THE ACCORD PROGRAM is in the headlines!!!!
 

Well, wouldn't you know it?? The ACCORD program (the protocol that I have been in for about 3 years (I'm in the standard group, not the intensive), well, it's in hot water.

People died, and for the life of me, I can't find exactly why when I read the article. I also received (via dispatch), a letter from the ACCORD people indicating that they are stopping the intensive program and moving everybody from the intensive program into the standard program. It doesn't involve anyone in the intensive blood pressure part of the program.

So someone read this and explain why the people died. By the way, I am not on any oral meds. Just the Lantus, which went from 46 units down to 26 (which I am now presently on)

Please?? I just got this off of my MSN homepage.

http://www.msnbc.msn.com/id/23029191

P.S. I am going there on Friday for my visit.

Mel

I could not really find a reason in the article why there were more deaths reported.

They stated they could not link it to Avandia or really to any major difference in that protocol, other than the more aggressive goal.

The above referenced article states only:

“A thorough review of the data shows that the medical treatment strategy of intensively reducing blood sugar below current clinical guidelines causes harm in these especially high-risk patients with type 2 diabetes,” said Dr. Elizabeth G. Nabel, director of the institute.

It was very vague. I am sure more articles will come out explaining it better.

I just finished a CE lesson on diabetes/goals.
 

What a coincidence.

It is not clear what is going on. Perhaps the cholesterol drugs were a factor, and just not mentioned in the article.

In this lesson is a reference to the EPIC-Norfolk study in Europe which suggested that A1c levels below 6 were a good target for death reduction.

It appears in the ACCORD study that the aggressive portion of glucose control was targeting that range. Typically in US the target is below 7, not 6.

I'll continue to look around...it might show up on PubMed, or a later article in more detail. NYTimes might do an in depth study, and expose more detail.

Diabetes drugs are not 100% innocuous either. Metformin can cause acidosis, and Avandia has shown some connection to death from heart disease. Diabetics have inflammatory vascular problems as well, which also might be a factor. I wonder if any of these people were tested for B12 levels, or other nutritional support? Obviously you Mel never were told to use B12 and you only do so because of this forum.

There were deaths in the HERS study on hormone replacement therapy, that study was ended early as well. Women were dying on estrogen. And developing dementia.

It looks like a complex situation. I predict there is not one clear answer to it.

Also, aggressive blood sugar control, can lead to hypoglycemia during the night. It would be interesting if these
subjects died at night. If blood glucose goes below 30 and the person is unconscious, they could easily die.

Holy Crap.

I keep taking my pulse. This darn thing scared the bejesus out of me.

I mean, give me a break. They put you in a protocol that is supposed to be saving lives, studying the affect diabetes has on the cardiovascular system, etc. etc.

I actually did better than I was supposed to. I got lower readings, my blood pressure is just fine, I went down on my meds. My a1c is better than the goal they set for me. They have no explanation, and as they put it "Melody, this is great for you, but not so good for the protocol you are in". We all had a good laugh (this was many months ago, because I go there usually every 2 months or so. And they give me a yearly BIG physical.

This friday is the BIG one!!! Marks the 2 year thing or something to that effect.

Thank goodness I wasn't in the intensive part of it. They told me "your body responded as if it were in the intensive part of the protocol, but you are actually in the Standard part".

I'll definitely ask some questions on Friday.

It ends in the spring of 2009. I mean, they are very good to me, take great care, (because I listened to every thing they told me to do), I took my meds faithfully and my sugar reading was better for it.

So how come 257 people died???

oh my!!

Mel, what is your A1c level?

Diabetics do die you know. They are not stable physiologically and have a shortened life span due to the damage the disease does to blood vessels.
This article did not clarify stroke -- thrombotic or hemorrhagic either.
So until the data is written up more clearly, it is hard to answer.

It is frightening to learn how much doctors don't know or understand. I wouldn't get all upset over this, since you appear to be doing well. If you were not so bad to start with, you may not have had the damage present already.
Some of those patients may have been really in poor shape.

another article:
 

from http://www.prnewswire.com/cgi-bin/st...4750723&EDATE=

It is a complex issue. The answer will take alot of time to be forthcoming, I predict.

