Another diabetic sent it to me…
https://www.reuters.com/investigates/special-report/usa-diabetes-overtreatment/
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Not enough information in the article to make a sensible comment.
- What insulins was he using.
- What other meds.
- Did he have a CGM?
- Did he drink alcoholic beverages?
- Had he received competent education on his condition?
My HbA1c is under 7 even now on prednisone. It’s generally 5.4 to 6.5%. I seldom have moderate hypos generally when sleeping or out on the bike. I’m hypo aware but even if I were hypo unaware, I see my BG on my watch, my pump and phone will alert.
The other day I my watch alerted, my BG was 100mg/dl but with double arrows down. I was driving, ate 16g glucose which brought me to 105 no trend arrow.
In my opinion which I acknowledge is ignorant of all the facts, this man did not have the knowledge necessary to achieve more normal BG management without having severe hypoglycemia and hyperglycemia. Go low enough will counter highs giving a good HbA1c.
Time in Range is a better indicator of good BG management than the HbA1c. This image shows that.
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I’d agree with that perspective. He was a fairly recently diagnosed T2. It’s interesting. I don’t tend to worry about low BG, but I’ve been diabetic a long time and we all know that individuals have different physical reactions to it. I need to be constantly reminded that low BG is a concern for a lot of people.
P.S. Good catch while driving!
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I blame my obsession with monitoring my BG on years of monitoring electronic circuitry metrics to determine their health or need for adjustments or repair.
When 1st monitoring. Well it looks good. But there’s a history. Oh look it’s trending off. Adjust, continue monitoring. Good at an hour, is that good enough? No with this history do a 24 hour monitoring. The story of most of my working life.
I left out, if concerned try a different test set.
What worries me about this article is too many docs are hypophobes. They want to have you at 250mg/dl before they do anything.
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They have ALWAYS been. They are the worst. But, on the other hand, maybe we have a bunch of new diabetics and older diabetics that are getting tossed onto an insulin pump and low a1c situations that are out of their league and its leading to increased deaths. I dunno.
To say what’s changed in the past 43 years: 43 years ago when I was diagnosed it was completely expected that I would develop retinopathy within a few years and kidney failure a little after that. There was almost no home bg testing available and when the doc ran a glucose test he would call my parents a week later with the result. Urine testing was the standard of care (but we all faked our test sheets ha ha). If any diabetic had an A1C test run it was because their doc was at a research hospital and they didn’t tell you your A1C number anyway. Joslin gave a medal to those who had survived 25 years with diabetes.
Today in 2025, after 43 years of diabetes? I visited the retina doctor for the zillionth time, no retinopathy. Kidneys working fine. All my docs (eye doc, GP, whatever) ask about my blood sugars. All because of the pioneering work of the DCCT studies in the 1980’s and an A1C goal. Going 25 years is no big deal now and the number of Joslin 50-year medal recipients is growing HUGELY. Having a CGM really does help.
The DCCT was a huge turning point in raising every T1 diabetic’s standard of care and in the past couple decades the tight bg goals have trickled down to T2’s. This is great. Yes hypos are a hazard.
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The facts in the article don’t match the headline.
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Ok. Yeah. Thanks for the feedback. That helps put me at ease. I’m running some of this DOJ complaint stuff past diabetics from other internet communities (just because we all have spoken to one another for a long time and might some group think). But, I am honestly running out of time. I really appreciate you all double checking the integrity of perspective about what I’m writing.
Very striking Overall theme theme has merit.
I don’t think generalizations can be made about both Type 1 and Type 2. One or the other must be addressed. That said, hypoglycemia, rather than T1D, is the worst problem in my life and my A1C is not always under 7.
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One of the things lost with the destruction of the Beta cells is the interplay between Alpha and Beta cells. There are glucagon receptors on the Beta cells and insulin receptors on the Alpha cells.
This may be why some with T1DM are prone to hypoglycemia. The Alpha cells insulin receptors only work within the islets, so exogenous insulin does not work.
The interplay of how hormones interact with each other is quite complex. I don’t know much, just a few bits about glucose management.
Really?!?!?! That is SO interesting, @Luis3
I KNOW that I won’t sleep through low BG. I start sweating and kicking adrenaline. I think my liver starts to chug and kick out stored sugar surplus in a way that helps me summon whatever energy I can muster.
@Sue_R, can you talk more about this? I’m just interested in how your physiology works, like what it feel like to wear your diabetes suit. That’s a big problem for a lot of people and it generates a lot of fear.
Luis has knowledge about alpha cells that I don’t. I’ve had T1D 57 years. My insulin sensitivity factor is 110. I’ve read that the average for people with T1D is 40. Small doses of insulin produce huge drops for me. Each low produces excruciating pain at the base of my skull, for which I’m prescribed Percocet. The symptoms of shaking and heart pounding do not stop when BG finally returns to normal (after far more than the 15 minutes we are told) and I am prescribed a beta blocker for these symptoms.
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This article is very misleading. I would like to highlight these facts:
“Carlson suffered multiple episodes of hypoglycemia before his death. He hit a car in a mall parking lot after his blood glucose plunged. Another time, he fainted at home and cut his face on broken glass. He was hospitalized in 2017 after a bout of hypoglycemia left him unable to speak or move one side of his body.”
