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Diabetic complications-reversible or even preventable?

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Posted 1/9/2006 12:06 PM (GMT 0)
I have been a type 2 diabetic since ten years.The honey moon appears to be over.In these ten years i have seen well controlled diabetics(mostly type 2) develop complications and a few who have been fatalistic,those people who believe" what's bound to happen will happen"getting on handsomely in their diabetic journey!In my ten years of discussions with  endocrinologists and physicians,i seem to have developed conflicting opinions regarding complications,A)complications due to diabetes are inevitable despite the best control, B)Complications can only be delayed but not prevented and C)the severity of complications can be modified by tight control and medical advances at present can offer no further hope!

                                                                 iam confused! please clarify. eyes

Posted 1/9/2006 2:00 PM (GMT 0)
This is a pivotal matter for me too. At this young age, I am more prone towards developing complications than others; simply because I have more time to develop them! Hence, I would only like to add to the urgency of this inquiry.

Regards,

AM_BD
Posted 1/9/2006 2:33 PM (GMT 0)

Diabetic complications are leading causes of blindness, amputations and kidney failure. Most diabetics develop a complication within 16 years of being diagnosed. Diabetologist's waiting rooms seem to be filled with people with white canes, overweight people, amputees in wheelchairs - people suffering the agonies of the darned.

A recent study I found called The Diabetes Control and Complications Trial followed two groups of insulin dependent diabetics, one following a casual regime of blood sugar control, the other attempting much tighter control with more frequent insulin injections. The results showed beyond doubt that high blood sugar is associated with neuropathies and microvascular (small blood vessel) complications, but does not lessen the macrovascular (large blood vessel) complications. In other words, tight control reduces the chance of kidney failure, foot problems, leg ulcers, blindness, amputation and neuropathy, but actually worsens weight gain, causes more and more severe hypoglycemia and increased risk of coronary artery disease (on the ADA-style high carbohydrate diet used in the DCCT).

The so-called microvascular complications are caused by high blood sugar and damage the capillaries and the organs dependent on them such as the kidneys (nephropathy), eyes (retinopathy), and the extremities which can lead to diabetic leg ulcers, gangrene and amputation. The neuropathies (nerve damage) include: itching, burning, numbness, and eventually the failure of organ systems to perform properly, as in delayed stomach emptying from damage to the vagus nerve, and eventually the progressive failure of the digestion.

The macrovascular complications - heart disease - are associated with and likely caused by high insulin levels: the so-called syndrome X. In this trial, the researchers acknowledge that high insulin levels are the price of tight control; and some of the tight control group gained weight and had increases in blood pressure and cholesterol, so they came to have an increased risk of vascular complications.. The larger vessels become blocked, like the coronary arteries which feed the heart muscle (setting the stage for heart attack), and the carotid artery which feeds the brain (setting the stage for a stroke). These conditions are shared with people without diabetes, but in diabetics they progress six times faster. Further, diabetics' blood has a greater tendency to clot, so that heart attacks and strokes are more common among them. The combination of numbness in the feet and poor circulation make diabetic feet and legs terribly vulnerable - even too-hot bath water can damage them - and wounds are slow to heal and may ulcerate.

So what can we as diabetics do about all this.  Is it all just a "fait au compleat"? 

All that really matters about complications is knowing how to avoid them.  Our meds seem to mitigate the microvasular problems but I feel that giving up the high carb diet in place of something that promotes ketogenisis (low carb higher protein diet) is the answer to solving the macrovascular problem.  This is something that not just diabetics can benefit from but that they happen to benefit from more than most.

