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In the story of Goldilocks and the Three Bears, children learn that too much and too little are not good. We all need to strive for just right. The same may be true for the management of type 2 diabetes.
There was a time when tight blood sugar control was considered highly desirable. This often meant treating type 2 diabetes quite aggressively in an attempt to achieve as close to normal blood glucose levels as possible. The hope was that this strategy would lower the risk of heart attacks, strokes and other complications of diabetes.
A new report published in The Lancet, however, suggests that such an approach may produce unexpected complications. In this European study patients who used insulin to bring blood sugar levels close to normal had a 49 percent higher risk of dying than those who just used oral medications to manage their diabetes. The results confirm those of a large U.S. trial that was stopped prematurely because there were one fifth more deaths in diabetes patients who were treated aggressively than among those treated more cautiously. The message seems to be that blood sugar should never be too high or too low.
[The Lancet, Feb. 6, 2010]
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I have been concerned that my blood sugar hovers between 150 & 200. Rarely does it drop below 150 or go above 200. Now, I just assume that that is normal for me. Nothing I do, diet or exercise, seems to make a significant change. Wonder if I am alone with this feeling?
My brother was insulin dependent for 25 years and did well with it. He went into the hospital for the flu, they gave him insulin, left him alone in the room while he was too ill to know his blood sugar was plummeting down. A nurse came in hours later and found him unresponsive. His blood sugar went down to 1. Yes you read correctly ONE.
They gave him an IV of sugar solution to bring it up. He came to miraculously, but all was not well at all.
He actually managed to get on a plane a few weeks later and the airline removed him from the flight and put him in an ambulance to the hospital. The hospital put him in ICU, while in ICU they also gave him too much insulin and again, a sugar IV drip.
My brother was 46 years old. He would have turned 53 tomorrow had the hospitals monitored his blood sugar while he was there......
I have heard that patients in hospitals are at very high risk of dying of low blood sugar. They need separate segregated areas where diabetics are monitored every 30 minutes by hospital staff. Or, hospitals can invest in the watches that set off alarms in blood sugars fall out of range.
Aren't our lives worth that investment?
I love this site and your work and helpful info on health...I am a fan. However, with this study, please go to http://diabetesupdate.blogspot.com/ and read Jenny Ruhl's comments and examination of the true meanings of this study.
I am a Type 1 Diabetic, currently working with Dr. Ron Rosedale, I am a follower of Dr. Richard K. Bernstein "The Diabetes Solution"and I love the information provided by Jenny Ruhl at her blog Diabetes update.
Diabetes is a disease which can be controlled in the normal blood sugar range. These kind of studies send the wrong and deadly message to diabetics that poor blood sugar control is better than good blood sugar control. When we keep normal blood sugar control, our risk of complications is greatly diminished.
PEOPLE'S PHARMACY RESPONSE: TYPE 1 DIABETES IS DIFFERENT FROM TYPE 2 DIABETES, SO THERE IS NO REASON TO ASSUME THAT THE RESULTS FROM THIS STUDY WOULD APPLY TO YOU. WE ALSO DON'T KNOW A LOT ABOUT THE PEOPLE IN THIS STUDY--HOW DID THEY ATTEMPT TO CONTROL THEIR BLOOD SUGAR, FOR EXAMPLE? WE HAVE BEEN VERY IMPRESSED WITH DR. BERNSTEIN'S BOOK, AND JENNY RUHL'S BLOG LOOKS INTERESTING. PROBABLY THE MAIN POINT FROM THE STUDY IS THAT THE DOCTORS' PREVIOUS AUTOMATIC ASSUMPTION (HOW LOW CAN YOU GO? GET EVEN LOWER) MAY NOT ALWAYS APPLY, PARTICULARLY IF THE PRIMARY MEANS OF LOWERING BLOOD SUGAR IS THROUGH MEDICATIONS RATHER THAN THROUGH DIET AND EXERCISE (MUCH MORE DIFFICULT, BUT POSSIBLY LESS HAZARDOUS).
I have two complaints. First, the last sentence seems to contradict the rest of the article: "The message seems to be that blood sugar should never be too high or too low." If blood sugar should never be allowed to get too high or too low, then it would seem that some kind of aggressive treatment is needed.
Second, the article doesn't say if the two groups of patients started with equally severe cases of diabetes. If this was not the case then it would be hard to draw any conclusions from the results.
PEOPLE'S PHARMACY RESPONSE: THE COHORT STUDY, IN ENGLAND, WAS NOT A CONTROLLED TRIAL, BUT RATHER GATHERED HEALTH DATA FROM THE MEDICAL RECORDS OF NEARLY 48,000 PEOPLE WITH TYPE 2 DIABETES BETWEEN 1986 AND 2008. SO IT IS NOT POSSIBLE TO SAY IF THE DIABETES WAS EQUALLY SEVERE AMONG THE VARIOUS GROUPS.
THE RESEARCH DOES SHOW THAT THOSE IN THE FOURTH OF PATIENTS WITH THE LOWEST HbA1c (AVERAGE 6.4%) AND THOSE IN THE FOURTH WITH THE HIGHEST HbA1c (AVERAGE 10.5%) WERE MORE LIKELY TO DIE IN THOSE TWO DECADES THAN THOSE IN THE MIDRANGE (AVERAGE ie MEDIAN HbA1c 7.5%). UNTIL RECENTLY, MOST DIABETES SPECIALISTS HAVE ASSUMED THAT GETTING HbA1c AS LOW AS POSSIBLE IS DESIRABLE, BUT THAT ASSUMPTION IS NOW BEING QUESTIONED.
Does the research come up with specific limits? How high is too high and how much is too low? I'm assuming that an A1C around 6 is still a desirable goal, but would like to see upper and lower number limits e.g. over 200 too high under 60 too low. Thanks for all you do.
PEOPLE'S PHARMACY RESPONSE: ACCORDING TO THE STUDY, HIGHER THAN 6.6 AND LOWER THAN 10.1. BEST WAS AROUND 7.5%. THIS IS A BIG STUDY, BUT BY NO MEANS THE LAST WORD ON THIS QUESTION.