Question about going from BG of 206 then 49 then 195 then 60

Type 1 and LADA
21

That is good info. That research group has also posted a review that’s available for free online:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769808/?tool=pubmed

I’ll say that I really like this group because they deal with conflicting data. They cite two papers showing that their data may not apply to T1Ds. The main conflicting paper is a retrospective one based on data from the DCCT. I think that a definitive study will have to be prospective, so I am far from convinced that variability doesn’t matter for us.

You’ve just substantially increased my reading pile:)

22

For:

Bragd J, Adamson U, Bäcklund L, Lins P, Moberg E, Oskarsson P. Can glycaemic variability, as calculated from blood glucose self-monitoring, predict the development of complications in type 1 diabetes over a decade/ Diabetes Metab. 2008;34(6):612–616.

Ceriello A, Esposito K, Piconi L, Ihnat MA, Thorpe JE, Testa R, Boemi M, Giugliano D. Oscillating glucose is more deleterious to endothelial function and oxidative stress than mean glucose in normal and type 2 diabetic patients. Diabetes. 2008;57(5):1349–1354. [T2D]

Monnier L, Mas E, Ginet C, Michel F, Villon L, Cristol JP, Colette C. Activation of oxidative stress by acute glucose fluctuations compared with sustained chronic hyperglycemia in patients with type 2 diabetes. JAMA. 2006;295(14):1681–1687. [T2D]

Cavalot F, Petrelli A, Traversa M, Bonomo K, Fiora E, Conti M, Anfossi G, Costa G, Trovati M. Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study. J Clin Endocrinol Metab. 2006;91(3):813–819. [T2D]

Against:

Kilpatrick ES, Rigby AS, Atkin SL. The effect of glucose variability on the risk of microvascular complications in type 1 diabetes. Diabetes Care. 2006;29(7):1486–1490. http://care.diabetesjournals.org/content/29/7/1486.long

Service FJ, O’Brien PC: The relation of glycaemia to the risk of development and progression of retinopathy in the Diabetic Control and Complications Trail. Diabetologia 44:1215–1220, 2001. [T1D]

Wentholt IM, Kulik W, Michels RP, Hoekstra JB, DeVries JH. Glucose fluctuations and activation of oxidative stress in patients with type 1 diabetes. Diabetologia. 2008;51(1):183–190. [related to oxidative stress as opposed to complications]

I’ll re-state my opinion that any definitive study will have to be prospective and well-designed for it to be meaningful for T1D. So, my feeling is that the jury is still out but that it is better to assume glycemic variability is important rather than unimportant until that day comes.

23

OK, one more. Below is a link to a review on the topic that is more comprehensive than my list. Note that it is written by one of the authors on the primary “Against” paper using DCCT data. It has an “Against” slant to it but doesn’t seem unreasonable. The only point I really take issue with is in the conclusions when he puts the burden on the “Fors” to prove their case before considering adjusting therapeutic goals. I think it should be the opposite.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769955/?tool=pubmed

24

Happy belated birthday. We can too have dessert, if we cover it with insulin. The problem is all those calculations. Sometimes we get them wrong and if we are trying to calculate a large number, the percentage of error increases. Also, we have to figure out how the insulin acts, when it takes effect and how long it lasts. Add in wine ( which drops bg), fats and protein ( that slow things down) and sugar (speeds things up) and calculating how much and when to take the insulin (no, I have never figured out that dual/square bolus dohickey on my pump) and you would have to be smarter than Albert Einstein to come up with the perfect numbers. Also, the stress of worrying will raise your BG. So occasionally we live dangerously, but not too often, mostly because rollercoasting up and down feels like crap and that’s no birthday present. So Happy Birthday. Making it through one more year is reason to celebrate, just in moderation. Moderation in all things—Terence. That includes worrying, and perfect numbers and cake.