So the long winded answer to your question is, NO, complications are not inevitable if you eat correctly and take the appropriate medications.  AND of course get some exercise to help get your body into its proper metabolic state!!

scool  Warren

Posted 1/9/2006 4:30 PM (GMT 0)
Dear Warren,
I post below a position statement on the DCCT published in the Diabetes Care journal

Notable are the results of the Diabetes Control and Complications Trial (DCCT) (2) and the similarly designed but smaller Stockholm Diabetes Intervention Study (3). These studies showed unequivocally in type 1 diabetes that lowering blood glucose "delayed the onset and slowed the progression of microvascular complications". Risk reductions for various outcomes ranged from 35 to 75%. Secondary analyses in these studies showed strong relationships between the risks of developing these complications and glycemic exposure over time. Moreover, there was no discernible glucose threshold, i.e., there was a continuous reduction in complications as glycemic levels approached the normal range. Improved glycemic control was also associated with reduced cardiovascular events in the DCCT, but the difference was not statistically significant. Perhaps this was because the population studied was young adults and therefore the event rate was very low.

You are skating on thin ice if the above is the conclusion of the editors.
Posted 1/9/2006 4:55 PM (GMT 0)
Dear Warren,
if i may add"lowering the blood glucose delayed the onset and slowed the progression of microvascular complications"was seen in the DCCT study only in the tightly controlled arm of the study protocol.In the"loosely controlled arm" of the study the complication rate was status quo ante.

sharer
Posted 1/9/2006 5:17 PM (GMT 0)
Dear Warren & Sharer,

In addition to your opinions I would like to add that the DCCT study was conducted on type 1 diabetics. A similar study is currently being undertaken on type 2's also. Although, I cannot remember the exact details, the study is supposed to be concluded on 2009. However, the study presumes that tight control of BS is equally helpful in type 2's as in type 1's.

Regarding Warren's prescription of a low-carb diet, isn't excess protein harmful for your kidney? I am only saying this because a relative of mine had severe kidney problems and was asked to stop eating all forms of protein.

Furthermore, sharer, would it be a good idea to leave "white rice" entirely out of my diet and instead go for choices like "Whole-wheat"? Since, I am also an aficionado of rice, I really would like to hear about a few benefits of white rice.

I apologize in advance for my uneducated opinions. But hey, I am only 22 and have plenty of time to learn!!

Regards,

AM_BD
Posted 1/9/2006 6:02 PM (GMT 0)
It is a very interesting question. You listen to the "experts" use the word reversable without explaining what reversable means to them. When I say experts I mean someone that has superior knowledge to the lay person, a researcher or educator of diabetes or doctor. Basically someone you trust their opinion because of their education or experience with diabetes.

Does it mean that if you are in excellant control and exercise you can get to the point where you are no longer type 2 diabetic. I don't read it that way. I believe they mean as long as you maintain that control you do not face the same complications as those that do not maintain excellent control. If you eat a high carb meal you bs's will rise just as they did before they were before you were considered "reversed.' I think the word 'cured' is not used for this reason.

I think this is only important because us humans are known for 'grasping' at anything to be normal or at least not sick. Maybe in this case sick is not the best word, but you get the point. I don't see us as sick. The good news, I would think, is that someone able to get to that point of having reversed type 2 is capable of maintaining that position. It is something for all of us to strive for - even if we do not 'reverse' it just trying will make us les likely to experience complications.
Posted 1/9/2006 7:44 PM (GMT 0)

Hi everyone,

I wonder what part of my post didn't state that "tight control reduces"......

Yes this was a "type 1 study" but most of the results will probably apply to type 2's.  The syndrome x type damage from insulin is more specific to type 1's but not exclusive and can be found in many type twos that have taken sulfonylureas.

Yes, a total protein no carb Atkins/Bernstein diet can damage your kidneys.  However, cutting back on the carbs and increasing the protein intake so that you are "realtively" low/lower carb is not a bad thing!  After all, you can see when you start getting to much protein in the urine, but it is much harder to see when you are getting hardening of the arteries, and other macrovascular damage. 

Six of one - half dozen of another, but I'll err on the side of lowering my carbs (bad carbs anyway) in hopes of staving off long term arterial damage!  Unfortunately we are living with a broken endocrine system and since we can't fix it, all we can do is try to make everything else as healthy as possible!!

