July 26, 2006

Diabetics and Wound Healing, Alzheimers, Heart attack, etc.

You see these studies all the time that tell you cheery "facts" such as that diabetics are more likely to get heart attacks, Alzheimers, and have poor healing after wounds or surgery. Depressing, isn't it?

What they don't tell you is that the "diabetics" they are talking about are really "Diabetics with lousy blood sugar control". The diabetics in the studies that lead to these conclusions universally have A1cs of at least 7% and often more like 10% along with fasting blood sugars near 200 mg/dl (11 mmol/l).

Doctors all too frequently tell people with Type 2 diabetes that an A1c of 7% is "fine" and don't point out that an A1c that high almost guarantees neuropathy and early changes in the retina and kidneys leading, eventually, to disaster.

The 7% A1c target was originally established after the DCCT study found that people with Type 1 diabetes who achieved that A1c had far fewer complications than those whose A1cs were higher. (No study ever looked at what happened to complications if the A1cs were LOWER than 7%). But when they ran a similar study of Type 2s, the UKPDS, while they found that the 7% A1c resulted in fewer complications than higher ones, they also found that people with type 2 diabetes at the 7% A1c got far MORE complications than Type 1s had who had that same A1c. In short, an awful lot of people with Type 2 diabetes followed in the UKPDS study who kept their A1cs at 7% ended up with serious complications including retinopathy (med-speak for blindness).

The conclusion that should have been drawn from this is that people with Type 2 diabetes need to shoot for much lower A1cs than those with Type 1. Unfortunately, that isn't what happened. Most doctors still tell patients that 7% is a good A1c target that prevents complications and labs flag anything under 7% as "good control."
It isn't. Good control is control that gets you as close to normal numbers as is possible.

What is normal? There's some evidence that true normal is an A1c of 4.7%, a fasting of 83 mg/dl (4.6 mmol/L) and post-meal readings no higher than 120 mg/dl (6.7 mmol/l) within 2 hours of a meal. That's a tough target to meet and one that a lot of us can't reach. But the closer you can get to these numbers, the better off you will be.

Most people with Type 2 diabetes CAN get their A1cs into the 5% range with a combination of cutting way back on carbohydrates, taking insulin resistance drugs like Metformin, and if things are really out of control, insulin.

So when you see yet another study that tells you that because you have diabetes you are doomed to yet another nasty life-shortening condition, remind yourself it isn't some underlying condition causing these problems, it is high blood sugars, day after day, meal after meal. If you can bring your blood sugars down to normal, your risk for these conditions will drop to normal too!