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From: Thomas Muffaletto on 24 Oct 2005 21:56
from experts you can trust the American Diabetes Associations web site.
..
Tight Diabetes Control
Keeping your blood glucose levels as close to normal as possible can be a
lifesaver. Tight control can prevent or slow the progress of many
complications of diabetes, giving you extra years of healthy, active life.

But tight control is not for everyone and it involves hard work.

By the Numbers


Good control means getting as close to a normal (nondiabetic) blood glucose
level as you safely can. Ideally, this means levels between 90 and 130 mg/dl
before meals, and less than 180 two hours after starting a meal, with a
glycated hemoglobin level less than 7 percent. The target number for
glycated hemoglobin will vary depending on the type of test your doctor's
laboratory uses.

In real life, you should set your goals with your doctor. Keeping a normal
level all the time is not practical. And it's not needed to get results.
Every bit you lower your blood glucose level helps to prevent complications.

What Tight Control Does


No one knows why high glucose levels cause complications in people with
diabetes. But keeping glucose levels as low as possible prevents or slows
some complications.

The Diabetes Control and Complications Trial (DCCT) proved it. Researchers
followed 1,441 people with diabetes for several years. Half of the people
continued standard diabetes treatment. The other half followed an
intensive-control program. Those on intensive control kept their blood
glucose levels lower than those on standard treatment, although the average
level was still above normal. The results? In the tight-control group,
compared with the standard-treatment group,

a.. Diabetic eye disease started in only one-quarter as many people.


b.. Kidney disease started in only half as many people.


c.. Nerve disease started in only one-third as many people.


d.. Far fewer people who already had early forms of these three
complications got worse.

Living With Tight Control


To get tight control, you must pay more attention to your diet and exercise.
You must measure your blood glucose levels more often. And, if you take
insulin, you must change how much you use and your injection schedule.

In intensive therapy, you provide yourself with a low level of insulin at
all times and take extra insulin when you eat. This pattern mimics the
release of insulin from the normal pancreas.

There are two ways to get more natural levels of insulin: multiple daily
injection therapy and an insulin pump. Both are good methods. Your choice
should depend on which best fits your lifestyle.

In multiple daily injection therapy, you take three or more insulin shots
per day. Usually, you take a shot of short-acting or Regular insulin before
each meal and a shot of intermediate- or long-acting insulin at bedtime.

With an insulin pump, you wear a tiny pump that releases insulin into your
body through a plastic tube. Usually, it gives you a constant small dose of
Regular insulin. You also have the pump release extra insulin when you need
it, such as before a meal.

With either method, you must test your blood glucose levels several times a
day. You need to test before each shot or extra dose of insulin to know how
many units to take and how long before eating to take it. Also, you may want
to test 2-3 hours after eating to make sure you took enough insulin. You
must adjust your insulin dose for how much you plan to eat and how active
you expect to be.

You do not need to figure these things out on your own. Whatever method you
choose, your health care team (your doctor, dietitian, diabetes educator,
and other health care professionals) should spend a lot of time teaching you
about it. Your team will help you make guidelines for how much insulin to
take and when. You will also come up with guidelines for eating and
exercising. These guidelines may change several times as you test them out.

You shouldn't try tight control on your own. A good health care team is a
must. Choose a doctor who understands diabetes well or is willing to learn
for your sake. Your doctor should have ties with other health professionals
you need, such as dietitians and a mental health worker. If you live in a
small town, look at your options carefully. You may be better off driving to
a city to see a specialist.

How to Keep Going and Going


Starting a program of tight control is exciting. But it can also be
overwhelming. How do you keep from running out of energy?

One way is to start slowly. For example, you might start by checking your
blood glucose more times each day. Get used to that first. Then start
multiple daily injections. Once you're used to those, add your new exercise
program and make the changes in your diet.

If you are newly diagnosed with diabetes, look honestly at yourself. Are you
still angry and depressed that you have diabetes? If so, you already have a
big challenge facing you. You may want to wait to try tight control until
after you've come to terms with the changes in your life.

Keep your goals realistic. No matter how hard you try, your blood glucose
readings will not be perfect every time. If they are often too high or too
low, you should talk to your doctor about whether your plan needs to be
adjusted. But if "wrong" levels happen only sometimes, that's life. With
practice, you will become more skilled at choosing the right insulin doses
for various situations.

If you need to, take a breather from the new routine. Having some time off
may make it easier to stick to your plan when you start again.

Pluses and Minuses


One big reason to try tight control is to prevent complications later. But
tight control has effects you can enjoy right now. You will probably feel
better and have more energy. Also, because you adjust your insulin dose to
your life, and not the other way around, you have more freedom. You can vary
your activities more. And you're not locked into having your meals at the
same time each day.

Tight control is especially good for pregnant women. It can reduce the risk
of birth defects in the baby.

But the DCCT found two major problems with tight control.

