Then I'm really screwed as I have had diabetes for 20 years and the first
fifteen I was in denial.

I always wonder what it means when somebody says they have been in "good
control" for X amount of time.  I think that can be widely interpreted.

I once worked with a man who died at 56 of a massive coronary.  He had no
health problems at all.  Fit, healthy, exercised regularly.  Up until the
day he died, he was the picture of health and vitality.  Diabetes may or may
not have been  a factor in your friend's early and unfortunate death.
Genetics plays a big role.

Outstanding.  My target weight is 225 by June of 06.  That is a great weight
for my build.

In the end, you do your best and you hope for the best.  What else can you
do?

Paul

That's a false statement.  All diabetics do have a greater risk than
non diabetics but that does not mean that all of any one type "will"
have one.

And diabetes aside, genetics plays a role in this that nothing we do
will change.

Okay, but how was his control before that? and how do you define
"great control"? and "great A1c"?  What actual numbers?  what amount
of home BG testing?  what regular types/amounts of exercise?

I hope you have read http://www.alt-support-diabetes.org

Just wanted to say I am very sorry for the person who passed at such a young
age. I am 55 and I dread dying young. I too have read what you did about the
heart attack/stroke. I have not been in control much in my six years but my
doc assures me if I do get into control I am good for another 30 years. I
sure hope he is right and then some as long as I am healthy and can enjoy my
family.

I say if you keep in control and they say "tight control" then maybe you
have a good chance of beating the odd's. Just keep a good check with your
doctor and always try even when you fall.

It means plenty.  But nothing's certain except,....
well, I won't say it lest I need an "OT"

Sounds like you're doing most of it.  Think you can get that A1c
down to 6% ?  HDL above 40 ?

Obviously not true. Some get hit by buses for example. Also everybody dies of
something, but your odds of dying of a heart attack or stroke are probably
higher than others.

What is true is that at any point in time - all other things being equal -
your chance of dying of heart attack or stroke over the next year are higher
than an average person your age and gender.

The trick is to make all other things not equal. It is not true that exercise
etc. does not help. Exercise, get weight down, get A1C down, take fish oil,
other medications if needed, less stress, etc. etc. and you can move the odds
in your favor.

Here is one example from numerous articles:

"The last ten years have seen a rapid expansion in the evidence-base for the
reduction of cardiovascular risk in people with diabetes. Following the
landmark Scandinavian Simvastatin Survival Study (4S), several other studies
have shown the benefits of statins in people with diabetes, but much less data
are available for the benefit of fibrates, and the main evidence to date comes
from subgroup analysis of the Veterans Affairs High Density Lipoprotein
Cholesterol Intervention Trial (VA-HIT). The Hypertension in Diabetes Study
(HDS), nested within the United Kingdom Prospective Diabetes Study (UKPDS),
proved that tight control of hypertension reduced microvascular and
macrovascular events in people with diabetes, and the Heart Outcomes
Prevention Evaluation (HOPE) and MICRO-HOPE studies suggested a benefit in
reducing cardiovascular events with angiotensin-converting enzyme (ACE)
inhibition, additional to blood pressure lowering effects. With regards to
glycaemic therapy, the UKPDS has shown the benefit of metformin in reducing
myocardial infarctions. The Fenofibrate Intervention and Event Lowering in
Diabetes (FIELD) and Prospective Pioglitazone Clinical Trial in Macrovascular
Events (PROactive) studies will be presented later this year and will give
information on the role of fenofibrate and pioglitazone respectively in
reducing cardiovascular events in people with diabetes."

http://www.medscape.com/viewarticle/514154_print

Bill

Couple of thoughts:

1)  Diagnosis is now happening earlier.  Historically, Type 2 has been
considered more of an older person's condition (in general terms).  If
Type 2 is undiagnosed for a long period then the blood glucose
"rollercoaster" means that people will be overweight as a result for a
long period and therefore increase the fatty buildup in the body.  So
for someone undiagnosed for 9 years (Diabetes UK often claims that
people are undiagnosed for "up to" 9 years) then their body has been
under coronary pressure for that period of time.  Earlier diagnosis
means that you can bring things under control that much sooner and
reduce or even reverse some of the damage.

2)  Treatment and handling of the condition.  As you say in the past
people have not dealt with it terribly well but resources like the
newsgroups can help you learn from the experience of others to reduce
your risks.  It sounds as if you have taken great steps to deal with the
condition and as a result have reduced your probability of problems well.

But as others have said, its down to so many factors such as genetics
that there are no givens.  Just making the best of what you have is your
best chance and it seems like you have made a good start.

The chances of cardiac problems drop along with your A1c, so get below 6
if you can and make sure your cholesterol panel is as good as possible.

Its partly down to luck in the end, but that does not mean you cannot
use weighted dice ;)

VBH.

ofd wrote in message ...

. . .(snip). . .

 Type 2 diabetics suffer at least three consequences of the disease which
increase heart attack probability:

  1.    High blood sugars damage artery walls
  2.    High levels of circulating insulin from high Insulin Resistance
damage artery walls
  3.   Lousy lipids caused by high Insulin Resistance damage artery walls

Working on blood sugars is up front and obvious.     High Insulin Resistance
is harder to detect,  harder to fight.

