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Medical Forum / Diseases and Disorders / Diabetes / August 2007We are diabetic
Only because the ADA lowered the blood sugar numbers. Unfortunately for me I would be diabetic by any definition. KC > Only because the ADA lowered the blood sugar numbers. > Only because the ADA lowered the blood sugar numbers. It does seem like the cutoff points for defining diabetes are somewhat arbitrary, but on the other hand, they are not without merit. By the time a person gets to the point of blood glucose control mentioned in the following graphic it is more than a little too late. ;) Glycemic Control: The Future of Diabetes Management - http://www.medscape.com/viewarticle/412864_8 "Slide 21. Prevalence of Retinopathy by Deciles: NHANES III This is the National Health and Nutrition Examination Survey (NHANES) III data -- looking at retinopathy and against fasting, 2-hour postprandial, and HbA1c. If you look at retinopathy, everything's fine, until one point where the rate starts to increase, and that is a HbA1c of 6%, a fasting of 110 mg/dL, and a 2-hour value of 154 mg/dL." Frank Jefferson <fwroy@adelphia.netxeopheno> wrote in part: >> Only because the ADA lowered the blood sugar numbers. > [quoted text clipped - 15 lines] > >Frank Question: What does 2-hr PG refer to in the chart? In NHANES III are we talking about 2-hr readings after a 75 mg glucose challenge test? Or are we talking about some kind of reading from patients actual meals? Or what? I assume that we are talking about glucose challenge test results, since I can't imagine the daily living PP data being collected. But then I would expect that many people with glucose intolerance who would get, say, a 195 at 2 hours after a glucose challenge test would be watching what they ate and avoiding spikes. What's the story? -- Jim Chinnis Warrenton, Virginia, USA Jim Chinnis <jchinnis@SPAMalum.mit.edu> wrote in part: >Jefferson <fwroy@adelphia.netxeopheno> wrote in part: > [quoted text clipped - 29 lines] > >What's the story? Maybe I've answered my own question. It looks like NHANES III collected data from "free-living" people who monitored their own bg. If so, that means the PP bgs in the chart Frank cited are readings after actual meals, not glucose challenge tests. -- Jim Chinnis Warrenton, Virginia, USA >>>Glycemic Control: The Future of Diabetes Management - >>>http://www.medscape.com/viewarticle/412864_8 [quoted text clipped - 25 lines] > PP bgs in the chart Frank cited are readings after actual meals, not glucose > challenge tests. You still asked a good question because such information on methodology tends to be hidden. But you made a good deduction. I would suspect that self-monitoring of 2 hour postprandials would greatly reduce the number of people that do these tests compared to fasting and A1c information. I also suspect that the 2 hour readings would not correspond that well with the fasting and A1c results since they would be a different population as well as people with more need to know such information, i.e., those using insulin therapy or those more motivated to control BG levels postprandially. I doubt that most PC doctors would encourage 2 hr. PPs. Of course my information is limited since I have only had 2 PC since diagnosis, assume that they were representative of fairly up to date PCs. Frank >You still asked a good question because such information on methodology >tends to be hidden. But you made a good deduction. I would suspect that [quoted text clipped - 10 lines] > >Frank To extend that thought, self-monitoring of PPP's or peak post-prandials would be even more effective and bear less corelation with those fasting numbers. The PPP may or may not occur at two hours. From my own experience and reading it more commonly occurs much closer to one hour for most foods. Cheers, Alan, T2, Australia. d&e, metformin 1500mg, ezetrol 10mg Everything in Moderation - Except Laughter. -- http://loraltraveloz.blogspot.com/ latest: Mossman Gorge in the Daintree Rainforest http://loraldiabetes.blogspot.com/ latest: Self-Testing and Type 2 Management >> Only because the ADA lowered the blood sugar numbers. > It does seem like the cutoff points for defining diabetes are somewhat > arbitrary, but on the other hand, they are not without merit. I might not have been diagnosed in '98 under the old standards, so maybe I'm lucky that the new numbers had (though only recently) come into effect & my doctor knew about them. She