HA1C vs Complications

I know that several studies, including the often cited DCCT have linked tight control, and lower A1C's to decreased risks for neuropathy, retinopathy, kidney disease, etc. In fact, risk factors seem to increase exponentially as values rise. This all seems perfectly logical on paper, but I believe it doesn't paint the whole picture.

I hear of many T2s and 1.5s diagnosed relatively late in life, pretty good A1C's (5-7) that develop serious complications.

Then, there are T1's myself that have had decades of poor control (myself 7-11) that have been lucky enough not to develop serious complications. I know T2s that completely ignore D. HA1c several consecutive years < 14, but still seem OK.

I've noticed many examples here of both. Any explainations? Theories?

On a brighter note, I was always told that complications were irreversible, but am now hearing the opposite. Has anyone experienced this?

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Permalink Reply by KatieT1 on May 9, 2012 at 2:51pm

well, if one's kidneys fail, or other organs, I don't know how that can be reversed..dialysis, transplant is the only alternative. If one loses a limb..not sure how that can be reversed, has a heart attack, stroke, or the tons of other stuff which can happen...some neuropathies can get better with improved BG's.

Permalink Reply by Sam Iam on May 9, 2012 at 3:06pm
Permalink Reply by Chris Miller on May 9, 2012 at 2:57pm

Diagnosed 38 years ago, I haven't taken good care of myself over the years. My HBa1C hasn't always been the best. But I have zero complications. Yet I hear of people diagnosed for 4 or 5 years and already have problems. I don't have a theory, except a degree of luck (God?) on our side.

Permalink Reply by Sam Iam on May 9, 2012 at 3:19pm

I wonder if your D started at an early age, with elevated BG, maybe your body adapted to it and somehow became more resistant to it? I'm glad you're doing fine. Take care of yourself.

Permalink Reply by DeeJay on May 10, 2012 at 11:27am

This has to be true. That where you said being diagnosed young. I've gone weeks with Glucose levels over 600 and felt normal without getting the severe symptoms of DKA. However, once I gained control, I can feel a high at 220

Permalink Reply by Sam Iam on May 11, 2012 at 12:20am

That's pretty disturbing. I could eat a whole pizza when I was a kid. Now, that would probably kill me in a second.

Permalink Reply by acidrock23 on May 9, 2012 at 3:16pm

It is like gambling and some people beat the odds and some people don't. I want to do everything possible to stack the odds.

I was certain I was having somethig going on in my eyes and the doc said "your eyes are shot..." which made me go "holy %$&*" in my head and then he continued "...you need bifocals" which I probably should have figured out myself.

Permalink Reply by Sam Iam on May 9, 2012 at 3:24pm

I completely agree with you about stacking the deck. I just wish we had a better rulebook.

Permalink Reply by acidrock23 on May 9, 2012 at 3:36pm

I agree with that. I think there's several key components that would be "easy fixes":

1) goals: 140 is in "the danger zone" to me and is not an appropriate long-term goal. If your current status is above that, which I gather can be the case, it may be an appropriate initial goal but I think that for long-term complication-free living, your goal should be lower?

2) food: I think doctors need to seriously engage with food. If you have diabetes, and you are balancing food/ activity/ insulin, it shouldn't be appropriate to refer food questions to dieticians, which has been my experience.

3) approach based on expecting change? This part may be a bit more nebulous but it seems like a lot of people's reported encounters with doctors lead to the doctor "setting" rates and ratios and scheduling a follow-up visit in 3 or 6 months. I don't engage my doc a lot and haven't ever tried calling and saying "hey, X number is a bit off, can I change it" or "what do I do" and I've seen people do this or reporting asking questions but I think that if you have diabetes, you have to be able to figure out how to adjust stuff yourself? A lot of people here do but a lot of people "arrive" reporting "how do I fix this, I don't have a doctor's appointment for 3 months..." too? I think that expectations should be set that we will encounter change and that we should all be equipped to deal with that?

The only "cost" involved in these things would be to be certain that test strips are available but, other than that (and I believe that test strips need to be available anyway...), the only cost is in talking and, as they say, talk is cheap?

Permalink Reply by Sam Iam on May 9, 2012 at 4:37pm

I'm mostly curious about these things for my own information. Almost every major step I have taken with my D has come when I had no insurance and no doctor. I have a lot of firsthand experience with the disease, but a lot to learn. I hope people a lot smarter than me can figure some of it out.

I think that many problems with treatment stem from problems with research. And it is very difficult to do good research on diabetics. There are infinite variables. So, doctors having nothing nothing else to go on, must rely on past speculation, misinformation, and advertising. For example, the Mayo Clinic recommends exchange lists to this day!

http://www.mayoclinic.com/health/diabetes-diet/DA00077

I think that to improve treatment, we need a better base of knowledge. I am curious exactly what one studies to become a CDE.

Permalink Reply by acidrock23 on May 9, 2012 at 4:46pm

Also, if you are taking "lab rats" who are directed to maintain BG levels that are basically bad for them, they will be predisposed to complications anyway? I think that to be a CDE you have to have some type of nursing/ scientific background. One of my friends just turned into one but I don't know her through D, just a coincidence, and I haven't asked her about it.

Permalink Reply by Sam on May 9, 2012 at 6:02pm

According to the CDE I met with first--- they have to be an RN, a Dietician, or a pharmacist plus complete the CDE program to become CDEs. I suspect that means that most are RNs or Dieticians.

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