How good is good enough?

(Scott Overby) said:

Dx'd T2 Oct-03 with A1c=10.2% A1c for Apr-04=6.4% Meds:
30mg Actos and 2500g Metformin. Was on 1 mg Amaryl
initially, not now. Moderate to heavy exercise 30min/day
5X/wk. Male, Age=46 Wt=240 and going down. Lipids:
Cholesterol=193 HDL=48 LDL=104 TG=155 BP= 130/82

My GP is currently happy.

Those are pretty good numbers, what's the lab range for A1c,
it can be different for different labs.

Scott Overby wrote in message
<[email hidden]>...

Quoted message said:

Dx'd T2 Oct-03 with A1c=10.2% A1c for Apr-04=6.4% Meds:
30mg Actos and 2500g Metformin. Was on 1 mg Amaryl
initially, not now. Moderate to heavy exercise 30min/day
5X/wk. Male, Age=46 Wt=240 and going down. Lipids:
Cholesterol=193 HDL=48 LDL=104 TG=155 BP= 130/82

My GP is currently happy.

Question is: How good of control is good enough? If I go
back on Amaryl, I can get my postprandials in the double
digits, but have also experienced hypo's.

Currently shooting for 2-3(15-45g) exchanges/meal. Should I
tighten up?

I known the holy grail of A1c's is < 6.0%, but at
what 'cost'?

I am not looking for specific answers, since ea. person's
situation is different, so I am really looking for
opinions.

Thanks.

The American Association of Clinical Endocrinologists sets
an HbA1c of
6.5% (DCCT/UKPDS Standard Lab calibration) as the maximum
acceptable HbA1c. If your HbA1c creeps higher than 6.5,
your doctor is supposed to somehow subject you to more
intensive therapy to bring it back down.

However, recently, they decided that selected patients
should have a target of 6.0%. I suspect that your overall
good health and vigor puts you into that "selected
patient" group.

One measure of the premature heart attack risk attributed to
Type 2 diabetes is the triglycerides/HDL ratio. You want to
shoot for a ratio of 3.0 or lower, preferably as low as you
can handle.

A ratio higher than 3.0 is a marker for higher than desired
Insulin Resistance. I suspect your doctor thinks your
Insulin Resistance is too high since he has asked you to
take about the maximum amount of prescription anti-Insulin
Resistance med available. (Actos, Metformin)

The recommended lifestyle change to knock down Insulin
Resistance is frequent, vigorous exercise and fat loss,
especially abdominal fat. Looks like you are doing your part
in that area.

Two over-the-counter remedies frequently used by T2 are
Niacin and Cinnamon. Time-release Niacin at 2 x 500 mg per
day is a doctor-recommended dose for knocking down
triglyercides levels.. There are quite a few folks using
Cinnamon because of evidence that it reduces Insulin
Resistance. Our poster "Jenny" has dug into the why's and
wherefore's of cinnamon and seems to be doing well with it.

The most important element of T2 control is a
"workayobuttoff" attitude. You seem to be doing well in that
area. Keep on truckin'

Regards
Old Al

"Scott Overby" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Dx'd T2 Oct-03 with A1c=10.2% A1c for Apr-04=6.4% Meds:
30mg Actos and 2500g Metformin. Was on 1 mg Amaryl
initially, not now. Moderate to heavy exercise 30min/day
5X/wk. Male, Age=46 Wt=240 and going down. Lipids:
Cholesterol=193 HDL=48 LDL=104 TG=155 BP= 130/82

My GP is currently happy.

Question is: How good of control is good enough? If I go
back on Amaryl, I can get my postprandials in the double
digits, but have also experienced hypo's.

What is normal for your lab? Mine is <6.0. My last A1c was
6.2 and my Endo. was displeased. He wanted to put me on
Actos in addition to the Starlix and Metformin I am taking.
I am fearful to take Actos because of the weight gain and
fluid retention it can cause. Apparently it is working for
you. I too used to take Amaryl, but had to stop because of
the hypos it caused.

Quoted message said:

Currently shooting for 2-3(15-45g) exchanges/meal. Should
I tighten up?

Maybe. BG varies throughout the day and the body is the most
insulin resistant in the morning. No way could I eat 3
exchanges then and currently I am not eating even one
exchange then. How are your numbers at 2 hours after eating?
If higher than 120, then you need to do something different.

Quoted message said:

I known the holy grail of A1c's is < 6.0%, but at
what 'cost'?

I'm starting to think the same thing. I keep paring my diet
back further and further to the point where the meals are
not satisfying and the weight loss has stopped. Oddly, I had
to increase my fat and calories to get the weight loss
started again. But now I find that I must eat less to keep
my BG under control. Something isn't working for me, but I'm
not sure I want to add more meds either.

