Diabetes Forum UK

About a week ago I joined a Facebook group supposedly for diabetics. After a bit of reading around I realised that the group had been set up and was administered by a homeopath. This set some alarm bells ringing. Then I noticed that he was offering "consultations" over Skype to the members of this group.

So my next thought was "is this an attempt to prey on vulnerable people and drum up business?"

Everyone has heard of homeopathy, but for anyone who doesn't know about it, heres the basics. They think that the more you dilute a substance, the more powerful it is and they use something which causes the original problem in order to "treat" it. So if you are having problems sleeping they may use a drop of coffee diluted in 100 drops of water. Then they tap it to "energise" it. Then they keep diluting it way past the point where there is absolutely none of the original substance left in it, tapping it every time.

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1)  Don't Panic.

We all panic at first.  Its a great shock to be diagnosed and all sorts of things run through your head.  There seems to be so much to learn and its all a bit much.  You dwell on the negatives and the future looks bleak.

However, its not as bad as it first appears.  With a little knowledge and advice from experienced diabetics you'll find that you are able to manage, understand and deal with diabetes.

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A friend of mine had an ultrasound and it was discovered she has a cyst on her ovary. Not uncommon. My friend has a slow-growing glioma in her brain - CANCER. Her gynecologist ordered her to get into the office the next day, so my friend was quite distraught, as you can imagine.

"Are you in any pain," I asked.

"No," she replied.

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The following blog is the first chapter in my book: Beating The Odds, 64 Years Of Diabetes Health. It was published in March, 2010 on amazon.com.

CHAPTER 1....My Early Years and Diagnosis

September 15, 1945 was the day. We had an appointment with a doctor in Salem, Virginia that day. He had ordered a blood sugar test to be done prior to that appointment. Mother and Daddy did not know what that test involved, or anything at all about "blood sugar". They had watched my health deteriorate over the preceding months and my pale, skinny body clearly showed I was very ill. There was much weight loss and no appetite. My other symptoms included drinking much water and passing urine frequently, in large amounts. I was weak and had very little energy for several months. My poor health began in early 1941.
I was born Richard Alvin Vaughn in Roanoke, Virginia on September 10, 1939. When I was two years old I had measles that settled in my ears. There was a fever that made me very sick. Mother told me I had three kinds of measles in nine months time. There was infantile measles, German measles (Rubella) and Red measles. Perhaps those illnesses lowered my resistance and began a spiral that led to more sickness in the years ahead.

In May of 1942 I had a hernia on my right side near my hip joint. It ruptured and I had to wear a truss. The rupture became worse and surgery was needed. There was such a long stay in the hospital that I had to learn to walk again.
My tonsils were removed later that year. There was some bleeding the first night after returning home and there were splotches of blood on my face the next morning. My parents thought that my throat had been bleeding. They took me to the doctor. He said rats had been biting me and had bitten through my lip. The rats had smelled the blood from the surgery. Mother's story did not say what was done to eliminate the rats. I do remember that big rat traps were set to catch rats while we lived in that house.

In early 1945, at five years of age, I had chicken pox and mumps, both within a few months time. Because of my previous illnesses and my hernia, I was already rather skinny and not very healthy. After partially recovering from the chickenpox and mumps I started losing weight and by mid-summer I was skin and bones. That was when all those symptoms began.
We saw a doctor but he had no diagnosis and he prescribed a tonic to help me regain my appetite. The tonic probably contained sugar and was most likely much the same as the old "snake oil" remedies that were not uncommon back then. The tonic was ineffective and we saw a second doctor. Still no diagnosis and it was the same with a third doctor. Mother and Daddy never gave up though and we saw a fourth doctor. He was the one who recognized my symptoms.

Despite my condition, my parents enrolled me in first grade at a nearby elementary school. There was a bathroom in one corner of the classroom. I spent much time there. Mrs Thompson, the teacher, became very annoyed with this despite the fact that Mother had explained my symptoms to her. Not long after school began that fall we were called and my parents were told that we should see the doctor the next day.

