Tuesday, June 19, 2012

T1D Exchange Finds People with Type 1 Diabetes Don’t Meet Targets

I just read Jessica Apple's analysis of the problem with T1 diabetics not being successful in achieving the health that doctors and the ADA desire for them. It hit a chord for me, because I was one of those people "doing everything right" but not getting the prescribed results.

Basically, the  study found that a large proportion of Type 1 diabetics are gaining weight and not meeting recommended A1C levels. The question is, will the ADA change their recommendations on diet and insulin? Personally, with kids, I think a higher A1C might be more appropriate, but with adults it seems that if healthy A1C goals can't be achieved, we have to look to the diet in a more aggressive way. If you are keeping your A1Cs in line, not gaining weight, and maintaining your health, then you are doing well.

I added my 2 cents in the comments, but, since it sums up some of my experiences, frustrations and core beliefs about diabetes. I'm going to repeat it here.
Here’s the thing… if you have a kidney problem or a gall bladder removed you have a list of foods that you have to avoid to stay healthy. No one really argues with that too much. But, for some reason we have been reticent to tell PWDs (people with serious metabolic issues) that anything is off limits. Let’s get real. Let’s not treat PWDs like little children who might throw a tantrum and give them the info that they really need to be successful. I think, with more success, the issue of depression linked with diabetes could be moderated. Poor control, weight gain, the threat of complications and a constant sense of failure… that’s depressing.
I tried to meet the recommended healthy A1C requirements for years while cooking from scratch, eating all whole foods, but never sorting out the fast acting carbs part of the equation. I never got there. I gained weight, became insulin resistant, and had poor control. Once I started limiting which foods I ate, I was able to make progress in my health goals. It was wicked simple.
The fact is, anyone who uses/creates too much insulin, PWD or not, will have negative impacts in their health. Hyperinsulinemia is a real problem. The ADA needs to encourage people to use less insulin, and therefore eat less foods that require lots of insulin. Good control is within everyone’s reach, but it’s like we/they are afraid to tell the D-community that they can’t have anything they want, all the time. The mantra that we can eat just like everyone else is silly, especially when you see that the rest of the western world (everyone else) is having it’s own insulin related metabolic problems.


  1. I think you are right on. What is the big disconnect here? People with diabetes have a carbohydrate metabolism problem. Why are we treating this with ample carbohydrates, acting like there is no problem, just not enough medicine? And you make a very good point about "eating like everyone else" when even the general population is having similar issues, and developing diabetes! AAAGH!

  2. I think some of it is specifically aimed at countering the Atkins' diet and things like that, and embracing the whole "personal choice" aspect of D-Management. You can, but...

    1. I know... personal choice is kind of "reverse psychology". It's like you have a personal choice to have better results or worse results.

      I totally believe that you won't get the best possible results until you totally, personally strive for it, and it takes time...

  3. People with their gallbladders removed don't have to stick to a diet, matter of fact. There are no foods at all that people without gallbladders have to avoid. Not one. I should know because I don't have a gallbladder, and I paid attention to what the nurses, doctors, and nutritionist told me (nutritionist was there to talk about pancreatitis).

    And if you have a kidney problem... for more than fifty years (sixty years?) doctors advised low protein diets for people with kidney disease. But the evidence, over and over, is that eating low protein with kidney disease increases risk of death and does not decrease time to dialysis. Dietary advice for many diseases is contested, and should be contested.

    And the dietary advice I got post pancreatitis, which I think makes a lot of sense for diabetes too, was to get a list of categories of foods that sometimes create issue and was told to really just avoid what made me hurt.
    With diabetes, I think the best advice should include something to the effect that a diet MIGHT be helpful, and you won't know unless you try- but it might not be necessary.
    I don't believe that limiting insulin injected actually improves health outcomes. I think insulin resistance causes health problems (and that poor blood sugar control causes insulin resistance), and that's another ball game.

    1. Jonah,
      Thanks for the clarification on the gall bladder, I know someone who recently had the gall bladder removed, but since it was related to pancreatitis I thought the diet recommendations were one and the same. My understanding is that the gall bladder produces bile that helps you to break down and metabolize fats.
      If diabetics are depressed, discouraged and claiming that the treatments they are being given are not working, then I think we can do better. If they don't WANT to limit their diets, that's their choice too.
      Here's the thing... you and I are both willing to research and experiment with our outcomes. You have tried various things and know what works best for you. But, for the people who look to their doctor or the ADA alone to tell them what should work... it's too bad that the average T1 diabetic is gaining weight, and achieving poor glucose control.

    2. The gallbladder doesn't make anything. It's the liver that makes bile, and the gallbladder stores it. It's like a little pouch that the liver sends bile to, and then when you eat it's supposed to contract and release bile, to add to the bile that the liver is also secreting right then. But in most people, the liver can just secrete a larger amount during meals, so there's no problem, at least not for most people.

      The ADA should encourage people either to:
      a) experiment, keep careful records, and adjust their own insulin dosages (if you read insulin package inserts you'll notice you're still not recommended to change your own dose without talking to your doctor), or
      b) eat consistently, except maybe in adding food when hypo and subtracting carb foods when hyperglycemic, so that insulin can be more readily matched to what they eat.
      I think advising people that their insulin dosages need to be low would negatively affect health outcomes because people wouldn't take insulin despite needing it- there are already too many people who avoid insulin because they are worried about weight gain, or are scared of needles, or think that medicine = bad for you.

    3. Jonah,
      I like your ideas about what the ADA should encourage. Eating consistently is huge. I think I could figure out how to eat more carbs and maintain decent control, but, it would be a long standing experiment in consistency. I think that's what it comes down to. Eating roughly the same thing everyday until you get it sorted out. I guess, the problem with most successful approaches is that we expect the person to research, tweak things, make decisions, and... actually care.

      I know there are people who are not taking insulin for the wrong reasons, diabulemia, etc., but those are separate problems. The message that you can eat whatever you want as long as you cover it with insulin, is wrong in the same way that "eating everything" is probably not a good idea for most people in general.

      My experience with diabetes has been a chronic underlying hunger that was almost never satisfied. It wasn't until I got my blood sugars under control and stopped the cravings for carbohydrates that I began to feel normal. Until that happened, I pretty much couldn't have good glucose control and feel good.

  4. Oh I totally agree. I try hard to go about it in a convincing and light stepping way but really what I want to say is what you just did. This issue drives me INSANE and I'm doing my best to teach my kids different since the world is soon to try to brainwash them. lol