<snip>

--
Type 2 users.bestweb.net~jboveOpen ↗

"Scott Overby" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

Dx'd T2 Oct-03 with A1c=10.2% A1c for Apr-04=6.4% Meds:
30mg Actos and 2500g Metformin. Was on 1 mg Amaryl
initially, not now. Moderate to heavy exercise 30min/day
5X/wk. Male, Age=46 Wt=240 and going down. Lipids:
Cholesterol=193 HDL=48 LDL=104 TG=155 BP= 130/82

My GP is currently happy.

The drop in A1c is good (VERY good) but you would still be
better off getting it below 6.2, which is the figure
regarded as the "trigger" point for increased risk of
complications. Not by me btw, but by the medical profession
as a whole and this figure was based trials run by the DCCT.
(Google DCCT if you want more info)

Quoted message said:

Question is: How good of control is good enough? If I go
back on Amaryl, I can get my postprandials in the double
digits, but have also experienced hypo's.

Reducing carbs at food time will help keep the PP spike in
single figures and a reduction in meds will help stop the
hypo's, but so will a SMALL "carby" snack a couple of hours
after your meal. That's a choice we all face at some time.
(Less meds or a small snack)

Quoted message said:

Currently shooting for 2-3(15-45g) exchanges/meal. Should
I tighten up?

Well it's really a matter of balancing the three main
variable. Carbs, meds and exercise, but if oyou want to lose
even more weight (and I suspect it'd be a good thing if you
did) then a small reduction in carbs would help.

Quoted message said:

I known the holy grail of A1c's is < 6.0%, but at
what 'cost'?

For me, none at all. In fact there IS no cost other than
feeling better. I don't feel good when I'm high and I
don't like hypo's anymore than anyone else, but for the
greater part of 16 years, I've had A1c's in the 5.xx range
and as yet, I've never had to call anyone for help in
relation to hypo's.

Quoted message said:

I am not looking for specific answers, since ea. person's
situation is different, so I am really looking for
opinions.

It's good that you're not looking for specifics, coz there
aren't any (as you rightly summise), but simply asking is a
good thing coz it shows you're interested in taking control
and keeping it, that (IMO) that's half the

Best wishes and well done on your efforts.

Beav

The lab report indicates <6%=non-diabeteic and 6-7% as
'in control'.

Scott

[email hidden] (gman99) wrote in message
news:<[email hidden]>...

Quoted message said:

(Scott Overby) said:

Dx'd T2 Oct-03 with A1c=10.2% A1c for Apr-04=6.4% Meds:
30mg Actos and 2500g Metformin. Was on 1 mg Amaryl
initially, not now. Moderate to heavy exercise 30min/day
5X/wk. Male, Age=46 Wt=240 and going down. Lipids:
Cholesterol=193 HDL=48 LDL=104 TG=155 BP= 130/82

My GP is currently happy.

Those are pretty good numbers, what's the lab range for
A1c, it can be different for different labs.

Scott Overby said:

Dx'd T2 Oct-03 with A1c=10.2% A1c for Apr-04=6.4% Meds:
30mg Actos and 2500g Metformin. Was on 1 mg Amaryl
initially, not now. Moderate to heavy exercise 30min/day
5X/wk. Male, Age=46 Wt=240 and going down. Lipids:
Cholesterol=193 HDL=48 LDL=104 TG=155 BP= 130/82

My GP is currently happy.

Question is: How good of control is good enough? If I go
back on Amaryl, I can get my postprandials in the double
digits, but have also experienced hypo's.

Currently shooting for 2-3(15-45g) exchanges/meal. Should
I tighten up?

I known the holy grail of A1c's is < 6.0%, but at
what 'cost'?

I am not looking for specific answers, since ea. person's
situation is different, so I am really looking for
opinions.

Thanks.

OK this is what works for me:

I'm on amaryl and metformin. I treat the amaryl as 'basal'
and the metformin I have with meals (think of as 'bolus'😉. I
'aim' to have normal numbers. For me this would equate to
around 4mmol/l before meals and a maximum of 7 2hr PP.
Rather than counting total carbs and 'exchanges', I just
avoid starch completely (by starches I mean all wheat
products, all grains, all rice, all potatoes (though I do
have the occasional potato now)). This works for me and is
easier, so more likely to be adhered to.

I don't do 'exercise' as such - I cycle and walk everywhere
(I don't drive). If I'm going to ride any long distance,
I'll need to have some potato before the journey otherwise I
will hypo. Either that or forego the amaryl/metaformin, or
decrease the amaryl dose.

The metformin supresses glucogenesis by the liver somewhat.
For me it 'smooths' the glucose level rise due to food.

