 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Diabetes / March 2006Timescale in which newbies should get control
As the ophthalmologist thread has been subverted : ) There was an interesting Medscape article today, talking in general terms about how to improve diabetic control. Page 3 of it, however, was very interesting wrt the discussion we've been having about the time it should take for newbies to go to normal levels. They're not talking any specifics about retinopathy here, but I wonder if it would kill 2 birds with one stone! Incidentally, they recommend insulin for a newbie with an A1c>9%. This is the bit that specifically caught my eye, though: Recommendation 6: Treat patients intensively so as to achieve target HbA1c < 6.5%2within 6 months of diagnosis. http://www.medscape.com/viewarticle/522344_1 Nicky.  SignatureA1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg -- A1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg > As the ophthalmologist thread has been subverted : ) > [quoted text clipped - 11 lines] > > http://www.medscape.com/viewarticle/522344_1 Interesting. But it doesn't sound like the 6 month time period suggested here was chosen with any thought as to the safety or non-safety of lowering blood sugars too swiftly or a fear of causing retinopathy. The authors are mainly arguing against the common practice which is to leave patients with blood sugars in the danger zone for a few years while putting them on this and that drug that don't work very well. Suggesting control be attained in six months is meant to be a "hurry up!" Looking at the references, the only reference to retinopathy is an article explaining the DCCT discovery that lowering the A1c cuts down significantly on the risk of retinopathy, which is cited in the article. Indeed, I doubt you will find any serious discussion of the question of whether retinopathy worsens in type 2s who get tight control quickly in any practice guideline like this one. With hundreds of thousands of people with Type 2 going blind because their doctors never get them below 8%, the rare people with type 2 who have mild worsening while getting better control does not seem to be something doctors are worrying about or discussing. The reports of worsening with gaining of tight control all came from the big Type 1 study (DCCT) not the type 2 study (UKPDS) where no Type 2s developed worsening when going for tight control. The few other studies that look at the connection between better control for Type 2s and worsening retinopathy are small, inconclusive, and have serious design flaws. None of them comes up with a recommendation of a "safe" time period. And it is worth reminding ourselves that the DCCT data did not show any difference in worsening between those who gained quick control and those who gained slow control. Indeed, the DCCT statistics suggest that the worsening comes from getting control after being very high, period, regardless of the time involved. Beyond the analysis of the DCCT data, where they did look at speed of gaining control, there is NO study that looks at different speeds of gaining control and plots that speed against retinal worsening. Period. The studies only show, incontrovertibly, that in a very small percentage of people, worsening occurs when control improves. I feel really bad that Chris has to go through what he is going through, but nothing he has posted goes beyond the anecdotal and it is likely that it may, when all is said and done, relate to people with blood sugars near 600 and massive infections with long histories of drug and allergic reactions who have some really, really bad luck. If you really are interested in this question, you might email the doctor who published the journal article (there always is an email address included in the actual article) and ask whether he'd advise against getting control more swiftly because of the retinal issue. --Jenny http:www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >With hundreds of thousands of people with Type 2 going blind because >their doctors never get them below 8%, the rare people with type 2 who >have mild worsening while getting better control does not seem to be >something doctors are worrying about or discussing. Agreed that they aren't discussing it, but they darn well should be, as it's nowhere near as uncommon as any of us had thought. It even has a name: Normoglycemic re-entry retinopathy. >And it is worth reminding ourselves that the DCCT data did not show any >difference in worsening between those who gained quick control and those >who gained slow control. Indeed, the DCCT statistics suggest that the >worsening comes from getting control after being very high, period, >regardless of the time involved. >Beyond the analysis of the DCCT data, where they did look at speed of >gaining control, there is NO study that looks at different speeds of >gaining control and plots that speed against retinal worsening. How can you say that conclusively? I haven't been able to find one, but that's not proof it doesn't exist. I intend to keep looking. >I feel really bad that Chris has to go through what he is going through, >but nothing he has posted goes beyond the anecdotal Would that include my retinal specialist stating, explicitly, that slower lowering is better? I don't see how that is at all anecdotal in this context. >If you really are interested in this question, you might email the >doctor who published the journal article (there always is an email >address included in the actual article) and ask whether he'd advise >against getting control more swiftly because of the retinal issue. That is an excellent idea! Thanks. And BTW, so far both my retinologist and opthamologist have said "slower would be better", and I'll try and get them to specify a timeframe. >>Beyond the analysis of the DCCT data, where they did look at speed of >>gaining control, there is NO study that looks at different speeds of >>gaining control and plots that speed against retinal worsening. > > How can you say that conclusively? I haven't been able to find one, > but that's not proof it doesn't exist. I intend to keep looking. Because when the ophthalmologists who have published the most on the topic of diabetic ophthalmology published a comprehensive review of the literature on the subject in 2004 in Diabetes Care, the premier journal covering treatment for diabetes (an article citing 134 research papers) they cited no such study. The authors on this review are researchers with a huge presence in the field. Do a Google Scholar search on authors Donald Fong or Ronald Klein and you'll see what I mean. Diabetic Retinopathy Diabetes Care 27:2540-2553, 2004 http://care.diabetesjournals.org/cgi/content/full/27/10/2540 They did say, discussing the DCCT data (the only major study to come up with data on this topic: "Analysis for early worsening was conducted and noted to be present at the 6- and/or 12-month visit in 13.1% of 711 patients assigned to intensive treatment and in 7.6% of 728 patients assigned to conventional treatment (P < 0.001). By the 18-month visit, there was recovery in 51% of the intensive and 55% of the conventional groups (P = 0.39). The risk of three-step or greater progression from the retinopathy level present 18 months after entry into the trial was greater in patients who had previously had early worsening than in those who had not, but there was a large long-term risk reduction with intensive treatment. Patients who developed early worsening as a result of the intensive treatment were similar to or had more favorable outcomes than those in the conventional group who did not have early worsening. Analysis did not suggest reduction of early worsening with more gradual reduction of glycemia." PLEASE NOTE THE LAST TWO SENTENCES > Would that include my retinal specialist stating, explicitly, that > slower lowering is better? I don't see how that is at all anecdotal in > this context. Yes. This is anecdotal, as is Wendy's distinguished retinologist telling her the exact opposite. In scientific terms "anecdotal" means "what I am concluding based on the stuff I've personally seen, as opposed to what large, well conducted studies have been able to document in ways that hold up to subsequent analysis of study design and which can be validated by reproducing results." These retinal specialists are in the field doing the laser coagulation and treatments. They aren't researchers setting up experiments or analyzing data. So their opinions are formed by what they see in their office which is only a small segment of the patient population. And if they are anything like the retinal specialist I worked for many years ago, most of their very sparse spare time is spent reading up on new surgical techniques and practicing them on sheep's eyeballs in the lab not reading up on the causes of the conditions they treat. > And BTW, so far both my retinologist and opthamologist have said > "slower would be better", and I'll try and get them to specify a > timeframe. When you do, be sure you ask them what they base their recommendations on. Have they seen research that supports that conclusion or is it an educated guess? I have found with my doctors, that they don't like to admit they don't know the answer to something. So If you ask them a question, they often will state things with great certainty which upon further examination turn out to be opinions not fact. (And in my case, turn out to be completely different than what labs turn out to show.) That's why it is always a good idea to ask what the basis is for a statement that has great importance to you. