Hypoglycemia Awareness improves with Self-Monitoring in Type 1 Diabetes

[Self..*]

http://www.diabetesincontrol.com/articles/53-/16724-hypoglycemia-awareness-improves-with-self-monitoring-in-type-1-diabetes

[Pro-Humanist FREELOVER]

- - -

Insulinitis (old name: type 1 diabetes)

- - -

I monitor constantly. My hypoglycemia unaware-
ness is the same that it has been both before
and after going on a Continuous Glucose Monitor
for the better part of the last year.

They mentioned "overall improvement", but they
didn't state if any differences in HbA1c levels
were entailed, nor did they iterate if anyone
was using a Continuous Glucose Monitor, nor did
they indicate the before/after regularity of
glucose testing, nor did they indicate whether
insulin dosing changed before/after.

They also didn't indicate before/after incidence
of hypoglycemia. They used a term "metabolic con-
trol", but didn't comment that one has limited
impact on metabolism, with an array of factors
involved, many of them outside of our awareness
or knowledge.

They called hypoglycemia a "severe condition",
and did not comprehend that a condition of hav-
ing a glucose level of 55-69 is far less severe
(some would call that mild or uneventful) than
is a condition of 45-55, very low, 35-45, scarily
low, or below 35, what I would call frequently
at high risk of a genuinely severe low, with the
scariest chance of an unconsciousness and/or loss
of cognizance event and/or a seizure.

The article you referenced, apparently unaware
of all of its flaws that I detailed above:

- - -
http://www.diabetesincontrol.com/articles/53-/16724-hypoglycemia-awareness-improves-with-self-monitoring-in-type-1-diabetes
- - -

By the way, "control" was lost in every last one
of us who has Insulinitis when we first got the
most severe form of the condition (i.e., not the
earlier stages of the latent adult onset type)
and had to go on exogenous insulin guesses for
all of our insulin needs.

- - - - - - - - - - - - - - - - - - - - -

- - -
Pro-Humanist FREELOVER (I got Insulinitis
at age 5 in March, 1961 -- I use a Dexcom
G4 Continuous Glucose Monitor -and- an
Omnipod Insulin Pump)

C.ure I.nsulinitis A.ssociation
http://prohuman.net/cureinsulinitisassociation.htm
- - -














--
Posted by Mimo Usenet Browser v0.2.5
http://www.mimousenet.com/mimo/post

[Alan Mackenzie]

Hello, Pro.

Pro-Humanist FREELOVER <love_fo...@hushmail.com> wrote:

> - - -

> I monitor constantly. My hypoglycemia unaware-
> ness is the same that it has been both before
> and after going on a Continuous Glucose Monitor
> for the better part of the last year.

Yes, we know. But this research wasn't about you. It was about T1s on
average.

> They mentioned "overall improvement", but they
> didn't state if any differences in HbA1c levels

> were entailed, ....

Of course not - HbA1c is irrelevant in the extreme to a diabetic who's
having frequent hypos (and thus frequent highs, too). HbA1c is merely a
crude average of BS of at best questionable usefulness. It's certainly
of no use to you, seeing as how you've got a continuous BS monitor.

> .... nor did they iterate if anyone

> was using a Continuous Glucose Monitor, nor did
> they indicate the before/after regularity of
> glucose testing, nor did they indicate whether
> insulin dosing changed before/after.

No. What was on that page was just a brief summary of the research. A
too brief summary. In fact, so brief that there's practically nothing of
substance to argue about.

> They also didn't indicate before/after incidence
> of hypoglycemia. They used a term "metabolic con-
> trol", but didn't comment that one has limited
> impact on metabolism, with an array of factors
> involved, many of them outside of our awareness
> or knowledge.

<sigh>. This isn't about you and your fantasies, it's about the real
world. Let's just say that the participants in the study, and those who
follow the results, will have, on average, less problem with hypo
unawareness than they used to.

> They called hypoglycemia a "severe condition",
> and did not comprehend that a condition of hav-
> ing a glucose level of 55-69 is far less severe
> (some would call that mild or uneventful) than
> is a condition of 45-55, very low, 35-45, scarily
> low, or below 35, what I would call frequently
> at high risk of a genuinely severe low, with the
> scariest chance of an unconsciousness and/or loss
> of cognizance event and/or a seizure.

