I mean obviously a steady and normal blood sugar without any treatment is optimal, right? But once you’ve hit that point, I question whether a person could be classified as T2D.
The fact is that almost no type 2s can achieve normoglycemia or anywhere near it without taking at least one, if not two, medications. So it feels pretty relevant.
I guess you could still ask about whether a type 2 who is only taking insulin would also be similarly harmed. In that case, it really seems tied to whether you could achieve normal blood sugar with no hypos.
Data from an earlier study showed higher all-cause mortality in T1s and T2s treated with insulin that was temporally tied to hypos:
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I think we are in violent agreement here. Anyone that thinks an observation study that finds an association is able to be extracted into an absolute care treatment guideline is misguided. Unfortunately most of the media reporting on these types of studies makes exactly these mistakes in their writing. The study referenced should only be used to guide individual decisions in consultation with a well read physician, and only when the definitive study is completed should (would) an absolute statement about A1c be warranted.
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I concur fully.
And most of the readers, including the really smart ones. Humans are just so strongly wired to infer causality…
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Love that comment.
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Do not currently have access CGM as Medicare doesn’t take into account once daily injections of long acting insulin (Tujeo). If I let my fasting BG >105, the numbness of the neuropathy in my feet interferes with my ability to find the brake pedal automatically, and severely limits my ability to drive safely! Keeping a tighter control and using TENS on my feet keeps me going
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Overnight lows would be my biggest concern. Talk to your CDE about buying an over the counter CGM,do a test run for 2 weeks and see how your night time lows are. That would give you a good picture. Also if you are having lows you can fight for a CGM. Nancy50
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The Medicare rules have changed significantly over the last couple of years. ATM any IDD satisfies the Medicare requirements for a CGM.
Repeated hypoglycaemia (with or without insulin treatment) also satisfies the requirements.
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According to my endocrinologist, part of the reason to avoid frequent lows in the elderly is not just to avoid falls, but to avoid subtle brain damage that can lead to dementia. He’s quite happy if my A1c is at 6.5, or even as low as 6.3, but what he searches more carefully is my cgm readings to make sure I’m not having a lot of lows and those I do have are only in the mid-to-high 60s.
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Ruth,I agree with you. SummerI hope to return to 6.5,winter I run 6.6-6.8. Fine with me. And my Endo FNP. Nancy50
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Yeah, my endo has been going on about this. I’ve yet to find any scientific studies; the only stuff I found was not about low BG but about high BG, which is certainly correlated with dementia/Alzheimers. There is a correlation with hyperinsulinemia and Alzheimer’s:
Hyperinsulinemia and risk of Alzheimer disease - PubMed [original research from 2004]
Changes in insulin and insulin signaling in Alzheimer's disease: cause or consequence? - PubMed [a review paper from 2016, free]
This is about elevated insulin caused by insulin resistance. There is a later 2019 article but it is paywalled. Searching for hypoglycaemia however shows this:
Hypoglycemia and Alzheimer Disease Risk: The Possible Role of Dasiglucagon - PMC [2022 sort-of review paper]
Notably, from that paper:
It has been shown that both hyperglycaemia and recurrent hypoglycaemia adversely affect the pathogenesis of AD (Chakrabarty et al. 2022). Notably, AD is regarded as type 3 diabetes due the mechanistic interplay between AD and T2D.
Welcome to the new diabetes, Alzheimer’s!
Sarcasm aside the whole thing here seems to be driven by “recurrent hypoglycaemia” in T2 diabetics. A well known problem correlated with insulin resistance (a known cause of T2), resulting in a requirement for high levels of insulin either produced by the T2 body or by medical intervention (injecting insulin), etc, etc…
More sunspot cycles I think.
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Sunspots…I’m gonna start blaming everything on sunspots!
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