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Permalink Reply by Jonah on May 20, 2012 at 3:07pm

I think there's a huge difference between an A1c in the 5s that a person like me could get- one that would reflect major highs and lows- vs an A1c in the 5s attained with "rarely a bg over 115".
A1c is not an adequate measure of blood sugar control. The average diabetic with an A1c in the 5s doesn't have blood sugar control like Lab Mouse.

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Permalink Reply by Tim on May 20, 2012 at 3:46pm

Yeah, that's one of the reasons I think that we cannot assume "my bg control is good enough there's nothing else I have to do." There simply is no bg below which we are safe from the risk of complications, no matter how much various websites promote their magic numbers.

For the microvascular complications, even just moderately elevated blood pressure is a risk factor that becomes more and more important as bg control is improved.

Same for everything we can do to reduce any and all risks from heart disease.

It will never be enough to eliminate the risk, like people want it to. But we still have to bust our butts doing everything we can. It's not just aboug bg's, because there is no magic number below which the risk disappears.

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Permalink Reply by Brian (bsc) on May 21, 2012 at 5:35am

The data I have seen suggests that those of us with diabetes have twice the risk of heart disease with an A1c of 6% compared to a non-diabetic (independent of cholesterol levels). And as Tim notes, reducing your A1c all the way down to "normal" probably won't eliminate all your risk. There is just some stuff about diabetes that messes with us. But there isn't anything that suggests that cholesterol is the "causal" source of these problems. There have not been any high quality studies (random controlled trials) which suggest that cholesterol lowering or statination helps us, let alone when our blood sugars are reasonably controlled.

When I looked through the numbers, having an A1c in the 9s or 10s resulted in a risk of heart disease far, far worse than any risk related to cholesterol. I suspect that if you are a diabetic with an A1c of 7% or higher, dropping your A1c by 1% would likely reduce your heart disease risk far more than any treatment for cholesterol has ever been demonstrated. So I choose to minimize my heart disease risk by keeping tight control on my blood sugars. I'll always be at higher risk of heart disease compared to my non-diabetic cohorts, but that is life.

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Permalink Reply by MossDog on May 21, 2012 at 7:02pm

But this is what I don't get BSC. You state: But there isn't anything that suggests that cholesterol is the "causal" source of these problems. There have not been any high quality studies (random controlled trials) which suggest that cholesterol lowering or statination helps us, let alone when our blood sugars are reasonably controlled.
But on the previous page you said it doesn't matter what the numbers are that you would not take a statin. So my question is: most people go by the numbers and are always looking for proof. There is proof that if your cholesterol is high you are at greater risk for heart disease and taking a statin to reduce your cholesterol lowers the risk. Why would you NEVER take them and even further not even want to know what the numbers are?

Believe me I am NOT all for statins but I think sometimes people attach a certain boogeyman attitude toward them that may be unjustified.

I also think people tend to gravitate toward research that SUPPORTS their view and find reasons not to believe those that don't. Not saying this is you but I find this to be highly prevelant.

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Permalink Reply by Brian (bsc) on May 22, 2012 at 4:53am

Those are all reasonable points. There is a clear "association" between cholesterol levels and CVD, not as great as between A1c and CVD, but you are right, it is there. But it is an association. I've looked at the intervention studies (intervention studies are required to establish a "causal" link). There has been no success at showing that cholesterol lowering improves CVD outcomes, there has been some mild success showing statins improve outcomes, but there is speculation that is because of some anti-inflammatory effect, it doesn't appear to be from cholesterol lowering.

Association does not imply causation. If we observe that the more fireman fighting a fire, then the bigger the fire, we cannot conclude that fireman cause fires. And it would be silly to fire all the fireman in the hopes that would eliminate fires.

In my case, I had statin side effects. In my individual case, they are harmful. That is why I would never take a statin, the risk equation is absolutely clear in my case.

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Permalink Reply by Cosumne Jan on May 18, 2012 at 5:55pm

Peter Attia has been doing a great series on his blog about cholesterol. It's very technical, but I've found it fascinating and worth reading. He's at waroninsulin.com. He's on the 5th installment of the series right now, but you can go back to older entries and read from the beginning. I'd sure do that before I took a drug, doctors seem to overprescribe statins. Some think it should be put in our water supply so everyone gets it. (Eeek!)

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Permalink Reply by Tim on May 19, 2012 at 6:02am

I found an interesting conclusion in a early 90's paper that looked at cholestorol/lipid levels in T1's. They credit the move away from the traditional diabetic low-carb/high-protein-high-fat diet, and towards a more balanced diet, with helping normalize lipid levels in T1's. Lipid and Lipoprotein Levels in Patients With IDDM: Diabetes Contro...

The differences between the DCCT data and older studies that demonstrated more profound abnormalities in lipid levels in IDDM populations may reflect patient selection and/or changes in dietary patterns (higher-carbohydrate and lower-fat content) and in glucose control that has occurred in recent years.

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Permalink Reply by Sam on May 20, 2012 at 8:28am

Just saw a segment on TV about the herbal supplement Red Yest Rice being used to lower cholesterol and triglyceride levels. I'm not generally a huge believer in herbal stuff but apparently there some pretty legit science behind this one and many doctors are recommending it for people who don't want to take statins. I'm going to mention it to mine.

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Permalink Reply by MossDog on May 21, 2012 at 7:04pm

Red Yeast Rice is actually very similar to I belive lovastatin and that is where all the latest and greatest Crestors and Lipitors stem from. In effect if you take Red Yeast Rice you are taking a statin. Me personally I would rather just take the statin- at least I can be sure of purity and that I am getting the right dose.

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Permalink Reply by Sam on May 21, 2012 at 9:20pm

I agree with your contention that legit prescribed drugs are probably far better than herbal remedies-- but there are also other considerations in play for some of us though-- such as employment medical requirements that put us further under the microscope for each prescription we are taking...

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Permalink Reply by Timothy on May 22, 2012 at 2:16am

I think you got things mixed up, either that or your doctor has.
your numbers look great.
My doctors want me on statins too, but my cholesterol and HDL/ LDL are perfect as they are.

you want your HDL to be HIGH. at 128 that is fantastic. You want your LDL to be low. 55 for LDL is also fantastic unless those numbers are switched, even if they were they would not be that bad.

Triglycerides are all about the carbs you eat, so You should expect them to be low with a low card diet unless you have something wrong with your liver. Trig of 57 is fantastic !!

There is a formula that you can use to decide if your lipid numbers are good it is called many different things, corinary risk factor or corinary heart factor.

divide your total cholesterol by the HDL to get the number. for women a 4.4 or less is considered good and for men it is 5.0 or less. The lower the better. You did not post your total Cholesterol or I would have calculated it for you.

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