It is strange that I can remember where my family members stood in the doctor's office that day. Mother sat to my left and Daddy stood behind us with my two year old sister, Shirley, in his arms. It is easy to remember that day so clearly because there was a look on Mother's face that scared me when the doctor announced my "sugar diabetes". That expression on Mother's face is something I will never forget.
The doctor did not say a lot about my disease. He said that they should take me to the hospital and that there would be another doctor who would meet us there. We were told that doctor knew a lot about sugar diabetes and he would be my doctor in the years ahead. Mother was too frightened to say much. Daddy said nothing. Mother was always the one to ask questions in a situation like that, but this time, even she was almost speechless.
We met Dr. D. for the first time at the hospital. They gave me insulin and said that it would make me healthy again. The insulin was called beef and pork insulin because it was taken from cows and pigs. He told Mother and Daddy to never give me sugar, or any food containing a lot of sugar. Those were the only instructions Dr. D., the "diabetes expert", had for us. He was a far cry from an endocrinologist but we were told that he was the best doctor for diabetes patients in the Roanoke-Salem area at that time. Doctors knew so little about diabetes in the 1940s.

My stay in the hospital is all a blur, but the insulin did great things for me in a short time. My appetite was good and there was some weight gain. Insulin from pigs and cows saved my life and I regained much of my health. Insulin was discovered in 1921 and first sold in 1923. It was there for me only 22 years after it was first available.

So there we were with vials of insulin taken from animals, a glass syringe, and metal needles that were twisted onto the end of the syringe. The syringe and a needle were sterilized by boiling them on top of our stove every morning. Daddy gave one injection before breakfast each day. The insulin was a twenty four hour insulin.
We also tested my urine for sugar prior to my injection. A blue liquid called Benedict's solution was poured into a large test tube, and 8 drops of urine were added. Then the tube was placed upright into a metal container and the water in the container was boiled. When the tube was removed the solution would progress in the colors of blue (with no sugar present), green, yellow, orange, red, and brick red or brown (with very high sugar present). A color change would indicate the presence of sugar. My urine was checked only once each day.
The needle was very long. It may have been about three quarters of an inch in length. We were instructed to stick the needle directly into the muscle on my arms or the top of my upper legs. The diameter of the needles was greater than the ones used now. That was necessary so that a piece of wire could be inserted to unclog them. The injections were very painful. I remember them very clearly.
My 6'th birthday was on September 10 that year and my diagnosis was on September 15. There was so much sickness from the symptoms of my diabetes. It was not a very happy birthday.

At six years of age I was too young to understand what was taking place. Candy and other sugar treats were not allowed and I am sure that disappointed me. There was really no other change in my rather normal life, except for the morning injections. Insulin made me healthy again and life went on as usual. I was a hapy and carefree kid. None of us knew how serious diabetes could be at that time.
I had also been a happy child before my diabetes symptoms began. There were blackouts in 1942 during World War II. On certain nights people had to turn out all their lights, in case of an attack. My old postage stamp collection contains some of the ration stamps my parents used during the war. After the war ended and the Allies were victorious, I went out in the backyard and ran about yelling that the war was over. The war having ended meant nothing to a five year old boy, but my parents were excited and some of their enthusiasm must have rubbed off on me. There are many things from my preschool years that are easy to remember.

Daddy and me, 1939




Mother had her appendix removed in late 1942. She was hospitalized for ten days. While she was there she learned she was pregnant. She also developed asthma and stayed very sick and nauseated until my sister, Shirley Ann Vaughn, was born on June 24, 1943.
Shirley was my first playmate and, as she grew older, we had good times together. We loved each other very much. Mother and Daddy did not have many friends. There were no other children in our neighborhood, so Shirley and I developed a very close relationship.
Pictures made before my diabetes symptoms.


Mother wrote her own story when she was in her 80's and she only briefly mentioned my diabetes diagnosis. She did not say anything about the months leading up to the diagnosis, or the trauma in the months that followed. My parents were devastated by my diabetes and not knowing how to care for me. The memories were probably too painful for Mother, and she chose not to include the details of that part of her life in her story. It is impossible for me to remember all of what happened back then, but my parents told me all the details years later.

