Low level hypos add to Cardiac Risk for T1s?

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everydayupsanddowns

everydayupsanddowns

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Read a link to a Stockholm study posted yesterday which has concluded:

Patients with type 1 diabetes who have repeated episodes of hypoglycemia appear to be at risk for early signs of atherosclerosis, researchers said here.
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Read more about it here (Part of the European Assoc for the study of Diabetes)

So it's another 'higher HbA1c = better' study.

BUT

Half way down the page is links to another article:

But the role of frequent hypoglycemia in heart and vascular disease in diabetes is still unclear. (See ADA: Still No Culprit for Excess Mortality With Tight Glucose Control)
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Which seems to suggest 'lower HbA1c = better'.

I am now completely confused. Anyone heard anything about this?

Gaaaaah! :confused::confused::confused:
 
Nah! Keep it simple is what I say.

Avoid Hypos.

Andy 🙂

p.s. I know that's easier said than done, though!
 
Andy HB said:
p.s. I know that's easier said than done, though!
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Hmmm yes... if the target range was 2.0 - 15.0 I'd find it a whole lot easier 🙂
 
There is much research ongoing into the long-term effects of hypoglycemia, but the available evidence does seem to be inconclusive. My own diabetes consultant is always concerned when patients present themselves in clinic and have uncontrolled diabetes with frequent hypo's, and his own opinion is that they are detrimental in the long-term and best to be avoided wherever possible. On my last diabetes check my hba1c had come down and I mentioned that my aim was to reduce this further to around 5.7-6, but his concern was that in doing so I may increase my incidence of hypo's in achieving this, which would lead to losing my hypo awareness symptoms, but more importantly was that present research suggests that the mortality rate increases in those patients that try and achieve non-diabetic blood glucose levels (unsure if this only refers to insulin users). So, like other's not sure which is the best way forward, but my own opinion is to avoid hypo's wherever possible (easier said than done I know) and eat a well balanced diet and exercise regular, after that it's all down to the throw of the dice!:( Toby.
 
Went to see dietician yesterday and showed her the graphs we've got for BG along with food and insulin.

Explained to her the dichotomy of wanting lower HbA1c so having to 'run low' and the desire to avoid hypos, which means the A1c will go a bit higher. Once the NHS is overrun with diabetics with heart problems, they might start to look at investing more in preventative than reactive.
ie. more effective testing and insulin delivery rather than laser and amputation (now to include pacemakers!).

I'm still aiming to get below 7 and stay there on HbA1c. I think, for me, it would be too stressful and too restrictive to aim lower.

Rob
 
Robster65 said:
Went to see dietician yesterday and showed her the graphs we've got for BG along with food and insulin.

Explained to her the dichotomy of wanting lower HbA1c so having to 'run low' and the desire to avoid hypos, which means the A1c will go a bit higher. Once the NHS is overrun with diabetics with heart problems, they might start to look at investing more in preventative than reactive.
ie. more effective testing and insulin delivery rather than laser and amputation (now to include pacemakers!).

I'm still aiming to get below 7 and stay there on HbA1c. I think, for me, it would be too stressful and too restrictive to aim lower.

Rob
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Regarding NHS being overrun with diabetics with heart problems - I remember listening to a talk by a dietician as a student nurse sometime between 1985 and 1988 (probably earlier in that range, rather than later). The dietician said she could remember just a few years earlier, advising people with diabetes to eat as much cheese as they liked when hungry, as it had no carbohydrate content. She said she felt responsible for people with diabetes eating high fat foods / diet, resulting in heart / vascular disease.
 