Hi Mrs. D.

Oh, I forgot to mention that when I INITIALLY TRIED TO GET INTO THE STUDY, my a1c was 7 and I was turned down. It was explained to me that I needed an a1c of 7.5 to be admitted to the study.

Because I was self-medicating with food at the time, and not really doing a good job of managing my blood sugar, it was almost a year later when I went back and my a1c was 9.0. So they took me in the study.

When I went into the study, my sugar was 400 (because I shoveled snow). But it usually was 265 or so. I was on lots of metformin (which killed my stomach). Thank the lord I was able to stop the metformin. I stopped going to the bathroom 6 times in the morning. It didn't make me lose weight either. I had been on it for years before I got to the ACCORD program and I never lost any weight on Metformin.

So I joined the study, they put me in the standard group. I was also put on Vytorin but my muscles did NOT LIKE THIS MED, so I stopped after a few months.

I'm in the intensive blood pressure group (I think they only have an intensive blood pressure group). They tweaked my blood pressure meds because they believe a person who has diabetes is greater risk for stroke and heart attack so while a regular person might have 120/70, they REALLY LIKE WHEN MY PRESSURE IS 106/65.

They walk in and say "wow, look at those numbers"!!! I once said "isn't that low??" and they said: "are you kidding, your pressure is perfect".

I've never had a problem with my pressure since I've been going there.

They take it 3 times and then they average it out.

And I can refuse any thing I don't want to take.

But so far, I'm doing okay, so I thank god.

I have noticed that when I'm there, I see other diabetics getting their checkups. These are always woman and they are over 250 lbs. They are ALL on humolog, or novalog or some kind of insulin. Now I don't know if they are in the Accord Program like me, but they are always there.

I once read where you can be a type 2 and be on insulin (not like the Lantus that I'm on). But on the ones where you take a shot before you eat.

Lantus is not like that.

I still have goals. I'd like to be off all insulin. Hey, I'm 60 and I'm entitled to my goals. If I can do it, I'll do it. They seem to feel it's not such an impossible goal to achieve.

Time will Tell!!!

I know many Type 2's and they are on a lot more meds than I am on, plus they are on Cholesterol meds, and oral meds, and high blood pressure meds (I know some people who take 2 or 3 blood pressure meds a day.

I have a 63 year old neighbor who is on 11 pills a day (3 of which are high blood pressure meds), She's on 3 different oral diabetes meds, and her sugar reading is always over 200. ALWAYS!! The other day it was 265.
Then it got down to 175 and she called me and said 'My sugar is really good now, it's 175". and I just said "why on earth do you consider 175 good"??

And she said: "well, you know me, I'm usually 265, so 175 is good for me". She is over 300 lbs and she could have gone to the Accord study with me but she didn't want to go into NYC.

You know what confuses me. The people on the Biggest Loser.

They go in there saying "I was borderline diabetic, or they say "I'm diabetic", then they lose all their weight and then they say "I"m no longer diabetic".

Hey, I lost TONS OF WEIGHT. How come I'm still diabetic??.

Guess I'm too old at 60, huh???

Forgot to mention, at my last blood work, my a1c was 6.5

Insulin is given two ways...
 

a long acting maintenance dose like Lantus.

And some people need a bolus with meals. These people have to count carbs,
so they can inject the correct amount.

Some people need both, and others don't.

Some people are very brittle and hard to control. I used to work with a nurse and supervisor who were younger than me, with type II who had to use the insulin pump.

There are many variations to controlling Type II. Many type II people can be controlled well, with diet and exercise, if they are good at compliance.

Good at Compliance??? I'm so good at compliance that I think it's a bonus if I get to eat half an orange. That's a treat for me.

Oh, you asked if the people at Accord cared if I was on B-12.

Not only do they NOT care. When I mentioned that my feet seemed to be better in the burning aspect of my neuropathy, it was mentioned "this has more to do with your good glucose control than the fact that you are on B-12'.

So you can FORGET B-12 as far as physicians are concerned.

As a matter of fact, the only physician who was actually interested in hearing more about B-12 Methyl, was the neurologist who came to one of the Neuropathy Support Group meetings.