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >>>Beyond the analysis of the DCCT data, where they did look at speed of >>>gaining control, there is NO study that looks at different speeds of [quoted text clipped - 8 lines] >covering treatment for diabetes (an article citing 134 research papers) >they cited no such study. OK, thanks, I did not know that, but I'm going to look for that online, or, failing that, order a copy. However, I'm still going to keep looking, as it's at least possible something was missed. You had to did very deeply and not give up in order to find some of the data on your website, as I recall, so I'm not giving up either. I learned long ago that it's darn hard to prove a negative, and just because I can't find it does not mean it does not exist. Don't worry though, I'm sure not going to base any advice on something I can't find! >The authors on this review are researchers with a huge presence in the >field. Do a Google Scholar search on authors Donald Fong or Ronald Klein >and you'll see what I mean. ARGH. I can't get google to load right now. ISP problems. I'll try later today, and THANK YOU! >Diabetic Retinopathy >Diabetes Care 27:2540-2553, 2004 >http://care.diabetesjournals.org/cgi/content/full/27/10/2540 > >They did say, discussing the DCCT data (the only major study to come up >with data on this topic: I'm slightly leery of the DCCT data, as it's a T1 study. The circumstances for a T1 at DX are quite different in this regard: mainly, they are quite unlikely to have had sustained high BG's for as long as a T2. There are also seem to be (not sure yet) differences in the IGF-1 profile. Also, why do you say the DCCT is the only major study? The article you cite cites both, and so I thought the UKPDS (a T2 study) would also qualify? And what about the following Henricsson M, Nilsson A, Janzon L, Groop L. The effect of glycaemic control and the introduction of insulin therapy on retinopathy in non-insulin-dependent diabetes mellitus. Diabetic Med 1997;14:123-31. http://tinyurl.com/pacyg I can see, though, why it wouldn't be considered a major study. However, please note the last line "In conclusion, while hyperglycaemia was a risk factor for the progression of retinopathy in all patients, change of treatment from oral drugs to insulin was associated with a 100% increased risk of retinopathy progression and a 3-fold increased risk of blindness/visual impairment." A 3-fold increase of risk is a rather significant finding IMHO. >"Analysis for early worsening was conducted and noted to be present at >the 6- and/or 12-month visit in 13.1% of 711 patients assigned to [quoted text clipped - 9 lines] >group who did not have early worsening. Analysis did not suggest >reduction of early worsening with more gradual reduction of glycemia." >PLEASE NOTE THE LAST TWO SENTENCES I'm well aware of them. But, this is far from conclusive. It's a T1 study, and "analysis does not suggest" is hardly a definitive outcome. Sorry, but IMHO, the jury is still out on this one. >These retinal specialists are in the field doing the laser coagulation >and treatments. They aren't researchers setting up experiments or >analyzing data. So their opinions are formed by what they see in their >office which is only a small segment of the patient population. I also worry about another phenomenon I've seen in other professions: the tendency to be biased in favor of their particular specialty. >And if >they are anything like the retinal specialist I worked for many years >ago, most of their very sparse spare time is spent reading up on new >surgical techniques and practicing them on sheep's eyeballs in the lab >not reading up on the causes of the conditions they treat. It think you are quite right on that. >> And BTW, so far both my retinologist and opthamologist have said >> "slower would be better", and I'll try and get them to specify a [quoted text clipped - 3 lines] >on. Have they seen research that supports that conclusion or is it an >educated guess? That's a very good point, and I'll make darn sure I ask that. >I have found with my doctors, that they don't like to admit they don't >know the answer to something. So If you ask them a question, they often >will state things with great certainty which upon further examination >turn out to be opinions not fact. ARGH! I've run into that with both Docs and other professionals. I have however observed a different response: they avoid a direct answer until pinned down. I've learned to assume that if they don't answer directly, they probably think they are on shaky ground. >(And in my case, turn out to be >completely different than what labs turn out to show.) That's why it is >always a good idea to ask what the basis is for a statement that has >great importance to you. That's very sound advice, and I shall do so. Thanks. > > I'm slightly leery of the DCCT data, as it's a T1 study. The > circumstances for a T1 at DX are quite different in this regard: > mainly, they are quite unlikely to have had sustained high BG's for as > long as a T2. There are also seem to be (not sure yet) differences in > the IGF-1 profile. The reason that DCCT data is cited is that it is the only large scale, long term study that found worsening and analyzed enough data to come to conclusions. The UKPDS is the other corresponding study of Type 2s, but it did NOT find evidence of retinal worsening in it's population though they made the same dramatic decrease in blood sugar levels. There are a few, much smaller studies of worsening in Type 2s put on insulin (your cite might be one of them.) Bbut one of the articles I cited for you back when you first posted (and don't have at hand, though the message is still out there and should be able to be found via Google) included a review of several small studies that found worsening in Type 2s put on insulin. If I recall correctly, that review explained that the problem with these studies was that the patients put on insulin in these studies were typically those who had been out of control for many years who were only put on insulin, very late, as a last resort. So there was a huge question as to whether their retinopathy was already pre-existent due to the decades of high blood sugar exposure. These after all, were patients whose A1cs had been over 10% for many years. Here's another relevant article for you from Medscape where the question is asked of experts from Joslin & Harvard Med School. They pretty much say the same thing as the Fong article, but they said it in 5/03. I've included most of the text for your convenience. Follow the link to see the references. http://www.medscape.com/viewarticle/452955 Does Initiating Intensive Glucose Control Worsen Existing Diabetic Retinopathy? Question Some endocrinologists in Japan state that controlling blood glucose levels too quickly in patients with severe diabetic retinopathy can worsen retinal lesions. Is there any evidence to support this statement? Response from Lloyd Paul Aiello, MD, PhD Assistant Director, Beetham Eye Institute, Joslin Diabetes Center; Associate Professor of Ophthalmology, Harvard Medical School, Boston, Massachusetts Jerry Cavallerano, OD, PhD Assistant to the Director, Beetham Eye Institute, Joslin Diabetes Center, Boston, Massachusetts The Diabetes Control and Complications Trial (DCCT) definitively demonstrated that intensive control of blood glucose levels in patients with type 1 diabetes mellitus substantially reduces the risk of onset and progression of diabetic retinopathy.[1,2] In addition, the reduced risks of onset and progression of retinopathy associated with intensive therapy persisted at least 4 years beyond the conclusion of the DCCT, despite near convergence of hemoglobin A1c levels in the intensive-therapy and conventional-therapy groups.[3] The United Kingdom Prospective Diabetes Study (UKPDS) found similar benefits of intensive blood glucose control for patients with newly diagnosed type 2 diabetes.[4] In the Kumamoto study in Japan of patients with type 2 diabetes who were taking insulin, the benefits of intensive control of blood glucose levels were likewise demonstrated.[5] The DCCT documented "early worsening" of diabetic retinopathy in the study population.