissed.
And all the time this is happening, that lack of 30 or 40 points on your
BS reduces you from a robust member of society to a weakling, a second
class citizen.
Having been there once, I don't intend to drop in for a second visit.
And if that means a fourfold increase in the risk of eye damage, and so
on, then so be it.
> However, having said that, these are some of the benefits they found:
> "Lowering blood glucose reduces risk:
> Eye disease
> 76% reduced risk
> Kidney disease
> 50% reduced risk
> Nerve disease
> 60% reduced risk "
> Those are pretty impressive percentages. Obviously, you are
> one of the lucky ones.
Yes, but I could well be typical rather than unusual.
And are these figures really that impressive? 76% reduced from what? If
1 in 10 are going to get eye disease, and you reduce that figure by three
quarters, you'll end up with 1 in 40. Your chances of AVOIDING eye
disease have thus climbed from 90% to 97½% So the next question is is
that marginal 7½% improvement worth the cost?
Also, eye disease can be treated. Missing out on life is permanent and
irreparable.
The trouble with these studies is not what they study or the results they
present (assuming the independence and integrity of the scientists).
It's when they start making recommendations. These recommendations
follow from the value judgements of the scientists, and when they have
been up to their eyeballs in their science, they can't help but reflect
their bias in these recommendations. Thus, despite their honest
intentions, the 50% reduced risk of kidney disease is given more
significance than the social troubles arising from hypos.
> And what did they recommend?
> "Elements of Intensive Management in the DCCT
> * Testing blood glucose levels 4 or more times a day
> * Four daily insulin injections or use of an insulin
> pump
> * Adjustment of insulin doses according to food intake
> and exercise
> * A diet and exercise plan
> * Monthly visits to a health care team composed of a
> physician, nurse educator, dietitian, and behavioral
> therapist."
Here again, how much disruption to a normal life will monthly visits to a
health care team cause? It's half a day off work at the very least.
> If you want the full details of the numbers they aim for (they were
> pretty modest by our standards IIRC), see the New England Journal of
> Medicine, 329(14), September 30, 1993.
No, I don't want the full numbers. Unless, of course, they also quantify
in some fashion facilitating comparison what achieving those numbers is
going to cost.
> And remember that that study is 12 years old and things have moved on
> since then as well.
Some things have.
> Cheers Alan
--
Alan Mackenzie (Munich, Germany)
Email: aacm@xxxxxxxx; to decode, wherever there is a repeated letter
(like "aa"), remove half of them (leaving, say, "a").
.
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