More Diabetes Answers

How low is too low for blood glucose?

As I discuss in The Diabetes Answer Book there are debates between doctors and research scientists about what the best average blood glucose level (usually measured by a blood test called glycosylated hemoglobin or HbA1c) should be for people with diabetes.  Should the target be less than 8.0%, less than 7.0%, or what?  Should there be different targets for people with type 1 diabetes rather than type 2 diabetes?  Should the targets be different for older people than for younger people?  Are there dangers of pushing the HbA1c level too low?  This last question seemed to get a resounding "YES" as an answer when a study called the ACCORD trial was recently stopped because the people with type 2 diabetes who were in the group pushing to get their HbA1c as low as possible had worse cardiovascular outcomes (more of them had heart attacks and angina) than the group that kept their HbA1c levels a little higher.  The researchers were not able to prove that those bad outcomes were because the group attempting to get their HbA1c lower had more bad low blood glucose events (hypoglycemic attacks) and they couldn't tie it to a particular type of drug that those people were being treated with but it is still possible that those things (low blood glucose and particular drugs) were the cause of the extra bad heart outcomes.  We won't know until more larger research trial are finished.

Where does that leave you now?  I still think the best target for HbA1c is for you to try to keep it as close to the normal non-diabetic range as you possibly can without ruining your life with too much stress, expense, and problems like low blood glucosse levels and weight gain.  If you are older, or if you know that you already have coronary heart disease then a target for HbA1c between 7-8% is probably safer and better than one below 7.0% but no-one knows that for sure.  Whatever the target HbA1c level that you choose and that you achieve it is really important to do everything you can to reduce your risk of heart disease, anyway.  Don't smoke.  Eat a healthy diet.  Get regular exercise.  Get your blood pressure checked regularly and try to keep it below 130/80.  Talk to your doctor about whether you should be taking a statin drug, an ACE-inhibitor drug, and aspirin.  I talk about these things in more detail in the section of "Staying Healthy Longer" of The Diabetes Answer Book.  I'd be interested to hear what you think.

Is blood glucose testing a waste of time?

This may seem like an odd question to you but in the almost thirty years since home blood glucose testing has become widely available there has been a lot of debates between academic researchers on this topic.  A recent study came out suggesting that if you had type 2 diabetes you could get your average blood glucose level (as measured by glycosylated hemoglobin, or HbA1c) to the same level whether you tested your blood glucose or not.  I remember a similar study being done over twenty years ago to "prove" that self-blood glucose monitoring was "unnecessary" in type 1 diabetes.  In these studies people with diabetes were randomly divided into two groups.  Both groups were seen frequently by the research nurses and doctors and were encouraged to increase their pills and insulin to the maximum doses that could be tolerated without getting side effects, including low blood glucose levels (hypoglycemia).  The results of these studies has usually been that both groups of subjects end up at the same level of HbA1c which, to the researchers, "proves" that self-blood glucose testing is not necessary.

I do not agree with that interpretation of those studies.  It would be like dividing people into two groups and asking them to get through a dense forest on a pitch black night but only giving one group flashlights.  In truth, both groups would get through the forest eventually.  The group without the flashlights might take longer and would have more bumps and bruises from hitting unexpected trees, but they would all get through if they were persistent enough.  To me that does not prove that flashlights are unnecessary, however.

As you can tell if you read The Diabetes Answer Book I really like comparing blood glucose self monitoring to carrying a flashlight.  The whole purpose of using self-glucose testing is to allow you to know what your blood glucose is at different times of the day and night, before or after meals, and when you are feeling peculiar.  It "shines a light" on the situation to let you understand what is going on.  So whether you have type 1 or type 2 diabetes and whether you use pills or insulin or both to treat your diabetes a blood glucose monitor helps you to see how your blood glucose levels change in response to changes to treatment or to other things going on in your life.  I bet you that if any of those academic researchers got diabetes themselves they would prefer to do self-blood glucose testing rather than just blindly increasing their doses of pills and insulin until they got side effects or got hypoglycemia!

Like most tools that are available to us in life they are only useful if we know how to use them and how to interpret the results that they give us.

Scruffy, rude, bad-tempered, mystery adventures for the young at heart!

I am writing a series of adventure stories suitable for those aged twelve to adult featuring scruffy, rude, bad-tempered Scottish rock creatures called Gomes (NOT gnomes).  The first three of these will be published by Windstorm Creative, a wonderful publisher with a great philosophy, in the fall of 2008.  Windstorm Creative publish interesting and innovative books for people of all ages.  Check them out at:
www.windstormcreative.com

Although my "Gome Stories" are, like the Harry Potter books, aimed at a teenage audience I think they have appeal to all ages.  My older children are in their twenties and thirties and tell me that they really enjoy them, but maybe they are just saying that to be nice to me!  Each adventure is written as a trilogy of stories, each with twenty or so chapters and about 200-300 pages long.  The first trilogy is called Blackhope Scaur where the fast-paced action takes the heroes and villains from the alleys and waterfront of Seattle to the mountains of Scotland and ends up trying to save the citizens of Edinburgh from total destruction.  If you like humorous, fast-paced, adventurous nonsense as an escape from day-to-day worries about diabetes, or if you have teen or pre-teen kids who might like a new book to read you can check them out.

I have a blog that accompanies the series.  I describe the background to the stories and read the opening few chapters.  If you are interested at all you can check it out at:
www.gomeworld.typepad.com