Now last but not least, the question of PREVENTABILITY/REVERSABILITY.  Well there are a number of well documented cases of pre-diabetic and newly diagnosed type two cases where a reversal has occured.  Usually these were in cases where there had been significant abuse of any appropriate dietary or exercise regimins.  HOWEVER, there are an equal if not far greater number of us that are stuck with the disease for life, simply because whats broken isn't fixable.  The near pandemic of diabetes in the US is mostly being caused by no exercise and horrendous diet.  This is preventable.  But lets not forget that there will always be those that are genetically pre disposed to this disease and nothing we do will prevent it!

So......the answer to the original question of this thread is YES & NO.  It all depends on the circumstances.

scool Warren
Posted 1/9/2006 9:21 PM (GMT 0)
Warren -

"Yes, a total protein no carb Atkins/Bernstein diet can damage your kidneys." Neither Atlins nor Bernstein has advocated a total protein with no carb diet for diabetics. You can dislike their approach - we all pick the "experts" we believe fit our lifestyles. ... There are so many choices out there. If you eat small protions and use the formulas you read on this and other sites you will see carbs close to both Bernstein and Atkins appraoch. I don't care what approach anyone uses as long as it suits their end goals. Sorry to say I see friends eat anything they want and don't care what their bg's are - and it suits them just fine.

I ask you what do you mean by reversed? Do you mean they are cured of the metabolic disorder they had? Can they eat whatever they want and not have to worry about high bg's anymore?

========
Please see Forum Rules #12 and #14.

Post Edited By Moderator (Jeannie143) : 1/10/2006 10:28:43 PM (GMT-7)

Posted 1/10/2006 12:35 AM (GMT 0)
1)Forget about the complications of diabetes,even diabetes itself(once confirmed) is progressive.Has anyone of you heard of complications once set in getting reversed?
2)Tight control in the trial which Warren mentioned was so tight that hypo's became so common they had to arrange for dedicated support staff round the clock to deal with these!
3)This trial(DCCT) most importantly was taken up on young type 1 diabetics who were complication free at the time of enrollment.So,we really are not very sure about the effects of tight control on the rate of progression of complications.
4)All of us knew that lowering blood glucose was good for us,but since there was no conclusive proof coming out of well designed studies that the trial DCCT was started.
5)My professors were chiding us that we are becoming too "gluco-centric"in our approach to diabetes and it was high time we started concentrating real hard on other parameters that affect a diabetic,like cholesterol profiles,blood pressure etc.

sharer
Posted 1/10/2006 12:51 AM (GMT 0)
Dear AM_BD,
whole wheat in much superior to white rice in every which way!I was reading the page 3 of discussions in this forum titled"glycemic index" which i found very informative and so shall you.Please look it up as the discussion is not only about glycemic indices but glucose load too.For Example the glycemic index of watermelon is high, but the amount of glucose per serving is so low you can eat it without fear of a glucose spike!
sharer
Posted 1/10/2006 12:16 PM (GMT 0)
Dear Warren,

As I was reading your post I was drawn by the distinction between diabetics who have a "broken endocrine system" & those who are primarily attacked by it due to "horrendous diet & exercise regimen". Theoretically, shouldn't the second group be able to substantially reduce their glucose intolerance by reducing the contributing factors - diet & exercise. After all, you propose it to be a causal relationship.

Regards,

AM_BD
Posted 1/10/2006 4:32 PM (GMT 0)
AM-BD

I think you are incorrectly adding a slant to type 2. As you said type 2 are insulin resistant. There are conficting reasons for getting insulin resistant. Not so much conflicting as they don't know for sure what causes it. They know that it is partly genetics and lifestyle a large contributor. In the lay circles where we live you will see many well defined reason for it, in the scientific community you will hear, "We really don't know what causes it." They do say the same genetics link and lifestyle but always add, we don't know for sure, yet.