sure wasn't wrong about my having diabetes, & the sooner one knows about this sort of thing the better. I've had a relatively easy time getting & maintaining control, with no complications. I went through surgery & rehab for a torn rotator cuff as well as surgery & treatment for thyroid cancer without any problem -- not that it was "easy" but I didn't have complications or any problems healing from the surgeries themselves. OK, it was partly luck (& a lot of hard work on the rehab which I'd done "before dm" on the other shoulder) but things might have been a lot rougher & harder to recuperate from if I'd still been an overweight & undiagnosed diabetic because of being between the old & new standards. Another benefit of regular checkups even when "I feel fine!" bj > Another benefit of regular checkups even when "I feel fine!" You in a sense raise a point that continues to bug me. I had annual visit with my PC and even filled out family diabetes background information (mother and sister) on my initial visit, but the guy never checked my fasting blood glucose level until I had other symptoms about 9 years later. I did have several aspects of the metabolic syndrome at the inception of my PC visits. Was it possible that I would not have progressed beyond pre-diabetes if I would have known sooner? I will never know. Frank > > Another benefit of regular checkups even when "I feel fine!" > [quoted text clipped - 9 lines] > > Frank It diesn't matter. In the end...what will it have mattered? >> Another benefit of regular checkups even when "I feel fine!" > You in a sense raise a point that continues to bug me. I had annual > visit with my PC and even filled out family diabetes background > information (mother and sister) on my initial visit, but the guy never > checked my fasting blood glucose level until I had other symptoms about > 9 years later. I did have several aspects of the metabolic syndrome at > the inception of my PC visits. > Was it possible that I would not have progressed beyond pre-diabetes if > I would have known sooner? I will never know. For many years before I became obviously diabetic the fact that my mother had diabetes, and that I knew I had symptoms which could have been metabolic syndrome, I'd ask my doc if I might be diabetic. They would take some blood for a BG and an A1C and send it off. When the results came back I'd be sometimes told "No need to worry, you're not diabetic, just getting older", and sometimes "No need to worry, you're not diabetic yet." I used to be very pleased and asked no further questions. I'm now pretty pissed off with my naivete, and even more pissed off with the docs who didn't offer me any further explanation of what they meant by "getting older" and "not *yet* diabetic." I now suspect that what they really meant was "We'll tell you when you start needing to take drugs to help your BG control. According my doctor's recipe book it's not yet quite bad enough for that."  SignatureChris Malcolm cam@infirmatics.ed.ac.uk DoD #205 IPAB, Informatics, JCMB, King's Buildings, Edinburgh, EH9 3JZ, UK [http://www.dai.ed.ac.uk/homes/cam/] >I used to be very pleased and asked no further questions. I'm now >pretty pissed off with my naivete, and even more pissed off with the [quoted text clipped - 3 lines] >to help your BG control. According my doctor's recipe book it's not >yet quite bad enough for that." You might have been able to avoid that heart attack, Chris, if you had known where you really stood in those days... Will, T2 >I used to be very pleased and asked no further questions. I'm now >pretty pissed off with my naivete, and even more pissed off with the [quoted text clipped - 3 lines] >to help your BG control. According my doctor's recipe book it's not >yet quite bad enough for that." Mad, isn't it. I watched my thyroid function deteriorating over 8 years - I even graphed it - there really ought to be another word beyond naivety for blind faith in doctors. Nicky. T2 dx 05/04 + underactive thyroid D&E, 100ug thyroxine Last A1c 5.6% BMI 25 > Only because the ADA lowered the blood sugar numbers. Well,I would be even if the numbers hadn't been lowered. I was 190 pre-glucose in my OGTT, and 317 or so two hours later... Emily >> Only because the ADA lowered the blood sugar numbers. >> >Well,I would be even if the numbers hadn't been lowered. I was 190 >pre-glucose in my OGTT, and 317 or so two hours later... > >Emily Same here. :-) Cheri |
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