My picture in first grade, age 6

Comment (1)

In my opinion all GP's, endocrinologists, and anyone else involved in the care of diabetes should be SHOT - with a little rapid insulin, that is. That way they would know what a hypo really feels like, not just symptoms on a page. Let them know how unpleasant the whole hypo business is. Perhaps this would stop them from thinking those of us who strive for good control are trying to go hypo to keep a good A1c, even when we show them numbers that say otherwise.

Let them get really low. Make them experience the mood swings, the shaking, sweating, and all the other lovely (not) things that go with the low. Let's see how dumb they feel when we lowly lay people have to tell them about the one thing they NEVER tell us about - the dreaded hypo hangover! Let them know that the work note should say "In case of low blood sugar, patient must go home." We need to sleep that hypo hangover off, not feel rotten and exhausted the rest of the day! 

I can't say I've ever seen any publication that even mentions the hangover. Has anyone else? Perhaps it's just another of those mysterious things that one can only learn from experience or from the experience of a fellow diabetic. 

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We know that carbs are the major problem for diabetics because thats what raises your blood glucose (BG), although the situation is slightly different for those who use insulin and those who do not.
For those who use insulin, the less carbs you eat, the more accurate you can be with your insulin dosage and be more controlled.
For people who do not use insulin the purpose of carb control is to stop the BG rising too far in the first place.
Because insulin users are balancing the number of units of insulin to inject against the number of carbs, the raw number of carbs is particularly relevant.  For T2s not on insulin this is very different.
T2s who are not on insulin are still producing insulin themselves, although the body is usually late in producing enough and releasing it into the bloodstream.  So the body will usually deal with the BG rise caused by the carbs eventually, but your BG will have gone far too high before your pancreas catches up and thats when the damage is caused.
So by managing carbs, we can control the BG rise.  But its not just about the raw number of carbs.  Different foods contain different types of carbs and these get converted to glucose at different speeds.  A baked potato will cause your blood glucose to rise extremely fast wheras some pulses and beans in particular will be far slower.  These slower carbs give the body longer to react, so it can keep up with the glucose better.
One way to get an idea of how fast and how far your blood glucose is likely to rise is the Glycemic Index (GI) and Glycemic Load (GL).  However these are only really a rough guess rather than hard facts.
So what seems to work best is the approach outlined in Jennifer's Advice - which is to test the effects of blood glucose on meals.  We tend to eat similar meals on a regular basis - for example I had weetabix or toast for breakfast for years before I was diagnosed.  So if you know the effects of meals on your blood glucose, you can find meals which do not raise your BG too far and continue to have those regularly.  If a meal raises your BG too high, then you can either avoid having that meal again or tweak the ingredients so that it has less of an effect.
This approach is commonly referred to as "managed carbs" as opposed to "low carb".  It doesn't necessarily mean a limit on the number of carbs - its just more based on managing what you eat in order to control your BG.
The low carb message on the other hand can be misinterpreted quite easily.  It started out as an approach for insulin users because it makes insulin dosing far more accurate.  With T2s not on insulin, the message can be too simplified and people tend to just concentrate on pure numbers of carbs.  Its quite possible to have more carbs of the right type and have lower BG rises.
So the number of carbs is not that important.  The effect that it has on your BG is.

Comment (2)

Its quite common for people to refer to the HbA1c as an average of their blood glucose but this isn't strictly true and can be quite misleading.

The first hint of this is that the HbA1c is reported as a percentage e.g. 6.0% wheras blood glucose readings are reported as mmol/l.

For example, if my Blood Glucose (BG) is 5.9mmol/l for an hour, then 6.1mmol/l for an hour, then my average over the 2 hours would be 6.0mmol/l.  It would not be 6.0%.  In the same way, if you have 2 apples weighing 49 grams and 51 grams, the average weight is 50 grams, not 50%.

Recently there was a change to reporting HbA1c in two ways - the old percentage figures and a new figure in mmol/mol.  So if your HbA1c were 6.0% then it would also be reported as 42mmol/l.

So does that mean my average blood glucose is 42mmol/l, when I usually see numbers betwen 4.0 and 8.0 on my meter most of the time?  No.

The reason for this difference is that they are measuring two different things and the HbA1c is not an average at all, but the two do follow very roughly in parallel.

