This is book of Bestselling Joslin Diabetes Manual. It is for reducing the effects of Insulin dependent Diabetes. So, I will take the questions author asked or presented and see how he answered to the questions he asked. Also there are mine answer's to the same question. I based my answers on the books I read and on my personal experience.
Can Diabetes Complications Be Prevented?
With intensive Insulin Therapy, when blood sugar was under tight control, meaning as closer to the normal, non diabetic level as it is possible, the outcome of study were:
eye complications reduced to 76%;
kidney complications reduced to 56%;
nerve problem reduced up to 60%.
Study did not have data how it reduced heart and stroke risk.
So, it is very easy to see, the benefits are obvious.
First question, why do not take the risk of tight blood sugar control?
Why studies were stopped one year early then they were planned?
How to take blood sugar under tight control?
What medicine used in study to study tight blood sugar control?
It was insulin. Studies were started in 1980 and stopped in 1993. It is DCCT studies, Diabetes Control and Complications Trial. Volunteers were divided on two groups:
'conventional' diabetes management with one or two injections of insulin every day, blood sugar readings once a day, dietary education, and clinic 4 times a year.
'intensive therapy' with four or more insulin injections daily, insulin dose adjustment according to the blood sugar readings, diabetes education program, and monthly medical visits.
What is downside of insulin intensive therapy?
severe low blood sugar.
Severe meaning, it was in need for outside help, or ER visit. Well, I can say about ER visit. I was in ER with stroke. I was discharged a few hours late with diagnose 'hypoglycemia'. I will trust that really it was severe low sugar of I will see the number. Otherwise, how it can be 'severe' depend from doctor or diabetic point of need. Someone see 'severe' with blood sugar 64mg/dl and go to ER, and other stay home even with 38 mg/dl or 32 mg/dl.
So, low blood sugar really prevent us from being enthusiastic to take insulin shots. It is in no one way preventable. This is biggest problem with intensive insulin therapy. 'Conventional' way is more convenient and out of danger. It leads to deeper degeneration of beta cells. So, it is only matter of time when we have to pay price for this convenience. The price we pay is pain, severe pain, and our timeless deaths.
Another downside is weight gain.
Do I really very care I do have 10 pounds more then I do have right now? Only when one is naive and have no understanding what is in the future. With time water retention will take over diabetic life, and there is no way to stop it from developing high edema, extreme weight gain. No any control to stop it. Only blood sugar control can prevent amputation, and kidney and heart failure. So, early or late, diabetic must take blood sugar under control. If it is early then it is easier. When it is late, it can be too late.
Tight Blood Sugar Control is more expensive then convenient therapy.
If diabetic start to take insulin early, as soon as one diagnosed with diabetes, then dose of insulin, long acting insulin lantus solo start would be lower, not so high, and most health care companies will cover this spending. Even diabetic can pay for insulin supply. It is one box about $400 for 5 pens 300 units every pen. Diabetics type 1 take less then 50 units daily. So, one pen for the week of insulin therapy. One box for the month. Diabetics type 2 can be good with 20 units daily.
Do your math if you wish.
Can Diabetes Complications Be Prevented?
With intensive Insulin Therapy, when blood sugar was under tight control, meaning as closer to the normal, non diabetic level as it is possible, the outcome of study were:
eye complications reduced to 76%;
kidney complications reduced to 56%;
nerve problem reduced up to 60%.
Study did not have data how it reduced heart and stroke risk.
So, it is very easy to see, the benefits are obvious.
First question, why do not take the risk of tight blood sugar control?
Why studies were stopped one year early then they were planned?
How to take blood sugar under tight control?
What medicine used in study to study tight blood sugar control?
It was insulin. Studies were started in 1980 and stopped in 1993. It is DCCT studies, Diabetes Control and Complications Trial. Volunteers were divided on two groups:
'conventional' diabetes management with one or two injections of insulin every day, blood sugar readings once a day, dietary education, and clinic 4 times a year.
'intensive therapy' with four or more insulin injections daily, insulin dose adjustment according to the blood sugar readings, diabetes education program, and monthly medical visits.
What is downside of insulin intensive therapy?
severe low blood sugar.
Severe meaning, it was in need for outside help, or ER visit. Well, I can say about ER visit. I was in ER with stroke. I was discharged a few hours late with diagnose 'hypoglycemia'. I will trust that really it was severe low sugar of I will see the number. Otherwise, how it can be 'severe' depend from doctor or diabetic point of need. Someone see 'severe' with blood sugar 64mg/dl and go to ER, and other stay home even with 38 mg/dl or 32 mg/dl.
So, low blood sugar really prevent us from being enthusiastic to take insulin shots. It is in no one way preventable. This is biggest problem with intensive insulin therapy. 'Conventional' way is more convenient and out of danger. It leads to deeper degeneration of beta cells. So, it is only matter of time when we have to pay price for this convenience. The price we pay is pain, severe pain, and our timeless deaths.
Another downside is weight gain.
Do I really very care I do have 10 pounds more then I do have right now? Only when one is naive and have no understanding what is in the future. With time water retention will take over diabetic life, and there is no way to stop it from developing high edema, extreme weight gain. No any control to stop it. Only blood sugar control can prevent amputation, and kidney and heart failure. So, early or late, diabetic must take blood sugar under control. If it is early then it is easier. When it is late, it can be too late.
Tight Blood Sugar Control is more expensive then convenient therapy.
If diabetic start to take insulin early, as soon as one diagnosed with diabetes, then dose of insulin, long acting insulin lantus solo start would be lower, not so high, and most health care companies will cover this spending. Even diabetic can pay for insulin supply. It is one box about $400 for 5 pens 300 units every pen. Diabetics type 1 take less then 50 units daily. So, one pen for the week of insulin therapy. One box for the month. Diabetics type 2 can be good with 20 units daily.
Do your math if you wish.
via Ravenvoron
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