[6] Early worsening of retinopathy was defined as a 3-step or more progression of retinopathy on the severity scale, the development of cotton wool spots and/or intraretinal microvascular abnormalities, and "clinically important retinopathy" if it occurred between baseline and the 12-month follow-up visit. Early worsening of retinopathy occurred in 13.1% of 711 patients assigned to intensive treatment and in 7.6% of 728 patients assigned to conventional treatment. Nevertheless, after 18 months this early worsening in retinopathy reversed, and patients in the intensive-treatment group fared better than those on conventional therapy. Risk factors for early worsening were higher hemoglobin A1c level at baseline and reduction of this level during the first 6 months following randomization. There was no evidence that a gradual reduction in A1c levels reduced the risk of early worsening. In the DCCT, the long-term benefits of intensive control clearly outweighed the risk of early worsening of retinopathy, and no case of early worsening resulted in serious visual loss. Based on these findings, it is recommended that persons with type 1 or type 2 diabetes initiate intensive therapy as early as possible, and maintain intensive therapy for as long as possible, with the expectation that intensive control of blood glucose levels will reduce the risk of onset and progression of diabetic retinopathy. For patients with elevated hemoglobin A1c levels, careful retinal evaluation, close retinal follow-up, and laser photocoagulation as indicated are important components of care as intensive therapy is initiated. Signature--Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > > >> I'm slightly leery of the DCCT data, as it's a T1 study. The [quoted text clipped - 6 lines] >long term study that found worsening and analyzed enough data to come to >conclusions. And those conclusions are slightly questionable for T2's under these circumstances. I'm not saying they are wrong, only that I can't see them as being definitive or proven. >The UKPDS is the other corresponding study of Type 2s, but >it did NOT find evidence of retinal worsening in it's population though >they made the same dramatic decrease in blood sugar levels. That I think depends on one's definition of dramatic. The studies involved A1c changes of 2 to 4 %, and made little reference for actual timeframe. Mine went down over 7 in three months, with the vast majority of the decline taking place in a week. >There are a few, much smaller studies of worsening in Type 2s put on >insulin (your cite might be one of them.) Bbut one of the articles I >cited for you back when you first posted (and don't have at hand, though >the message is still out there and should be able to be found via >Google) I still have the links. I've been saving everything. >If I recall correctly, that review explained that the problem with these >studies was that the patients put on insulin in these studies were [quoted text clipped - 3 lines] >the decades of high blood sugar exposure. These after all, were patients >whose A1cs had been over 10% for many years. My A1c at Dx was 12.5, but my BG's at Dx were far higher than that would indicate, probably due to my infection. However, a couple of months before I was Dx'd, I had a full retinal exam, and no signs of retinopathy were seen. >Here's another relevant article for you from Medscape where the question >is asked of experts from Joslin & Harvard Med School. They pretty much [quoted text clipped - 3 lines] > >http://www.medscape.com/viewarticle/452955 I've seen this one, but I missed some critical items (one very critical to me personally), so I'll comment on those below and THANK YOU! >The Diabetes Control and Complications Trial (DCCT) definitively >demonstrated that intensive control of blood glucose levels in patients [quoted text clipped - 4 lines] >despite near convergence of hemoglobin A1c levels in the >intensive-therapy and conventional-therapy groups.[3] >The United Kingdom Prospective Diabetes Study (UKPDS) found similar >benefits of intensive blood glucose control for patients with newly >diagnosed type 2 diabetes.[4] In the Kumamoto study in Japan of patients >with type 2 diabetes who were taking insulin, the benefits of intensive >control of blood glucose levels were likewise demonstrated.[5] >The DCCT documented "early worsening" of diabetic retinopathy in the >study population.[6] Early worsening of retinopathy was defined as a >3-step or more progression of retinopathy on the severity scale, the >development of cotton wool spots and/or intraretinal microvascular >abnormalities, and "clinically important retinopathy" if it occurred >between baseline and the 12-month follow-up visit. Mine certainly qualifies for that. >Early worsening of >retinopathy occurred in 13.1% of 711 patients assigned to intensive >treatment and in 7.6% of 728 patients assigned to conventional >treatment. Nevertheless, after 18 months this early worsening in >retinopathy reversed, THIS is something I missed: It *REVERSED*!!! I had seen some other reports of it doing so in up to 50% of cases, but this seems to state it as an absolute. >There was >no evidence that a gradual reduction in A1c levels reduced the risk of >early worsening. I still say I would like to see a study done on this, as I suspect there never has been one. Even the mechanisms for early worsening (normoglycemic re-entry) is only theoretical at this point. >For patients with elevated >hemoglobin A1c levels, careful retinal evaluation, close retinal >follow-up, and laser photocoagulation as indicated are important >components of care as intensive therapy is initiated. This part I missed too: Get an exam as intensive therapy is *INITIATED* OK, I'm going to SHOUT here, to draw attention to this, for anyone reading: For anyone with high A1C's at Dx, and going on insulin, GET A RETINAL EXAM FROM AN OPTHAMOLOGISTS ASAP!!!!! >>>I'm slightly leery of the DCCT data, as it's a T1 study. The >>>circumstances for a T1 at DX are quite different in this regard: [quoted text clipped - 105 lines] > reading: For anyone with high A1C's at Dx, and going on insulin, GET A > RETINAL EXAM FROM AN OPTHAMOLOGISTS ASAP!!!!! Chris, The difficulty with the study of Type 2s is that for a definitive study you need a very large group because in most studies Type 2s don't develop this problem, so only a tiny number might even develop the problem in your study. Then you need to have subjects broken into groups and very well matched with controls and you need to have a protocol where the speed is controlled at different speeds and the insulin types controlled and the diet controlled. All this would be very expensive to do, if it is even possible, and will not enrich any drug company--and in fact might end up putting the insulin companies into a Vioxx-type condition. So the chances of it being funded are zilch. The other problem is that all the data shows that this is only a problem for people with existing retinopathy. You would not even have fallen into that group given your recent retinal exam showing no problem. Every study I've seen shows that people with the tight control end up in no worse shape and mostly in much better shape than those who don't control tightly no matter what the initial worsening is. That is probably why Wendy's doctor says go for the control. And I still think your own situation may be complicated by a drug reaction or something to do with the infection itself, which doctors wouldn't be aware of. I have never yet found a doctor who was aware that the drug I took causes permanent tinnitus, though I have found two other people online who have suffered the same injury from the same class of drugs. Signature--Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >Chris, > [quoted text clipped - 6 lines] >controlled and the diet controlled. All this would be very expensive to >do, Not to mention perhaps exposing some groups to increased risks. >if it is even possible, and will not enrich any drug company--and in >fact might end up putting the insulin companies into a Vioxx-type >condition. So the chances of it being funded are zilch. Yep... >The other problem is that all the data shows that this is only a problem >for people with existing retinopathy. Not exactly. I've seen at least one report of it occurring in 2% of people without retinopathy, and I'm one of them. >Every study I've seen shows that people with the tight control end up in >no worse shape and mostly in much better shape than those who don't >control tightly no matter what the initial worsening is. That is >probably why Wendy's doctor says go for the control. OK, we might be discussing tangential issues here: Tight Control Vs. Speed of tight control. I'm absolutely not questioning tight control. Everything I've seen indicates tight control is the best defense. The only thing I'm questioning is the SPEED of attaining tight control. I think it might be that excessive speed is an aggravating factor in normoglycemic re-entry phenomenon, but I don't know if that's true or not. >And I still think your own situation may be complicated by a drug >reaction or something to do with the infection itself, which doctors >wouldn't be aware of. I think that's possible, too. >I have never yet found a doctor who was aware >that the drug I took causes permanent tinnitus, though I have found two >other people online who have suffered the same injury from the same >class of drugs. Same with me and lisinopril: my Doc was unaware that it can cause tingling in the fingers and toes. >And BTW, so far both my retinologist and opthamologist have said >"slower would be better", and I'll try and get them to specify a >timeframe. But the real question is how slow. I understand the problem you've had and that you want to prevent it in others. Definitely a worthy goal! But I can imagine the newbie coming along -- just diagnosed, doctor said "take this pill, stay away from sugar, and test your blood sugar in the morning." The guy is scared, wondering if his whole life is going to change, wondering if he's going to end up on dialysis, and then he reads "don't get your blood sugar down too quickly." And he thinks "hey, my doctor wasn't too excited about this and now this guy says be careful about going down too fast. So I'll just keep taking that pill every day and I'll be fine." What's really needed is a number. You should aim to lower your BG by X points a week or Y points a month. Or maybe by a percentage. I don't know if such guidelines exist, but