Yet again, the study wasn't about you. I think everybody who's any
knowledge at all about T1 diabetes knows that hypos come in varying
severities. By the way, your numerical scale of scariness vs BS level
only applies to you. Everybody's reaction to different BS levels is
different. For example, I'm still coping fine at 30 - scarily low for
me is below 20, but I don't know how far below.

> The article you referenced, apparently unaware
> of all of its flaws that I detailed above:

> - - -
> http://www.diabetesincontrol.com/articles/53-/16724-hypoglycemia-awareness-improves-with-self-monitoring-in-type-1-diabetes
> - - -

Its only flaw is that it's a summary lacking detail. If you found and
read the actual scientific paper it's reporting on, you'd probably find
most of your quibbles dealt with.

> By the way, "control" was lost in every last one

> of us who has diabetes when we first got the

> most severe form of the condition (i.e., not the
> earlier stages of the latent adult onset type)
> and had to go on exogenous insulin guesses for
> all of our insulin needs.

Bollocks! This is just you playing word games again, as usual. You know
full well what is meant by "control" in this context, and even you have a
smidgin of it. I have adequate control, thank you very much.

> Pro-Humanist FREELOVER

--
Alan Mackenzie (Nuremberg, Germany).

[All..*]

All uninformed self indulged questions answered here:

http://care.diabetesjournals.org/content/37/8/2114.abstract

Results, no differences with those using the pump and cgm toys and those
not.

Recalling always, it ain't ;bout you.

[Pro-Humanist FREELOVER]

On 10 Aug 2014 04:02 PM ,Alan Mackenzie <a...@muc.de> wrote:

> Hello, Pro.

> Pro-Humanist FREELOVER <love_fo...@hushmail.com> wrote:

> > - - -

> > I monitor constantly. My hypoglycemia unaware-
> > ness is the same that it has been both before
> > and after going on a Continuous Glucose Monitor
> > for the better part of the last year.

> Yes, we know. But this research wasn't about you. It was about T1s on
> average.

> > They mentioned "overall improvement", but they
> > didn't state if any differences in HbA1c levels
> > were entailed, ....

> Of course not - HbA1c is irrelevant in the extreme to a diabetic who's
> having frequent hypos (and thus frequent highs, too).

I suppose you mean that it's not as desirable
to have lower HbA1c levels if the incidence of
hypoglycemia is higher than _?_ (unknown,
and my endo wants my below 70 events to
be -0-, a level that I suspect is impossible
to obtain unless I was willing to raise my
HbA1c level, and I've done that a tad, up
from 4.7 to 5.1, but I'm not willing to go as
far at that as my endo wants me to, for
fear of all of those adverse long-term com-
plication risks).

In any case, many studies have proven that
the closer one's HbA1c level is to the level
which those without any glucose anomaly
have, the lower the risk of long-term compli-
cations, but the greater the risk of both hypo-
glycemia and severe hypoglycemia.

I have, in the past (not recently) had readings
below 30 (can't recall ever having a reading in
the teens), but of course, as we both know, the
lower the reading, the greater the risk, and we
also know that occasionally, even readings above
40 can cause cognizance struggles.

> > The article you referenced, apparently unaware
> > of all of its flaws that I detailed above:

> > - - -
> > http://www.diabetesincontrol.com/articles/53-/16724-hypoglycemia-awareness-improves-with-self-monitoring-in-type-1-diabetes
> > - - -

> Its only flaw is that it's a summary lacking detail. If you found and
> read the actual scientific paper it's reporting on, you'd probably find
> most of your quibbles dealt with.

> > By the way, "control" was lost in every last one
> > of us who has diabetes when we first got the
> > most severe form of the condition (i.e., not the
> > earlier stages of the latent adult onset type)
> > and had to go on exogenous insulin guesses for
> > all of our insulin needs.

> Bollocks! This is just you playing word games again, as usual. You know
> full well what is meant by "control" in this context, and even you have a
> smidgin of it. I have adequate control, thank you very much.

