Diabetes is a bummer. It increases the risk for all sorts of serious chronic conditions. Patients with diabetes are at increased risk for heart attacks, strokes, kidney problems, vision loss, nerve damage (peripheral neuropathy), and foot and skin problems. There is also an increased risk for dementia.

With such a list of complications, it is hardly any wonder that physicians would want to reduce those risks as much as possible. One approach they have tried over the last several years has been “tight control” of blood sugar. Experts came up with recommendations to keep blood glucose, cholesterol and blood pressure as close to normal as possible. This was accomplished by prescribing multiple medications to reach a target range and was tested in a large study called the ACCORD trials. (ACCORD stands for Action to Control Cardiovascular Risk in Diabetes).

The only trouble with the program was that it didn’t work. Aggressive control of blood sugar, blood pressure and blood fats (including cholesterol) did not keep people with diabetes from dying prematurely of heart attacks and strokes (The New England Journal of Medicine 2008; 358:2545-2559).

As disappointing as these results were, there was another gigantic OOOPS associated with the ACCORD trials. Patients who received the most intensive (tight) control of blood sugar actually did less well than those with more flexible treatment. Patients in the aggressive treatment group died earlier and fared worse than those receiving more moderate treatment (The Lancet 2010; 375:481-495). That appears to be because low blood sugar may be just as bad as high blood sugar. Tight control often leads to dangerous dips in blood glucose.

All that is old news, though. A brand new study in The Lancet suggests that tight blood sugar control doesn’t help prevent dementia either (The Lancet 2011;online Sept. 28, 2011). In this study roughly 3,000 patients with diabetes were randomized to receive either aggressive blood sugar management (below 6 percent on the A1c test) or more flexible treatment (A1c levels between 7 and 7.9 percent). After more than three years of treatment there was no difference in cognitive function between the two groups.

The bottom line conclusion from all this research suggests that people with type 2 diabetes need to be prudent but not obsessive about controlling blood sugar levels. There is a sweet spot that is a little like Goldilocks’ porridge. If you remember, it should not be too hot or too cold. The same can be said for blood sugar…not too high nor too low. People with diabetes need to find a health coach who can help them keep their weight in a good range, exercise regularly, eat sensibly and maintain reasonable blood sugar control.

By the way, next Tuesday (October 4th) we launch a brand new book, Top Screwups Doctors Make and How to Avoid Them (Crown, a division of Random House). In it you will learn that health care harm is one of the top killers in America, rivaling heart attacks and strokes. We discuss the ACCORD trials in much more detail along with the top screwups doctors make for a variety of conditions including diabetes, Alzheimer’s disease, arthritis, asthma, celiac disease, depression, fibromyalgia, heartburn and osteoporosis. Look for it in bookstores, libraries or online. It will be in our shopping cart on Tuesday.

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  1. Sara

    The new theory is what the above article talks about, but drugs were usedin the ACCORD studies to bring down A1cs. Others, myself included, argue that if a low carb diet is followed, the a1c lowers without the need of the many drugs aside from metformin that patients are put on.

  2. abigail

    Metformin, one of the drugs used to keep blood sugar levels in normal range for diabetics, can result in B12 deficiency.
    For elderly persons, A1C levels should not be below 6 – this is the new theory. Too low can be harmful also.

  3. sd

    I totally agree!! Remember the saying “You ARE what you EAT”? Well this seems to keep coming up as the truth. Everything in moderation. Don’t just eat and then SIT… get up and MOVE, or you will become just a sick LUMP! Educate yourself about what you are eating. It’s YOUR body. What quality of life do you want if you abuse it?!

  4. MJ

    Type 2 varies tremendously from one person to another. Losing weight had much better results than taking insulin for me, but I ended up having to do lap band to achieve it – and even then it is a struggle to maintain – and yes, I watch what I eat and I exercise (completed a marathon earlier this year.) I knew that the extreme insulin I was taking was doing me more harm than good and finally had to put my foot down. It was just making my insulin resistance stronger and making it impossible to maintain, much less lose weight.
    I would have terrible lows but then bg would sky rocket right back up again. Exercise also makes my bg go up, not down. The more I exercise, the more it goes up and the longer it stays up. Have gone back to 1 1-hour or 2-1/2 hour walks a day with one or two longer hikes each weak, sometimes mixing in bicycling or paddling. All things in moderation is what works best for me – no extreme diets, no extreme exercise, no stressing over diet, exercise, and perfect bg levels. I do think stress management may be the most significant component. Walking, hiking and paddling are like meditation for me. I am trying to add in some daily yoga for flexibility and light strength training.

