The psychology of living with diabetes

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psychology of diabetes The psychology of living with diabetesType 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?

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9 Comments

  1. The unspoken reason why the ACCORD study found “tight control = higher death risk” is because they were using Avandia to enact that tight control.

    http://diabetesupdate.blogspot.com/2011/06/avandia-is-sufficient-to-explain-excess.html

    • I agree with Sparrow, the use of drugs later proven to increase cardiovascular disease risk in the ACCORD study (notably Avandia and Actos) does not seem to get as much much attention as they finding itself. But anyone who reads through the journal articles sees this glaring not-so-little problem with inferring that glycemic control was the problem rather than the drugs being used.

      • I actually have spent the last 24 hrs looking into this after reading Sparrow and Jenny’s article and yes it does seem to infer that some of these diabetes drugs had something to do with it, obviously they will never come out and say that but it is interesting that both these drugs have recently been banned but to their catastrophic links to heart disease and bladder cancer.

  2. The first decade of my life with diabetes my A1c was rarely below 9%. So when people ask me why I make my life so restricted and try to maintain an A1c that starts with 5%…I explain the first decade and that my fear is that I’ve put myself on the brink of complications and now I feel like I have no other options but to have extremely good control…even though said “control” is fleating. I still try. I don’t know how not to try.

    It was interesting to hear your thoughts as someone with type 2 and to learn about how those deal with a disease that continuously progresses :(

    • Thanks SYSY It does bring out the old age question of the magic number to shoot for as far the A1c is concerned. I think I will research this some more…..:)

    • Sysy, take heart in that I’ve read some arguing that when you maintain good control your body can actual undo some amount of the damage that was done by earlier bad control. Not all of it, but even cases of neuropathy have begun to reverse after maintaining good control for some time.

      So stick with the vigilance! You may be doing your body even more good than you realize!

      • How could I have missed that Sparrow. The reversal point should have been part of my research and thank you for pointing that out, I have often wondered if this is possible. With the neuropathy it makes sense but what about some of the other complications, If you catch these early enough is it possible to reverse them. I think I will revisit this issue soon.

  3. Big help, big help. And superlative news of course.

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