they would be helpful. -- Lord, make me an instrument of your peace... where there is hatred, let me sow love. remove "spamtrap" for e-mail >>And BTW, so far both my retinologist and opthamologist have said >>"slower would be better", and I'll try and get them to specify a >>timeframe. > >But the real question is how slow. Exactly... And right now, I haven't got a clue. >I understand the problem you've had and that you want to prevent it in others. >Definitely a worthy goal! Thanks... >But I can imagine the newbie coming along -- just diagnosed, doctor said "take >this pill, stay away from sugar, and test your blood sugar in the morning." [quoted text clipped - 3 lines] >about this and now this guy says be careful about going down too fast. So >I'll just keep taking that pill every day and I'll be fine." Tentatively, I can say that I think such a newbie would have little to worry about in this regard, as insulin intervention seems to be a requirement for Normoglycemic re-entry phenomenon. >What's really needed is a number. You should aim to lower your BG by X points >a week or Y points a month. Or maybe by a percentage. I don't know if such >guidelines exist, but they would be helpful. They would be perfect, and that's exactly what I'm trying to find. The problem is, I am beginning to think that they don't exist. This post not CC'd by email On Fri, 24 Feb 2006 22:50:14 -0000, "Nicky" <ukc802466929@btconnect.com> wrote: >As the ophthalmologist thread has been subverted : ) > [quoted text clipped - 13 lines] > >Nicky. G'day G'day Nicky, Thank you. A couple of things have troubled me over the situation Chris found himself in. Firstly since the specialist he visited most recently has stated there is a risk associated with rapidly dropping blood glucose, why wasn't he provided with this information on a discharge sheet? Secondly although the latest specialist has identified a risk associated with reducing blood glucose rapidly he doesn't have given the relative risk of not doing so. Put simply monstrously high blood glucose is a risk in itself. There is a risk if one reduces them rapidly and a risk associated with leaving them high. It could be that there is risk associated with rapid decreasing them of 2% ie 1 in 50. What is the risk associated with leaving them high for 1 month, 2 months, 3 months etc? There must be some break even point unless the risk of leaving them high is always higher than 2%. Best wishes, SignatureQuentin Grady ^ ^ / New Zealand, >#,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin > Put simply monstrously high blood > glucose is a risk in itself. Yes indeed. I don't think anyone's cavilling about knocking down bgs like Chris had ASAP. Another variable here is, what's a monstrously high bg? The link I posted suggested an A1c of 9.5, which must be a, what, 250-300 ave bg? > There is a risk if one reduces them > rapidly and a risk associated with leaving them high. Without knowing the damage mechanism, I'm worried that there may be an increased potential to damage at having bgs running around the 140 mark too, or whatever an individual's retinal threshold might be, as pressure is reduced... and increased... reduced... increased... > It could be > that there is risk associated with rapid decreasing them of > 2% ie 1 in 50. What is the risk associated with leaving them high for > 1 month, 2 months, 3 months etc? There must be some break even point > unless the risk of leaving them high is always higher than 2%. Yup. And how do we trade that off against the known risks of micro and macro damage from a >6 A1c. The problem we have is that Chris is going through a deeply bad experience, and has a duty to tell his story to newbies. As he's articulate and persuasive (and a moral person) it's important for him, newbies, and us that he is able to recommend a path that's as healthful as possible - or (quite apart from confused newbies!) we're going to have endless paths where Chris says "watch out!" and we say "But that's a small comparative risk!". We need to find out as close to a mutually agreed path as possible - preferably via Chris' eye doc. Nicky. SignatureA1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg > Yes indeed. I don't think anyone's cavilling about knocking down bgs like > Chris had ASAP. Another variable here is, what's a monstrously high bg? The > link I posted suggested an A1c of 9.5, which must be a, what, 250-300 ave > bg? Using the formula that came out of DCCT, a 9.5% A1c relates to an Average Plasma glucose of 261 mg/dl or 14.5 mmol/l. Since it is an average, it could easily represent swings from 100 to 400 mg/dl. Chris reported that his blood sugar in the hospital was 600 mg/dl 33 mmol/l which is more than twice as high. That sounds pretty "monstrous" to me. >>There is a risk if one reduces them >>rapidly and a risk associated with leaving them high. [quoted text clipped - 3 lines] > or whatever an individual's retinal threshold might be, as pressure is > reduced... and increased... reduced... increased... The "retinal threshold" for glucose is a speculation advanced in discussions here, but has no basis in fact. A threshold is, by definition, a sharp cutoff. With the renal threshold, for example, there is no glucose spilling in urine and then at the threshold, the glucose spills. But from what I can see scanning research on retinal thresholds, glucose in the eye does not appear to have a threshold, but rises in a straight line relationship with the concentration of glucose in the blood. The 140 mg/dl number is a GTT number that correlates with a threshold increase in nerve damage, not retinopathy. There is NO number that has a clearcut relationship to the increase in retinopathy, a point that was emphasized by the recent discovery that there is a significant percentage of people with blood sugars in the pre-diabetic range who have already developed "diabetic" retinopathy. What little research there is online suggests that the glucose level in the eye rises in a straight line, which is why there is some research on using visual tests to non-invasively measure blood sugars. > The problem we have is that Chris is going through a deeply bad experience, > and has a duty to tell his story to newbies. As he's articulate and [quoted text clipped - 4 lines] > to find out as close to a mutually agreed path as possible - preferably via > Chris' eye doc. But we have to remember, also that Chris' eye doctor is a retinal specialist who sees only a population of people after they have developed retinopathy. He is also a hands-on technician whose focus is on eye surgery, not a specialist in the treatment of diabetes as a whole. This means that his statement while worthy of consideration is not the last word on the subject, any more than your cardiologist's might be, no matter how busy his practice, unless backed up with some kind of evidence beyond "this is what it seems to me I'm seeing in my office." --Jenny http:www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control Jenny, Nicky, Others: >> Yes indeed. I don't think anyone's cavilling about knocking down bgs >> like Chris had ASAP. Another variable here is, what's a monstrously [quoted text clipped - 11 lines] >>> There is a risk if one reduces them >>> rapidly and a risk associated with leaving them high. I posted the following in another thread but no one commented on it. Progression of Retinopathy During Pregnancy in Type 1 Diabetic Women Treated With Insulin Lispro - http://care.diabetesjournals.org/cgi/content/full/26/4/1193 found on page 874 in a 1999 Diabetes Care article - http://care.diabetesjournals.org/cgi/reprint/22/5/874 The thresholds have both upper and lower aspects (involved is rapid BG change that results in retinopathy problems). The kind of insulin used may also be a factor. There are some aspects of diabetic complications that do involve genetics as Nicky has mentioned. [retinopathy+edema+genetics+diabetes - http://tinyurl.com/mx39u or retinopathy+edema+genetics+diabetic - http://tinyurl.com/q4sqc.] The case with Chris may seem extreme but upper thresholds much lower than his high might also be involved. A growth factor termed "VEGF is involved in normal angiogenic processes in adults such as cardiac collateral circulation, wound healing and menstrual cycle." Angiogenisis (growth of new blood vessels)is also necessary for a cancer turmor to grow larger than a pencil dot. "Apparently clinical trials of lispro insulin in nonpregnant diabetic women did not show unexpected development of PDR. Lispro is a homolog of IGF-1. The role of the growth hormone–IGF-1 system in the development of PDR is under increasing scrutiny. Insulin is known to enhance IGF-1 production, but the effect of insulin lispro on the IGF-1 system is not well described." From the second citation above. The articles I have cited pertain to diabetes and pregnancy which involve other factors involved in pregnancy. Frank >I posted the following in another thread but no one commented on it. Frank, I'm brave enough to be honest. Sometimes we need you to also provide your synopsis, translated from medicspeak to something laypeople can understand. I know it may not be always possible to dumb it down and remain valid, but it would help if you added some sort of personal analysis on what a study means to you - the significance of it's findings or the validity of it's recommendations. What is obvious to you is sometimes a little obscure to me. