Tight glucose control not useful? what?

We have had study after study since Orinase was first approved which show early insulin intervention will stop the progression in early T2s. The problem is ALL T2 meds except insulin do not directly address high BG but rather over time burn out the pancreas by making it work overtime.

Soon CGMs will be worn by most PWDs and they will start seeing their numbers. Tim Cook from Apple had his non-invasive IWatch CGM on a few weeks ago at the Apple conference.

The problem this doctor faces and the pharmas which have introduced 42 new T2 treatments since 2005 is once people start seeing their numbers and start seeing they are spiking 200+ after meals they are going to want to address the problem. Once they know the numbers there is no place to hide. This will dramatically effect how T2s are treated.

What we do know is a BG 140+ for a few hours or more causes microvascular damage. What we also know is if we can keep a tight range 80-140 with new T2s for a few months, many can then control at the same level for years without meds.

Who thinks the pharmas and this doctor wants that?

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Orinase stopped production in 2000 although a generic is available. It is a sulfonylurea class of drug and it has been superseded by newer and “safer” sulfonylureas. Research work by people like Ralph DeFronzo showed clearly that sulfonylureas are not durable, hence the oft cited aspect that sulfonylureas burn out your pancreas. DeFronzo showed that other treatment approaches are durable and some might even lead to some partial healing of pancreas damage. And you are right, early treatment with insulin also shows good effects, probably halting the damaging effects of high blood sugars on your beta cells. I started insulin early 7 years ago and have not had any degradation of my diabetes control over that time.

I’ve been reading and ignoring Mayo’s advise for months. Just this morning I unsubscribed from their emails.
I didn’t follow them. I don’t need them and as of last week my HbA1c is down to 6%. Diagnosed at 7.7% about 3 years ago. What worked for me is a low dose (my dr says ) of metformin, low carb eating and walking.
I want to maintain an A1c in the 5 percentile. Hopefully its right around the corner.

I think the article raises an interesting discussion. First they raise the question of tight control but they never define what they mean by tight control. Then they question the value of T2 meds.

The article says “We have taken for granted or assumed that the evidence was very clear that if you control you blood sugars tightly, you will prevent diabetes complications,” Montori said. “The answer is less clear than expected and, as a result, it would suggest that our thinking about it may have been flawed.”

Gary Scheiner in “Think like a pancreas” defines very tight as 60-160 and tight as 70-180. Three years ago I would have agreed with him but with CGMs and monomer insulin I would revise them to 70-140 and 70-150.

Now, what T2 med is designed to keep that control? The answer is none. All but insulin treat high BG indirectly. I suspect that meal time spikes 180+ is typical for most T2s. Then it takes hours to come down below 140 and we know BG 140+ for even a few hours causes microvascular damage. We also know 70%+ are not meeting the 7.0 A1c target.

And then they say “We know, for instance, that the higher the blood sugar the higher the risk of heart attacks, the higher the risk of cancer, the higher the risk of strokes,” Gerstein said. “But whether other things related to the diabetes are causing those things is not known.”

The short answer is in some cases the T2 meds are the cause. Orinase came on the market in 1957 and it took 13 years before the reports started coming out about it causing heart attacks. Then it was not withdrawn until 2000. We have had 44 new diabetes drugs approved since 2005 with most targeting T2s. Avandia did not work out so well. I see one TV commercial after the next by lawyers looking for Invokana users. Trulicity and the rest could very well follow the same route but only time will tell.

Knowing these T2 meds are not going to keep meal time spikes under 140 or even 150 or 160 what value are they really having? Metformin for example, demonstrated a 31% reduction in three-year incidence of development of diabetes relative to a placebo but was outdone by the lifestyle-modification arm of the same trial which demonstrated a 58% reduction.

Unless the T2 is going to use mealtime insulin to address the spike and keep A1cs in the 5’s or below I tend to agree with the article. The T2 meds may be causing more harm than good and the T2 should be cutting carbs and walking more.

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Well, not quite all—Invokana and its lookalikes don’t, for example—but most do, and your basic point is true and valid: only insulin acts to directly control blood sugar. And even if a medication doesn’t directly stimulate the beta cells, failure to adequately control blood sugar means that they’re going to continue to suffer damage anyway.[quote=“Brian_BSC, post:22, topic:56256”]
I started insulin early 7 years ago and have not had any degradation of my diabetes control over that time.
I started it late but have seen the same result, i.e., no further loss of control since.[quote=“George44, post:24, topic:56256”]
Gary Scheiner in “Think like a pancreas” defines very tight as 60-160 and tight as 70-180. Three years ago I would have agreed with him but with CGMs and monomer insulin I would revise them to 70-140 and 70-150.
Even that’s too high for me. If my PP reading goes much over 120 I’m dissatisfied. Everyone has their own comfort zone.

Everyone who knows me knows that I am a true believer in early intervention with insulin. It is, as was said, the only medication that directly lowers blood sugar—not surprising since it’s the one the body makes and prefers. Even if it’s only used temporarily to get BG down until lifestyle changes can kick in and take effect, it’s still the most powerful weapon in the arsenal; nothing else even comes close. Why not use the best tool for the job??

ive been reading jason fung’s work lately, and while i still follow berstein‘s dogma that controlling and obtaining normal blood sugars is optimal, i also now believe that reducing insulin levels (endogenous or exogenous) is a key component of optimal management and that high insulin levels/insulin resistance are probably key players in the development of or avoidance of complications.

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Certainly a possibility that can’t be counted out. I have to confess I don’t think much about insulin resistance since I don’t have it in any significant way.

I attended a conference a few months ago where a panel of diabetic experts were asked pretty much this question, “If a diabetic, newly diagnosed, is able to achieve and maintain a blood sugar that is close to or within a normal non-diabetic range, will that diabetic be less likely to develop diabetic complications?” Well, I thought this was a slam-dunk question. But to a fault they agreed that, yes, but only for the first 10 years. After that the risks start to ramp up. It seems microvascular changes are in play. Without close blood pressure control and efforts to minimize renal disease, etc., diabetics, even those under strict control, see their risks rise faster than the general non-diabetic population. So, this isn’t carte blanche to throw away our meters but it is suggesting we need to be on top of all of our health metrics. We are at a higher risk for complications, period.

This kind of thing is disheartening.

When I was a kid and first diagnosed I was told the cure was right around the corner.
Twenty years later complications have arisen and all there is is more therapy.
And these doctors still can’t define the true nature and what causes it
All I see is greedy people profiteering off our misery.
I hate being a pin cushion for more then twenty years but I do have more energy then most of my friends approaching 40
I feel better when my A1c is low regardless of study results

Bottom line.

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Ditto…I know that I feel best when my A1c is low. The best I’ve been able to achieve with any consistency is 5.4 to 5.8 but it’s a constant work in progress. Higher blood glucose leads to feeling rotten for me.

As another member so elegantly put it, as a woman of a certain age :blush:, I am constantly looking to develop healthy habits that make me feel good and give me energy. Very low carb keeps me stable with flat numbers and my green smoothies help to make sure I get enough and variety of veggies with small amounts of fruit.

After 30 years with Type 1, I do firmly believe that my journey with diabetes has made me a stronger person in many ways. All of my health metrics are good and, in fact, much better than younger folks in my office. If it weren’t for needing to be on top of my diabetes, who knows how focused I would be on other health metrics.

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