From Merriam Webster's definition of control,
the parts behind the colon :s, along with my
comments on the definition:

con�trol verb
http://www.merriam-webster.com/dictionary/control

: to direct the behavior of (a person or animal)

So, Insulinitis, we direct some of our behavior,
when conscious, but much of our metabolism, we
don't direct, having limited capability to impact
that critically important aspect, and when asleep,
our ability to direct is absent. We guess at insulin
dosages, and our bodies have probabilistic responses
to that insulin -- i.e., that's an unpredictable
enterprise.

: to cause (a person or animal) to do what you want

None of us wants glucose levels to go too low -or-
too high, so in that critical aspect, we have
limited capability with exogenous insulin, food
and drink ingestion, and exercise, and the actual
control we desire, that which was lost when we
lost our insulin production, is impossible with
the current modalities of administering insulin
exogenously.

: to have power over (something)

We have limited power, and can impact but don't
have the critical elements of automatic preven-
tion of below 70 events, and automatic preven-
tion of glucose levels too high, both of which
were lost when (in most of us) our autoimmune
systems attacked our pancreases and in a small
minority, when other conditions resulted in a
loss of all or nearly all insulin procuction.

: to direct the actions or function of (something)

See above, no dirction when asleep, and only
probabilistic direction, with metabolic un-
knowns, when awake.

: to cause (something) to act or function in a certain way

See above, though in a broad sense, we can
lower glucose levels with exogenous insulin,
though that takes time and to increase the
rate of lowering, we also increase the risk
of a below 70 event. Conversely, on the low
side, we can raise glucose levels, but that
is difficult to do without the glucose going
too high, although I've found I've had more
success in that area recently, with lower
carb and lower overall insulin dosages, but
still, not always successful at having the
glucose within "normal" parameters when I
ingest a glucose-raising substance in re-
sponse to the glucose going too low.

Under their "full definition" of control,
I have some comments about the following

2 c: to reduce the incidence or severity
of especially to innocuous levels

Well, certainly, exogenous insulin allows
us to reduce the incidence or severity of
hyperglycemia, and arguably, that reduc-
tion is to innocuous levels, although one
might argue that since the risk of severe
lows is present in everyone on exogenous
insulin, that makes the treatment a high
risk adventure that's non-innocuous.

[Include..*]

Read the abstract for the study given you. All your questions, and the
several misunderstandings and irrelevant items you raised are addressed.

A hint, ask if you do not understand it, don't whine and preach about how
it doesn't say this orthat. Even based on the news article given you
before, much of what you complain about was given in it.

We have two ears and one mouth for a reason.

[Alan Mackenzie]

Hello, Pro.

>On 10 Aug 2014 04:02 PM ,Alan Mackenzie <a...@muc.de> wrote:

>> Pro-Humanist FREELOVER <love_fo...@hushmail.com> wrote:

>> > - - -

>> > They mentioned "overall improvement", but they
>> > didn't state if any differences in HbA1c levels
>> > were entailed, ....

>> Of course not - HbA1c is irrelevant in the extreme to a diabetic who's
>> having frequent hypos (and thus frequent highs, too).

> I suppose you mean that it's not as desirable
> to have lower HbA1c levels if the incidence of

> hypoglycemia is higher than _?_ .....

No, I meant what I wrote. HbA1C levels have nothing useful to say to
such a diabetic. They merely indicate an average level, whereas what is
pertinent is the roller coaster (s)he suffers.

[ .... ]

> In any case, many studies have proven that
> the closer one's HbA1c level is to the level
> which those without any glucose anomaly
> have, the lower the risk of long-term compli-
> cations, but the greater the risk of both hypo-
> glycemia and severe hypoglycemia.

Have they really? Maybe you could cite one or two of these many studies,
so that we can see what they really say. But it's important to
understand their message, which you do not. HbA1c is not a cause - it's
merely correlated with something which is a cause, namely high blood
sugar. HbA1c was useful to doctors several decades ago because it was
all they could measure. Nowadays, when diabetics regualarly measure
their own BS, it's of little or no value. HbA1c is a crude average.
You've spent a lot of time and money getting yourself a continuous BS
monitor, yet you're still obsessed with an outdated, second rate smudge,
rather than concentrating on the high quality readings your instrument
gives you.

