Is there a distinct line between type-2 diabetic and non-diabetic or is there a fuzzy zone where you can go either way?
My wife in not overweight, 22.7 BMI. She had a FBS of 6.1(110) at the Lab and passed the OGTT because she had a reactive hypoglycemic reaction. She got an A1c of 5.6%. However, give her a glass of orange juice and she hits 200+ real fast.
Our Doctor has not marked her as diabetic, but has written an Rx for test-strips which I consider is very thoughtful of him. His words were "Just watch it!". One diabetic per house is enough. I have convinced her to cut the carbs and she does test quite a bit. She is on a half-ass version of Dr Bernstein because I am leaning on her to go in that direction. She is getting a lot of BGs under 6.0(108). Her mother was a T2 and I think my wife has got the message without freaking out.
I hate to see true T2 diabetics not diagnosed early enough to prevent damage. Also I'm not impressed with the "See your Doctor, take your meds" over simplification of treatment.
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And thanks, Alan, for this important question.
Not that most doctors do right by very young & adult diabetic patients, but they sure don't know what to do with senior diabetics. For one thing, we didn't used to live that long to make it into their outdated education.
An emaciated woman on a weight loss regiment--sigh. Doubtful that her doctor told her to limit protein since most don't even understand how that impacts BG. Do you think she'd listen if you told her to increase protein? Increased protein will help her gain weight, or at least not lose any.
I did talk to her both about increasing carbs and protein. I saw her log book, and she's NEVER above 120 on the diet she's been following, and she could afford a little bit higher BGs if it meant putting on some weight. But she really didn't seem to want to change what she was doing, so I dropped the subject.
One thing that disturbs me is that I have heard CDEs talk about elderly diabetics, and insist that they be treated the same as everyone else, with the same goals. But I'm not so sure that should be the case. While I can't predict my friend's life expectancy, I just can't see the rationale behind such tight control at the expense of needed calories.
I dunno -- maybe I need to see what I can find out about diabetes in the very old -- maybe I'll be one some day (64 on March 7!!).
Fat & protein are very calorie dense. The problem is that if her BG gets too high, she won't gain weight.
I respect that CDEs have the same goals for elderly patients. Too often, medical professionals have horribly lax attitudes towards older patients in general. Many older people have high BP. Increased BP with high BG are high risks for stroke. Throw in the other risk factors associated with high BG & I understand their stance.
You do have a point with the observation about hypertension. But I do think that the geriatric population (which is going to explode -- we Baby Boomers are coming!) is a special needs population that needs specialized knowledge, thinking and goals. And I'm not sure that having the same goals for a 30-year-old as for an 80-year-old is necessarily appropriate. In my own case, yeah, I'm insulin dependent, and that won't change, but my friend is not on any medications at all, and if she had 150 or 160 post-prandially, would that hurt anything? I don't think she needs to stay below 120 at all times, even though *I* would like to be able to do that, LOL! Anyway, it's her life, and her decisions, and she's a smart lady, so I leave it in her hands.
I think over 140 could potentially harm her more than it would a younger person. I'm against lower standards for anyone:)
Darn!! There goes my plan to start eating nothing but angel food cake and ice cream when I turn 80 (I should be so lucky)!!!!! :-)
Does she write the right numbers down in her log book? My grandma didn't have D but sort of avoided going to the doctor for a different problem, didn't eat (which aggravated the problem...) and ended up dying of it. I think that some people in successful cohorts (having exceeded life tables for their group...) sort of run their own show. Not dissimilar to people with diabetes having to run their own show. I considered "forging" a logbook to get a pump but when I sat down to do it, I started spinning threads of fiction all over the place and realized that it would be more time-consuming than just plain logging. I could see someone with perhaps additional time on their hands, who realized the consequences-- the "you've been very naughty" lecture from the doc-- might choose to just write down some decent numbers?
I also agree with Gerri that the consequences of "off" numbers or getting pulled into an off-number lifestyle would likely be more severe in someone who's older. I would think that people in the older cohorts are already having eye problems, feet problems (including balance and stability problems), digestive problems and other things that don't perhaps work quite as well as they used to and, if you add diabetes' propensity to trash things that are a little bit off in, it is a grim combination.
I had better start smoking...