She said "I would never NOT be interested in anything anyone has to say about how they deal with their neuropathy. We learn new stuff every day"!!!

And this was a young woman who was specializing in Neuropathy.

She has been (to my knowledge) the only physician I have ever spoken to about Methyl B-12, and believe me there have been plenty, she's the only one who actually LISTENED.

Everybody else either said "I don't believe it" one guy actually said "it's only for Anemia, and I WOULD NEVER PRESCRIBE B-12 FOR NERVE DAMAGE". He actually said that.

Mind boggling.

How can physicians not LEARN as they PRACTICE. I mean, we learn new stuff every day.

Mel
 

It's all over the news I thought it might be your program but wasn't sure.
The one part was lowering the insulin level and caused some to died
from heart problems. Just like when I was on Advanta for a shoet time,
I called my dr. told her hold my insulin level had dropped to 60
she got me right off and had me keep eye on blood pressure. They had
the Dr. over the program,he said well we learned something,we were doing
this wrong.but he are the program would not name the meds not on the
show I saw. There was a patiient hhe name was Williams ,who was in the
group where some people died,they said everybody would be on the
program tha had no problems..When it drops that low you can feel it.
Sue

It was on local news,we have a big diabetic testing center here. But
it's on cnn,fox and msmbc..I think they said something about cho med
I won't take that crap. When I had that advata thing believe I knew
it,my heart was fluttering..Sue

Reading this stuff a bit more carefully--
 

--I realized that this is coming from a statistical comparison more than anything else; 257 people died over the course in the intensive treatment group compared to 203 in the standard treatment group. As the second article says, this amounts to 0.3 more deaths per 100 people in the study.

I'm assuming that whatever statistical analysis they performed here reached the level of statistical significance in order for this to get this much play, but I'd like to see that analysis (I haven't seen it in anything I've Googled up yet). Considering the many different mordities and mortality factors associated with diabetes, I wouldn't be convinced yet that this difference is not caused by chance factors (or lack of randomness in the study, such as there being higher incidence of morbidity factors in the "intensive" group to begin with).

New York Times article has more
 

http://www.nytimes.com/2008/02/07/he...rssnyt&emc=rss

These subjects took cholesterol drugs, too, according to it.

This is what I think:

It is time for doctors to understand what drugs DO. They deplete substances from our bodies, and change us. Some do alot this damage others less (or still unknown factors).

Statins damage mitochondria in cells. You cannot live when that happens.
Statins prevent the body from making CoQ-10 which when lost damages the heart. Metformin depletes B12 and folic acid.
ACE inhibitors (used in this study) deplete Zinc.
Diuretics deplete magnesium. Low magnesium causes heart arrhythmias.

Melody, did anyone at your appointments try to cover these bases?
I suspect not, since the most important one for diabetic neuropathy would be the B12.

So like many things in medicine today, it shows how smart and how stupid smart people can be. Doctors need to take a serious look at how medications affect people. ALL of the effects.

Not surprising...
 

...at all. I'll be damned if these doctors are'nt absolutely obsessed with numbers..the lower the better. Until all your numbers are zero and you are taking a dirt nap. Because everyone should have a BP of 110/70. -an a1c of 5.0- and cholesterol of 100! A year ago I felt fine . I built a backyard deck ,put up a fence with post hole diggers ,planted a rose garden for the wife...well..you get the idea. Now I cant do crap, my wrists hurt ,my ankles hurt, hell, my whole body hurts! But boy am I healthy ..just look at my labs ,thanks to statins, bp meds,metformin etc I will probably be miserable all the way till 90 ! Last March I was sitting in the doc's office holding a ziplock bag of ice cubes in my hands because of pn and all the doc and RNP could do was pat themselves on the back about my LDL of 50 ! I haven't had a LDL of 50 since I was a teenager! And my glucose was down from an a1c 0f 9 to a 6 ! Now, I'm not nearly as smart as some on this site and damn sure no doctor but lowering lipids that fast ( 1 month ) has to radically change the environment of your periphial nervous system. Oh well..dont mind me doc, I'm just a patient. My apologies for the ramble and I will get off my soapbox now....Tom..ps;I stopped the damn statins!