[ .... ]

>> > By the way, "control" was lost in every last one
>> > of us who has diabetes when we first got the
>> > most severe form of the condition (i.e., not the
>> > earlier stages of the latent adult onset type)
>> > and had to go on exogenous insulin guesses for
>> > all of our insulin needs.

>> Bollocks! This is just you playing word games again, as usual. You
>> know full well what is meant by "control" in this context, and even
>> you have a smidgin of it. I have adequate control, thank you very
>> much.

> From Merriam Webster's definition of control, .....

[ long, irrelevant, pretentious, patronising drivel snipped. ]

You know, Pro, it's that sort of garbage which makes your posts so
disliked in this newsgroup. No amount of word games can disguise the
fact that your control was very poor, though it has become better in
recent months. If you hadn't been in such denial about it, you might
have had less difficulty in improving it.

> - - -
> Pro-Humanist FREELOVER

[Pro-Humanist FREELOVER]

On 14 Aug 2014 01:36 AM ,Alan Mackenzie <a...@muc.de> wrote:

> [skipped inaccuracte mischaracterization
> of my post]

Your post about HbA1c being relatively less
important than a detailed analysis of actual
glucose levels as revealed by a CGM, well,
by both measures. I'm doing great. As for
my HbA1c levels being near or even below
what many who don't have any High Glucose
Condition are at, that's outstanding in any
medical or endocrinological viewpoint.

As well-documented, I've not had any severe
lows since January. That's outstanding in any
medical or endocrinological viewpoint, espe-
cially when combined with my low HbA1c levels,
which I expect will still be estimable when
my HbA1c level is next tested on August 21,
and I get the results back on August 28.

As for above 130 events, few and far between
these days. As for my below 55 events, well,
here's my complete what's called a "Success
Report" from the Dexcom program which dis-
plays my CGM levels on a computer:

Since July 28, 2014, 3 days after going on the
low carb diet I'm currently on:

< 55 mg/dl ... 0%

>=55 and < 70 mg/dl ... 8%

>=70 and <= 130 mg/dl ... 87%, with most
of the readings being >=70 and <=99 (64%)

>130 and <= 160 mgl/dl ... 4%

> 160 mg/dl ... 0%

Average glucose level = 92.

By any/every perspective one might come up
with, that's simply outstanding, stats that
should go in the Hall of Fame for those who
have Insulinitis and are forced to guessti-
mate the insulin dosages many times per day
and night (yesterday, for example, I made
24 dosage decisions, 6 involving changes to
basal delivery, 18 involving bolus delivery).

I suspect that the intense effort I put into
dealing with Insulinitis is not doable, and
certainly is not practicable, for anyone who
relies on insulin injections, so that type
of intense management is only practicable
by someone who is using an insulin pump.

As for your request for information on lower
HbA1c levels being tied to higher hypogly-
cemic risks, and also tied to lower long-
term complication risks, those reports have
been widespread for many years, and I've
included links to them on occasion during
my many posting efforts in this newsgroup.

I suspect that your reticence to endorse
my efforts is because of my detailed report-
age of my struggles with severe hypoglycemia
(which, by the way, have been successful, with
only 1 severe low since November of last year)
and because of my endorsement of new names
for each of the High Glucose Conditions.

As I've taken measures to minimize the risks
of severe lows (seeing an endocrinologist,
going on a CGM and later, on an insulin pump,
accepting a slightly higher HbA1c level while
still keeping it very low, and recently, exper-
imenting with a low carb diet (not as low as
suggested by Richard Bernstein, but still,
qualifying as low carb by the < 126 grams of
carbs per day standard mentioned in recent
articles), I would submit that your stance
is in need of a re-do.

As for the word "control", I dileneated in
detail why that word was not an accurate
description of the manner in which Insulin-
itis is currently dealt with using insulin
guesses and all of the other tools we have
at our disposal, but in any case, I will
submit that -if- one wished to use that
word in assessing how one deals with this
condition, I would come as close as possible
to qualifying for that attribution -if- one
does not disqualify someone for that nomen-
clature if one uses terms you rarely hear,
like "insulin guesses" -or- "Insulinitis".

