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The Question
Tue Nov 06 14:26:51 UTC 2012

Is tight control acceptable for Type 2 diabetics who are diagnosed in their 20s and are lean and physically fit based on new standards from ADA?
Asked By: jojo321  

Background Info Hide
Have always been on tight control and modified cardiac risk factors, triathlon train and have had Type 2 for 12 years since I was 27. I was lean and fit when diagnosed but do take medication to keep cholesterol down and BP lowered. I am concerned as have been told they would like my control to be around 7-7.5% for the past year when I've always been under 6.5%. I recently have had a diagnosis of slight background retinopathy to one eye and worry my control over the past year has not helped this situation. Thanks for any advice.
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Expert Answers (1)
2013-06-02 11:54:43.0

Hello jojo321
Thank you for bringing your question to dLife. You have been in tight control reported as around 6.5% HbA1c level but for the last year, your providers have recommended that you should maintain a 7-7.5% level. There are studies that show that tight control can increase cardiac risk especially if the person experiences episodes of hyopglycemia. This could be why your provider feels it is safer for you to stay between 7-7.5%. You should ask your provider about why you need to change your goals.

Retinopathy is a long term complication from Diabetes. The retinopathy could be the result of the progression of the disease. Having a higher HbA1c may have hastened the symptoms or maybe it would have developed anyway.

Answered By: Rita Juray
Accreditations: RN, MLT-ASCP, CCM, CDE
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Community Answers (4)
2012-11-27 04:02:33.0

Let's consider two hypothetical people. They will represent extremes on purpose and are not intended to stereotype anyone. Person A goes on a low carb diet and begins exercising or continues ongoing exercise. For such a person, though there may be exceptions, typically the blood glucose, blood insulin, triglyceride and 'bad' cholesterol levels will significantly reduce to plummet over the course of a few months. Person B continues eating the same high carb diet, 'covers' with insulin, and has no time or energy of exercise. For such a person, though there may be exceptions, blood glucose will tend to go down but blood insulin levels, triglycerides, and 'bad' cholesterol will tend to be higher after a few months. If I recall the previously reference study correctly the problem with it is it doesn't distinguish between people of the first type and people of the second type. It just says generically that 'control' is bad without specifying how it was achieved. This is not to say people who use insulin are 'bad' in any way, it's just to point out different types of control likely have different impacts which deserve to be considered separately.
Answered By: gphx

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2012-11-17 13:36:39.0

If you were 27 at diagnosis, lean and fit, I question whether you are actually a Type 2. High cholesterol occurs with high blood sugars for anyone, and high blood pressure can have other causes. Have you been tested for antibodies? You might have LADA -- Latent Autoimmune Diabetes in Adults, which is actually Type 1, and needs to be treated accordingly. In addition, the ACCORD study was conducted on obese adults with long-term T2 -- that doesn't fit you, either. The other concern I have is that you ALREADY have retinopathy, and tight control HAS been shown to reduce retinopathy, although you have to go slowly in order not to exacerbate it from quick changes. In your particular case, especially since you do NOT fit the profile of a typical T2, I would take overgeneralizations with a grain of salt. Do your research and do what's right for YOU.
Answered By: natsera

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2012-11-16 16:14:23.0

There is a fair bit of controversy about it. It is best to discuss with your doctor. I have added the link at the bottom about the ACCORD studies mentioned by the expert. Unfortunately the link she posted does not work.
Answered By: greendrive

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2012-11-16 13:23:52.0

This might be one of the worst answers given by an expert here ever. What study is she referencing, what A1c numbers did they come up with? Saying "an HgA1c of 7% or less as a safe range" is nice, but since the gist of the study being referenced said tight control led to more cardiac events, shouldn't the acceptable low end numbers be stated? Isn't that the question he was asking and the alleged findings of the study? I can see people reading this and giving up on tight control because of some mystery study said it caused heart attacks. Diabetes is one of the rare diseases where you can actual track, with actual numbers, what it is doing to you. To give out vague, alarmist info like this, when the actual metrics should be readily available for this study, is a disservice to everyone watching their numbers. Give the numbers to support the theory.
Answered By: malpaso

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