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. > Jenny, Nicky, Others: > [quoted text clipped - 48 lines] > > Frank Frank, I did scan your posting, but it wasn't clear to me how it would fit in as pregnant type 1s are a whole different thing from obese type 2s metabolically, and so much weird stuff happens during pregnancy that it is hard to tease out what anything might mean in that context. And the edema issues alone fill many books. It's a good point that the kind of insulin might be related, except that the one major study documenting the worsening was DCCT done long enough ago that they may very well have been using nothing but animal insulins. OTOH, there's a mention of Lantus possibly being associated with worsening of retinopathy mentioned in the Lantus prescribing information but rather brushed off as with some wording about how one tiny study found it and another didn't and it isn't clear what the relationship is to the insulin. Interestingly, worsening is NOT cited as a side effect in the Levemir Prescribing Information that came with my starter kit. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >Jenny, Nicky, Others: > [quoted text clipped - 15 lines] > >I posted the following in another thread but no one commented on it. I did comment on it, but it looks like the internet gremlins ate it, so I'll paste them in here. >Progression of Retinopathy During Pregnancy in Type 1 Diabetic Women >Treated With Insulin Lispro - [quoted text clipped - 26 lines] >The articles I have cited pertain to diabetes and pregnancy which >involve other factors involved in pregnancy. Interesting articles, though they seemed to show that Lispro didn't increase the incidence of retinopathy in pregnant T1's. BTW, there is even a name for what happened to me: normoglycaemic re-entry phenomenon. Apparently, it's well known in ophthalmologic circles. I'd never heard of misc.sci.diabetes. Thanks! I'm thinking that I might try both there and MHD as they might find it interesting. BTW, I can't find misc.sci.diabetes on my server, so I'll try google. >Dr. William Biggs - who once worked as Joslin. He contributed to the >following thread: > Lantus and cancer - http://tinyurl.com/eba3q. This was in October of >2002. Thanks.. I'll head on over and do some reading. : Jenny, Nicky, Others: : >> Yes indeed. I don't think anyone's cavilling about knocking down bgs : >> like Chris had ASAP. Another variable here is, what's a monstrously [quoted text clipped - 11 lines] : >>> There is a risk if one reduces them : >>> rapidly and a risk associated with leaving them high. : I posted the following in another thread but no one commented on it. : Progression of Retinopathy During Pregnancy in Type 1 Diabetic Women : Treated With Insulin Lispro - : http://care.diabetesjournals.org/cgi/content/full/26/4/1193 : found on page 874 in a 1999 Diabetes Care article - : http://care.diabetesjournals.org/cgi/reprint/22/5/874 : The thresholds have both upper and lower aspects (involved is rapid BG : change that results in retinopathy problems). The kind of insulin used : may also be a factor. : There are some aspects of diabetic complications that do involve : genetics as Nicky has mentioned. [retinopathy+edema+genetics+diabetes - [quoted text clipped - 5 lines] : menstrual cycle." Angiogenisis (growth of new blood vessels)is also : necessary for a cancer turmor to grow larger than a pencil dot. : "Apparently clinical trials of lispro insulin in nonpregnant diabetic : women did not show unexpected development of PDR. Lispro is a homolog of : IGF-1. The role of the growth hormone?IGF-1 system in the development of : PDR is under increasing scrutiny. Insulin is known to enhance IGF-1 : production, but the effect of insulin lispro on the IGF-1 : system is not well described." From the second citation above. : The articles I have cited pertain to diabetes and pregnancy which : involve other factors involved in pregnancy. : Frank Frank, I have been slogging through a couple of articles you posted, and thanks. From what I can gather (plese correct me if I am wrong) Lispro seems to be the particular insulin to avoid in order to prevent neovascularization. Is this just tht this iw what they happened to use in the test or could we assume other insulins might be better on this score? Wendy-just trying to make sense of it all. > I have been slogging through a couple of articles you posted, and thanks. > From what I can gather (plese correct me if I am wrong) Lispro seems to [quoted text clipped - 3 lines] > > Wendy-just trying to make sense of it all. Unfortunately, since this study takes place in the context of pregnancy, the growth hormone environment is already altered, making the application of results to non-pregnancy questionable. Lantus is the insulin I have seen implicated in worsening, but the DCCT retinopathy worsening results were gotten years ago in a population using the older insulins. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >> Yes indeed. I don't think anyone's cavilling about knocking down bgs like >> Chris had ASAP. Another variable here is, what's a monstrously high bg? The [quoted text clipped - 8 lines] >mmol/l which is more than twice as high. That sounds pretty "monstrous" >to me. The big unknown there is: how much of that was due to the big infection? I've had differing opinion from Docs on that, but more than one has told me that it would be impossible to get from there to Euglycemic (normal) Bg's in 12 days, and remain there on just metformin, if a big part of it wasn't the infection. Also, my A1C was 12.5, which is too low for 600+ fasting BG's. However, even that is in doubt as I'd had the infection for weeks when Dx'd. Oh, what I'd give for a few meter readings in the months before I had the infection. >> The problem we have is that Chris is going through a deeply bad experience, >> and has a duty to tell his story to newbies. As he's articulate and [quoted text clipped - 9 lines] >developed retinopathy. He is also a hands-on technician whose focus is >on eye surgery, not a specialist in the treatment of diabetes as a whole. Let me clarify here: he is a retinal specialist who sub-specilazes in diabetic retinopathy. And, after chatting with him on BG's A1c's, and everything from incretin mimetics to peripheral neuropathy, I'm convinced he knows a great deal about diabetes. However, I'd certainly prefer to find a good study. : > Put simply monstrously high blood : > glucose is a risk in itself. : Yes indeed. I don't think anyone's cavilling about knocking down bgs like : Chris had ASAP. Another variable here is, what's a monstrously high bg? The : link I posted suggested an A1c of 9.5, which must be a, what, 250-300 ave : bg? : > There is a risk if one reduces them : > rapidly and a risk associated with leaving them high. : Without knowing the damage mechanism, I'm worried that there may be an : increased potential to damage at having bgs running around the 140 mark too, : or whatever an individual's retinal threshold might be, as pressure is : reduced... and increased... reduced... increased... : > It could be : > that there is risk associated with rapid decreasing them of : > 2% ie 1 in 50. What is the risk associated with leaving them high for : > 1 month, 2 months, 3 months etc? There must be some break even point : > unless the risk of leaving them high is always higher than 2%. : Yup. And how do we trade that off against the known risks of micro and macro : damage from a >6 A1c. : The problem we have is that Chris is going through a deeply bad experience, : and has a duty to tell his story to newbies. As he's articulate and [quoted text clipped - 4 lines] : to find out as close to a mutually agreed path as possible - preferably via : Chris' eye doc. : Nicky. I am not referring to the studies, but do want to reiterater what my macula specilaist, who deals with man diabetis as well as non0dibetics with AMD(Adult Macula Degeneration{wet}). Whe I describred Chris's situaltion t him and asked, specifically, about what advice we should think about giving on asd which he respects, (at lest a a concept) He sid whe should not advise slower stivign for control, or slower lowering of bgs, dispite the rare problem like Chris's of some retinopathy and macular edema with fast reduction, as the long term benefits of rapidly lowered bg's is so great. I do not know if he is speking form knowledge gained form research or from a long expeience with diabetics as well resaerch. This doctor is delighted with my A1c's as well as my fsting glucose readings and sees no canges in my slight background retinopathy which has been stable for , at lest, the last 10 years. He wishes all his diabetics had similar readings. (A1c-varyig between 5.2 and 5.9-fbgs between high 70's to low 90's) Wendy >I am not referring to the studies, but do want to reiterater what my >macula specilaist, who deals with man diabetis as well as non0dibetics [quoted text clipped - 5 lines] >macular edema with fast reduction, as the long term benefits of rapidly >lowered bg's is so great. The question I have with that is what, exactly, are the benefits of RAPIDLY lowering BG's? And what would he define as rapid? Did you mention that in my case I went from a fasting of 600+ to euglycemic range in nine days? Would a month have been rapid enough? Or two? But, I will say that it appears that Wendy's specialist contradicts mine. I do know that Wendy's is very highly regarded in this field. >This