You are expressing very accurately what is happening today in medicine.
Quality of life, is not considered. These studies become like bibles to these doctors. And in many cases the studies themselves are flawed in some way.
It took about 6mos or more before much of the data from the HERS study was released. And that data was OPPOSITE the data supplied by drug companies themselves for 20 years to doctors, about estrogen replacement therapy, based on drug companies funded studies.

I'd like to know who funds the ACCORD study.... drug companies perhaps? I am going to look around for that info.

Low B12, low folate cause increased homocysteine. Homocysteine damages blood vessels. So patients receiving metformin should be taking both of these vitamins to replace what is lost. This is not a "secret" or made up in any way.
But for some reason doctors won't pay attention to these facts.

Funding for ACCORD:
 

Here we go folks:

http://www.accordtrial.org/web/publi...TOKEN=69922238
More data here:
http://www.accordtrial.org/web/public/index.cfm

http://www.nhlbi.nih.gov/health/prof...d/q_a.htm#cost

I guess I'm very lucky then.

They can't make you take any meds you don't want to take. This I know. And way back when I was on the vytorin, as soon as I got the muscle aches and I told them, they immediately stopped. I might be luckier going to Cornell than others who went to other places for the study. And I am lucky that I was not in the intensive group.

I just did basic common sense. Good eating habits, tried to walk as much as I could and paid attention, and took my B-12.

I'm much luckier than other diabetics. Some people can do everything right and nothing changes. I'm aware of that.

But my diabetes was because of my obesity. I finally got the lightbulb moment. A bit late in life, that's true, BUT THE BULB GOT LIT.

I'm keeping it lit, if you get my drift.

I shall be talking to them tomorrow. Let's see what they say about the letter I got from the Accord Program.

Will update. Oh, I'd like to add one more thing. We all know that STRESS exacerbates our PN. That's a no brainer. Don't know if stress raises our sugar reading, but it definitely impacts the PN.
I found this out personally, every time my son called. Not that he's verbally abusive, or anything like that. He just is who he is, does nothing all day long, stays in his room, is 26 years old and does not work and is on SSI and gambles whenever he can and has been diagnosed with Aspergers. So essentially I have a son in another state who never gives us a second thought. Alan is emotionally distraught by this, and while I have had my moments, I also have spoken to professionals, I run my own Asperger forum, and I put up boundaries. I had no choice.

But once in a great while (like yesterday), when speaking to a friend who is going crazy with her own alcoholic son, it brings up feelings, and I said to myself "my god, I don't know if my son is alive or dead, we haven't heard from him, blah blah, you know, the mother heartstrings get tugged". My feet started to burn. I went over to Alan and said "how are you coping with the Frank thing (we call it the Frank thing). Alan said "how do you think I'm coping, I gave up, my son doesn't call, doesn't care about our health, how do you think I'm doing?"

My feet were burning like crazy. (I'm telling this story because there's a point at the end of it). He doesn't answer his phone so there was no point in calling him.

Before I emailed him I said 'let's see if he is in Second Life". I went into Second Life (my feet are still burning and my whole body is burning". I know his account, I looked for him, and found he was not online in Second Life.

So I said to myself "I'll email him, and if he answers at least I know he's alive".

I emailed him asking him how he was doing, how his thyroid levels were and if he still goes into Second Life??

In 10 minutes I got a reply. "Yes I go into Second Life, I have 3 accounts, I took down my website, I'm building a new website for people to play games and have fun on the internet. I'm also moving into my former housing development (he was initially kicked out for gambling the rent)."

Well, you should have seen my face. I immediately got up, walked over to Alan and said 'he's alive and he's moving back to his former apartment". ALL THE BURNING STOPPED.

Alan said 'so he's fine, he hasn't called us since January 1, just to see how we are, he didn't ask about us??" I said "no, get it through your head, he has Aspergers, he only cares about himself, but he's got a roof over his head and he's not living at home stealing from us".

Alan said: "you know, you're right"

So in my case, when I concentrate my feelings about my son, and they are negative mommy moments, m whole body reacts with the PN.

