We often focus way too much on blood sugar with our diabetes. and one of the big things that we can become obsessed with is diabetic complications. So I like to provide some links with these posts quite often, sometimes providing supporting views or studies and sometimes providing the alternative view, which can be very helpful in looking at the way people think about certain things and providing some contrast to that.
So when it comes to worrying about complications from blood sugar, popular diabetes blogger Jenny Ruhl immediately came to mind, and I actually plan on looking at a few of her articles, maybe quite a few, to provide some contrast. So today we'll be looking at "Do People With Type 2 Always Deteriorate."
Generally speaking, type 2 diabetics do deteriorate, and as she points out, doctors do see this with their patients and tell them this is inevitable, and I do agree with her that this isn't necessarily the case, although we're talking about deteriorating diabetes here, not necessarily deteriorating complications, to be fair.
So in other words insulin resistance gets worse from conventional treatment, and not surprisingly, because it's not being treated, and that's what tends to happen when you don't treat it. A big part of this is eating the wrong diet, not eating to your disease, and Jenny and I agree on that point for sure.
So people do tend to get worse on conventional treatment, which by the way focuses exclusively on lowering blood sugar, and over time that ends up failing to some degree anyway because the underlying condition deteriorates. Now some diabetics to be fair may not get bad enough in the end to run very high, the kind of blood sugar that brings with it a lot of risk for complications, but some do, and overall people are exposed to a significant degree of risk in the end when people can no longer be medicated to target.
We don't have to look any further than the average A1C of diabetics being treated by conventional medicine to see this, the treatment target is generally below A1C 7, and most diabetics do not achieve this on medication, they often do initially but as time goes on, even though more and more medication is thrown at them, it works less and less and their condition goes downhill such that even the medical standard, which some people think is too high, fails to be achieved.
Jenny is certainly one of them and states she feels that the problem is that people are getting complications below 7, that's not really the case generally as the incidence of complications in this area, in the 6's, is quite low, but the truth is, a lot of diabetics don't achieve this target, and many who do require toxic levels of insulin to achieve this, which is also dangerous.
We need to be focused on the real problems here, which is clearly blood sugar much higher than that, and the risk starts becoming significant at 8 and goes up geometrically from there, especially when you look at how risk plays out over time. When we get to the double digit A1C's, were talking a massively higher amount of risk, so this is a big deal indeed but we need to keep things in perspective.
So Jenny of course is frightened even by pre diabetic blood sugar, in a nutshell she looks at evidence that there is glycation that goes on above 140, and even above 100, there's glycation that goes on with normal blood sugar too by the way, but this is only meaningful if it leads to actual damage, not theoretical damage.
So the only way to decide this is to look at correlations between blood sugar and damage, that tells the real story, even though there are other factors involved here and some pretty significant ones. All things being equal though, which equates to a neglect of these other factors, we know that the risk is insignificant below 6.5, and while the risk does go up from here, it's not really until we get above 8 that there's real reason for a lot of concern.
The big thing though is that if we do really care about these complications, we want to pay attention to reducing the damage itself, the processes that are involved, such as oxidation and glycation. I do care a lot about complications myself and actually found out I had diabetes when I got peripheral neuropathy, my blood sugar at the time was also super high, so while I needed to reduce that to more acceptable levels, an even bigger task was to heal from this and also take steps to reduce the sort of thing that causes this.
So that's the part that gets left behind in these discussions. So people like Jenny preach strict blood sugar control to manage complications, stricter than the medical profession does in fact, and although there's nothing wrong with this provided it's done without worsening our disease, and it usually is if you are using medications to do this, that's only one side of the story and maybe not even the most important part.
So she references a study where there were people with good control that showed microvascular damage, and this does happen in some cases, but non diabetics get this too, and there are several factors that influence this, the treatment itself, co morbidities that are being untreated, especially obesity, and one's natural defenses towards these complications, which are neglected and if anything compromised.
What this data shows us in fact is that it is not just about blood sugar and you can be well controlled and still have risk, and we have to look at the entire picture here and treat the whole person rather than just treating one's blood sugar, and everything else be damned.
Good control does reduce our risk, to be sure, but there is a diminishing return with this and below 7 does reach that level pretty much, where further reductions in blood sugar don't reduce the risk in a very meaningful way, and you get to the point where the risks of the treatment itself outweigh the benefits, and that probably happens at a blood sugar level well higher than A1C 7, especially when we look at studies that showed greater numbers of fatal complications in medicating people below 7 versus below 8.
There's nothing wrong in itself with having better blood sugar but this often doesn't come without risks of its own. The bottom line though in all cases is that we need to look at influencing overall health and especially treating other co existing metabolic conditions, and we especially want to look to help ourselves in defending against the higher degrees of oxidative damage that we get, that's actually the biggest thing, it's what does us in.
Few of us are even aware of the benefits of things like benfotiamine, astaxanthin, and other nutrients to prevent diabetic damage, blood sugar control is just one part of this, if we really want to help ourselves we need to actually look to try to help ourselves more and not just worry or even become paranoid about blood sugar, especially since good control isn't as protective as we may like it to be.