One clue:   triglycerides/HDL ratio.   Keep it as low as possible.  3.0 is
just about as high as tolerable  (in mg/dL units,  1.3 in mmol/L).

Another:  low HDL in general.   Do everything you can to increase HDL.

Regards
 Old Al

There are other things that can cause a stroke in a young person. (I'm
57 too, so I'd like to think of that as "young.")

Tedy Bruschi had one because of a small hole in the heart leading to a clot.

Some drugs can cause stroke as a side effect because they mess up
clotting and if a person already has a low platelet count and gets a
tiny brain bleed that can cause death.

You can have a stroke/heart attack if your blood pressure drops way too
low early in the very early morning while you are sleeping. And of
course, if it goes way to high at any time.

You can die from a tiny aneurysm. Or you can get hit by a bus.

Culturally we have a huge control-freak mentality which tells us we can
live forever if we eat the right micronutrients, supplements, and take
expensive Big Pharma drugs.

But this is simply not true. I know a cardiologist who dropped dead of a
heart attack in his 30s--at a party where he was surrounded by other
cardiologists.

OTOH, my dad was diagnosed with heart disease in 1977 and told he had a
year to live. His cholesterol was 340 and he refused to take drugs for
it. He died 28 years later after a fall and led a very active life for
25 years after the diagnosis.  He did eat a relentlessly low carb, low
fat, low salt diet so boring few of us could ever  eat that way,
especially not for 30 years.

Statistically, it looks like if you can get your A1c under 5% you
eliminate a lot more risk, which means keeping your blood sugars under
100 mg/dl at all times. But this is still a statistical thing. The
probability of some kind of death might be one in 25 but if you are that
one, you are 100% dead.

--Jenny

http://www.geocities.com/lottadata4u/  Type 2 Diabetes info
http://www.geocities.com/jenny_the_bean/  Low Carb info

My opinion?  LIFE is a scary disease.  (By that I mean even non
diabetics are gonna DIE!)  Enjoy what you have as best you can.  That
doesn't mean let yourself go to pot; it means your attitude about life
is more important than your situation.  A multi billionaire can be happy
or unhappy.  A person living in a hut can be a productive, caring,
loving and HAPPY individual. Don't get hung up on fate.  NOBODY GETS OUT
ALIVE.

Dave

Sorry - the cat jumped on the keyboard!  I don't know whether my
comments got sent or not..............
My parents did not have diabetes (dad being a doctor, he would have
known) and he died at 77, my mother at 73.  Heart attacks both.  I was
diagnosed with diabetes at 62, had a heart attack at 69, and am in
pretty good shape at 77.

Point being that 90 years ago if you got diabetes you DIED.  Period.
Back in 1967 quadruple by-passes weren't common ( if they existed at
all) and my father didn't get one.  With medical knowledge every year
you live, the better your chances of living are.
(For fun, look up an annuity table sometime.  At 65 your life
expectancy is 16 or 17 years.  16 or 17 years later, your life
expectancy is another 10 years or so.  I love the 102 figure of another
year and a half!)

Anyway, the better your condition (weight, diet, exercise) the better
your chances of beating the curve.

Nan, Type 2 since 1990 or so

We all die eventually.

However, my aim is to make "eventually" as far in the future
as possible - and for the years between now and then to be
as enjoyable and complication-free as possible.

Read this 2001 BMJ article in full, but this is the
interesting part: http://tinyurl.com/dcthp or
http://bmj.bmjjournals.com/cgi/content/full/322/7277/15?maxtoshow=&HITS=&hits=&R
ESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=EPIC-Norfolk+H
bA1c&andorexactfulltext=and&searchid=1114001362105_10054&stored_search=&FIRSTIND
EX=0&sortspec=relevance&resourcetype=1

"The increased risk of death among men with diabetes was
largely explained by HbA1c concentration. HbA1c was
continuously related to subsequent all cause,
cardiovascular, and ischaemic heart disease mortality
through the whole population distribution, with lowest rates
in those with HbA1c concentrations below 5%. An increase of
1% in HbA1c was associated with a 28% (P<0.002) increase in
risk of death independent of age, blood pressure, serum
cholesterol, body mass index, and cigarette smoking habit;
this effect remained (relative risk 1.46, P=0.05 adjusted
for age and risk factors) after men with known diabetes, a
HbA1c concentration >= 7%, or history of myocardial
infarction or stroke were excluded."

You said "I don't want to have to worry about these kind of
things. I'm 41 (dx a little over a year ago A1C 7%) and have
since gone from 225 lbs to a lean,mean 145 lbs (i'm 5' 11")
and i'm hoping to avoid cardiac problems."

It sounds like you're doing the right things. What is your
A1c?

Personally, I agree about aiming for low A1c's, but I also
target low post-prandial numbers because of other studies I
have read. The two are not always as closely linked as
people assume.

Cheers, Alan, T2, Australia.

What were his cholesterol and triglycerides? Being in good control of
diabetes does not necessarily mean he was in good control of everything.

What genetic predisposition to cardiac disease, apart from diabetes, did
he have?

Maybe he had what I just had (blood clots) and that's what caused it.

I don't think your opening sentence is completely true. I think having T2
merely increases the chances.