- - - - - - - - - - - - - - - - - - - - -

Excerpts [with inserts, not part of original
article, included in brackets]:

- - -
Hypoglycemia in ... [Insulinitis]

A still unresolved problem in the era of
insulin analogs and pump therapy
http://care.diabetesjournals.org/content/31/Supplement_2/S121.full.pdf+html&keyword=pediatrics-and-hypoglycemia-clinical-significance
- - -

Abstract

The Diabetes Control and Complications Trial
demonstrated that in patients with ... [Insul-
initis], tight metabolic control achieved with
intensive insulin therapy can reduce the risk
of long-term microvascular complications.

However, strict glycemic control carries an
increased risk of severe hypoglycemia.

Recurrent episodes of hypoglycemia, especially
at young ages, can lead to hypoglycemia unaware-
ness, exert adverse effects on neurocognitive
function, and cause significant emotional mor-
bidity in the child and parents.

Although the introduction of the new insulin
analogs ... and the use of continuous subcutan-
eous insulin infusion raised hopes for a solu-
tion to this problem, these modalities have not
been associated with the expected reduction in
hypoglycemic episodes.

The findings suggest that the prevention of hypo-
glycemia in patients with ... [Insulinitis] lies
in biologically controlled insulin secretion, as
in islet transplantation, or the development of
an autonomous closed-loop system [i.e., an arti-
ficial pancreas, also referred to by some as a
bionic pancreas] that efficiently mimics the
action of the pancreatic beta-cells and maintains
blood glucose levels within the desired range.

CSII, continuous subcutaneous insulin infusion

The benefits of intensive management of ... [Insul-
initis] were clearly established with the publica-
tion of the Diabetes Control and Complications
Trial in 1993. [That trial] demonstrated that
tight metabolic control achieved with intensive
insulin therapy is superior to conventional treat-
ment in reducing the risk of long-term microvas-
cular complications.

However, strict glycemic control has been found
to carry an increased risk of severe hypoglycemia,
especially in patients receiving intensified
insulin therapy. Nocturnal hypoglycemia, which
accounts for about half of all severe episodes,
is particularly dangerous because the warning
symptoms are blunted or absent during sleep.

In healthy subjects with an intact counterregu-
latory defense mechanism, the presence of hypo-
glycemia generates autonomic symptoms that alert
the individual. The body responds by suppressing
insulin release and stimulating glucagon release
from the pancreatic islet cells, thereby protec-
ting the brain from glucose deprivation.

By contrast, in patients with ... [Insulinitis],
the circulating insulin concentration depends
on exogenous administration, so that an insulin
suppression response is impossible. With time,
the glucagon response, too, is diminished partly
or entirely. Recurrent blunting of these auto-
nomic processes, even over the short term, leads
to hypoglycemia unawareness, which in turn further
increases the risk of subsequent severe hypogly-
cemic episodes.

...

- - - end excerpts - - -

- - - - - - - - - - - - - - - - - - - - -

- - -

[Alan Mackenzie]

Hello, Pro.

>On 14 Aug 2014 01:36 AM ,Alan Mackenzie <a...@muc.de> wrote:

>> [skipped inaccuracte mischaracterization
>> of my post]

How dare you! There was _NO_ mischaracterisation of your post by me.
Or, if there was, it was wholly unintentional. Perhaps you could have
the decency, if that concept means anything to you, to point out where
this alleged "mischaracterization" happened, so as to allow any
misunderstanding to be sorted out by discussion. This is the normal to
and fro of human relationships.

> Your post about HbA1c being relatively less
> important than a detailed analysis of actual
> glucose levels as revealed by a CGM, well,
> by both measures. I'm doing great. As for
> my HbA1c levels being near or even below
> what many who don't have any High Glucose
> Condition are at, that's outstanding in any
> medical or endocrinological viewpoint.

I don't give a damn how great you're doing. My point, which you snipped,
was that HbA1c levels are unimportant, not about your personal state.
This thread is not about your personal state, it's about more abstract
and more important matters.

