The psychology of living with diabetes
Type 2 diabetes is a progressive disease.
Most pundits predict that this progression starts at year 14 and I am currently skirting that alarming threshold. When I was diagnosed with diabetes the doctor told me I have to watch my diet, exercise and take my medications in order to avoid future diabetes complications. I dont know if I was just young, naive or in denial but at the time it seemed that the complications he was talking about were so far off.
I have done and still do alot to keep my diabetes in check. For the most part I have been in control aside from the usual high sugar flare ups or high cholesterol and high blood pressure episodes. I consider myself truly blessed that I haven’t succumbed to any of the serious complications and for this I am truly truly grateful.
Except in the back of mind I know diabetes is a ticking time bomb and I might be now fully in its blast radius.
Last year when my Metformin failed it took me completely by surprise. I was happily coasting along with a level of control that had been working and it did not dawn on me that the progression caught up with me. Initially I even blamed it on a bad batch of Metformin and my complacency but after doing some research it could well be explained by the progressive nature of diabetes.
So maybe I am shifting the blame a little bit, or maybe it is truly the nature of the disease but truth be told even after making my leap back to Insulin and all the other adjustments I have made to my diabetes management routine to get back to my previous control levels, I am still in somewhat afraid that something is just lurking in the shadows waiting to jump out and scare the hell out of me.
I am not an alarmist by any means of the imagination, but I do realize the long term reality of my diabetes. Even in circumstances where diabetes is well controlled only mitigates the complications and does not fully eradicate them. There is still some damage that was done to my body and that makes just makes my vigilance at this point even the more crucial.
Does this mean, I should adopt a more stringent control model to my daily diabetes management given these set of circumstances?
Back in 2008 there was an ACCORD study on the benefits of adopting an aggressive control model to diabetes management. The study examined adults who had type 2 diabetes and were considered at a high risk for stroke or heart disease.
There were 10,251 patients who were divided into two groups. One received intensive treatment with the goal of lowering their HbA1c below 6% (that of a normal person) while the other group was in standard treatment whose HbA1c goal of about 7% (normal for a person with diabetes)
The study was halted however before some crucial components were looked at after it was discovered that 257 patients who received intensive treatment had died, compared with 203 receiving standard treatment. Participants were urged to seek remedy from the intensive therapy treatment because of this.
The Washington post lead story on the study is here. and the ADA response.
The quote I found most interesting was this
This recent announcement by ACCORD investigators suggests that very intensive glucose lowering treatment aimed at normalizing blood glucose (A1C<6%) may be detrimental, at least in middle-aged and older adults with vascular disease or multiple risk factors for vascular disease. The exact reason for the increased death rates with intensive treatment that occurred in ACCORD is not yet known. However, an analysis of the ACCORD data indicates that the detrimental effect of intensive therapy was not due to hypoglycemia or any specific combination of drug therapies.
Above and beyond all the arguments tossed around about the magic Hba1c numbers ( my doctor actually recommends a 6.5% number). As stated earlier due to my circumstances, adapting a somewhat aggressive attack mode would only be logical risk factors or not.
I am on a fact finding mission before I discuss this with my doctor but does it not make sense to be more proactive towards treating highs and any other flare up that might occur. Would this not by definition be be construed as engaging in an intensive treatment plan even though it would then positively reflect on my hba1c numbers?