What the HbA1c measures is the amount of red blood cells which have a glucose molecule attached to them.  In non-diabetics this is normally around 5% to 6% of all red blood cells.  thats perfectly normal.  In diabetics it can be higher because when your blood glucose is higher, more glucose attaches to red blood cells.

But the higher your blood glucose, the more chance there is of a glucose molecule attaching to a red blood cell.  So if you are running higher blood glucose, then your HbA1c will be higher.  Thats what I mean by them running roughly parallel.

The reason it may be misleading is that it appears from research that damage may be done to the body before any glucose attaches to red blood cells.  If your BG is 10.5 for a while then some small amount of damage may be done to the eye for example.  But although some damage has been done, your blood glucose was not at 10.5 for long enough to affect your HbA1c.

So your HbA1c might look fine, but its the peaks of your blood glucose that do the damage.

Small amounts of damage (microdamage) happens all the time and the body can repair some of it automatically.  If you keep your BG under control then this should not be too much of a problem.  However if you are having a lot of short high peaks, more microdamage is caused and may not be reflected in your HbA1c.

Looking again at averages, when we test blood glucose it tends to be before or after meals.  These are the times when the blood glucose changes the most, so your BG may be higher or lower at those times than the rest of the day.  The other approach is to use your fasting BG to work out roughly what your HbA1c should be.  The problem with that is that I can change my fasting BG by at least 1.0 mmol/l by having a snack before bed.  That throws the figures out considerably.  The only way to get a true average of your BG is to use a continuous glucose monitor which are very expensive and rare.

While there are calculators on various sites online, they are really just a rough guess about what you can expect your HbA1c to be.  They will nearly always be out to some degree, although often they will be out by the same range every time if you are consistent in the way you live your life.

But they also miss the point in that the real problem is the blood glucose peaks

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

Comment (5)

There's a few misunderstandings around the subject of cholesterol, in particular which numbers are important.

Cholesterol is made up of 3 main parts - LDL, HDL and Triglicerides (Trigs).  HDL is considered to be "good" and the other two "bad".

Early research into cholesterol and heart attacks came to this conclusion:
"high cholesterol means greater risk of heart attack"

Then they did some more research and narrowed it down to:
"high LDL cholesterol means greater risk of heart attack"

Then they did some more research and came up with:
"High levels of small particle LDL cholesterol means greater risk of heart attack".

Most people are not up to date with this and seem to be stuck on the first one, possibly the second.  So treatment for cholesterol tends to be based on what your total cholesterol test result is - despite the fact that we now know it revolves around LDL.  Even if a GP looks at the LDL test result, they will tend to prescribe a statin, which reduces the LDL - but this does not necessarily improve the particle size.

So the treatment does not necessarily address the right problem.

The real danger is the particle size of the LDL and because of the way that HDL, LDL and trigs are made, we can get an idea of the LDL particle size by looking at the relationship between trigs and HDL.  If you take your trigs result and divide it by your HDL result, a low number (below 1.3 at least) is good.  So high trigs are bad, high HDL is good.

So for example, if your total cholesterol is 5.2, this will be considered to be too high and you will probably be prescribed statins.  However, your detailed test results might reveal that your LDL is 1.9, Trigs 0.8 , and HDL is 3.5.  This is a pretty good profile and theres no reason to reduce your cholesterol at all.  Most of the cholesterol in this example is HDL - the good stuff.  The trigs are low which means that the LDL particle size is good.

But if you don't know what the cholesterol breakdown is, the total cholesterol of 5.2 can look quite bad.  On the other hand, your breakdown might be HDL 0.5, Trigs 1.5 and LDL 3.2 which is not good at all and you would need to take some action to sort out your cholesterol.

So from all that we know:
- HDL should be as high as possible
- trigs should be as low as possible
- LDL should not be ridiculous, but if the other two are ok then there may not be a problem.
- Total cholesterol doesn't actually tell you that much (unless its ridiculously high)

The most common treatment for high cholesterol is statin drugs.  Statins work to reduce the LDL specifically, but this appears to be a reduction in the overall level of LDL and may have no effect on particle size.  So they can quite easily be aiming at the wrong target.

A better approach to improving your cholesterol profile can be to lower your trigs and raise your HDL.