[ 45 tedious, self-congratulatory, irrelevant lines snipped. ]

> As for your request for information on lower
> HbA1c levels being tied to higher hypogly-

> cemic risks, .....

Again, a distortion of my text by you, one I suspect was deliberate. I
did not "request information" on HbA1c levels; Rather, I challenged you
to cite studies which support your view on the relationship between HbA1c
levels and long-term health.

> .... and also tied to lower long-

> term complication risks, those reports have
> been widespread for many years, and I've
> included links to them on occasion during
> my many posting efforts in this newsgroup.

Sure. I don't believe you. I think you're lying. Anyhow, if you've
posted such links from time to time, you'll have no difficulty posting
those links again. As I said, I'm curious about what these studies
really say, assuming they exist.

> I suspect that your reticence to endorse
> my efforts is because of my detailed report-

> age of my struggles with severe hypoglycemia .....

No, it's because I find your postings singularly unattractive. They
suggest that you are a self-centred person who cares nothing about
anybody else. They scream "me! me! me!". Most people emerge from this
self-centred state in early childhood, learning to engage with other
people and their points of view. Not you.

At every juncture you insert long, long comments about yourself, which,
quite frankly, nobody wants to read. This newsgroup is not about you,
it's about diabetes. When other people raise on-topic points in response
to your posts, you do not engage with them.

I detest your habit, when responding to me, of deleting my text,
mischaracterising it, then responding to what I _didn't_ write. This can
only be deliberate distortion, since it is so easy to leave my quoted
text in.

And, on top of everything, I detest your contempt for other people's
feelings and desires, manifested by your continued use of your own silly
"words" and euphemisms in place of accepted terminology.

[ .... ]

> As I've taken measures to minimize the risks
> of severe lows (seeing an endocrinologist,
> going on a CGM and later, on an insulin pump,
> accepting a slightly higher HbA1c level while
> still keeping it very low, and recently, exper-
> imenting with a low carb diet (not as low as
> suggested by Richard Bernstein, but still,
> qualifying as low carb by the < 126 grams of
> carbs per day standard mentioned in recent
> articles), I would submit that your stance
> is in need of a re-do.

That's a non-sequitur. There's no connection between my "stance" (that
basing a diabetic therapy on HbA1c is foolish) and your recent success in
eliminating your hypos.

[ .... ]

[Gary Woods]

Alan Mackenzie <a...@muc.de> wrote:

>How dare you! There was _NO_ mischaracterisation of your post by me.

You're arguing with an obsessed loon (as always, IMHO only).
That way leads madness. IMHO.

--
Gary Woods AKA K2AHC- PGP key on request, or at home.earthlink.net/~garygarlic
Zone 5/4 in upstate New York, 1420' elevation. NY WO G

[Pro-Humanist FREELOVER]

- - -

I've not experienced any improvement in hypogly-
cemic awareness, although thanks to my CGM I
am aware of every low glucose event due to my
constant monitoring of glucose levels via my CGM.
That awareness, external, and my internal sense
of low glucose levels is as it's been ever since I
became hypoglycemic unaware, counter to the
reported improvement in the initial post in this
thread which was reported in a study to have
happened to those who made an unspecified
increase in bloodpricked glucose tests.

- - -

Insulinitis (old name: type 1 diabetes)

- - -

On 15 Aug 2014 09:39 AM ,Alan Mackenzie <a...@muc.de> wrote:
> Hello, Pro.
>
> >On 14 Aug 2014 01:36 AM ,Alan Mackenzie <a...@muc.de> wrote:
>
> >> [skipped inaccuracte mischaracterization
> >> of my post]
>
> How dare you! There was _NO_ mischaracterisation
> of your post by me. Or, if there was, it was wholly
> unintentional.

Yes, your post was as stated. We don't
agree on much of anything regarding this
condition, or on how to characterize the
current state of affairs regarding the short-
comings in the exogenous insulin treat-
ment we (those of us with Insulinitis) are
all forced to engage in to stay alive.

You've show oblivousness regarding the
admirable nature of how I'm dealing
with this condition, even though I've
provided substantial details regarding
that.

- - - - - - - - - - - - - - - - - - - - -

- - -