Tuesday, June 10, 2008

Diabetes - Quandaries of Preventing Health Disease in Diabetes

High blood sugar as a toxin, the higher it is, the more it poisons the system. High blood sugar leaves a sludge in its path that plugs capillaries, arterioles, and blood vessels large and small. Bring down high glucose, and you can control the disease and its complications.

Unfortunately, tightly controlling blood sugar, keeping it constantly low as measured by a hemoglobin A1c of 7.0 or less, has its hazards too – episodes of hypoglycemia with occasional deaths.

At the American Diabetes Association in San Francisco – three studies featuring glucose control to prevent heart attacks – ACCORD from NIH, ADVANCE from Australia, and the Veterans Affairs Trial from Phoenix – reached four broad conclusions.

• One, the best way to reduce cardiovascular risk is lower cholesterol and blood pressure, but reduced blood sugar levels have little additional benefit.

• Two, avoid hypoglycemia. Episodes of hypoglycemia double risk of heart death and triple risk of death of any other cause.

• Three, aggressively controlling glucose levels early in the disease but not after having the disease for several years.

• Four, aggressive treatment helps prevent eye and kidney complications, especially if coupled with improved diet, exercise, and aspirin therapy.

To conclude, diabetes is a disease best viewed through the lens of complexity. It is the most studied disease in history, but remains a mystery. It is better controlled than uncontrolled. It is genetic in children and certain kindred, but acquired, most often as a result of obesity. It has highs and lows, and both are bad. It is one of the few metabolic diseases curable by surgery (gastric bypass for obesity). It is a cluster disease, often occurring with heart failure, heart attacks, and peripheral vascular disease, to name but a few. Treatment can be simple – exercise, diet, and aspirin – but more often involves pills to control the disease itself and its companion co-morbidities. Avoid it if you can; control as best you can.

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