Trigs are manufactured in the body from carbohydrates.  Reducing the amount of carbohydrates in the diet tends to reduce the trigs.  HDL can be raised by increasing the amount of "good fats" in your diet - such as fish oils, nut oils and so on.  Often these two approaches lower the LDL at the same time.  Plus of course, lowering carbohydrates generally improves blood glucose(BG) levels as well.

The other factor which can make quite a difference in terms of cholesterol levels is exercise and in particular regular exercise.

There is however a lot of talk about reducing fat in order to reduce cholesterol and this is where there's more of a problem.  If you reduce your intake of the good fats, then your HDL will go down and your cholesterol profile will get worse.  Plus, most of the evidence for reducing fats helping cholesterol levels has been performed on people on a high carb diet.  It appears that if you eat less fats on a high carb diet, then your cholesterol goes down a little.  On the other hand, people on a lot less carbs, but eating MORE fat have a much better improvement in cholesterol levels and profile.

In a study involving 48000 canadian women on a low fat diet, over a period of 8 years, there was shown to be no signifcant improvement in the rates of heart disease.  However, all of the studies into low carb diets either show an improvement in overall cholesterol or an improvement in the cholesterol profile - or both.  However, this is only in studies where "low carb" is a significant reduction.  The standard intake of carbs is 230g per day.  Some "low carb" studies have been on 210g of carbs per day.  The studies which do show a significant difference are at levels of 150g/day or lower.

So eating less fat may make a small difference in reducing cholesterol, but eating less carbs appears to make far more of a difference.

There's another myth about cholesterol which is proving particularly hard to shift because "everyone knows" that eating eggs raise your cholesterol.  Except that it doesn't.  This is a misunderstanding based on the fact that eggs contain cholesterol.  But that cholesterol has to pass through your digestive system and get processed like all other foods and by the time it gets through all that, its been converted to something else.  Its no longer cholesterol.  So the cholesterol in eggs does not lead to higher cholesterol in your bloodstream *

This myth was debunked about 10 years ago but people still believe it today.  In an edition of BBC Radio 4's News Quiz last year, they mentioned a new survey that eating eggs does not raise cholesterol.  Nobody on the programme gave any indication that they were aware this was old news.  Its a myth that lives on, long after its been disproved.

Its not just eggs of course, but any food which contains cholesterol - something which is marked on many food packets in the USA, but not in europe.  Eating cholesterol is unlikely to raise your blood cholesterol level.

Finally, theres one other thing to consider.  Cholesterol is necessary.  It performs or helps with a number of functions in the body including the body's repair systems.  This may be why smokers have higher LDL levels in particular.  The body will increase its production of cholesterol in order to help repair the damage caused by smoking.  At diagnosis, many type 2 diabetics have high levels of triglicerides and this may be due to the damage caused by high BG, or perhaps a reaction to what is causing the insulin resistance.

This may in some way explain why elderly patients with very low levels of cholesterol (particularly women) have a higher mortality rate.  The cholesterol level is too low for some of the body's essential systems.

So when looking at cholesterol its important to look at the whole picture.  As with many things connected to diabetes, things are not as simple as they are first made out to be.  The more you dig into it and the more you increase your understanding the better off you will be.


*There are a tiny proportion of people for whom the opposite is true and eggs will raise their cholesterol according to research.  But this is the exception rather than the norm.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

Comment (1)

This myth is not about the glycemic index as a whole, but about some of the hype surrounding it and the misunderstandings which arise.

The glycemic index (GI) certainly has its uses and its a good rough guide as to how fast foods will raise your blood glucose.  So its an indication of the speed that your BG will rise when you eat a particular food.  Its usually based on glucose having a GI of 100 and a food which raises your BG slower, will have a lower GI.  So wholemeal bread for example has a GI of around 70 (in the UK).

One of the most reputable sources for GI data is the University of Sydney GI testing service.  http://www.glycemicindex.com/

However, there have been some books, articles and so on which tend to overestimate the importance of GI particularly with reference to diabetes.  To understand why this is a problem, we must know certain things.