First, people had three times as many low blood glucose reactions
(hypoglycemia). You will need to be alert to the symptoms of hypoglycemia so
that you can treat yourself quickly. Also, you should always check your
blood glucose levels before you drive.

If you often have low blood glucose reactions when you try tight control,
talk to your doctor. You may need to ease up on your goals or go back on
standard therapy for a while.

Second, people on tight control gained more weight than people on standard
insulin treatment. The average in the DCCT was 10 pounds. If you are
concerned about putting on pounds, work with your dietitian and doctor to
devise a meal and exercise plan to prevent it.

You should also consider the cost. You will need to see your health care
team more often. Pumps cost about $5000, and pump supplies run $60 to $80 a
month. Multiple injection therapy is much cheaper. But you will still use
more supplies, like test strips and syringes, than before.

Tight Control and Type 2 Diabetes


The DCCT studied only people with type 1 diabetes. But doctors believe that
tight control can also prevent complications in people with type 2 diabetes.

Most people with type 2 diabetes do not take insulin. You may be wondering
how you can achieve tight control without it.

One way is to lose weight. Shedding excess pounds may bring your glucose
levels down to normal. The key to losing weight and keeping it off is
changing your behavior so that you eat less and exercise more. Your doctor
should work with you to find an eating and exercise plan you can stick to.

Even if you don't need to lose weight, exercise is helpful in controlling
your blood glucose levels. It makes your cells take glucose out of the
blood.

You will need to check your blood glucose regularly. You should decide with
your doctor how often. Once a day or even once a week may be enough for some
people with type 2 diabetes.

If exercise and good eating habits are not enough to keep your glucose under
control, you doctor may prescribe pills. And if these don't work, you may
need to take insulin.

People with type 2 diabetes should talk to their doctors before starting
tight control.

Tight Control Is Not for Everyone


Tight control is not safe for everyone with diabetes.

Children should not be put on a program of tight control. Having enough
glucose in the blood is vital to brain development. Some doctors say that
tight control should wait until a child reaches 13; others say after the age
of 7 is okay.

Elderly people probably should not go on tight control. Hypoglycemia can
cause strokes and heart attacks in older people. Also, the major goal of
tight control is to prevent complications many years later. Tight control is
most worthwhile for healthy people who can expect to live at least 10 more
years.

Some people who already have complications should not be on tight control.
For example, people with end-stage kidney disease or severe vision loss
probably should not try it. Their complications are probably too far along
to be helped. Some people who have coronary artery disease or vascular
disease should not try tight control. People who have hypoglycemia
unawareness probably should not go on tight control.

--
Tom
Exercise Today = Life Tomorrow
ADA's Diabetes Learning Center
http://www.diabetes.org/all-about-diabetes/chan_eng/channel.htm
Information you can trust from the diabetes experts...
Your American Diabetes Association
http://www.diabetes.org/home.jsp
the American Diabetes Association's Message Boards
http://community.diabetes.org/n/pfx/forum.aspx?webtag=amdiabetesz&nav=index
Pictures of My motorcycle and I think 2 of my doggies.
http://www.adventurseofvtx1300c.com.50megs.com/photo.html


From: Alan S on 24 Oct 2005 22:08
On 24 Oct 2005 15:29:12 -0700, naneklund(a)aol.com wrote:

>Right or wrong depends on YOUR body and what testing tells you. It
>takes time to establish YOUR pattern and needs. Some can eat corn;
>some can't. Some can drink orange juice; some can't (that's one of MY
>problems'; I can't drink juice but can eat a whole orange). We all
>learn over the months and years and don't forget there is interaction
>between medication, age, exercise, and diet.
>The two things I've learned in 15 years with diabetes and nearly that
>many with this group:
>YMMV (Your Mileage May Vary - that is, you and I are different) and
>TEST, TEST, TEST. That's how you'll learn what YOUR body needs.
>Nan, Type 2 since 1990 or so

Listen to Nan - she knows what she's talking about.
To help in following her "TEST, TEST, TEST" advice, read
this link:
http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

Cheers, Alan, T2, Australia.
--
Everything in Moderation - Except Laughter.
From: J. David Anderson on 25 Oct 2005 00:39
Sarah wrote:

>
> Your post meal numbers, 160-170, are not real bad but many T2's here would
> like to keep them under 140. The thinking is that under 140 will give the
> best chance of avoiding complications.
>
> To do this you could either increase your meds or lower your carbs.


You can also increase exercise to enable the consumption of more carbs.

I wonder why so many people either forget or ignore this?

I eat most of my carbs shortly before morning and evening exercise and
it is extremely effective. I got a very clear reminder of just how
effective last night.