When I realized he was perfectly fine, I felt like the weight of the world was lifted off of my shoulders.

It's amazing what the mind can do to the body, isn't it???

Mrsd I could of guessed that,when I was young and thin I had prediabtes
Mel but when I gained when to debectics 2 ,I was told don't go over 180
I think went to that from 80,90 and very avtive. Lost the weight but
still take 2 metformin..My Dr. always tell me of Vits to take,that's GP
the other Dr.I check or ask Gp. Glen was right on nose about deaths. But
should have listing meds. I'm not as active as i was,Mrs d you stopped
treadmill because of you knees,what was it you switch to? I saw som kind
of chair for all kinds of stretch and a petals for legs,at bottom,I miss
dancing with my walker.

Mel did you have to sign any papers like you do before sugery,if anything happens do to this trial ect.. I wasn't surprised a pharma..was involved.
And the Cholestorol pills just make PN worse eat oatmeal or plain cheeriors
My 91 yr. aunt eats very well is very thin,still puts in a garden cleans
her house,but has high cholestorol like the rest of the family.My grandmother
cooked everything in Lard I still can taste it.. I sorry this happened Mel
and for those peoples family..

I did a spine trial and was allergic to the med. they were trying,they shut
that one down. Damm I wish we would get a better health care system..
Hugs to all Sue

Sue;

In your post your doctor told you not to go over 180. Is that your weight or your sugar reading??

And yes, when I joined the ACCORD program, you sign a bunch of papers. You agree to let them do all their testing. I believe I even agreed to let them do DNA testing with my blood.

I was given memory testing (I passed, can you believe that). all kinds of testing, initially. Then I was able to be examined by the top eye specialist at Cornell (as part of the protocol). Very impressive. I remember the doctor telling me "you are not a candiate for Lasik surgery". Forgot the reason (and I actually passed the memory test).

They would ask you "repeat after me", and give you 12 words" Then you give them back to them in any order you could remember". Then they would give you another 12 words, then ask you "give me the names of the first 12 words". I never laughed so hard. This was about 2 years ago.

I wonder how many times they give you that memory test. I have no idea.

Anyway, I have a cold.

Just had some soup. The weather is absolutely bonkers here in NY.
Yesterday it broke an all time record. Got up to 68.
Right now it's freezing.

Holy Moly

Personally, I would never be involved in any program that results in increased deaths at any level.

Mel
 

That was never go over 180 in weight and I was told that years ago.
I keep my suger level 120 and under,but don't want it down to
60..Sorry you have a cold it's bad then a little warm then a snowstorm

Oh Herb every time you go into the hospital,you sign a paper if there going
to do a lot of tests or sugery,that you know you might die..Or your kidney
stones ,heart trouble,hernia,infected ingrown toe nail just might not get
fixed. Just ask The med students or reident who spend the whole day
scaring old people. gezzzz. Hugs to all Sue

Thanks for clearing that up Sue:

I DO INDEED HAVE A COLD. I did not drink any liquids yesterday because Alan had the ivig and I was so busy keeping him hydrated that I forgot to keep myself hydrated.

I woke up sniffing and sneezing, and I said 'oh brother, I have a cold, oh well". I did not drink any liquids after breakfast, then I ate my soup for lunch, and AGAIN, DID NOT DRINK ANYTHING TILL 4:30, when I took my sugar and it was 248. Believe me, my sugar is NEVER 248. I then realized that I should have been rehydrating. I immediately drank a nice cup of green tea.

In 20 minutes my sugar went down to 185.

I shall be drinking tea or water as needed. I only hope I never forget to hydrate.

I am assuming that this is the reason for my reading of 248. I don't eat anything white or cake, or candy, or anything. and I've been having the same wonton egg drop soup for lunch for years. I love it and it's my guilty pleasure. It never impacts my sugar.

But today, well 4 hours after lunch, it rose to 248, then dipped back down.

Tomorrow is Cornell.

THAT SHOULD BE MOST INTERESTING!!

P.S. It's 7 p.m. just took (90 minutes after dinner), and it's 156.

I think I'll live after all!!

