28 July 2011

Should We Strive for Lower BG Levels?

Everyone seems concerned with Type 2 diabetes and the advantages and disadvantages of maintaining near or normal blood glucose levels. What no one is willing to tell us is a way to maintain stable blood glucose levels.

The advantages of maintaining lower blood glucose levels are less risk of heart attacks, kidney failure, neuropathy, and loss of eyesight. The disadvantage generally is listed as one problem and that is hypoglycemia. Generally hypoglycemia is listed as blood glucose readings below 70 mg/dl. I would agree that this should be the lower limit for most people and for some nearer to 80 mg/dl. I admit that I do not get concerned until I get lower than 65 mg/dl, but this is not good for most people.

I will not discuss the study from Germany that has so many flaws in it that it is easy to understand why they take the position they do. When a healthcare system is operated by the government, cost is always at issue and often best results are deemphasized at the harm of the patient. Alan at loraldiabetes does an excellent job of analyzing the study and showing its weaknesses and I urge you to read his blog about this.

I do need to quote Alan here though – Quote  The problem (of the study) is not the goals but the methods. Sadly, all they have done is confirm something that has been discussed by type 2 diabetics on diabetes forums ever since ACCORD and ADVANCE (both are included in this meta-study) were published. Those papers did not show that tight control is harmful, instead they showed that intensive use of oral medications and/or insulin to push A1c or FBG down can be hazardous to the health of a diabetic.

The factor missing from all of these studies is use of lifestyle changes, particularly diet and exercise, to achieve near-normal A1c and blood glucose levels. Repeatedly in all these studies the subjects were advised to follow the traditional (since Keyes) extremely low-fat high-carbohydrate diet and to then use medications and insulin to combat the results of that way of eating. I wrote some brief comments on the ACCORD and ADVANCE trials back in 2008 when they came out; nothing has changed since then. Unquote.

This is so typical of studies and points out why we should not rely on them for our own care. They do not consider the essential lifestyle changes that need to be made in diet and exercise. Until researchers understand the value of people and what is reasonable, studies like this will proliferate and doctors will continue to discourage people from attempting to manage diabetes to their abilities and benefit. Doctors will use studies like Alan covers to instill fear by citing them.

So now, not only is it necessary for us a patients to be more proactive in our care, but we need to be aware of these studies and how to refute them when they are used by doctors to discourage testing and bringing our A1c's closer to the normal range.

No comments:

Post a Comment