My wont is to eat a supper of carbs and protein with a glass of red wine
and then exercise (both anaerobic and aerobic) for a minimum of 45
minutes before retiring. Last night we had a sudden and very severe
storm with heavy rain, including a blackout. I ate my late supper but
ended up tending to potential flooding problems rather than exercising
(we live on a tidal river frontage and it was high tide) and when I
awoke this morning my fasting BG was 5.8 (104) a number I haven't seen
since last year. My normal is 4.7 - 4.9 (84 - 88) or as low as high 3's
if I become engrossed in a DVD (I watch them while exercising) and
extend my exercise time well beyond my minimum 45 minutes, perhaps to
120 mins +. The reason for this is that I have a personal rule that I
only watch DVDs while exercising, never at any other time. It helps with
incentive.

Well timed and regularly executed exercise is perhaps the *most*
effective way of handling high BGLs while consuming sufficient carbs to
allow fully unrestricted brain function i.e., 120 - 150.

Regarding brain function, an area of dispute among radical low carb
adherents, I decided to resolve the issue for myself. Several weeks of
consistently replicable test results some time ago confirmed for me that
carb consumption under 120g per day slows my reaction time and thought
processes. This of course is anecdotal to anyone reading, but as
empirical as it gets for me as it applies to me directly.

It isn't hard to test and is quite fascinating to observe; I used
computer games (strategy and reaction based - Chess, Zuma, Boulderdash
etc.) and logged resulting scores over a period of several weeks with
both high and low carb levels. I obtained consistently better scores
when carbs were over 120g. Very poor scores when under fifty. The
results were always replicable. On low carb levels the computer would
consistently thrash me at Chess, Zuma etc., while at above 120g, using
the same difficulty levels I would win more often than lose. A crude but
effective experiment that says a lot about the effects of low carb on
brain function. The brain certainly continues to work when the body is
deprived of carbs, but it does not work at full capacity. I would not
like to sit an important exam while extreme low carbing.


Regards

David

--

To email me, please include the letters DNF anywhere in the subject line.

All other mail is automatically deleted.
From: Andrew B. Chung, MD/PhD on 25 Oct 2005 07:22
Nirvana wrote:
>
> Hi
>
> After finding out 3 months ago I am type 2. My doctor sent me to a
> dietician. After doing a few calculations using my weight and age. She put
> me on a 2200 calorie a day diet. She told me I should eat 90 g of carbs each
> meal.
> Does this sound right?

3 ounces of carbohydrates per meal sounds fine.

> I had been talking metformin and my BG lowered a lot, but my tests still
> averaged in the 220's.
>
> Now I am on metformin and glyburide. My BG is even better. But sometimes
> goes to 200, but usually 160's, 170's after meals. before meals it is
> usually in the low 100's or lower.
>
> What am I doing right or wrong? Am I eating too many carbs at each meal?

You may be eating too much food altogether.

> Any advised would be helpful

I personally invite you and all other ASD participants to an on-line
chat where one of the topics covered will be diabetes:

http://www.OurMableton.net/ParadiseChat

Hope to see you in Paradise this Thursday from 6-7 pm EST :-)


In Christ's love and service now and forevermore,

Andrew

--
Andrew B. Chung, MD/PhD
Board-Certified Cardiologist

**
Suggested Reading:
(1) http://makeashorterlink.com/?G1D5217EA
(2) http://makeashorterlink.com/?W13A4250B
(3) http://makeashorterlink.com/?X1C62661A
(4) http://makeashorterlink.com/?U1E13130A
(5) http://makeashorterlink.com/?K6F72510A
(6) http://makeashorterlink.com/?I24E5151A
(7) http://makeashorterlink.com/?I22222129
From: Ma?k on 25 Oct 2005 22:14
On Mon, 24 Oct 2005 22:13:03 GMT, "Nirvana" <dcalaniz(a)verizon.net>
Huffed and Puffed the following into the madness of usenet:

>Hi
>
>After finding out 3 months ago I am type 2. My doctor sent me to a
>dietician. After doing a few calculations using my weight and age. She put
>me on a 2200 calorie a day diet. She told me I should eat 90 g of carbs each
>meal.
>Does this sound right?

I was put on a 2200 calorie diet, being a type 1 using insulin, and at
a time when I was active in sports. it does not sound right for an
adult type 2.


>
>I had been talking metformin and my BG lowered a lot, but my tests still
>averaged in the 220's.
>
>Now I am on metformin and glyburide. My BG is even better. But sometimes
>goes to 200, but usually 160's, 170's after meals. before meals it is
>usually in the low 100's or lower.
>
>
>What am I doing right or wrong? Am I eating too many carbs at each meal?
>
>
>Any advised would be helpful
>
>n
>


try reading http://www.alt-support-diabetes.org especially the section
Newly Diagnosed.

--
M?ck??
Type 1 since 1975
http://www.alt-support-diabetes.org
http://www.diabetic-talk.org
http://www.insulin-pumpers.org



"To announce that there must be no criticism of the
President, or that we are to stand by the President
right or wrong, is not only unpatriotic and servile,
but is morally treasonable to the American public."
....Theodore Roosevelt

(o o)
--ooO-(_)-Ooo--------------------

"I don't know half of you
half as well as I should like;
and I like less than half of you
half as well as you deserve."



Jesus never hated anyone.
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