How aggressive are we type 2's in our treatment....

I think that at the start I was like every other type 2 and wanted to avoid medications - and certainly not getting to the point of injecting insulin. I read and heard people who I respected in the field keep saying no matter where you are in your treatment it is no different than people who are not taking as much medications or not injecting insulin. I just did not understand how a person that is not taking any medications could be the same as someone that was taking several different medications and insulin and still not able to control. The more I read I began to understand what they are talking about. The disease is progressive, we all get diagnosed at different 'stages' of our particular disease. Handled aggressively enough we all might not have to progress at the same rate and might not progress as far into the different treatment options available. In the end we are all the same in that we have the same disease with the same treatment options and face the same complicatons if we progress to that point.

To the point. When I was diagnosed my fasting glucose was something like 150. Not all that bad in the overall scheme of things. My doctor put me on Metformin 500mg 3 times a day along with 2mg of Avandila twice a day. From what I hear this is rather aggressive to start with. Most people seem to start with just Metformin twice a day and don't progress to two medications until they are unable to control with jsst one. I actually cut back on mine some because I thought it was overkill, and it might have been. Now I am controlling very well and see the medications just as important as they were when I was not controlling as well. I lost 70 pounds - gained back 10 after starting a serious exercise program. I am right at the top of my weight range and just below the top of the BMI acceptable range. about 3 weeks ago my A1c was 5.2. I believe that I could maintain 5.5 easy with diet and exercise only.

Why would anyone take medications if they can control at 5.5 without medications? Good question. I do believe that we should shoot for the best and the most rormal range that we can acheive. That would be an A1c of 4.2 to 4.6. Higher is above where the body would control if it could. I believe that if you are in the 5's and above your beta cells are working very had to maintain those levels. Beta cell burnout is a major problem for type 2's. Avoiding beta cell burnout is paramount to me. To prevent this we have to maintain our blood glucose levels as close to mid 4's as much as we can. Most people will not agree with me on this. I don't think most doctors would agree either - but that is a completely different rant for a different time.

My question is how aggressive are you in controlling your blood glucose numbers? Most people seem to feel taht if you can control under the danger range of >7.0 you are doing ok. Well, that would be true if you did not think that your disease is progressive and it is the progression that will get you in the end. Changing the treatment after you are unable to control is following the curve - we should be ahead of the curve. While I do agree that medications are not natural I also believe that diabetes is not natural either and having the goal of no medications and no insulin is short-sighted and end the end will in most cases end up just where you don't want to be - on drugs and on insulin - Can you avoid medications forever - I don't think you can if you keep stressing your beta cells too much. Maintain a low enough A1c and probably you can avoid medication your entire life. That is not happening that often - in my opinion, anyway. Why am I still in the low 5's and not in the mid 4's? I did not say that I was successful as I want to be. I am normal in that respect. It is not the medications that are failing me, it is me that is failing me.

Boy, so long a post just to ask how aggressive are you in your own treatment program?

I think people should monitor their blood sugar to avoid future complications, because thats what diabetes does to you,

HOWEVER, I think advocating an A1c of 4.2-4.6 is not in a persons best interest!  That is an aveage blood plasma range of 60-75 mg/dl and the operative word is AVERAGE!!! that means you have some lower and some higher and already 60's is begining to flirt with Hypoglycemia and below that is definately hypoglycemic which has serious, deleterious even fatal consequences.  Low 5's (5-5.5= 95-105mg/dl) are just fine for an average and don't really have any serious long term consequences for a normal or diabetic person!  Lets just be a little careful about what we advocate to people here and not try to push them into a danger zone.

Warren

Ok, for everyone that is wondering what in the world is an A1c number and how does that relate to my blood sugar:

HbA1c	4.0	4.1	4.2	4.3	4.4	4.5	4.6	4.7	4.8	4.9
Glucose	65	69	72	76	79	83	86	90	93	97
HbA1c	5.0	5.1	5.2	5.3	5.4	5.5	5.6	5.7	5.8	5.9
Glucose	101	104	108	111	115	118	122	126	129	133
HbA1c	6.0	6.1	6.2	6.3	6.4	6.5	6.6	6.7	6.8	6.9
Glucose	136	140	143	147	151	154	158	161	165	168
HbA1c	7.0	7.1	7.2	7.3	7.4	7.5	7.6	7.7	7.8	7.9
Glucose	172	175	179	183	186	190	193	197	200	204
HbA1c	8.0	8.1	8.2	8.3	8.4	8.5	8.6	8.7	8.8	8.9
Glucose	207	211	215	218	222	225	229	232	236	240
HbA1c	9.0	9.1	9.2	9.3	9.4	9.5	9.6	9.7	9.8	9.9
Glucose	243	247	250	254	257	261	264	268	272	275
HbA1c	10.0	10.1	10.2	10.3	10.4	10.5	10.6	10.7	10.8	10.9
Glucose	279	282	286	289	293	297	300	304	307	311
HbA1c	11.0	11.1	11.2	11.3	11.4	11.5	11.6	11.7	11.8	11.9
Glucose	314	318	321	325	329	332	336	339	343	346
HbA1c	12.0	12.1	12.2	12.3	12.4	12.5	12.6	12.7	12.8	12.9
Glucose	350	353	357	361	364	368	371	375	378	382
HbA1c	13.0	13.1	13.2	13.3	13.4	13.5	13.6	13.7	13.8	13.9
Glucose	386	389	393	396	400	403	407	410	414	418

Now, with that being said I'd like to continue with the fact that there is NO correlation between Heart disease and an A1c number. 

Glycated hemoglobin (A1C) is a measure of long-term blood glucose control. Keeping A1C levels close to normal is an important part of diabetes care.

Some studies suggest that A1C levels may predict cardiovascular disease (CVD) and related problems of heart and blood vessels, such as heart attack or stroke, even in people without diabetes.  HOWEVER, a 2004 study among middle aged Type 2 health professionals (1500 of them for 7 years) found that the A1c level in these people was not a predictor of future heart problems. 

What they did find was that having diabetes was a fairly strong link to future heart problems.  Hmmmmm!!! could it be that high cholesterol, high blood pressure, associated weight problems, stress, smoking, drinking and a myriad of other factors all exacerbated by type 2 diabetes caused these heart problems??  Probably since they found there is absolutely no link between the A1c number and heart problems.

So for my 2 cents worth, keeping your blood sugar relatively normal is important since higher sugar levels in the blood can tend to do nasty things to a lot of your systems. By being myopic and focusing solely on this number to the exclusion of cholesterol, BP, and other very important "risk factors" just doesn't make much sense. 

I have a son with low blood pressure, normal blood sugar, thin as a rail and high cholesterol.  His Vegan diet has brought his cholesterol out of the 300's and into the 200's. Is that good enough? NO!...he's now on statins.  The point being here is someone with a "low" A1c who had a "significant" risk factor for heart disease - again, NO CORRELATION between A1c and risk factors.

Being "diabetic" of any type, means something is broken. You do the best you can to live a healthy lifestyle and use medication as an "intervention" to slow down and keep the disease at bay. If you want to be a zealot about lifestyle and numbers, be my guest; but I certainly choose "quality of life" and will have that chocolate chip cookie or ice cream once in awhile and if my blood sugar averages 95-100 instead of "83" I'm not going to get bent out of shape about it as long as the other "risk factors" in my life are normal.

 Warren