September 18, 2007

Why Monitoring Doesn't Reduce High A1cs

This AP news release

Diabetics Try New Round-The-Clock Sensor

touting the success of Continuous Glucose Monitoring Systems (GGMS) cited this statistic attributing it to Dr. Irl Hirsch of the University of Washington:

Diabetics who do the worst job fighting their disease aren't going to put in extra effort to improve just because of a sensor, says Dr. Irl Hirsch of the University of Washington.

"We learned that lesson the hard way," says Hirsch, who presented research at a recent diabetes meeting suggesting the sensors instead will most benefit patients who can't lower their blood sugar to optimal levels — a score below 7 on a test called the A1C — despite following best-care guidelines.

Hirsch finds the sensors help lower A1Cs between 7 and 8.5, but not those who start out higher.
[emphasis mine]

There's a reason for this, and sadly, it is another case of iatrogenic [doctor-caused] failure.

Monitoring and testing are worthless if doctors don't give people effective strategies for responding to unfavorable test results.

In the case of an unacceptably high blood sugar, the one strategy that will solve the problem is cutting way back on carbohydrates. It is carbohydrates that raise blood sugar and it is by lowering carbohydrates that you can bring down a very high blood sugar.

But most patients and, sadly, most doctors, don't get this.

Every week I get emails from recently diagnosed people with diabetes that they are baffled because at their doctor's urging they have "improved their diets" by adding lots more fruit and healthy whole grains, but their blood sugar is not improving.

Well, given that most fruit and all grains--whole or not--are full of carbohydrate, this should surprise no one. But when even doctors and nutritionists are telling people with diabetes to start out the day with a big bowl of oatmeal and a banana, you can see why these poor victims/I mean, patients can test 20 times a day and it isn't going to make a bit of difference.

If you give a patient a meter or CMGS and tell them that they should cut out the starches and sugars in their diet--no matter how "low GI"--and replace them with protein and fat until the blood sugar comes down into the safe zone, you will see huge improvements in people with A1cs as high as 13%.

My web page documenting reports from people who joined "The 5% Club" shows this very clearly.

The reason that Dr. Hirsch's patients with high A1cs aren't benefiting from monitoring is most likely because the reason they got those high A1cs in the first place is that they were eating the usual high carb/low fat diet that a frightening number of nutritionists and doctors still prescribe their patients.

Give people with high A1cs a CGMS or a blood sugar meter along with the simple advice you'll find here:

and you'll see people attaining far better A1cs than the not-low-enough-to-prevent-blindness 7% A1c that Dr. Hirsch seems to think is impossible to attain.


Barbara Hairston said...

In the artical I read concerning this monitoring an example was given of a 7 year old Type 1 whose mother discovered her bg was 300 after her oatmeal breakfast. The solution to this was increasing her morning insulin. No idea of a diet change.

When I read this I knew all the monitoring in the world won't make a difference without a change in thinking that control must be medicinal nor diet. I am depressed about this ignorance.


Barbara Hairston said...

I checked my comment and see that I misspelled article and put nor rather than diet.

Barbara Hairston said...

This is sad. I still have an error. I was trying to say the " powers that be" are recommending medicine use rather than diet to contro bg.

Barbara Hairston

Anna said...

Wow, I was struck by that mother's reaction in the article, too. A more moderate 200 reading? I suppose compared to 300, ok, but I would be freaking at gettng even a 200. And after oatmeal, a so-celled healthy whole grain, too! The next surprise was reading that the mother is a Type 1 diabetic, too. She needs some serious education. Clearly she has not been reading your blog, Jenny. Or the latest research. Sad, very sad. And so unnecessary.