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Medical Forum / Diseases and Disorders / Diabetes / March 2008

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Complications, A1c, Standard Deviation

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Uncle Enrico - 10 Mar 2008 16:50 GMT
I recently crunched 4 months worth of meter readings beginning one month
before the onset of my neuropathy.

You may remember my posting that Dr. Irl Hirsch, M.D., a Type I and the
director of the University of Washington Diabetes Care Center
recommended that diabetics aim for a standard deviation of one-third of
their avarage blood sugar or lower.  http://diabetesmonitor.com/m57.htm

Here's what I found using Accu-Chek's Compass software: (they sent it to
me for free when I phoned them to inquire about it).

Four months worth of readings beginning one month before my neuropathy
symptoms onset elicited the following data:

657 tests
4.7 tests per day
Average reading 98.2
Standard Deviation 18.3
Ratio of SD to Average:  18.6% (well below the recommended <33%)

Time since diagnosis: 9.7 years
Typical A1c over that time:  5.3---which included an unexpected and
suspicious 4.5 before onset.
Current BMI: 22.9
Average BMI last 3 years 24.5
BMI at diagnosis: 31.3
Retinas and kidneys test as healthy.

Conclusions?
YMMV
Our vulnerability to complications varies and likely increases over time.
No calculation using only 5 tests per day can give a true picture of
blood glucose fluctuations over 4 months or particularly 10 years.
Fluctuations are thought to increase oxidative stress and damage leading
to complications.

Medical recommendations using any numbers have to be judged in light of
all of the above and more perhaps.

Neuropathy affects 50% of diabetics--it's the most common complication.
John - 10 Mar 2008 19:34 GMT
> I recently crunched 4 months worth of meter readings beginning one month
> before the onset of my neuropathy.
[quoted text clipped - 36 lines]
>
> Neuropathy affects 50% of diabetics--it's the most common complication.

With your remarkable level of control, it would appear that there is
something besides high BG that is responsible for neuropathy.

John C.
Uncle Enrico - 10 Mar 2008 19:23 GMT
> With your remarkable level of control, it would appear that there is
> something besides high BG that is responsible for neuropathy.
>
> John C.

I should have added that I had a couple of weeks prior to the onset of
symptoms where the SD/Average ratio was 21% and 24%--putting me closer
to Hirsch's <33% during those weeks. Earlier in the 10 year lead up from
DX to symptoms, I very likely had some over 33% weeks.

My podiatrist tells me the following:

Some diabetics get neuropathies no matter how controlled they are.
Ten years post diagnosis is a familiar point of onset for neuropathies
from his clinical experience.

My feeling is that no matter how well a human controls his blood sugar
with the tools he has, he will never be as good as a fully functioning
pancreas with all the hormones balanced and in play.

For those who must play catch-up with a neuropathy, here's a link you
should read and reread. You can Google any medical terms you don't know.

http://www.medscape.com/viewarticle/565795_1

You may need a free Medscape account.
 
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