1)  GI testing is not performed on diabetics.  Its performed on 10 non-diabetics and the results are used to look at the average effect - a GI is calculated from these results.  They do not perform the tests on the same people every time, so theres no real comparison between the results.
2)  The GI does not tell you how long your BG will be raised for, or by how much.  Its just an indication of the speed of the rise.
3)  GI values are for individual foods.  As soon as you combine that food with another in the form of a meal, the GI changes.  Fats in particular can reduce the GI of foods.
4)  Particularly on food packaging, labels like "low GI" are meaningless.  They can mean whatever they want it to mean and the foods have not been tested in any standardised way
5)  The GI is very very specific.  There is no GI value for "an apple".  Gala, golden delicious, granny smith etc all have different GI values.
6)  Particularly with fruit & veg, factors such as the place where they were grown and their ripeness can make an enormous difference to the GI.
7)  Cooking methods change the GI.  Potatoes have a GI under 100, but baked potatoes have been clocked as high as 158.

So as you can see there are various problems with the GI - not that this renders it useless, but we need to bear in mind the above when looking at GI.  Despite all the problems, it still remains a useful rough guide.

I mentioned in point 2 that the GI does not indicate how high or for how long your BG will be raised.  The Glycemic Load does that.  These two are related and together give a far better indication of the probable effects on the BG.  For those who are more mathematically minded, the GL gives an indication of the area under the curve.

So a while ago GI became quite a buzzword and it seemed like everyone was talking about it.  Books on GI diets were everywhere and in the main, the messages given out were reasonable on the basis that if you eat lower GI foods in general then you will be better off.  But in some cases they did not take the GL into consideration, particularly if it was not aimed at diabetics - and to diabetics GL is the important one.

Look at it this way - the GI of wholemeal bread in the UK is between 68 and 72 depending on brand.  Since glucose with a GI of 100 is bad, wholemeal bread is often referred to as "low GI".  But the GI of table sugar is 65 - so its lower than bread.  Does that mean its better for diabetics to eat 100g of sugar rather than 100g of bread?

No.

So if we look at these things too simplistically, its easy to get the wrong idea.  This is particularly the case when foods are referred to as "low GI".  A DSF member was told on a course that a particular chocolate cake was "low GI" despite:
a)  She hadn't had it tested, so had no idea if this was true
b)  Where does "low" start and end?  Is it anything with a GI between 99 and 100?  Or between 5 and 10?
c)  Its clearly not low GI and the GL of any choc cake made with flour would be pretty bad.

Overall, despite the hype that makes the GI look like some magic bullet answer to diabetes, this is not the case.  What we really want to know is how foods will affect our BG and what we can eat without raising our BG too much and for too long.

The only way to reliably do this is to try things for yourself and see with your meter what the actual effect of a meal was on your BG and learn from it.  Perhaps try the meal again using a lower GI/GL version of one of the ingredients and see what that does to your BG.

So the GI and GL used together will not tell you what will work for you to keep your BG low.  But they do point you in the direction of things to try.

Further information on GI and GL:
http://www.mendosa.com/gi.htm

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

Comment (0)

These two myths are linked, so it makes sense to look at both at the same time.  We'll start with progression.

Myth #6 - Diabetes is Progressive

Its generally accepted that diabetes is a progressive condition, although this is being questioned more and more as diabetics learn from each other more on the web and gain better control.  Because of bad health advice and low expectations in the past there is an assumption that patients will be diagnosed, move quickly onto pills, then onto insulin with their health deteriorating along the way.

The problem is that historically, the expectations have been low and the targets unambitious.  The ideal of course is to have blood test results which are the same as those for non-diabetics and this is achievable for the majority of diabetics.  However if you get halfway towards that target then most GPs will be perfectly happy with that.  Also the dietary advice in particular from health professionals (see myth #5) makes it almost impossible to reach non-diabetic numbers as well.

Running high blood glucose over a long period does cause deterioration and so diabetes under those circumstances really is progressive.  The pills will stop working and you will move onto insulin.

But its doesn't have to be like that.  People who manage to get good control by learning what works to help control their blood glucose tend not to deteriorate or at least if there is progression, it is slowed down considerably.  The risks of diabetic complications such as blindness and kidney failure fall rapidly the closer you get to non-diabetic numbers.

So perhaps if our control is good enough we can avoid any progression at all.  Unfortunately things are never that simple and other things in life conspire to make things difficult, including other medical conditions interfering, but the better control we have overall, the less progression there will be.