As a motorcycle rider myself, I have my phone mounted on my handlebars so that I can get blood sugar readings at all times. I don’t ride low. I don’t ride tired. I keep dextrose with me at all times. I hate to blame the victim, but this guy had at least three serious dangerous outcomes from hypoglycemia that required hospitalization before this fatal incident. There are enough risks riding a motorcycle without adding in low blood sugar.
It’s not the drugs. It’s lack of education and not taking responsibility for your own safety, not to mention the safety of others.
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I think the point of this article is to show continued focus on only A1C as a criteria and to focus only on keeping it below 7 is the issue. The implication in this article is that Mr Carlson died due his effort to get his A1C below 7%. As pointed out by others, there is too much missing information, so we cannot judge Mr Carlson other than the comment from his wife that he tried hard to get his A1C below 7. Medicine needs to keep pharmacy companies from being the main purveyors of how we should keep track of our health. Someone I know has been diagnosed with LADA T1, for about the same time as I, we both pump and religiously use our CGM’s to keep track, yet my A1C is consistently 6.1 and theirs is roughly 7. WE ARE ALL DIFFERENT and what my norm is not your norm. My analogy is just because the normal shoe size for a certain size person is size 8 does mean that your size 9 foot has to be crammed into a size 8 shoe. Mr Carlson and others may be dying from trying too hard to fit a “norm” that is unrealistic for them. We need to broaden our idea of what is normal for different people.
I am unable cite the study that referenced Alpha cell disfunction as a result of the loss of Beta cells, but Alpha cell disfunction in both T2DM and T1DM is well known, just not fully understood.
As an electronic technician using negative feedback is the way to keep systems stable. Positive or lack of negative feedback causes uncontrolled oscillation.
For us that puts us on the BG roller coaster.
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Thank you. That fits with my thought that there is more involved than just just sugars/carbs, insulin, exercise. Have always thought there was more to it. And this does make sense
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my a1c is fine but this article raised my blood pressure
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@mohe0001 The article initially seems to focus on one person without sufficient information; its easy to find a single case to build around. The case presented is questionable on many fronts and thus a disservice to the readers. As to the discussion of the ADA recommendation for “below 7%”, it’s easy to find all the dissension surrounding the decision and the fact big Pharma played a significant role should come as no surprise. The fact ADA takes money from big Pharma at alarming rates should make anyone question ADA’s independence and recommendations; nobody, particularly big Pharma, gives that much cash without expecting a return on investment of some sort. Big Pharma were not the only ones advocating for <7%, there were many in the medical community as well, many in the medical community were also advocating something around 8% or <9%. Unfortunately, the decision was made, it’s been stuck with far too long, been incorporated as a standard in the medical community training for years, and will take at least as long to be undone. It’s been inculcated with those with diabetes, both T1 and T2, so well that many suffering the two diseases think the lower, the better. I’ve heard T1s/T2s advocate for <6% and <5%, one took pride in stating a 4.2 A1c! Those levels may be good for them, but it all comes with risk of going too low. The article goes on that big Pharma and the medical community now cry out for “individuality” of treatment; I believe in the YDMV (Your Diabetes May Vary) mantra, but I also believe Big Pharma and many of the medical community hide behind their own culpability and a lack of knowledge. “It depends” is an answer, it is not “the” answer. Generalizations can and should be used in the “starting” treatment of the “majority” of T1s and T2s, when the results of that treatment are displayed, THEN the treatment gets adjusted, refined, or “dialed in.” That’s the way of just about anything, including T1 and T2 diabetes.
This article…and quite frankly many in the medical community…take the overly simplistic approach of trusting A1c as the end all, be all of measurements. It is not and those that present as such are just plain wrong! A1c is a fine measurement, for those that don’t have or can’t afford CGMs, it may work well; but its for past period of time measurement and can misrepresent reality; it can hide high swings of BG that are very un-healthy and may cause significant medical problems as other’s have noted. For those with CGM access and affordability, much better measurements have existed for several years; e.g eA1c, GMI, SD (standard deviation), and CV (coefficient of variability), among others. Any decent cell phone, tablet, or computer app can provide these measurements and the medical community, as well as T1s and T2s, need to update their knowledge of them. Others will say GMI/SD/CV have their own faults, and they’re right, but these measurements are a significant improvement beyond A1c. If SD and CV are in the right range, then an A1c, eA1c, or GMI of 5-8% is fine, with little to be concerned about hypoglycemia impacts. Another article statement is that 70% is the limit for hypoglycemia; for myself it would be a concerning level, but I’m not so sure knowledgeable medical folks and some T1s/T2s would agree. I’d agree depending on the person that depending on their norms and whether BG was headed downward and how fast, it should be a matter concern. But if the BG of the person was stable or rising (and how quickly), it might be considered just fine.
All this said, I’m not a doc, nurse, or PA. Be your own, do your own research. My PCP mis-dx’d me for 8+ years; I relied on him and his training, but his training was wrong: A person over 50 can develop T1! I now have an Endo, value his knowledge, discuss treatment with him; but I’m the team “Captain” and I decide. Trust, but verify!
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same
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The amount of time and worry consumed in having enough supplies to treat, endlessly planning - it is endless real time traumatic stress injury, in addition to the pain caused.
One thing I’ve learned - never eat candy for treatment. Consume recognizable medicine such as Transcend Glucose Gels. Don’t give the ignorant a chance to endanger your life at these critical times.
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