http://care.diabetesjournals.org/content/41/Supplement_1/s13#T5
“Standards of Medical Care in Diabetes” 2018 by ADA
Every year ADA publish upgraded Standards to use to treat Diabetes foe Professional Practitioners. Now this 'Standard' published, and it is time to take a close look at the how ADA recommend address to Diabetes Treatment.
At first, of cause, before any treatment would start, it is diagnose and definition of what treatment suppose to treat. In new "Standards' there is nothing new. As usual,
Now there is another odd definition, diabetes type 2. It is said that diabetes type 2 happened due to a progressive loss of B-cells. So, if progression of loss continues then what is difference between types of diabetes? Is this possible that with time till diabetes was not even diagnosed yet the B-cells loss was so progressive that there is absolute insulin deficiency?
Types of diabetes where defined as 'insulin dependent' and 'non-insulin dependent'. What about those of us who diagnosed as type 2 diabetic and need insulin added in injections? Are we 'insulin dependent' or we are 'non-insulin dependent'?
In my reference books Doctor Joslin defined insulin resistance as type of diabetes when diabetic needs more then 200 units of insulin. So, does diabetic type 2 insulin dependent or not insulin dependent? Still not clear.100 years after insulin discovery the definition of diabetes still confusion and not clearly defined.
There is nothing new to define the stages of diabetes. They simple does not have place to be. All attention to diagnose diabetes. The diagnose of diabetes based on level of sugar in blood, just above the range level. In reality no one of us ever was diagnosed with this level of sugar. But the level 'above range' is so warred. To get my point just think about the temperature of body of Blood Pressure. Every one of us do know very well that flu and pneumonia is not the same. Every one of us do know that 140/80 is not the same as 220/100. If so then why ADA has no any classification how to define stages of diabetes type 2? 200mg/dl is not the same as it is 370 mg/dl fasting, or 599 mg/dl random. There still no any info on this matter. So, when reader take a look then one think that type 1 diabetics do have high blood sugar. This is why they need insulin. Type 2 diabetics do not have high blood sugar. They just have elevated blood sugar and this can be easily
worked out with activity, work outs, and diet. No one think that 700 mg/dl is the ordinary blood sugar level for people with diabetes type 2. This is why diabetics type 2 die due to diabetes, number 7 cause of Death in America.
Metformin was discovered almost at the same time as Insulin. But only later, about 1950 it was active in treatment of diabetes. There were three generation of this medicine which were discontinued due to high toxic effect. Last one, Metformin, stay longer then any of them. It is considered to first MD choice to treat diabetes type 2. To see, if Metformin really work or not, just stop to take it and see, now level of sugar going up or down. BTW, Medical Pro do not like to take Metformin. They also do not like to take SU. They do not like to lost B-cells. For the rest of us it is OK. We are not VIP.
Now back to the starting point. If initially diabetics type 2 would require insulin therapy then why do not start with this therapy as first line of treatment? Long before the rest of insulin secreting B-cells would be lost, let us to preserve our health and well being. Just start with insulin rather then Metformin. No one has benefits form Metformin but company which manufacture it and sell.
Still, it is not the first line of therapy for diabetics type 2. It is diabetes as cause of death stand on spot number 7. Diabetics type 2 stand first in all spots in all cause of death. We cannot live without medicine. We need insulin. Then wider gap between insulin in demand and insulin available in secretion then wider our middle area. Insulin would shrink this size. Insulin let us live longer.
“Standards of Medical Care in Diabetes” 2018 by ADA
Every year ADA publish upgraded Standards to use to treat Diabetes foe Professional Practitioners. Now this 'Standard' published, and it is time to take a close look at the how ADA recommend address to Diabetes Treatment.
At first, of cause, before any treatment would start, it is diagnose and definition of what treatment suppose to treat. In new "Standards' there is nothing new. As usual,
Type 1 diabetes (due to autoimmune β-cell destruction, usually leading to absolute insulin deficiency)
Type 2 diabetes (due to a progressive loss of β-cell insulin secretion frequently on the background of insulin resistance)So, to be clear, if diabetic is diabetic type 1 and has no insulin secretion then "Honeymoon phase' come from where? Odd, is not it? Hally Berry stopped to take insulin, she was diagnosed as type 1 diabetic, and insists that now she is type 2 diabetes. She needs medicine, but does not need insulin. It is official and published everywhere. If this is possible that sometimes diabetics type 1 do not need insulin injection then it is really odd that they do have 'absolute insulin deficiency'.
Now there is another odd definition, diabetes type 2. It is said that diabetes type 2 happened due to a progressive loss of B-cells. So, if progression of loss continues then what is difference between types of diabetes? Is this possible that with time till diabetes was not even diagnosed yet the B-cells loss was so progressive that there is absolute insulin deficiency?
Types of diabetes where defined as 'insulin dependent' and 'non-insulin dependent'. What about those of us who diagnosed as type 2 diabetic and need insulin added in injections? Are we 'insulin dependent' or we are 'non-insulin dependent'?
In my reference books Doctor Joslin defined insulin resistance as type of diabetes when diabetic needs more then 200 units of insulin. So, does diabetic type 2 insulin dependent or not insulin dependent? Still not clear.100 years after insulin discovery the definition of diabetes still confusion and not clearly defined.
