I was diagnosed in my (type 2 ) 40’s had gestational diabetes in my late 20’s. At first I dropped 35 lbs and got my A1c from 9.3 to 6.3. A few yrs later I hit a denial phase gained back a few lbs but never went over 7 and my Dr never complained said I was doing well. But got back on the straight and narrow after a few yrs and kept my A1c around 6. Last 10yrs A1c has been in the 5.5 range currently 5.2. I do have some mild neuropathy in my feet and scalp. But not much of a problem yet and I am 74 yrs young. So I am hoping it will stay as is. Tempted at times to pretend I am normal. But this group keeps me going!

This is why Diabetes needs to be "managed" with a plan from the beginning

If you are in your 40's or 50's when diagnosed with Type 2 (or younger) you NEED to get control quickly (first couple of years) and maintain "non-diabetic" numbers for as long as possible while you are young, cumulative damage hasn't set in yet, and you need to maintain it until you have "kicked the can" far enough down the road that the Beast won't get you before you die of (old age)

The problem with the overwhelming majority of Type 2's is they either outright ignore the problem (70% of Type 2's currently have an A1C over 7.0%) and cause a lot of damage in the early years OR they mistakenly believe that an A1C of 7.0% is "good enough"

If you are in your mid-60's or younger and your A1C has been a "what they call controlled" 7.0% for the past few years, it is "unlikely" that you will live to see Life Expectancy (early 80's)

7.0% will buy you 10 years before the worst complications start setting in and reach the point of inevitability and then take another 10 years to take you out

Maybe not a concern if you are older than 70, but if you are just in your 50's maybe don't make too many plans for your "golden years"

But the Medical Establishment at least in most of the Western World won't tell you that because the perceived negative effects on the mental health from "knowing you are killing yourself" is considered worse then drastically reducing your life expectancy

We have morphed into a society where "how we feel about things" has been elevated to the point that we are living unhealthy, and shaving years and years of function off our lives in order not to hurt anyone's feelings

Unfortunately for Us, Diabetes doesn't care how we feel about it, how hard it is to control, how many cravings we have or how depressing and life altering it may be

Control = long life, good function and die of old age (or something else)

No Control = A1C above 6.5% WILL result in micro and macro vascular damage 100% of the time and on average will shave 15 to 20 years of function and life from the uncontrolled Type 2

And the longer you go uncontrolled in the early years, the less ability you have to control it later - too much cumulative damage gets done and can not be reversed

@A DiabetesTeam Member I never did see a final (wrap up) but the interim information when they halted the study talked about (I'm paraphrasing from murky memory now)

The assumption they were working on was since this (bunch) in the study had A1C's in the higher 7's (on average) and they were an older cohort and likely many had pre-existing early stage of CHF (congestive heart failure) or were at high risk, that lows being caused by the intensive treatment were "more damaging" and more "deadly" (sooner - was implied) then simply controlling a little less stringently AND treating the complications as they came along

Not long afterwards, Harvard Med put out a pretty good paper on "why it was potentially beneficial to allow (older or those with comorbidity) diabetics to run higher than recommended A1C's compared to the "keep it under 7.0" standard that was widely accepted, even though it would potentially shorten their life (since the "treatment" could shorten it even further)

Then in 2019 most of (Diabetes Associations including the ADA etc) adopted (new) Glycemic Targets for management of Type 2 and even put out a "kinda neat" little chart to help GP's/Primary/Family Doctors set more realistic A1C targets for individual patients (see below)

So we don't all fit into the "same scale"

The only issue I have with that, and believe it probably is more viable - is that Doctors are afraid to tell patients the truth (as in "yes, you can run with a higher A1C because of X, Y or Z but just don't be surprised when you DO Develop these complications - we know that will happen but it's easier to treat those then risk killing you even earlier)

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@A DiabetesTeam Member
Brutal but excellent post. Every diabetic should print this and put it on their fridge door.

Sure some diabetics reach 90+ without any meaningful diabetes management. They’re the exception, not the rule.

Did the VA say why people with regular hypos have damaged hearts?

The clue might be that most were on insulin therapy and paradoxically insulin resistant.

Insulin therapy + hypoglycaemia = possible Hyperinsulinemia = probable damage to heart and/or other organs.

Insulin therapy + insulin resistance could equal hyperinsulinemia with probable damage to heart and/or other organs.

Unless vital insulin therapy should be avoided especially if you are very insulin resistant.

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@A DiabetesTeam Member yes I can explain 😁

High blood sugar is what Type 2's tend to focus on because that is "usually" our biggest (diabetic) issue

Over time (10 to 20 years) elevated blood sugars can damage the heart to the point of causing Congestive Heart Failure - in fact that is what will take almost 85% of ("Us") out - Type 2's die from heart failure in the end "most of the time"

So a few years back the V.A. in the US undertook a study to see if they could reduce the risk/rate of heart failure in Veteran's with Diabetes

Conventional wisdom and scientific research established that if you control your blood sugar, as measured by A1C, to non-diabetic levels, you lower the risk of complications

So the V.A. figured if we take a whole bunch of Veterans that have Diabetes with A1C's greater than 7.0% and we medicate the snot out of them, alter their diets etc and try to get their A1C below 6.5, they should be able to improve the mortality rate from heart disease - made total sense

They had to stop the study because too many of the participants were Dying from heart attack, stroke or premature heart failure

They had to figure out why and what they discovered is, as we age (biggest factors but other diseases may contribute) while high blood sugar is "dangerous" for heart health, Low Blood Sugars are downright deadly

And if you medicate and diet older diabetics that have been "running high for a while" they tend to see significant and regular "low blood sugar episodes" and that will shorten your life to weeks or months, not "years" like the higher blood sugar

There is (now - past number of years) a whole treatment guideline in the guidelines used to Treat Type 2 for patients that must be "protected from hypoglycemia" - a different level of treatment with more relaxed A1C targets

Type 2's older than 70 years old who are in reasonable health and have not yet experienced significant diabetic complications can target an A1C in the 7.5 to 8.5 Range and not experience a negative outcome

It's morbid, but statistically once you reach age 70, if you have been reasonably controlled up to that point, you simply won't live long enough to develop the major complications that a 7.5-8.5% A1C will eventually cause

But if you try to hard to get that A1C down to sub 6.5 to "protect the heart" and end up experiencing low blood sugar events regularly (typically happens with insulin therapy) you can literally "stop your heart" a decade or more before the high blood sugar would result in your death

Bottom line - High Blood Sugar will kill you in a decade or two - Low Blood Sugar can kill you "tonight"

If you need "intense therapy" to achieve normal blood sugar levels that would protect the heart you put it (the heart) at greater risk because in order to implement that "intense therapy" you risk regularly going "low" which is "more deadly"

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A Diabete...