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Re: [IPk] Re: Question on lowering BG's

I would hasten to add that although the DCCT found that there was a reduced 
rate of complications when HbA1c was kept at around 7, they also strongly 
warned that tighter control will often bring hypo unawareness. The full 
DCCT report is available at http://content.nejm.org/cgi/content/full/329/14/977

And as far as hypo unawareness goes, I suspect that it was not the change 
from Novorapid to Humalog that caused the hypo unawareness, but the ongoing 
tighter control. The other instances I know of hypo unawareness developing 
have been caused by massively bouncing blood sugars (your body "forgets" 
what abnormal BGs are, and so doesn't bother warning you at all). In the 
first instance, awareness can be regained by allowing the BGs to be taken 
into a slightly higher range; in the second case, tightening control can 
reinstate awareness.

An interesting study on Humalog and hypo unawareness (etc) was conducted 
some while ago (1998), and the results can be seen at 

The endocrinologist who conducted the study above recommends type 1 
patients keep their HbA1c between 7 and 8%, to minimise long term 
complications and to prevent hypo unawareness. An HbA1c in this range 
translates as an average BG of about 7.2-8.9. I choose to adopt this 
practice towards my own control as it maximises my quality of life whilst 
preventing massive hypos, but I suppose it is up to each person largely to 
determine what works best for them.

Also bear in mind that all of the meters on the market today have an 
accuracy rate of "within 20%", so a reading of 6 or a reading of 9 could 
both actually be a reading of 7! Unfortunately this is an issue that is not 
widely known or discussed; people tend to accept their meter's reading as 

Tori (last HbA1c 7.2, everyone is happy!)

At 05:51 AM 19/03/2003, you wrote:
>The lower bg targets are NOT ARBITRARY figures based on non-diabetic 
>levels. They are recommended in light of the Diabetes Control and 
>Complications Trial (published 1994), a long-term study on type 1--the 
>most comprehensive EVER--which showed conclusively that the closer a 
>person with diabetes keeps his/her blood sugar to non-diabetic levels, the 
>lower the risk of complications. Complications were *70%* (70%! Really!) 
>less likely in the subjects of the study who got HbA1cs closer to 7 than 
>they were in the subjects who routinely had higher HbA1cs.
>Shame on your doctors and DSNs for not giving you access to the findings 
>of the DCCT. Without knowledge of the long-term benefits of better 
>control, the occasional inconveniences in the short term are quite a lot 
>more off-putting.

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