As soon as you can tell me how to introduce a study about whites having more complications of diabetes at lower A1C levels while “leaving race at the doorstep,” I will endeavor to do so.
In any event, I’ve been boppin around the site some more, and understand there can be a general discomfort in talking about (seemingly harmless) topics such as social determinants of health, which some in health care deal with on the daily (unmodifiable risk factors, anyone?). How a site with the name “**TU**diabetesforum” could have commenters so resistant to this topic is kind of amazing, but I’m still relatively new here. Oh well. I won’t antagonize your sensibilities further.
Scott, one implication of the study could be that my clients’ protests about their doctors’ expectations of their numbers are worth listening to.
You listed an article. It was not a study. There were studies that were relevant in the article though, but there was not a consensus. In fact, the article ends with “Although the evidence does not currently exist to state unequivocally that race alters HbA1c independently of glycemia, the lack of direct evidence does not negate that possibility. As scientists, we must be willing to accept the possibility that there are alternative explanations for established dogma. The failure to acknowledge alternative hypotheses will slow scientific progress and has the potential to do great harm.”
Some of the studies support the idea that complications occur at lower A1c levels for white people than other races, but some studies referenced in the article do not. Some studies specifically state that race was essentially irrelevant when evaluating A1c levels and complications.
More than anything else though, there is no way of knowing the racial makeup on this site. I think those specific comments you made regarding race and this website were inappropriate.
However, I’m a little disappointed that it sounds like you would recommend that your clients not adhere to their physician’s guidelines of aiming for lower postprandial glucose levels. I do not know what the correlation is between race and complications, but I do think that aiming for postprandial levels as close to normal is the best course of action for people with diabetes. I feel bad that our resistance to your ideas may have rooted this idea even deeper into your perception of how diabetes should be managed. Race is essentially irrelevant in this particular discussion, and I would encourage you to continue to discuss this with us because I think it is very important given your profession.
How can you infer this based on anything I’ve said? “However, I’m a little disappointed that it sounds like you would recommend that your clients not adhere to their physician’s guidelines of aiming for lower postprandial glucose levels.” In my role, it would not be ethical for me to go against a doctor’s advice. What I did imply was that it would be reasonable to listen to patient complaints.
Thanks for your concern and encouragement, but your resistance to topics like social determinants of health has done absolutely nothing to how I think on the job and what I will do in the future.
I have no problem discussing race, socioeconomic factors, or anything else if there is a legitimate reason for it. I am certain that there are inequities in our society based on these things and those inequities prevent people from getting the best possible treatment and outcomes, which is absolutely wrong and worth discussing. In this case, you haven’t shown evidence that people of different races have different A1Cs and normal glucose ranges and so the treatment and expectations shouldn’t differ based on a patient’s race. I think there are far too many diabetics of every race who keep higher glucose levels than they should because they fear low blood sugars. Some will suffer for it and some won’t, but it doesn’t mean it’s an acceptable treatment goal.
I’m so sorry you’ve had to go through this. I’ve had similar reaction from an endocrinologist: she took one look at my chart, then looked up and said: “have you ever actually been diagnosed as diabetic?” She then spent half an hour trying to convince me that it was completely unhealthy to have an A1c below 6.0%, and that I should immediately stop all treatment and eat more carbs until my A1c was back between 6.0% and 7.0%.
My endo yesterday stopped just short of making similar suggestions – though the conversation sounded more like he was trying to convince himself that my A1c of 5.6 was tolerable because I have the safety net of a CGM and because I have never had a low for which I needed outside assistance to treat. (He did mention that the definition of a “severe low” is a low requiring assistance OR any more below 54, however…) He refused to accept that the goal of “normal blood sugar” is worth the effort vs. any BG under 6.5 – he cites studies that show only marginal benefit at best. He won’t stop me from aiming for better – but only because I have that safety net.
Note - this same endo was going to change my Dx back to Type2 on the presumption that “it is impossible for a Type 1 diabetic to have blood sugars that good (as mine are).” I asked him to research names like “Dr. Richard K Bernstein” and “Dr. Stephen Ponder” for starters… Again - he’s “playing along” but unconvinced (and did not have the nicest things to say regarding Dr. Bernstein… _.
Yes, that’s been my experience almost exactly. Medical professionals who absolutely do not understand or condone low carb diets, aiming for normal BG profile, or even understanding that diabetes comes in multiple iterations beyond “adult” and “childhood” versions. It’s really frustrating, but I suppose it’s a price I pay for living in a small college town in a very rural area.