Oh, one interesting point.

Alan went to his podiatrist today and told him about the Cornell thing.
His doctor said: "yeah, I heard about this, and in my opinion, it's the people who have diabetes and who continue to smoke, these are the ones that have major problems and ultimately expire". So maybe the people in the intensive group were smokers??
Perhaps we shall never know. Alan asked his doctor "can I quote you on that, and he replied "Absolutely"

sugars go up
 

when you have an infection, Mel. This is typical.

Yeah, that's what I said to myself "sugars go up when you have an infection".

Now here is where I get confused.

I have an infection??? Where do I have an infection?? I thought I just had a cold, which is caused by the Rhinovirus that gets into your nose and then you get a cold.

See, I watch the Discovery channel all the time (lol).

So is this to mean, that when a body gets a virus, a bacteria, or ANYTHING?, this means AN INFECTION??

And then the body puts out it's antibodies to FIGHT THE INFECTION.

I've been using the Zycam swabs. They did wonders for me the last time I caught a cold. Shorted the duration and I wasn't that bad.

So I just want to understand the word INFECTION in the body. OH, and here's a really good question. Does this ONLY HAPPEN TO DIABETICS, or to non-diabetics too??

Thanks much

Melody

infection means STRESS...
 

The body responds to stress by making more steroid hormones, one action of which is to raise blood sugar.

A cold is a virus, but you also get secondary infections when the cold ends.
The viral part is only a couple of days long, the rest is infection from bacteria
that live in you all the time. The body makes antibodies and white cells and this takes energy.

Your sugar elevation is mild. I know a non-diabetic who went up to 800 with the flu!

Mrs. D.

I do not KNOW WHAT I WOULD DO WITHOUT YOUR BRAIN, YOUR KNOWLEDGE AND YOUR HELP!!!

I just came back from Cornell (I wrote about today, under the thead "Nutritional wasting with Diabetes).

They explained about what having a cold does to the body and the doctor told me exactly what you just told me about viruses and bacteria, etc.

What do I need Cornell for?? I have Mrs. Doubtfire.... lol

And the info about the non-diabetic person who got a sugar reading of 800, well that alone blew me away.

You see, I never knew that non-diabetics could have elevated glucose readings FOR ANY REASON. I now have learned something new today.

I thank you soooo much.

A tip and it is annoying but will give it to you. I am suppose to set my cell phone to go off every hour to remind me to drink my water 8-24 ounces of water. I am sorry you have a cold. Plenty of vitamin c I think and jewish penicillin aka chicken noodle soup.

Yeah, I'm going to make a nice cup of green tea when I get off the computer. I'm so used to not putting anything in my mouth after 7 p.m. that I forget to drink.

They were surprised (at Cornell I mean), that I'm not up peeing all night. They asked me. "How many times do you get up in the middle of the night?" I answered "Once". They said "that's it??" I said "yeah why" but I didn't get an answer. I had to fill out a "feeling temperature" I think it was called.

It's a chart with a thermometer on it. One of the guys said 'what is the number of your pain level". (Today my back and joints were killing me). So I laughed and said "I have degenerative joint disease, mark me as 70". So he did.

Never heard of feeling themometers.

I filled out pages and pages of questions of how do I feel, do I have bad feelings about myself. Do I have depression, blah blah.

I answered them all. Hey it's a study, and someone has to read these right??

Oh, I met a woman who was waiting for the access-a-ride. She was sitting there on the stoop smoking a cigarette. She said "I have brain lesions". and I said 'you have MS??" and she said "that's what they thought, then they thought I had Alzheimers because I forget stuff". "Then I remembered that I had a traumatic brain injury when I was a kid, so these lesions are from the brain injury". I said 'oh you poor thing"

Then she said "I'm wearing a pump" and I said "an insulin pump??" and she said "no, a pain pump". I said 'you have pain in your brain, and they gave you a pump??" And she said "no, I have pain in my body, my arms and my legs"

I felt really bad. She said "I'm only 48 years old and I can't work any more and I need this medicine but medicare won't cover it".

I found out she had the medtronic pump (the older kind), inplanted in her.

