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Thursday, 19 April 2018

New Diabetes Guidelines. What's New? April 19. 2018

[Editor's Note: These recommend setting most A1c targets between 7% and 8%, scaling back treatment when A1c drops below 6.5%, and avoiding A1c targets altogether in elderly and chronically ill patients where harms might outweigh benefits.]
 https://www.medscape.com/viewarticle/894841?nlid=121889_1521&src=WNL_mdplsfeat_180417_mscpedit_wir&uac=164666HZ&spon=17&impID=1609945&faf=1#vp_1
        Interesting, is not it? Really, what does it mean when A1c between 4.8% and 5.9%? Does it mean that patient is no longer diabetic, does not need insulin? Without insulin what would happen with A1c as soon as insulin injections stopped? Do your trial study if there are many diabetics type 2 who has this level of sugar in blood. There are not too many if any. If so then say me, why diabetics who improved level of sugar and very closer to be cured and diabetes type 2 free, why this diabetic must be scaling back? Does this diabetic getting more ill, disabled, or any health problem in addition to those which are already in the basket? Not at all. Diabetic getting better, and this is the problem. There is no Cure for diabetics type 2. When cure is very close, the treatment must be stalled back, and diabetic must be put on scale to be ready for fatty coffin.
       To set the record straight, they are (ACP)very concerned about hypoglycemia risk and weight gain. I am also very concerned about hypoglycemia and weight gain. And in all of the older studies, these were major risks.
     For the record, those of us who was able to get to the point A1c<6.5% already do know very well how to deal with low blood sugar. It is danger for those who has A1c>8% with sugar rising above 400 mg/dl. Also I will say that the danger of low sugar is higher when sugar is higher. Interesting discrepancy, then higher level of sugar then loser it drops, and faster. With sugar around normal level sugar drops slow, and low sugar even when it is really low such as 42mg/dl, is not so danger. Paradox in Diabetes type 2 treatment with Insulin Injections.
      There is another paradox, weight gain. It does not happen when blood sugar start to drop with insulin injections. Weight start to drop, or stop to getting up. I am prove of that. My weight does not go up with 600 units of Lantus Solo Star. It stay on the level as it was before, 380 pounds, and a little bit less. This is for records only.
But we now have drugs that do not cause hypoglycemia and weight gain. We actually have drugs for the treatment of type 2 diabetes that reduce both cardiovascular risk and progression of nephropathy. So, I think the way the world looks for the treatment of type 2 diabetes now is quite different from the world when the studies they are quoting were conducted. (Anne Peters)
Say me, what drugs are they that does not cause both, weight gain and hypoglycemia?  There is no drugs like that. There are limited number of studies, yes. If we do not have info it does not mean that the point can be taken for granted. Show me one diabetic type 2 who started drugs and did not gain weight? Well, it can be Invokana. Invokana is strong diuretic. Invokana leads to weight loss and CVD, Death as a result of stroke, MI, or kidney failure. I never take Invokana, or any other diuretics.
     The drug which does not cause low blood sugar is Metformin, very popular number one MD choice. Metformin does not effect level of sugar, so why it is Rx as treatment for Diabetics type 2? Because of it is cheap, and MD can Rx it without any problem. All problems will come later. This is why Diabetes type 2 is number 7 cause of Death in America. Over 80,000 diabetics die every year due to diabetes. With Insulin ready on market, perfect cure for diabetes of any type, it is not MD choice when Diabetic type 2 come to clinic. The result is, less then 10 years after being diagnosed with diabetes type 2 diabetic die if one did not stop all medicine for diabetes type 2 and started to take Insulin, Insulin only as First drug to treat diabetes type 2. In this case diabetic type 2 keep to walk on two legs, and with time can be cured.
"We know irrefutably that reducing the A1c to below 7% is associated with a reduction in diabetic retinopathy, nephropathy, and neuropathy." (ACP)
 If so then say me, what is the reason for me to "caling back treatment"? My A1c< 5.9% now. This took years to go High - Low, and now what, to take that swing another time? Say m, why do I need it? I do not. It is ACP who need to keep me on the top of diabetes danger list. I do not need it. But I need insulin to keep my sugaar under Diabetes type 2 cut level. With Guidance like that Insulin supply would be stopped. Sugar really very fast will go back to 699 mg/dl and over. This is swing we are all on.

 You may say that we do not have lots of good, long-term data about these new treatments, but I believe that we actually have a lot of data to inform us. (Anne Peters)
      OK, I got it, there is no data about new treatments, What about "old" treatments, Metformin and SU?  Is there are data how this drugs work? Not at all. Both these drugs are not expensive, so there is nothing to worry about them. Does that drug treat or cure, diabetes type 2, or lead to reduce nephropathy? No. If "no" then why do I need drugs which does not do what they Rx to do, and all what left just side effects? Thank you so much, I will not bite it.
 They say that if someone's A1c is too low, and the patient is getting hypoglycemic and gaining weight, back off. I could not agree more. (Anne Peters)
I am not agree.
     At first, say me, how do I know if my A1c is too low? Really, it is easy to say, but this test we do have  in best way 3 within the year. Many of us do not have this test at all, or less then year.
      Second, how MD do know if I do have low blood sugar? Only if I said it, or I was treated in hospital caused by low blood sugar. Usually we do not go to hospital when sugar is low. We go to kitchen and grab something to eat. So, there is no one way that MD do know about my low blood sugar.
    So, Anne Peters and ACP agree in what? Only in one point, they do not know what id Diabetes type 2 and how Human Body System works. I am agree with that.
If I have a 50- or 60-year-old with new-onset disease, who I believe does not have a number of limiting comorbidities, that patient may well live longer than 10 years, longer than 20 years, maybe even longer than 30 years. That patient may say, "I want my target to be less than 7% so that I avoid those complications." (Anne Peters)
    Sorry, does not it sound as discrimination? What are difference between 50, 60, and 16 years old in regard of diabetes treatment? 16 years old would be treated with Insulin and live over next 70 years. 60 years old would be treated with SU, get amputation, at first one leg, then another leg, and heart attacks and all what is possible to get. But A.P.right, diabetic type 2 who today is 60 years old will live 10 years and probably 20 years, miserable, in pain and suffering, paying high price for discrimination, collect pounds, gain weight, and finally rejected by society that this diabetic who lived up to 60 years old, must be treated with disciplinary correction. 16 years old does not need any disciplinary correction. It is slim and pretty.


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