I found a lot of RN’s ( and most people) don’t have a clue about how to actually treat type 1 diabetes? Since I have RN’s that are my friends, I just educate them depending if they seem interested, because I’m hoping they will learn something that might be useful for them in the future. It hasn’t ever upset me, but I’ve never had one try to tell me how to treat that has been a friend.
The one that was more off putting was a registered dietician’s response to my BG levels. I had sent them in to my Dr because I had just gotten a reader/sensor and the RD replied. She said she saw I was spiking after dinner. She asked if I was taking corrections with dinner. Would I drop at all to normal levels if I hadn’t? Lol, I just didn’t reply!
Joke is that this endo DOES understand the concept of a “low carb diet” – problem is, he’s where I was two years ago - defining “low carb” as 90-100g carbs per day. While that might be low carb for some, it certainly was NOT low-enough carb for me. I gained quite a bit of weight attempting to manage diabetes on 100gcarbs per day while taking insulin. Did I get good numbers? Sure, my A1c was a solid 4.9. But the price was a lot of “excess” that I find nearly impossible to shed - and perhaps also some of the other challenges I am facing today.
Perhaps at 30-50g carbs per day, I am still not quite there - but I know I am better off than I was trying to manage with more - as defines by much higher time-in-range, fewer spikes, very few lows (<1%), and very rare “severe lows” by anyone’s definition!
It is scary sometimes to realize that medical professionals - the RNs in your case- are so unknowledgeable about things which to us are second nature. Whenever I have been hospitalized I have ‘fought’ to maintain control of my own diabetes management (not hospitalized for diabetes related issues, btw). I literally talked one nurse into agreement that I knew far more about diabetes - let alone my diabetes - than she did and she was happy to leave its management in my hands. Just this month, I had hand surgery, and in the pre-op set up going over my supplements (I also have pancreatic insufficiency and non-celiac gluten intolerance) I was surprised that the nurse could not pronounce, let alone be familiar, with some of the common nutritional supplements I take - and I am not talking strange ones, but things like ‘selenium’ and ‘alpha lipoic acid’. That is why it is so important that we become and remain our own advocates and educate ourselves about our conditions because no one is going to be more invested in our well-being and the outcome of our health management than we are. Our doctors support us but they just do not have the time and resources to be as familiar with our diabetes as we are. I am sorry you have to deal with this with your sister because that adds an even more difficult element to the situation.
That doctor has sway with other patients and unfortunately they are following her “expert advice”. I don’t know much about DKA, but it seems her advice could put you there.
Oh gosh Thas… I’m going back to low carb now that my clothes don’t fit anymore. I didn’t seem to have much weight gain on novolog but when I added Afrezza I plumped out… probably because I could eat carbs without spiking.
I agree with the fewer spikes and lows. Low carb makes D so much easier to manage.
I am a newly diagnosed type 1 diabetic (>99% likelihood) and I saw that you are a long-term type 1 diabetic with good control of your A1C. I also saw your post about long-term hyperglycemia and the long-term risks associated with it even with good blood glucose control. My main interest is in your diet, which I think you said is the same every day and time. If you are willing to share it, I would love to hear it (though I would be changing it a little to fit my lifestyle of weightlifting).
My diet is nothing unusual in terms of its balance of carbohydrates, proteins, and fats, and it is probably nothing you would want to copy, since my gastroparesis requires a diet of only soft or pureed foods. I don’t think my good control has anything in particular to do with the diet, except that by keeping the diet constant, I can get a better estimate of how much insulin is required to match it. But even then, I am constantly shocked by the spontaneous variation in insulin requirements for every meal and every day, which show that no matter what the patient does, there is no way to know how the body is going to respond in diabetes.
I eat finely ground meat, mashed potato, ground carrot, and a small bowl of fruit every morning and every night, aside from when I have to treat a low, for which I use a small plastic container of vanilla pudding, which acts quickly to restore a physiological blood sugar level without going overboard. I know it’s a dull way to eat, but I focus my interest on other things in life.
@jxlegend, I’m just gonna mention, incase you haven’t heard of this, that intense anaerobic exercise can increase BG until you run out of glycogen stored up in the liver. Don’t stop participating in physical things that you love, just be prepared that there are some goofy things like that. People sometimes complain about that phenomenon associated with weightlifting. I get it when I ski in tough, rocky terrain.
I was told by my MD that a woman “your age” should be closer to 7.0. I’m 74 with an A1c of 5.9 and quite healthy, thank you very much! I walk 4 miles/day, haven’t been sick in years. I don’t get it…