So in a sense, diabetes is as progressive as you allow it to be, but its not all in your hands and luck is involved.  At the very least you can slow the progression right down.

Myth #7 - Pills or insulin mean failure

People want to avoid medication if possible and thats certainly understandable.  Its something we would all prefer to be without because even at its best its an extra little hassle you could do without.

But many people feel that if they have to start taking pills or have to start using insulin then its some kind of failure.

There's several reasons for this including the vague general preconception of the public that all diabetics have to do is stop taking sugar in their coffee.  But doctors can also often give the impression that they are "threatening" insulin or pills if you do not improve.  But one of the biggest factors which influences this sense of failure is the way that diabetes is seen as progressive.  Because there are some people out there who seem to be able to manage their diabetes with just diet and exercise, it seems to be assumed that everyone can and that they can do it forever.  So if you need medication to help control diabetes, you've not done as well as them and you have somehow failed.

This is quite definitely a misconception.  Diabetes affects different people to different degrees.  Genetically we are all different and our bodies react in different ways to all kinds of things.  So because we are all different, the degree to which diabetes is controllable is going to be different.  Plus our bodies age and if we are not expected to be as physically fit as 60 as we are at 18, we can assume that our bodies will be less able to cope with diabetes later in life than when we were younger.

In addition, the longer that diabetes is undiagnosed and untreated, the more of an effect it is likely to have.  Above I discussed how uncontrolled diabetes is progressive.  So if you were diabetic without knowing it for a period of years before being diagnosed, then the damage has been done and diabetes is going to have more of an effect on you.  This is in no way your fault, but its the situation you are faced with.

So just because one person can get away with treating their diabetes just with diet and exercise simply means they are lucky in that it was caught early enough to do something about it or their genetics mean they can get away with more.

But there's one more factor in this.  My prescription is 1500mg of metformin per day.  I estimate it would be possible for me to do without the metformin altogether and just control it with diet and exercise, but I won't.  Its techically possible for many type 2s to eat such a low carb diet that they do not need any medication at all, perhaps also doing an awful lot of exercise along the way.

But that is the point where it takes over your life completely.  Food is one long exercise in denial and exercise may have to be scheduled in after every meal in order to control blood glucose.  You could reach a point where your entire life is taken over by simply staying alive.  Is that really worth it?  Is someone in that position really better off just for the sake of avoiding taking a couple of pills every day?  Before the discovery and production of insulin, type 1 diabetics ate an almost no carb diet and usually died young.  If taking pills or insulin are a failure, they were a resounding success.

So medication can simply be a way of making life easier, even allowing you to have some kind of life which does not revolve around diabetes.  Even if you could techincally manage without the medication, it can take the pressure off enough to make things an awful lot easier.

If someone is blind then a white stick or a guide dog is not a symbol of some kind of failure.  They are just tools to get things done because they are either necessary or make life easier.

The biggest "threat" is that if you do not control diabetes well enough, you will need insulin.  If like me you are needle-phobic then its not a nice prospect at all.  But I would cope.  I know that if thats whats needed, then thats simply whats needed and I will get on with it.  From talking to insulin users for years I know its not as bad as people fear anyway.

When it comes to insulin there are even advantages which non-users do not have.  For starters, if someone is on a decent basal/bolus insulin regime then they can modify their dosage to balance for their carb intake.  So a type 1 can typically handle more carbs without going hyper than I can.  While its true that reducing carbs means less margin for error, a basal/bolus user can be a bit more "naughty" more often than me and has a tool which allows them to do it.

Even pills have their advantages as well.  Metformin for example is cardioprotective, so a type 2 diabetic taking metformin is less likely to have a heart attack than a type 2 diabetic who isn't.  ACE inhibitors such as ramipril are primarily for controlling blood pressure, but prevent kidney damage in the long term as well.

So rather than medication being a sign of failure, its simply a tool which might make things easier, have additional advantages and avoiding it could cause you further damage while you lose BG control.

So perhaps to some people since I take medication I am some form of "failure".  But I'd rather "fail" than be "successful" and dead.

This is a series of blog entries about diabetes myths.  Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average

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