doctor is delighted with my A1c's as well as my fsting glucose >readings and sees no canges in my slight background retinopathy which has >been stable for , at lest, the last 10 years. He wishes all his diabetics >had similar readings. (A1c-varyig between 5.2 and 5.9-fbgs between high >70's to low 90's) Mine said an A1c 6 or under is preferred as a goal. He also said "the lower, the better". When he asked for my A1c, and I told him 5.4 3 months after Dx (he already knew my BG's at DX) he thought I was mistaken and asked for my test sheet. Fortunately, I had it with me. His comment was that in the long run, I'm much better off. My comment was "not if this costs me my sight". He said he couldn't disagree there. Shortly after this is when I asked for his recommendation for newly Dx'd, and he came up with "slower would be better". This post not CC'd by email On Sat, 25 Feb 2006 19:30:14 +0000 (UTC), "W. Baker" <wbaker@panix.com> wrote: >I am not referring to the studies, but do want to reiterater what my >macula specilaist, who deals with man diabetis as well as non0dibetics [quoted text clipped - 16 lines] > >Wendy G'day G'day Wendy, You're a gem. You asked THE most important question needing to be asked of someone qualified to answer it. Special thanks for being up front with what you wanted the answer for. I'm sure it makes one heck of a difference to a specialist to know how the answer they give will be used. For instance if they thought the patient wanted the information for a court case their answers might be very different. Best wishes, SignatureQuentin Grady ^ ^ / New Zealand, >#,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin >The problem we have is that Chris is going through a deeply bad experience, >and has a duty to tell his story to newbies. As he's articulate and [quoted text clipped - 4 lines] >to find out as close to a mutually agreed path as possible - preferably via >Chris' eye doc. This explains my dilemma very well. At the moment there are too many unknowns for me to know what the heck to say to a newbie about this. I've decided to have a consultation conference with both the specialist and ophthalmologist about this issue (what to say to newbies). It's going to cost me, but it's sure worth it. The biggest unknown: what rate of reduction is optimum? The big problems here seem to be that the underlining mechanism for normoglycemic re-entry retinopathy is not known. So, without knowing the mechanism, it's hard to even theorize a good strategy. My biggest fear at this point: that I'll end up with conflicting or non-definitive answers, and then be faced with a newbie, and have no clue as to what to say. And yes, that one *IS* keeping me up at night. > This explains my dilemma very well. At the moment there are too many > unknowns for me to know what the heck to say to a newbie about this. [quoted text clipped - 10 lines] > non-definitive answers, and then be faced with a newbie, and have no > clue as to what to say. And yes, that one *IS* keeping me up at night. The problem is that there doesn't seem to be, so far, a definition of what "too fast" is, or what the starting number danger zone is. Then there's the question of whether it's the method or the speed of lowering that causes the problem? Susan >The problem is that there doesn't seem to be, so far, a definition of >what "too fast" is, or what the starting number danger zone is. Then >there's the question of whether it's the method or the speed of lowering >that causes the problem? Those are indeed parts of the problem. From what I've seen, even the specialists (Mine, and Wendy's) disagree, so I'm wondering if I'll ever be able to figure this out. I'm going to try, though. >>The problem is that there doesn't seem to be, so far, a definition of >>what "too fast" is, or what the starting number danger zone is. Then [quoted text clipped - 4 lines] > specialists (Mine, and Wendy's) disagree, so I'm wondering if I'll > ever be able to figure this out. I'm going to try, though. I would wager, without actually knowing, that it's the growth factor from the intensive use of insulin during rapid lowering that's responsible. If you'd been instructed on proper diet at the time, you wouldn't have needed nearly as much insulin. OTOH, we still don't know how much the threshold of "too much" would have been. Months of glucose toxicity wouldn't be any safer, necessarily. Susan >x-no-archive: yes > [quoted text clipped - 10 lines] >from the intensive use of insulin during rapid lowering that's >responsible. IGF-1 seems to be triggered also by the change in BG's themselves. > If you'd been instructed on proper diet at the time, you >wouldn't have needed nearly as much insulin. That's not true in my case. If anything, I went too far the other way, and thus needed very little insulin and for a very short time. My diet was exceedingly low carb and low calorie in those early days. My total insulin use, for the entire time I was on insulin, was under 100 units (not counting one day in hospital, and I don't know the totals for that day). > That's not true in my case. If anything, I went too far the other way, > and thus needed very little insulin and for a very short time. My diet [quoted text clipped - 3 lines] > 100 units (not counting one day in hospital, and I don't know the > totals for that day). My mistake; I know you ate way too little and extreme low carb at home, but I thought you'd been in the hospital on an awful diet and insulin to cover it for longer. Susan >x-no-archive: yes > [quoted text clipped - 9 lines] >but I thought you'd been in the hospital on an awful diet and insulin to >cover it for longer. Even in the hospital, there was quite a difference between what they tried to feed me, and what I actually ate. However, my eating in the hospital was by no means healthy, just a lot healthier than what they tried to feed me. I was only in a day and a half, and only ate two meals there (one Breakfast, and one dinner). So, I doubt it could have had much effect no matter what I'd have eaten there. This post not CC'd by email On Sat, 25 Feb 2006 20:33:50 -0500, Susan <nevermind@nomail.com> wrote: >The problem is that there doesn't seem to be, so far, a definition of >what "too fast" is, or what the starting number danger zone is. Then >there's the question of whether it's the method or the speed of lowering >that causes the problem? > >Susan G'day G'day Susan, This is all too reminiscent of the issue of exercise with newly diagnosed T2 diabetics. We all know exercise is so important that it comes first. Here is a rough guide to dealing with T2 diabetics. 1. Exercise. 2. Exercise and diet. 3. Exercise, diet and take oral medications. 4. Exercise, diet, take insulin. It is tempting to think everyone should exercise if they are T2 diabetics. Forget for the moment those who are crippled and consider just those who have high blood pressure. Sometimes it is vital to get the high blood pressure in check before engaging in vigorous exercise. It can be fatal not to do so. Other people write about these matters of high blood pressure and exercise so much more elegantly than me, I'd rather leave the details to them. The point I'm driving at here is that for MOST people getting rapid tight control is not problematic at all. If they get cracking they'll simply get healthier and reduce a multitude of risks. Then there are those who start out with enormously elevated blood glucose. Let's say for arguments sake that we probably recognise people likely to be that group. They are most likely a subgroup of those who need insulin immediately to overcome glucose toxicity. At least we now have a name we can use for searching for information on the issue. Best wishes, SignatureQuentin Grady ^ ^ / New Zealand, >#,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin > The point I'm driving at here is that for MOST people getting rapid > tight control is not problematic at all. If they get cracking they'll [quoted text clipped - 3 lines] > group. They are most likely a subgroup of those who need insulin > immediately to overcome glucose toxicity. And it must not be forgotten that the problem is documented ONLY found in people who lower glucose using insulin, almost all of them Type 1s. Another point to remember: The danger of a blood sugar of 600 in a person who still produces their own insulin is death from something called hyperosmolar Coma. This condition occurs in people who do not develop ketoacidosis because unlike type 1s, their bodies don't consume their own tissue with extremely high blood sugars. But the dehydration this condition causes can be fatal or can cause permanent brain damage. That probably is why doctors would administer large doses of insulin immediately to anyone with a fasting blood sugar of 600 mg/dl. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control This post not CC'd by email On Sat, 25 Feb 2006 18:21:22 -0700, Chris J. <chris@noadress.com> wrote: >>The problem we have is that Chris is going through a deeply bad experience, >>and has a duty to tell his story to newbies. As he's articulate and [quoted text clipped - 10 lines] >specialist and ophthalmologist about this issue (what to say to >newbies). It's going to cost me, but it's sure worth it. G'day G'day Chris, WOW. You are one impressive bloke. It's a privilege to be able to call you are friend even if we have never met. In New Zealand much of the specialist care come care of the state if recommended by doctors and one doesn't mind waiting. Not so in some places elsewhere. I'm deeply impressed that someone would dig deep into their pockets to find out information which can't materially change their own situation but could be a benefit to countless others. >The biggest unknown: what rate of reduction is optimum? The big >problems here seem to be that the underlining mechanism for [quoted text clipped - 4 lines] >non-definitive answers, and then be faced with a newbie, and have no >clue as to what to say. And yes, that one *IS* keeping me up at night. Why do we care so much? It's not an easy question to find an answer to. Best wishes, SignatureQuentin Grady ^ ^ / New Zealand, >#,#< [ / \ /\ "... and the blind dog was leading." http://homepages.paradise.net.nz/quentin >This post not CC'd by email >>This explains my dilemma very well. At the moment there are too many >>unknowns for me to know what the heck to say to a newbie about this. [quoted text clipped - 11 lines] >find out information which can't materially change their own situation >but could be a benefit to countless others. Thank you my friend. I can't take too much credit for this, though. I have a pressing need for some good to come out of my experience. It sure as heck beats stewing about it! :-) I'm also holding out hope that, given my purpose, the two Docs might go easy on the billing for this one (I won't be trying to get my insurance to cover it). :-) There is indeed some waiting here, though it's on the order of days, not weeks. I had to wait two weeks for my initial appointment, and I'm still trying to set up the conference. However, part of the waiting in this case was due to me not being near a city. Had I wished, I could have probably found a good ophthalmologist in Phoenix who would see me very soon. However, due to wanting to use the one who was familiar with me, and one I knew my insurance would accept, I chose to wait two weeks. I also didn't know there was anything amiss, so the waiting seemed like no big deal. t's hard to even theorize a good strategy. > My biggest fear at this point: that I'll end up with conflicting or > non-definitive answers, and then be faced with a newbie, and have no > clue as to what to say. And yes, that one *IS* keeping me up at night. It should. I have already gotten hate mail telling me that following the advice on my web page has caused someone to go blind. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >t's hard to even theorize a good strategy. >> [quoted text clipped - 4 lines] >It should. I have already gotten hate mail telling me that following the >advice on my web page has caused someone to go blind. WHAT!?!!?!?!?!? Jenny, I'm so sorry to hear that. People can be such a.ses at times. I can't recall seeing anything on your pages that would be harmful, let alone lead to blindness. >> My biggest fear at this point: that I'll end up with conflicting or >> non-definitive answers, and then be faced with a newbie, and have no [quoted text clipped - 4 lines] > >--Jenny I'm terribly sorry to hear that Jenny. I presume from the context that you believe it was triggered by this discussion? Keep doing what you're doing. I doubt you'll ever know how many lives your web-site has improved. Including mine. Cheers, Alan, T2, Australia. d&e, metformin 2x500mg SignatureEverything in Moderation - Except Laughter. >>> Chris J wrote: >>>My biggest fear at this point: that I'll end up with conflicting or [quoted text clipped - 9 lines] > context that you believe it was triggered by this > discussion? Given who signed one of the emails and the content, the conclusion is inescapable. This isn't the first time if I've wondered whether bad temper and paranoia might also be diabetic complications. > Keep doing what you're doing. I doubt you'll ever know how > many lives your web-site has improved. > > Including mine. Thanks! --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control > This isn't the first time if I've wondered whether bad temper and > paranoia might also be diabetic complications. It does seem to go hand in hand with lousy diet and/or glycemic control. Susan > > This isn't the first time if I've wondered whether bad temper and > > paranoia might also be diabetic complications. > > It does seem to go hand in hand with lousy diet and/or glycemic control. so susan since you brag about having such a good diet then what do you blame your paranoia and being an a-hole on? hmmm? TO ALL NEWBIES: please keep in mind when reading advice from susan and other shere that you should first find out what the state of their health is, how much they exercise, what medical problems they have, and what kind of medications they are taking. this has a direct impact on what advice they are giving to others. you'd be surprised to find out the loudest voices in here are usally the ones with the most medical problems. don't be bullied into being like them! Sally >>> My biggest fear at this point: that I'll end up with conflicting or >>> non-definitive answers, and then be faced with a newbie, and have no [quoted text clipped - 8 lines] >context that you believe it was triggered by this >discussion? I sincerely hope that is not the case! Jenny, if so, I'm deeply sorry for my inadvertent role in this. >Keep doing what you're doing. I doubt you'll ever know how >many lives your web-site has improved. >Including mine. I second that! > I sincerely hope that is not the case! Jenny, if so, I'm deeply sorry > for my inadvertent role in this. The only thing I'm deeply sorry about is that you have to go through this nightmare with your eyes! The only reason I brought this distasteful issue up was to make sure you understood that not everyone reads critically and with the kind of intelligence you bring to a topic. And when a topic as emotional as blindness comes up among people with diabetes, emotion really enters the picture. Stir in a pinch of the usual newsgroup conflicts, and the result is pretty predictable, if sad. Hopefully when you have dug around and asked your questions, we'll all end up knowing a lot more about how to protect our eyes. Or if nothing else, we'll know this is another area where there's a lot we need to know that no one has gotten around to figuring out--which seems to be where all too much related to diabetes sits right now. >>Keep doing what you're doing. I doubt you'll ever know how >>many lives your web-site has improved. > >>Including mine. > > I second that! You guys are sweet, and I am feeling a lot better about this whole imbroglio. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >> I sincerely hope that is not the case! Jenny, if so, I'm deeply sorry >> for my inadvertent role in this. > >The only thing I'm deeply sorry about is that you have to go through >this nightmare with your eyes! Thanks, but I'm dealing with it OK. The waiting is the hard part, but I'll know a lot more in about a week. Weirdly, I don't tend to stress out over major stuff. I have for example stressed out a lot more over a single blood sugar spike than I did over an arguably more serious aviation emergency: On my long cross-country solo as a student pilot, I had a massive fuel leak which required me to shut down both the engine and electrical system. It was a low wing single engine (Piper Cherokee) that had very poor glide characteristics, and also electric flaps (which I couldn't use). I had to dead-stick that flying bomb into an emergency landing, no flaps (so a much higher than normal touchdown speed, something I'd never done before.) and make darn sure there were no sparks. Couldn't use the brakes as I suspected fuel in them, too. I ended the rollout at an airport restaurant, with several feet to spare. I had only one injury from that: while walking away from the plane after the landing, my knees went weak and I fell down and skinned my elbow. (go ahead and laugh, I sure did!) But, I wasn't nervous or stressed until I was safe. >The only reason I brought this distasteful issue up was to make sure you >understood that not everyone reads critically and with the kind of >intelligence you bring to a topic. And when a topic as emotional as >blindness comes up among people with diabetes, emotion really enters the >picture. Stir in a pinch of the usual newsgroup conflicts, and the >result is pretty predictable, if sad. Thanks... I've been expecting trouble over this, and that doesn't bother me (I have a very thick skin when needed). What does bother me is anyone else (you in this case) being caught in the crossfire. >Hopefully when you have dug around and asked your questions, we'll all >end up knowing a lot more about how to protect our eyes. Or if nothing >else, we'll know this is another area where there's a lot we need to >know that no one has gotten around to figuring out--which seems to be >where all too much related to diabetes sits right now. That's my sole interest in keeping this topic going so long. >You guys are sweet, and I am feeling a lot better about this whole >imbroglio. Not that anything on your site is capable of leading to blindness, but I feel it would be a good idea to mention that I was already off of insulin (and thus the damage probably done) *BEFORE* I read Jenny's site. > Weirdly, I don't tend to stress out over major stuff. I have for > example stressed out a lot more over a single blood sugar spike than I > did over an arguably more serious aviation emergency: On my long > cross-country solo as a student