I don't you will find that type 2 is just caused and maintained by "horrendous diet and exercise regimen." What I mean is it is not a situation where all you have to do is change that regimen and the problem will not be there. What I belive they are saying is that changing that poor regimin will reduce your chances of complications or the possibility of complications in the future - it does not do away withe the original problem. There there may be more than one reason a person is insulin resistant at the cell level but we are all basically insulin resistant or we are not - to different degrees. Some of us and most likely more so the newly diagnosed are now thought capable of avoiding complications by taking an aggressive regimin approach. Type 2 have already crossed that line and have some degree of insulin resistance no matter how they originally got there where pre-diabetics are belived to be heading there but are in a better position to avoid complications.
Posted 1/10/2006 4:58 PM (GMT 0)

Type 2 diabetes is supposedly caused by either reduced insulin secretion or insulin resistance and usually both contibute.In lean individuals with a heavy genetic burden of diabetes in the family preponderantly have reduced insulin secretion as identified by insulin assays;an element of insulin resistance exists in these individuals.In the overweight and obese individuals it is the peripheral insulin resistance which contributes most to the development of type 2 diabetes,and insulin secretion is definitely reduced too.Professor Sutherland showed the world that every human cell has a chemical moiety called an insulin receptor and that these are  present in normal numbers in non-obese or non-overweight persons.He dramatically demonstrated that these receptors simply disappeared once the person became obese leading to Diabetes;incidentally he received the Nobel prize for this discovery.These "insulin receptors facilitate the entry of the insulin- glucose complex into the cells,especially in the brain,liver,muscle and kidney.Accumulation of glucose in the circulation occurs once this is impaired leading to hyperglycemia.We should not lose sight of the contibution genetics makes in a person developing diabetes,type 2.Faulty food habits alone do not make a diabetic!

                                          sharer cool                                           

Posted 1/11/2006 6:07 AM (GMT 0)
Thank you for your insights.
Posted 1/12/2006 4:20 AM (GMT 0)
I have said this too many times , but 3 years ago I was diagnosed type 2. At the time my ankles were swelling (edema-heart trouble?..no ekg issues though...maybe weight pounding! the lower extremities damages..??), had IBS, bloating, frequent illnesses(mostly upper respiratory-2-5 time a year), 160-180# over normal(high end), frequent headaches(no I think may have been high blood pressure events caused by specific foods), Very BAD Reflux at nights !!!( had to sleep sitting up!), A1c was 8.7!! BGs ran 180-240 1-2 hours after eating, and I was physically incapable of exercising!! Also my total lipid(triglycerides.ldl,hdl)..or whatever were real high!!(ok...? theory!!)

Read a 1989 copy of a book "Reversing Diabetes"(Whittaker, MD) and used a very low volume(1/2 my previous intake volume) diet, high "RATIO" of carbs to meat(by volume...I'm a Physicist and I know what a calorie is, but while I can convert volume to calories, why!! just use volume...it is simpler!!! and weighable!!) Lost 60-80# in a year(no exercise and no medication and NO drinks except WATER(still today 3 years later), and as the weight went down by 30% my A1c went 8.7 to 5.4(30%?), then 3 5 months later 5.5, ...and so on still normal -not just within diabetics acceptable range. (...if i didn't know better?? I have to observe that weight Loss and A1c Loss go in the same direction....so why not measure weight loss ot gain rather than BG rise or fall......no needles, just a digital scale!)
.

I don't believe that Glucose Tolerance tests tell you anything(if you want some references there are many doctors, about 50%, who do not buy this test as meaningful, though I get the point-"insulin response" to glucose(fluid) rapid-intake-references on request)).

Reversible? All of the above symptoms disappeared. I caught a cold for a week this year and before that I was only sick once 3 days in the last 3.5 years. Also last 2 years on this reduced volume diet, my Bg never stays above 130 -140 over an hour after I begin eating.

My wife use to say "eat slower!!!"....maybe this keeps BGs down longer?? All blood work normal.

