That sounds like a stupid question, I know. Nobody wants to be
diabetic. But once you’ve been diagnosed as Pre-Diabetic or Type 2, you have,
for life, for better or worse, to one degree or another, a condition called Insulin
Resistance (IR)). For all intents and purposes, that means you are
to some degree Carbohydrate Intolerant. You got this way by 1) having a
genetic predisposition and 2) eating a diet too high in carbohydrates for too
long.
Don’t blame yourself entirely. By 1961 the AMA had come out
against saturated fat and dietary cholesterol and in 1977, the Senate Select (McGovern)
Committee issued their Dietary Goals of the United States, recommending we all eat a
low-fat, high-carbohydrate diet. Both the medical and public health
establishments were tragically misguided in these recommendations, and they
were soon ably abetted by Agribusiness and Big Pharma.
So, if you’ve been diagnosed either Pre-Diabetic or Diabetic
(Type 2), as I ask rhetorically in #344,
using the hemoglobin A1c, today’s marker for blood sugar control, “How Diabetic
Do You Want to Be?”
Is an A1c of <7.0% (or <8.0% if you are elderly) the
target that you and your doctor are comfortable with?
Or, is <6.5% your target, to avoid being officially
diagnosed a type 2 (by current medical standards)?
Or, is <5.7% your target, so you can comfort yourself with
the phrase, “consistent with the absence of diabetes”?
Or, is an A1c in the “low 5s” your target? It has been for me
for half of the 30 years that I have been a diagnosed Type 2. My doctor isn’t
worried, though. He, like most and the ADA, considers under 7.0% “well
controlled.”
Or, is an A1c ≤5.0% your target? I know several long-term type
2s who manage their disease this way; this is the true “optimal” or normal A1c.
They do this with a combination of a strict Low Carb diet and insulin injections.
So, to be an informed consumer/patient, you need to be armed
with some facts. The following is filched from one of, if not the
best, on-line sites for Pre-diabetics, Type 2s and Type
1s: Jenny Ruhl’s “Blood Sugar 101.”
“Risk
Quantified For Non-Diabetic A1cs and Heart Attack Risk
The Atherosclerosis Risk in
Communities study tracked 11,092 black or white adults who did not have a
history of diabetes or cardiovascular disease for 15 years. It found no
association between fasting blood sugar and risk of heart disease, but A1c was
a different story. The table below summarizes the correlation of baseline A1c
with the risk of developing cardiovascular disease. [CVD]
Multivariate-Adjusted Hazard Ratio [with my translation,
for the statistically challenged].
5%:
0.96 (0.74-1.24) [If you have an A1c of 5.0%, your chance of developing
CVD is just below “even.”
5% to < 5.5%: 1.00 (reference) [In this range, your CVD risk is THE SAME AS ANYONE ELSE!]
5% to < 5.5%: 1.00 (reference) [In this range, your CVD risk is THE SAME AS ANYONE ELSE!]
5.5% to <
6%: 1.23 (1.07-1.41) [In this range, you are almost 25% more likely than if your A1c
is 5% to <5.5%.]
6% to < 6.5%: 1.78 (1.48-2.15) [In this range you are more than 75% more likely (range almost 1½ to >2 times)].
≥6.5%: 1.95 (1.53-2.48) [If your A1c is ≥6.5%, you are almost twice as likely to develop cardiovascular disease, and the range of risk is from more than 1½ times to almost 2½ times.
6% to < 6.5%: 1.78 (1.48-2.15) [In this range you are more than 75% more likely (range almost 1½ to >2 times)].
≥6.5%: 1.95 (1.53-2.48) [If your A1c is ≥6.5%, you are almost twice as likely to develop cardiovascular disease, and the range of risk is from more than 1½ times to almost 2½ times.
Glycated Hemoglobin, Diabetes, and Cardiovascular Risk in
Nondiabetic Adults. Elizabeth Selvin et al.NEJM
Volume 362:800-811. March 4, 2010 Number 9.
Keep in mind that because these
subjects were probably diagnosed as "non-diabetic" using a fasting
glucose test many of those with the higher A1cs probably were diabetic at the
study outset based on post-meal values. If you are recently diagnosed with
diabetes and have no signs of heart disease, your risk/A1c ratio should be
similar if not identical to those shown here.”
So remember, if your doctor is like mine (or any
MD, DO, RD or CDE who follows the ADA Standard of Care), (s)he is going to
consider anything under 7.0% (or maybe 6.5%) to be “good control,” or
worse, “optimal,” so you are pretty much on your own if you
choose to strive to attain an A1c lower than 6.5%, or <6.0% or even <5.5%.
Thank you so much for sharing this chock-a-block of useful information! In today's world, where this disease is becoming more and extra common throughout the world diabetes empowerment would play a significant role.
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ReplyDeleteThanks, James. I appreciate it. I have now published over 450 posts.
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