She advised no more than 2 or 3oz of cheese per week. I'd had more than that grated on my pasta at lunch time. 😱

I did counter it with my low alcohol intake. Probably about a unit per week on average so I use a cheese-offsetting system. She didn't look too happy about it but I am. :D

Rob
 
Mike, thanks for posting the link.

everydayupsanddowns said:
Read a link to a Stockholm study posted yesterday ...
So it's another 'higher HbA1c = better' study. ...
Half way down the page is links to another article: ...
Click to expand...
Hmm I do not think the Stockholm study does support aiming for a higher HbA1c. It just says less hypos are better. There is no suggestion that the control group had a higher HbA1c than the test group. In fact for them to be a worthwhile control group they should have comparable HbA1c levels so that the difference in these values could not be a factor that influenced the results observed.

So I would agree with Andy's ...
Andy HB said:
... Keep it simple is what I say. Avoid Hypos ...
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I interpret the second report to say that although there are both benefits and risks in aiming for a lower HbA1c the aim of a lower reading does benefit at least some people, namely those who start to improve their HbA1c within three months of adopting what they call the more intensive approach to lower it. People who are on intensive control tend to have more severe hypos but there is no guarantee that a higher HbA1c will reduce the risk of severe hypos for an individual. Also people who adapt well to the intensive regime have fewer hypos and any severe hypos they suffer appear to be less damaging.
Those who struggle to adapt to that type of approach however, tend to suffer if they continue to be pushed to implement the intensive approach by their medical team. As it says towards the end
"There was concern we went too far," commented [Dr] John Buse ... "But it's probably more that we pushed too hard in the people who weren't getting to goal. You have to individualize these targets," he said, which was the take-home message expressed by many experts and remains part of [American Diabetic Association] guidelines.
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I think this is key, choose the approach to treating your diabetes that best suites yourself, as Rob and Toby appear to be doing from what they say in their earlier posts.

To be perfectly honest I would also, given the choice, prefer to pass away from a quick heart attack rather than live longer but suffering long term the potential complications that a higher HbA1c can make more likely. Of course ideal would be a long life without any major complications and that is the aim. 😎

Robster65 said:
She advised no more than 2 or 3oz of cheese per week. I'd had more than that grated on my pasta at lunch time. 😱

I did counter it with my low alcohol intake. Probably about a unit per week on average so I use a cheese-offsetting system. She didn't look too happy about it but I am.

Rob
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Yes you have got to view the wider picture, it is no good having no cheese whatsoever if you are consuming a tub of lard each night! 🙄
 
Those are really interesting comments about cheese etc - I clearly remember as a kid being directed if I wanted to have a snack to have something like cheese, cold cooked meat etc... or for mid am / pm snacks it was usually something deliberately savoury like cheese & crackers or crisps 🙂eek:!) Unfortunately whilst that meant I avoided the sugary biccies etc I do wonder what 30 odd years of those fats has done to my arteries!! Dread to think...

Re the hypos that's interesting too... I was also told whilst pregnant to "get rid of the hypos to get rid of the highs" in certain cases - you should be able to tell from your results when an high result is an upswing from a previous hypo I guess...

Anyway, off to try to figure out how to clean my arteries lol!
 
Thanks rossoneri.

I've always known too many hypos were a bad thing, but as people have said they are not always easy to avoid if one is aiming for the recommended target range. Yesterday had breakfast, followed by a trip to the gym which left me at 10.x. This morning, same breakfast (weighed on a scale)+same dose+same gym program+similar fbg+almost the same post-gym quick-acting carbs (just a little less so as not to go high) = 3.5

Low-level hypos are bad. But I've sort of accepted them as a consequence of aiming for tight control in an effort to avoid complications. Studies that I've read so far had mentioned problem with tight control that were more to do with the nuisance factor and/or the issue of severe hypo episodes (which I have been fortunate to pretty much avoid).

This was the first that suggested a direct physiological consequence of having a few dips in your day-to-day.

They do say that they don't understand the link. Other factors may well be at play. After all half these reports seem to be different conclusions drawn from the same sets of data!

Still makes ironing out those low-level lows seem a little more important.
 
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I believe one or two a week is acceptable, healthy even, for a diabetic......and I mean between 3-4mmol/l.........I think if your going lower then doses or the like need to be reviewed.
 
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