It makes so much sense. There was a lot of remote medicine during COVID but now back to in house. My husband and I are healthy (one, maybe tow visits per year) for routine checks that could be organised by a nurse leaving the doctor to see patients requiring more care. It's not rocket science.
It does make sense. We could save so much on bricks and mortar facilities. We could provide excellent care to remote rural areas. Push for change where you are.
They are claiming that but it reflects a gross misunderstanding of diabetes. Type 2 diabetes is defined by the blood sugar level. That is how we diagnose diabetes. If your fasting sugar is 126 or higher or you have any blood sugar reading over 200 that establishes the diagnosis of diabetes. A hemoglobin A1c test of 6.5 or higher also establishes the diagnosis of diabetes.
These diagnostic standards are somewhat misleading, however. You might think that if you cut back on sugar and carbs and lose weight leading to a consistently normal blood sugar, you have “reversed diabetes”, but that is a dangerous misunderstanding. By the time your blood sugar or hemoglobin A1c passes the numbers required to make the diagnosis of diabetes many other changes have occurred in which genes are switched on and these changes remain after your sugar becomes normal. That means your increased risk remains and no matter how thin you become or how low your sugar goes you should stay on metformin which blocks the effects of switched on genes. Blood pressure medicines like lisinopril or losartan and statin cholesterol medicines block the effects of these switched on genes to dramatically reduce your risk of diabetic complications.
Yes. Those are intermediate outcomes. Optimal medical therapy reduces death, heart attack, stroke, and dialysis compared with usual care. I have seen no such data from those who claim to reverse diabetes and frankly don't expect to see it.
I don’t know if there is any data on it yet, there may be. But as a layman it would make a lot of sense to me that if your blood markers, weight, blood pressure etc were all normal or trending that way then your risk of heart attacks and strokes is also considerably less even if your once were “diabetic”.
It does make a lot of sense David. That is the reason we have been stuck in that paradigm for so long. Lowering those risk factors provides some fractional protection. But you must have a comprehensive solution even to move those relaibly. Most effort to lower the pressure, sugar, and cholesterol fail at scale. These risk factors are related to excess oxidant production and they cause excess oxidant production. If you lower the risk factors, you get a fractional improvement. If you aggressively lower sugar, more patients may even die.
Right there with you. Our physical office space is being remodeled to allow for more procedure space and less “exam” room space. This week I have decided to remote from Southern California simply because I want warmth and sunshine. Next week perhaps it will be elsewhere. It is the future.
It makes so much sense. There was a lot of remote medicine during COVID but now back to in house. My husband and I are healthy (one, maybe tow visits per year) for routine checks that could be organised by a nurse leaving the doctor to see patients requiring more care. It's not rocket science.
It does make sense. We could save so much on bricks and mortar facilities. We could provide excellent care to remote rural areas. Push for change where you are.
Cool article Dad
Thanks Bill. We could have a better system that was easier to navigate.
There are practitioners now reporting diabetes reversal with diet now Dr. B. Interested in your thoughts on that.
They are claiming that but it reflects a gross misunderstanding of diabetes. Type 2 diabetes is defined by the blood sugar level. That is how we diagnose diabetes. If your fasting sugar is 126 or higher or you have any blood sugar reading over 200 that establishes the diagnosis of diabetes. A hemoglobin A1c test of 6.5 or higher also establishes the diagnosis of diabetes.
These diagnostic standards are somewhat misleading, however. You might think that if you cut back on sugar and carbs and lose weight leading to a consistently normal blood sugar, you have “reversed diabetes”, but that is a dangerous misunderstanding. By the time your blood sugar or hemoglobin A1c passes the numbers required to make the diagnosis of diabetes many other changes have occurred in which genes are switched on and these changes remain after your sugar becomes normal. That means your increased risk remains and no matter how thin you become or how low your sugar goes you should stay on metformin which blocks the effects of switched on genes. Blood pressure medicines like lisinopril or losartan and statin cholesterol medicines block the effects of these switched on genes to dramatically reduce your risk of diabetic complications.
I’ve seen studies that show blood pressure coming down along with other markers like A1C??
Yes. Those are intermediate outcomes. Optimal medical therapy reduces death, heart attack, stroke, and dialysis compared with usual care. I have seen no such data from those who claim to reverse diabetes and frankly don't expect to see it.
I don’t know if there is any data on it yet, there may be. But as a layman it would make a lot of sense to me that if your blood markers, weight, blood pressure etc were all normal or trending that way then your risk of heart attacks and strokes is also considerably less even if your once were “diabetic”.
It does make a lot of sense David. That is the reason we have been stuck in that paradigm for so long. Lowering those risk factors provides some fractional protection. But you must have a comprehensive solution even to move those relaibly. Most effort to lower the pressure, sugar, and cholesterol fail at scale. These risk factors are related to excess oxidant production and they cause excess oxidant production. If you lower the risk factors, you get a fractional improvement. If you aggressively lower sugar, more patients may even die.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2249652/
Lisinopril, losartan, amlodipine, atorvastatin, and metformin are antioxidant that lowered heart attack 4 fold and stroke five fold- not fractionally
https://www.nejm.org/doi/full/10.1056/nejmoa0706245
We must all rely on facts. Not what makes sense.
Right there with you. Our physical office space is being remodeled to allow for more procedure space and less “exam” room space. This week I have decided to remote from Southern California simply because I want warmth and sunshine. Next week perhaps it will be elsewhere. It is the future.
Great! Let's work together to make it real now!
wbestermann@congruityhealth.com
Once again a truly engaging insightful article. I am RN and totally agree. The stories I hear daily are frightening
I would love to know more about you and what you are doing.
wbestermann@congruityhealth.com