pilot, I had a massive fuel leak which > required me to shut down both the engine and electrical system. This is how the human mind works, When my Sweetie was taken to the hospital in a state of near-shock, bleeding out, and went into convulsions in the ER, I remember how strangely calm I felt. In the back of my mind was the thought, "How odd. He might die, and I don't feel anything." Same when my 11 year old daughter underwent two dreadful surgeries on her jaw. Only when they were both clearly out of danger did the emotions kick in. When my daughter was finally safe I ended up getting extremely sick, probably from the stored up terror. OTOH, maybe your story is also a pilot thing. My brother is a small plane pilot and on his last trip across the country in a plane built in 1966 he'd call me every night with cheery reports on how his radio had broken or how some piece had fallen off the plane requiring the emergency landing in Nebraska where a guy at a gas station had tied something together till he could get to an airport, etc. etc. I'd stay up all night worrying, but he was having the time of his life. He did end up losing his plane, eventually--it was turned over and smashed by a downdraft when it was tethered at its home airport. > Not that anything on your site is capable of leading to blindness, but > I feel it would be a good idea to mention that I was already off of > insulin (and thus the damage probably done) *BEFORE* I read Jenny's > site. And don't forget that Jennifer's advice which is what most newbies here read first is NOT mine (though, of course, I would have been proud to have written something that life-changing!) --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm Get Your Blood Sugar Under Control >> Weirdly, I don't tend to stress out over major stuff. I have for >> example stressed out a lot more over a single blood sugar spike than I [quoted text clipped - 10 lines] >the emotions kick in. When my daughter was finally safe I ended up >getting extremely sick, probably from the stored up terror. Those kind of stresses are about the worst imaginable IMHO. I'm glad you all made it ok. >OTOH, maybe your story is also a pilot thing. My brother is a small >plane pilot and on his last trip across the country in a plane built in >1966 he'd call me every night with cheery reports on how his radio had >broken or how some piece had fallen off the plane requiring the >emergency landing in Nebraska where a guy at a gas station had tied >something together till he could get to an airport, etc. etc. ROFL!!!!!!!! Yep, he's a pilot. I never did understand the look of horror on a friend's face when I mentioned that I needed to borrow a pencil for my flight, so I could plug up a broken vacuum line so the vacuum driven instruments would work. >> Not that anything on your site is capable of leading to blindness, but >> I feel it would be a good idea to mention that I was already off of [quoted text clipped - 4 lines] >read first is NOT mine (though, of course, I would have been proud to >have written something that life-changing!) [Usenet logic] You both have names beginning with Jenn, so therefor you must be the same person, or close enough that you are each to blame for the other. [/Usenet logic] :-) >Weirdly, I don't tend to stress out over major stuff. I have for > example stressed out a lot more over a single blood sugar spike than I [quoted text clipped - 12 lines] > laugh, I sure did!) But, I wasn't nervous or stressed until I was > safe. Some people will do *anything* to park close to the door. :) bj (your landing sounds even more exciting than the ones in dark & stormy weather that I've endured (as an airline passenger) at Boston's Logan....wondering if we'd stop before we hit the water....) >>Weirdly, I don't tend to stress out over major stuff. I have for >> example stressed out a lot more over a single blood sugar spike than I [quoted text clipped - 19 lines] >weather that I've endured (as an airline passenger) at Boston's >Logan....wondering if we'd stop before we hit the water....) Logan is the pit of the pits. Sleepy ------------------------------------------------------------------ It is easier to make a saint out of a libertine than out of a prig. -George Santayana (1863-1952) ------------------------------------------------------------------ >>Weirdly, I don't tend to stress out over major stuff. I have for >> example stressed out a lot more over a single blood sugar spike than I [quoted text clipped - 15 lines] >Some people will do *anything* to park close to the door. >:) ROFL!!!!!!!!!!!!!!!!!! >bj >(your landing sounds even more exciting than the ones in dark & stormy >weather that I've endured (as an airline passenger) at Boston's >Logan....wondering if we'd stop before we hit the water....) I've been in a few anxious moments on commercial airliners, including severe turbulence (enough to cause a loss of several thousand feet of altitude), a near mid-air collision over Dallas, and a partial stall due to avoiding a mid-air near NY. I've had a few minor airline scares such as a blown tire on landing, and an engine failure on takeoff, too. Actually, all those bothered me more that my emergency as a pilot, because as a passenger I was helpless. I've heard quite a few people comment on logan approaches. I've never been there, so I can't say. I do remember flying into Hong Kong (the old airport in Kowloon, not the new one on the island) and you literally thread the tall buildings on final. The approach to the airport (when i had my fuel leak) was fun. I had shut off the master electrical switch, so had no radio (or anything else electrical, including transponder). I also didn't know if I had enough altitude to make it to the airport. For a while, I thought I'd have to set it down on a dirt road (which would have been fun with a landing speed of over 100mph). Fortunately for me, I picked up a bit of a tailwind, and stretched it out enough. But, I was a new pilot, and had never done a dead-stick before in the type of aircraft, so I darn near blew the landing. I had also never flown a straight in approach before, nor landed without flaps, and I found I was coming in hot on final (would have touched down too far down the runway). Being dead stick, I couldn't go around, and I had to crab the thing at full rudder, then keep reversing it, to increase my rate of decent. I overdid it and barely cleared the airport fence. I held it off the ground as long as I could, and set the wheels down on the threshold. weirdly, it was probably the smoothest landing I ever made, didn't even feel a bump. I probably wasn't in too much danger at that point, as I'd have used the breaks if I absolutely had to. I later learned that I'd have been unlikely to set myself on fire by doing so, but I didn't know that then. Half an hour later, I'd fixed the leak and was in the air again, no worse for wear (except for my skinned elbow). > It should. I have already gotten hate mail telling me that following the > advice on my web page has caused someone to go blind. That's disgusting. Apart from being an outright lie! Your research is like a wake-up call - "Hey! You need to know this, and the starting point is right here - in English, not medicalese!" That's how I felt/feel, anyway! Please don't let the nutters make you feel bad! Nicky. SignatureA1c 10.5/5.4/<6 T2 DX 05/2004 1g Metformin, 100ug Thyroxine 95/74/72Kg >A couple of things have troubled me over the situation Chris found >himself in. > >Firstly since the specialist he visited most recently has stated there >is a risk associated with rapidly dropping blood glucose, why wasn't >he provided with this information on a discharge sheet? That's a very good question. >Secondly although the latest specialist has identified a risk >associated with reducing blood glucose rapidly he doesn't have given [quoted text clipped - 5 lines] >1 month, 2 months, 3 months etc? There must be some break even point >unless the risk of leaving them high is always higher than 2%. This is precisely the sort of question I need to be able to answer. >As the ophthalmologist thread has been subverted : ) Thanks, Nicky!!!!!! >There was an interesting Medscape article today, talking in general terms >about how to improve diabetic control. Page 3 of it, however, was very [quoted text clipped - 9 lines] > >http://www.medscape.com/viewarticle/522344_1 Thanks, interesting! However, I do wish someone would do a study to examine the increased incidence and severity of normoglycemic re-entry retinopathy (the name for what happened to me) when temporary insulin intervention is used. But, that 6 month figure is very interesting!!! I'll bounce it off my retinal specialist next week. >>As the ophthalmologist thread has been subverted : ) > [quoted text clipped - 18 lines] > incidence and severity of normoglycemic re-entry retinopathy (the name > for what happened to me) when temporary insulin intervention is used. Chris, The ONLY increases in retinopathy reported in the literature are found in a small percentage of people (almost all type 1s) using insulin. It is not an issue in people NOT using insulin, which is very important to keep in mind before telling newbies with type 2 that they will go blind if they bring down their blood sugar with dietary control. --Jenny http://www.phlaunt.com/diabetes Diabetes Info http://www.alt-support-diabetes.org/newlydiagnosed.htm< |
Enable EMail Alerts
Start New Thread
Reply to this Message