Coincidince? Maybe. Weight goes down, A1c goes down. ..to normal///how long??... is it up to me?..hope so...losing beta cells?....doubt it....all "I" can do is wait and see an d KEEP weight, and benges as close to zero as possible....a fight!... I visit a lot (4-6/mo) of diabetes support groups. These people are 95% medicated, over 50 and overweight like me! I don't see any!! Progeress(improvement) in 3 years(100 folks at least) and they all seem afraid of Hypoglycenic events that the frequently experience from their meds, so they seem to over compensate by eating a (large) "snack" at night to avoid these horrible frightening attacks!! And they frequently have morning highs (bgs)....think what you want....I have heard several explanations....one from doctors and quite a different one from patients...I am very upset about my impression that the medication, fear of hypoglycemia from undereating or exercise seems to trap them in this “progressive” medicated hyperglycemic/hypoglycemic delima. This is very PROGRESSIVE in my observations.

I believe if you get blood circulating...feeding and carrying off waist or whatever !!.. the human body has a much more efficient natural repair system than human science can possibly ever imagine! But I think we have to feed it correctly and allow it to function(and quit poisoning it), as best we can. Unfortunately some people are physically impaired and management is much more difficult...and hopefully ....possible.

(note to moderator: must have a very tough time avoiding censorship…right?…when you mentioned this activity, I wondered what I had not had the opportunity to read. We all are adult enough to understand differences of opinion, but we can’t be telepaths. And censorship can cause a loss in confidence that what we read isn’t complete. Your choise. Tuff job!)
Posted 1/12/2006 4:22 AM (GMT 0)
choice, not choise!
Posted 1/12/2006 5:45 PM (GMT 0)
Wa,
Just so you know... you may edit your own posts by clicking on the pencil up in the corner. That way if you detect a spelling error you may go back and fix it... or if you say something you want to change.

Now, about your volume thing.. I'm very interested in how you lost the weight because I'm having trouble understanding it. I would very much like to lose more weight but the low blood sugar episodes are a problem.

Did you simply take your regular daily diet and cut the volume in half? Were you on meds when you did this?
What did you do about hunger? And more importantly.. HOW DID YOU SURVIVE WITHOUT COFFEE? (Jeannie quickly takes another sip of her precious coffee!)

One thing I love is salad. I eat tons of spinach and raw broccoli salads with cabbage and tomatoes, yum! How does this translate...? I'd like more information please.
Posted 1/13/2006 6:48 AM (GMT 0)
Pencil?

I've tried to stress that I was not on any meds, because most meds for Diabetes are Hypoglycemic agents and without these meds it is almost impossible to have BGs below 70 (unless you almost quit eating and maybe for a while....days?..or intense prolonged physical activity wo eating.), and I consider accidental hypoglycemic events the real enemy in the treatment of Hyperglycemia ("Diabetes") and potentially more dangerously and producing cumulative damage than the treated condition. In my non-professional, type 2 diabetic, opinion, I think this risk is unreasonable, if there is any possibility of dietary control (which for some inactive and physically impaired is not an option of course).

Non medicated, no risk of hypoglycemia, I shoot for 1/3 my initial volume(real high!!!) , and the actual 50% reduction as failure to meet my goal,but enough reduction to maintain 2-3# wt. loss per week(with luck). This can only be realized over a month though since body wt fluctuates about 2-3% daily(my observation). Cut coffee back to 1/2 cup 2X per day ......and then the really!! hard part, continue to lower volume intake as wt. decreases every 15-20#. This got me off 3 plateaus.

I was talking to several doctors and dieticians, and nurses..about content. Also went to OA and CEA-HOW and listened and learned. Eliminated foods that even at small volume made my BGs shoot up, or made me sick(frequently it seems). avoid white flour foods , drink only water!, try to eat as many unprocessed fresh(??) fruits and nuts within the volume limits I set. If any only 1 oz snacks 2Xper day. No food after 7pm, and low stress Yoga to relax, ...fail..frequently and keep trying....very hard!!
Posted 1/13/2006 5:36 PM (GMT 0)
Pencil! Look at the upper right corner of your posts and you should see a pencil by the x and the exclamation point and the thumbs down and the yellow diamond? Yes? No?

Anyway, although your idea works great for you, I couldn't be that restrictive in my busy life. And I'd have a problem with my meds so I guess it's back to the ole' doctor and get her to help me.
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