  5. darma

    I find it hard to believe these people were only on diabetes medicines since most doctors insist a diabetic “must” be on statins, which are well known for cognitive problems among many other side effects, including increasing your blood glucose.
    I found the most improvement in my meter readings – not to mention several other health problems – when I gave up wheat (no pasta, bread, etc.). Now gone are: migraines, dry skin, excessive dandruff, IBS and flatulence, restless legs, back pain, and ALL medications (for blood pressure and diabetes). . And I highly doubt my 4.7 A1C is going to kill me. My doctor was very pleased to see that. Tight control without meds is not only possible but a heckuva lot more natural, at least for those who still have some working beta cells left.

  6. Dr. Don Selvidge

    This is another example of how our modern approach to healthcare is illogical. The body has an amazing built-in ability to regulate itself without our measuring and tampering. We need to be concerned about living a lifestyle in harmony with the way the body was designed and everything takes care itself. Maybe that is too simple for modern man.

  7. RobLL

    Generally tight diabetic control is attempted by a lot of oral drugs most of which have a lot of side effects, some serious. I would not take any of them, save Metformin (which unfortunately I do not tolerate). Very low carb and insulin keeps my A1Cs at about 5.0 My retinopathy is continuing, but no longer threatening my sight.
    Tight control is below 6, and almost of necessity entails low to very low carbs. Few in the field suggest it. For most of us who do complications seems to diminish.

  8. JLJ

    I am aware of 2 people who have reversed blood sugar problems (pre diabetes in one case) through following the no oil diet of Dr Esselstyn (book is “Preventing and Reversing Heart Disease”). This is the diet that former President Bill Clinton is now following. It is worth considering. it results in weight loss but also other significant health benefits as well.

  9. GNT

    it is so much easier for folks to take a pill, or even a shot, compared to a healthy diet, sensible weight and regular exercise. The number of obese children in our community is depressing! We need funding for motivating and helping folks adhere to behavior change – advice, goal setting and follow-up visits only work with a few, already motivated people. Now… how to make the others ‘thirsty’?

  10. HJL

    Sara has it right. A low carb diet promotes weight loss which as stated above, in and of itself, will lower A1C. In addition, a low carb diet will keep your glucose normal in a healthy range w/o ups or downs.
    You had Eric Westman, MD on recently and he said flat out he gets Type 2 diabetics off all diabetes meds in about a week. He also said that the diet brings down BP among other good blood results (trylcerides, HDL and VLDLPDs).
    The answer is right in front of us if we only will listen, learn and keep an open mind.

  11. Karen

    >That appears to be because low blood sugar may be just as bad as high blood sugar. Tight control often leads to dangerous dips in blood glucose.
    Or is it possible that the various medications required to obtain tight blood sugar control, in the absence of tight intake management, cause more problems than they solve? Non-diabetics achieve remarkably tight blood sugar control all the time, and it doesn’t affect our/their long term outcomes one bit.
    It would be more helpful if studies like these reported dietary information as well as drug-related outcomes.

  12. B.C.

    We are so thankful to be in contact with you both! I believe so little of what I read – except – the information that arrives from you. Thank you so much for your honesty and excellent hard work. From a Canadian who is most appreciative…..B.C.

  13. jncjnsn

    My Doctor doesn’t pay any attention to my BG readings. He is only concerned with my A1C test which is usually good

  14. am

    Informative article.

  15. Victor W. M.

    Approaching 80….Type ll for over 20 years….I try for moderately tight control with an a1c slightly below 7….blood pressure controlled with medication and moderate exercise in the 125/65 range with some variation. Check blood sugar 2 to 4 times daily as needed.
    My approach is based on common sense given an awareness of all the parameters. I maintain weight control within a 5 lb range…. I am 5’9″ and about 158#…moderately active and more fit than most who are much younger. Surprising I have had no significant adverse reactions. Believe there are a lot of myths!

  16. Sara

    The problem with these studies is that they relied on multiple medications to control blood sugars. More meaningful would have been a control group that was able to keep their blood sugar levels below 6 for example by diet alone. Too many diabetics rely on meds because they don’t want to limit their carb intake enough to get good results.

  17. DRC

    Whew, thanks for the info….

  18. Fran

    It seems that, so many times, drugs do more harm than good. And yet, at times, they are life savers. As for diabetes and sugar, it seems to me it is folly for Americans to eat as much sugar as they do. I once did, but a doctor helped me to see what it was doing to me. After I truly saw the connection between those heavy desserts and my health–the way I felt every day, it was easy to have a desert only occasionally. Education and moderation truly is the key. Thank you People’s Pharmacy for helping us educate ourselves.

  19. cpmt

    Recently I was in a clinic in W. Palm Beach, Florida for treatment my diabetes 2. Some time ago I read here that people can get rid of diabetes if you lose weight. When I was there, several people with uncontrollable
    diabetes 2 lost 10 lb., 15lb…. etc ( in three weeks) and they reversed and stopped having problems with their diabetes, they went home without the need of diabetic medication. During the time I was there my sugar went down to 100, 115, (from 180,200,…) I think diabetes 2 can be reversible if you follow a special diet and you control your weight. ” If you want, you can” Some people, like me, need a little help to get there.

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