Here's a secret. When it comes to blood glucose levels, nobody knows what "normal" means.
As noted before, medical research finds increased incidence and risk of diabetic comorbidities or "complications" (late-stage symptoms) correlating with blood sugar levels currently deemed "pre-diabetic" or even normal.
We know this more precisely now, yet it's nothing new. The correlation of elevated blood glucose with morbidity and mortality is long-established; it informs our current definition of normal as fasting blood glucose under 100 mg/dL, although in an entirely inadequate way.
As long ago as 1980, impaired glucose tolerance (defined as blood sugar levels of 96 mg/dL or greater after a clinically-administered "challenge" of 50 g oral glucose), roughly doubled risk of death due to coronary heart disease.
In short, that level of post-challenge glucose intolerance, several points within today's "normal" fasting range, kills people. Quibbling over the additional 25 mg/dL that distinguish the "pre-diabetic" from the diabetic seems as useful as speculating over how many angels can dance on the head of a pin.
p.s. I was recently surprised to find an untapped prescription for glucose test strips, and was able to get it extended. I'm gathering new data on my own progress and setbacks, and should be able to publish them soon. I shall also finally incorporate into the data the standards for normoglycemia that have been tightened - obviously to my mind not enough - since my original intervention in 2003.
Showing posts with label normoglycemia. Show all posts
Showing posts with label normoglycemia. Show all posts
eye risk before diagnosis
A recent study proposes new thresholds for predicting risk of diabetic retinopathy. Using more precise gradation in the "good control" or "prediabetic" range than comparable earlier research, Massin et al. found the following correlations among 700 French volunteers studied for ten years, and were confident in proposing them as predictive:
The takeaway? A difference in the range of half a percentage point of HbA1c, or 8 mg/dL of fasting plasma glucose, roughly doubles one's risk of potentially blinding retinopathy, from about one in 15 to one in 7. This risk correlation held even among subjects who did not develop diabetes, as currently defined, over the course of the study, retaining their diagnosis of "impaired fasting glucose".
The current diagnostic threshold for diabetes is an HbA1c of 6.5, the highest value in the proposed predictive model. Since the diagnostic threshold in terms of fasting blood glucose is 126 mg/dL, the remaining values are well below the threshold, in the so-called "prediabetic" range. Normoglycemic, neither diabetic nor prediabetic, is currently defined (at the upper end) as under 100 mg/dL fasting glucose or under 5.7% HbA1c.
I have two reasons for highlighting this study:
| HbA1c % | fasting plasma glucose mg/dL | predicted retinopathy |
|---|---|---|
| 6.0 | — | 6.0% |
| — | 108 | 8.4% |
| — | 116 | 14.0% |
| 6.5 | — | 14.8% |
The current diagnostic threshold for diabetes is an HbA1c of 6.5, the highest value in the proposed predictive model. Since the diagnostic threshold in terms of fasting blood glucose is 126 mg/dL, the remaining values are well below the threshold, in the so-called "prediabetic" range. Normoglycemic, neither diabetic nor prediabetic, is currently defined (at the upper end) as under 100 mg/dL fasting glucose or under 5.7% HbA1c.
I have two reasons for highlighting this study:
- Absent a risk of going hypoglycemic—into dangerously low blood glucose levels—there is a compelling argument for driving blood glucose levels down even if you are being told, as people in the "prediabetic" range often are, that they have "good control". A level of control that may double my risk of blindness doesn't seem to me to have much good about it. (Type 1 diabetics or others considered to be at higher risk for "going hypo" may want to check with their care team about the extent to which tight control might mitigate both short- and long-term risks.)
- If diabetes is a progressive, degenerative, debilitating, and potentially fatal disease with multiple comorbidities—it is—and if "prediabetes" is an independent mortality risk whose defining numbers successfully predict so-called "complications", or more precisely late-stage symptoms, of diabetes—it is and they do—why on Earth is the diabetic establishment still sugar-coating the reality of this disease by mucking around with terms like "prediabetes"? When will medicine catch up with science and lower the diagnostic threshold? It has done so before, and can do so again. Come the day!
remission? cure? control?
2003/12/16 "Looks to me like you're not diabetic anymore."