Classification is important for determining therapy, but some individuals cannot be clearly classified as having type 1 or type 2 diabetes at the time of diagnosis. The traditional paradigms of type 2 diabetes occurring only in adults and type 1 diabetes only in children are no longer accurate, as both diseases occur in both age-groups.With millions of adults who live with non diagnosed diabetes it is easy to assume that they are diabetics type 1, but they were not diagnosed with diabetes when there were children. So, to diagnose diabetes according to age of victim is not reasonable. It is diagnose, not the beginning of disease. It is not duration of disease, or any reasonable health mark such as the level of B-cells lost. Not at all. In diagnose and classification there is only tools clinicians use, the age, size of middle area, and of cause ability of MD to use Art of Medicine. Not reasonable or reliable tools or marks.
Although difficulties in distinguishing diabetes type may occur in all age-groups at onset, the true diagnosis becomes more obvious over time.Not really true. If once adult diabetic was diagnosed with type 1 diabetes, then with time MD such as doctor A.Peters will re-diagnose victim and stop insulin therapy replacing it with Metformin. In case one was diagnosed as diabetic type 2 there are never another diagnose come to replace this stamp. Regardless of how many b-cells was lost, and even if there are still b-cells to secret insulin.
Diabetes may be diagnosed based on plasma glucose criteria, either the fasting plasma glucose (FPG) or the 2-h plasma glucose (2-h PG) value during a 75-g oral glucose tolerance test (OGTT), or A1C criteria (6) (Table 2.2).Many years I try to find out, how type of diabetes diagnosed. I still try, but no result. Both types diagnostic based on the level of sugar in blood. So, how one type of diabetes different from another? No difference. The normal range is the same. The abnormal range is very different, from normal such as 100 mg/dl up to 700 mg/dl, and higher. Still, if size of body is wide then it is type 2 diabetes, regardless of the level of sugar in blood. If size of the body is normal then .... then it still type 2 diabetes. Only children diagnosed with type 1 diabetes, or VIP. The rest of us type 2, non-VIP population.
There is nothing new to define the stages of diabetes. They simple does not have place to be. All attention to diagnose diabetes. The diagnose of diabetes based on level of sugar in blood, just above the range level. In reality no one of us ever was diagnosed with this level of sugar. But the level 'above range' is so warred. To get my point just think about the temperature of body of Blood Pressure. Every one of us do know very well that flu and pneumonia is not the same. Every one of us do know that 140/80 is not the same as 220/100. If so then why ADA has no any classification how to define stages of diabetes type 2? 200mg/dl is not the same as it is 370 mg/dl fasting, or 599 mg/dl random. There still no any info on this matter. So, when reader take a look then one think that type 1 diabetics do have high blood sugar. This is why they need insulin. Type 2 diabetics do not have high blood sugar. They just have elevated blood sugar and this can be easily
worked out with activity, work outs, and diet. No one think that 700 mg/dl is the ordinary blood sugar level for people with diabetes type 2. This is why diabetics type 2 die due to diabetes, number 7 cause of Death in America.
The recommendation regarding the use of metformin in the prevention of prediabetes was reworded to better reflect the data from the Diabetes Prevention Program.Metformin work perfectly to prevent diabetes type 2. But in any cases when someone pretend that one is diabetic and takes Metformin no one MD will consider this diabetic as diabetic. It is only for prevention. It works for every 9 person out of ten. One out of ten is diabetic. Metformin fail to prevent it. So, regardless one takes Metformin or not, diabetes would be developed or not. Classic Prevention.
New recommendations for antihyperglycemic therapy for adults with type 2 diabetes have been added to reflect recent cardiovascular outcomes trial (CVOT) data, indicating that people with atherosclerotic cardiovascular disease (ASCVD) should begin with lifestyle management and metformin and subsequently incorporate an agent proven to reduce major adverse cardiovascular events and/or cardiovascular mortality after considering drug-specific and patient factors.So, if Metformin fail to prevent diabetes type 2 then it is time to Rx Metformin as treatment for diabetes type 2.
Metformin was discovered almost at the same time as Insulin. But only later, about 1950 it was active in treatment of diabetes. There were three generation of this medicine which were discontinued due to high toxic effect. Last one, Metformin, stay longer then any of them. It is considered to first MD choice to treat diabetes type 2. To see, if Metformin really work or not, just stop to take it and see, now level of sugar going up or down. BTW, Medical Pro do not like to take Metformin. They also do not like to take SU. They do not like to lost B-cells. For the rest of us it is OK. We are not VIP.
Many patients with type 2 diabetes eventually require and benefit from insulin therapy. The progressive nature of type 2 diabetes should be regularly and objectively explained to patients. Providers should avoid using insulin as a threat or describing it as a sign of personal failure or punishment.Now the question is, if diabetic type 2 would start to take insulin, would this diabetic considered as 'insulin dependent' or one would stay 'non insulin dependent diabetic'? And if diabetic type 2 who takes insulin considered as insulin dependent diabetic then what is difference between two types of diabetes? No difference.
Now back to the starting point. If initially diabetics type 2 would require insulin therapy then why do not start with this therapy as first line of treatment? Long before the rest of insulin secreting B-cells would be lost, let us to preserve our health and well being. Just start with insulin rather then Metformin. No one has benefits form Metformin but company which manufacture it and sell.
Still, it is not the first line of therapy for diabetics type 2. It is diabetes as cause of death stand on spot number 7. Diabetics type 2 stand first in all spots in all cause of death. We cannot live without medicine. We need insulin. Then wider gap between insulin in demand and insulin available in secretion then wider our middle area. Insulin would shrink this size. Insulin let us live longer.
via Ravenvoron
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