ADA Stabdard Care for Diabetics type 2. December 20, 2016

The classification of diabetes according to ADA Standards of Care:

Diabetes can be classifed into the following general categories:1. Type 1 diabetes (due to autoimmune β-cell destruction,
usually leading to absolute insulin defciency)2. Type 2 diabetes (due to a progressive loss of β-cell insulin
secretion frequently on the background of insulin resistance)3. Gestational diabetes mellitus
(GDM) (diabetes diagnosed in
the second or third trimester
of pregnancy that is not clearly
overt diabetes prior to gestation)

This is classification, and there is no classification, why there are diabetes type 2 due to 'progressive loss of B-cells and type 1 due to B-cell destruction? What are differences? Why in one case the treatmnt is one, and in another case the treatment is right opposite?
After Life Style Modifications the first line of Pharmacological therapy for diabetes type 2 is  Metformin. What is Metformin? Why for diabetics type 1 it is insulin, but for diabetics type 2 it is Metformin? In ether case it is B-cell dysfunction and insulin secretion deficit.
        But before we go to take a look at the pharmacology, why do not take closer look at diagnostic? It is ADA recommendations to providers how to treat diabetics type 2. Well, now we are not 'diabetics type 2' we are 'people with diabetes type 2', but I am old fashioned, and I really do not pay too much attention for the words. I pay attention to the meaning. Regardless if I am diabetic type 2, or person with diabetes type 2 level of sugar in my blood way too high and I need right treatment, insulin, rather then attention if I am 'person with diabetes type 2' or 'diabetics type 2'. It is  really does not matter for me. The treatment stay the same, Metformin which I cannot take, and I need insulin, which ADA consider is not part of diabetes type 2 treatment regime.

Consider initiating insulin therapy (with or without additional
agents) in patients with newly
diagnosed type 2 diabetes who
are symptomatic and/or have an
A1C ≥10% (86 mmol/mol) and/
or blood glucose levels ≥300 mg/
dL (16.7 mmol/L). E

       When diagnose was made the criteria  for diagnose was A1c > 5.7% , ether type of diabetes, type 2 or type 1. Now with A1c> 10% insulin must be considered as initial therapy. What are the differences between types of diabetes? Why those types taken into diagnostic? And even more then that, A1c level, what is it? Why it is A1c must be considered as insulin therapy initiation, and not the level of sugar such as 599 mg/dl., which is much higher then 300 mg/dl, and more dangerous?  With diagnose according to the level of sugar on my glucose meter I can see the criteria. But A1c only done in lab, so it is only doctor who can order this test. No any control from the patient of our families.
        Now, let us take a logical look at, why with blood sugar 300 mg/dl insulin must be considered as initial starting therapy, and at the same time, any level below 300 mg/dl must be treated with Metformin? Say me, is there are some logic which I missed? Why do not start with Insulin as soon as diabetes, elevated level of sugar, was detected? Probably in this case, when insulin therapy started as early as it was possible, the dangerous life threatening complications never would be surface?
      There are many talks what is types of diabetes. At the same time, there are no one diagnose when and how diabetes progresses, or it is going to regress, healing, curing. There are no cure for diabetes. There is 'reverse diabetes type 2', say me what is this? Bloody Sweet humor?

If noninsulin monotherapy at
maximum tolerated dose does not
achieve or maintain the A1C target after 3 months, add a second
oral agent, a second oral agent, a
GLP-1 receptor agonist, or basal
insulin.

Now, after three month target A1c was not achieved,  why? Just say me, why this target was not achieved? Was it possible to be achieved as it is presented by ADA? They are professionals. They spend millions in study diabetes. What they do talking about why Aic level was not achieved after 3 month of non-insulin therapy?
Take a look back to diagnose. The diagnose is A1c > 5.7%.  How high after 5.7% level of sugar go? There is no one mention, what was A1c at the time of diagnose. What if A1c was 9.4%? Is it possible that Metformin would reduce dangerous level of constantly rising level of sugar just during 3 month? Not at all. Metformin is not the medicine to work in such high diabetes progression. But even insulin, which is highly effective and eventually will lead to high blood sugar reduction, it is not possible to achieve healthy normal ranger in A1c from 9.4% down to 5.7% during 3 month. Try it. See by yourself. Then really, what ADA talking about? Is the goal, A1c really reasonable?
       Still ADA continue to the next level of its twisted logic. "second oral agent must be added'. Really this is what about? There are no initial level of sugar in blood. But there is final destination and time how soon it can be reached. If one medicine did not work, because of it is not effective, then add to this type of medicine another non-effective type of medicine and let us take a look what will happen. Nothing good. Diabetes progress to the next level. Diabetes has no one difference with any other medical conditions. Try do not treat infection and see what will happen. Would infection stop somehow? Or it would spread wider and wider till it would be too late to hold it back?
       Does ADA have any idea how diabetes progressed before it was diagnosed? Or we all just come to clinic, our blood sugar tested, it is above 126 mg/dl fasting, and this is when our diabetes type 2 journey started. It would be too good to be true. Unfortunate level of sugar in blood is not Vital. So, no one take blood sugar reading if one was not diagnosed with diabetes, ether type of it.
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Standards of Medical Care in Diabetes: Abridged for Primary Care Providers

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