—my Kaiser Permanente doctor
Wow. I didn't think they were allowed to say that. Nor that any doctor would ever say, as mine did later in the same conversation, "You've cured yourself."
As I've learned since, only the first of these statements is true. Being "not diabetic anymore" can serve, with certain caveats, as an attainable goal in diabetes control. This is what I, along with more and more lay people and professionals, call remission.
The technical term is normoglycemia: normal, or non-diabetic, levels of blood glucose (blood sugar).
I was diagnosed as a type 2 diabetic in December of 2002, after at least three frustrating years of debilitating, bloody, scary symptoms. In January, 2003, I started an aggressive, measured program of self-treatment through diet and exercise. My health improved dramatically. Over the course of a year, I lost about a hundred pounds. Since June of that year, my blood sugar readings were consistently good enough that I began to have vague hopes that I might someday hear the word "remission"—so vague that as I made up my list of things to take up with the doctor a year after my diagnosis, that question literally didn't even enter my mind.
Suddenly I was hearing "cured yourself" and "not diabetic anymore". Sweet Jesus!
2009/01/14 "[Y]ou are not diabetic, but you aren't cured of diabetes either. It could be said that you have diabetes but you're not diabetic—but that sounds too ridiculous."
—Tom Ross, of Not Medicated Yet
After years of backsliding and recurring symptoms, I've learned that the question of cure, remission, and control is more complicated than I or my doctor had thought. As Tom Ross points out, a person can have diabetes and be "not diabetic". In the same dLife.com forum discussion, "nomorecarbs" writes:
The feeds and links on this page, along with some additional information on diet and exercise, are the chief online resources I used to put myself into remission, or use to this day in the hope of returning to that state.
—my Kaiser Permanente doctor
Wow. I didn't think they were allowed to say that. Nor that any doctor would ever say, as mine did later in the same conversation, "You've cured yourself."
As I've learned since, only the first of these statements is true. Being "not diabetic anymore" can serve, with certain caveats, as an attainable goal in diabetes control. This is what I, along with more and more lay people and professionals, call remission.
The technical term is normoglycemia: normal, or non-diabetic, levels of blood glucose (blood sugar).
I was diagnosed as a type 2 diabetic in December of 2002, after at least three frustrating years of debilitating, bloody, scary symptoms. In January, 2003, I started an aggressive, measured program of self-treatment through diet and exercise. My health improved dramatically. Over the course of a year, I lost about a hundred pounds. Since June of that year, my blood sugar readings were consistently good enough that I began to have vague hopes that I might someday hear the word "remission"—so vague that as I made up my list of things to take up with the doctor a year after my diagnosis, that question literally didn't even enter my mind.
Suddenly I was hearing "cured yourself" and "not diabetic anymore". Sweet Jesus!
2009/01/14 "[Y]ou are not diabetic, but you aren't cured of diabetes either. It could be said that you have diabetes but you're not diabetic—but that sounds too ridiculous."
—Tom Ross, of Not Medicated Yet
After years of backsliding and recurring symptoms, I've learned that the question of cure, remission, and control is more complicated than I or my doctor had thought. As Tom Ross points out, a person can have diabetes and be "not diabetic". In the same dLife.com forum discussion, "nomorecarbs" writes:
I've had blood sugars in excess of 400, today they are usually in the seventies or eighties. If I ate a loaf of bread, I'd wind up closer to 200 than 100. Am I cured? As far as I'm concerned, it's just semantics, as long as I maintain normal blood sugars, I believe I'll avoid complications. I've been diabetic for 30 years, did develop complications, they've been reversed. There are people who've been diabetic for over 50 years, and they're complications free. There are people in their 60s who are not yet diabetic, but will be and who will develop complications. It's all in how you manage your life after diagnosis. As far as I'm concerned, it's just a word, "cure". If you mean can you live a normal life expectancy with no complications, yes, diabetes can be cured. If you mean, can you eat whatever you want, stop being physically active, and still remain healthy, no, diabetes is not "curable".
The feeds and links on this page, along with some additional information on diet and exercise, are the chief online resources I used to put myself into remission, or use to this day in the hope of returning to that state.
Subscribe to:
Posts (Atom)