Throughout my 52 years with type 1 diabetes, I have found a disposition to unnecessary meanness in the treatment of the disease. When I was first diagnosed, doctors at the renowned Joslin Clinic in Boston would forbid patients to use any of the new artificial sweeteners or diet soft drinks, since these would “just keep the taste for sweet things alive,” even though this is now known not to be a problem. There were many medical journal articles published in which you could literally hear the authors shouting at you about how foolish it was to think that you could just increase the insulin dose and eat high carbohydrate items like cake or ice cream, and yet today that is standard practice. Similarly, strict blood sugar control is often insisted upon for patient groups for whom it may cause more harm than benefit, such as type 2 patients who were found to have a higher death rate from strict control than without it in the Accord Study and other investigations, or for people with dangerous hypoglycemia unawareness, or for those who were diagnosed so long ago that strict control was not possible for the first 20 or 30 years they had the disease, so now, because of hyperglycemic memory, they are automatically going to develop further complications over time regardless of their present blood sugar levels. There is also the constant mistreatment that occurs at countless office visits, where a doctor who has zero understanding of the difficulties in managing the disease blames the patient for achieving less than perfect numbers.
Perhaps the same phenomenon is operative in modern western medicine as occurs with witchdoctors studied in the undeveloped world, who are gentle with patients who are curable, but viciously reject and condemn those who are incurable. Incurable disease turns the patient into the embodiment of illness and death, and no healthy person likes to be reminded of the inevitable decline of the body. The incurable patient also defies medicine, showing its inadequacies.
I have read countless journal articles discussing hyperglycemic memory, and after finding that in patients having it, complications will continue to develop automatically no matter what their blood sugar now is, they draw the conclusion of how important it is to put the patient through the rigors of strict control from the very outset of the disease to prevent hyperglycemic memory from coming into operation, but there is never a word about the fact that older patients with hyperglycemic memory should relax about strict control. Not only do older patients have less time to live in which complications can develop, but their fate is pre-determined, so what is the use of punishing themselves with strict control, which can lead to hypoglycemic episodes causing social disruption, accidents too serious for an old person to recover from, or even death?
Consider this excerpt from S. Venugopal, “Hyperglycemic Memory and Its Long Term Effects in Diabetes,” Biomedical Research, S354-S361 (2016):
“Impaired fasting glucose and impaired glucose tolerance predisposes to development of vascular complications and the hyperglycemia that develops as a consequence of poor metabolic control, at the early stages of diabetes releases excess superoxide radicals that impairs the mitochondria . Advanced glycation end products and elevated RAGE expression activates a series of signal at the cellular level that increases the risk of microvascular and macrovascular complications. The metabolic memory established in the initial phase cannot be reversed by good glycemic control in the later stages of the disease by therapeutic measures. Hence a severe intensive treatment in the early stages of IFG/IGT after suitable diagnosis is essential to prevent the progression to diabetic state and the metabolic disturbances which develop further in the course of the disease.”
If the mechanism of spontaneous further damage “cannot be reversed by good glycemic control in the later stages of the disease by therapeutic measures,” then why not lighten up on the patient? Instead, all we hear about is “a severe intensive treatment in the early stages.”