I notice you quote 1mg amaryl. I'm on 6mg. (4mg in the
morning and 2mg in the evening). 2mg had no effect on me. If
I don't take the amaryl, I don't make even enough background
insulin and the levels will rise to 15mmol/l fasting. I
could afford to lose a few lbs I reckon, but I'm not what
you would call obviously overweight.

In answer to your question, what is 'good enough' is a
combination of where you are at and what kind of lifestyle
you want. Tight control takes a while to pay off and isn't
for everyone. For me, if I was repeatedly hitting over 7 2hr
PP, I'd be looking to restrict diet further, for a start.
Remember that most normals doen't even see 6mmol/l 2hr PP.
Also remember that some people on the higher side of normal
but still 'normal' may get diabetic complications even if
they don't fall into diabetic criteria as is currently
defined. If I had been dx'ed at 65 I probably wouldnt worry
about what food I ate. But at 38 I have to appreciate that
if I don't nail my numbers to the floor whilst avoiding
hypos right now, I'll have a snowballs chance in hell of
seeing 50 without significant degradation in health and
consequent quality of life. "Good enough" for me means in
the median of what is defined as normal, because I can
acheive it through diet and meds and exercise.
--
John38 : t2 since 11/03 : 6mg amaryl 1.5g metaformin :
aspirin Hb1Ac@dx=11.9% now=7.4% : FBG@dx=14mmol/l now
5mmol/l : no wheat for me!

Scott Overby wrote in message
<[email hidden]>...

Quoted message said:

The lab report indicates <6%=non-diabeteic and 6-7% as 'in
control'.

Scott

A lot of us don't trust those "non-diabetic range" or "in
control" statements you find on the lab reports.

If you define a "non-diabetic" as a person whose FbG is
below 110 mg/dL and 2-hr-after-eating bG is below 140
mg/dL, then the average HbA1c of U.S. non-diabetics is 5.27

The 6% figure is the mean (5.27) plus about 2 standard
deviations.

(from medscape.com403327 2Open ↗)

Many folks are suspicious of the 5.27 value. It basically is
derived from testing folks who "haven't been diagnosed" as
diabetic. However, Type 2 diabetes is a Progressive disease.
The UKPDS data suggest that a T2 diabetic can experience 10
years of steady deterioration in their bG control mechanisms
before any bG problems are serious enough to formally meet
the Diabetic limit. Therefore, many of us suspect that those
"averages" of non-diabetic HbA1c are contaminated by the
HbA1c of folks in the T2 Diabetic Progression whose steadily
worstening bG control has not been noticed yet.

I have seen estimates of an HbA1c of 5.0 for the average,
true non-diabetic.

Using the latest correlations I have found, a 5.0
corresponds to a 24/7 bG of 100 which is a very reasonable
value. (medscape.com427799Open ↗ )

HbA1c of 6.0 and 7.0 correspond to bG of 136 and 172. Those
are pretty high bG for an "in control 24/7 average".

Regards
Old Al

(Scott Overby) said:

Dx'd T2 Oct-03 with A1c=10.2% A1c for Apr-04=6.4% Meds:
30mg Actos and 2500g Metformin. Was on 1 mg Amaryl
initially, not now. Moderate to heavy exercise 30min/day
5X/wk. Male, Age=46 Wt=240 and going down. Lipids:
Cholesterol=193 HDL=48 LDL=104 TG=155 BP= 130/82

My GP is currently happy.

Question is: How good of control is good enough? If I go
back on Amaryl, I can get my postprandials in the double
digits, but have also experienced hypo's.

In my humble opinion, you can only do as good as you can do.
So when you factor in weight loss, your diet and exercise,
meds or not, you will end up at a certain point where things
stabilize and what you have is what YOU can do. If you can
do better with tweaking any of the above and not risk
frequent hypos, all the better.

Quoted message said:

Currently shooting for 2-3(15-45g) exchanges/meal. Should I
tighten up?

There is no should's, it's more what are you willing to do
and be consistent with? Why not try it for a couple of weeks
and see how things work for you?

Quoted message said:

I known the holy grail of A1c's is < 6.0%, but at
what 'cost'?

Who's holy grail? If you take 10 people and 4 can do
4.8, 2 can do
4.5 and all the rest are somewhere between 6.0 and 7, who's
doing better? If they are all healthy, losing weight if
needed, all watching their diets, and exercising on a
regular bases, using their meds/insulin and adjusting
their meals to how their blood glucose is reading for
their meals, then I would say they are all doing the best
that they can for now. Those willing to tweak their
exercise, diets and meds, will do so.

Quoted message said:

I am not looking for specific answers, since ea. person's
situation is different, so I am really looking for
opinions.

Heheheh you will sure get a lot of those in this
newsgroup. Hopefully without a flame war in the middle of
the thread. ;-)

--
Type 2 - Dx'ed 11/2001
Stopped Metformin 2003
Now D&E, A1c 5.2