I said "then you don't go to the bathroom do you"? She said "oh my god, how did you know"?. I explained that my husband used to be on the Fentanyl patch.

She said she had just started smoking again. She couldn't help it.

To be honest, I just said (to myself), Oh my god, some people have such misery in their life. I just wished her well and said she would be in my prayers. And she was.

I'll tell you, with all the people coming in and out of Cornell, well, I started to count whatever blessings I had.

Jury's still out
 

I have no answers but I thought I'd post a link to the nearly completed Australian ADVANCE study which also enrolled 10K+ type II diabetic patients like the ACCORD study. The mortality results between the two studies differ considerably, i.e. the ADVANCE study did not see the same link between agressive treatment and death so there is general agreement among the clinicians that the two studies will need to be compared critically to assess the reasons for the outcomes. In the interim the Australian Docs were going to continue treating their patients as before.
One of the ACCORD study directors herself noted that the results could be related to the meds each patient was using at the time - an issue that has been repeatedly pointed out on this forum and others like it.

http://www.reuters.com/article/marke...0080213?rpc=44

"There are some differences between the ACCORD and the ADVANCE studies. We will need to communicate about the data with each other to understand what those differences are," Dr. Denise Simons-Morton, project officer for ACCORD at NHLBI, said in a telephone interview.
"The data I would like to see are exactly what drugs people were on, what were the mortality rates ..." she said.

Alkymst

I really hope that
 

someday doctors will look at drugs more openly and understand that drugs change the body, and induce nutrient changes.

Were any of these patients checked for B12 losses? Metformin causes low B12 in 30% or more who take it chronically. Also lowers folic acid.

Will someone running a study someday, read my posts...? And help these people in a more complete way?

Diabetics lose magnesium thru the urine, on a daily basis. Was this tracked?
How about Inositol, which is also lost? I think these studies do not examine other parameters.

You'd expect specialists to be more informed. When will they ever?

I just had to post this. A friend of mine (who has been diabetic (completely uncontrolled) for about 10 years, and WHO WOULD NEVER GO ON INSULIN, just called me. She went to her doctor today.

She said" "I'm on 10 units of Lantus and some Jenuvia in the afternoon, and some glyburide". I said 'did he give you a prescription for syringes?" and she said: "why do I need syringes"?. I said "oh, you got the pre-filled cartridge one??" and she said "I got the what??" The doctor DIDN'T GIVER HER ANY INSTRUCTIONS, JUST HANDED HER A PRESCRIPTION.

I just said 'call me when you get home from the drugstore".

This should be MOST interesting!!!! lol

Alkymst, and Mrs D...then Melody
 

Alkymst, it's good you pointed out that other study, I've been watching from the sidelines as a friend has definite type 2 and has been up/down and sideways the meds prescribing mill. Often to patient's discomforts and other potential issues. NOT LISTENING!
Keeping in mind a balance in terms of test size, structure and biases that are brought into the goals of a test are key to assessing any true and valid outcomes. Seems like these days that 'biases' or 'philosophies'-premises if you will, for a quick and dirty result these days seems to be the norm. Pity that-we here should surely know that there are no quick fixes..Tho they are surely wished for. With every new drug comes a slew of peculiar side effects. The price to be paid for later by US the patients. Surely no doc is ever gonna be responsible-they only lissen to what the drug co's tell them. Liability twice/thrice removed...I believe it's called.
Mrs D? I pointedly asked a doc about 'keeping up with research' about 2-3 years ago...the response was..I could 'keep up' but it would be a full-time job just to do so...I will just keep on DOING what I do...& well, and 'research' as I need to. Doc also said to me, that I'm making him do research that they never thought they would have to do. I think that was a sign of appreciation, but, will never know?
Melody? As for advising a friend or neighbor? I first suggest that the person actually talk to their doc and pharmacist first? I don't know about you, but I've got to sign off on any prescript s I pick up that say 'I'VE BEEN INFORMED ABOUT THIS MED -How to use it and any side effects' Yada yada yada...By signing that the patient waives all liability by the drugstore...The doc SHOULD have staff to tell patients about the meds and their proper uses. IF NOT shame on that doc...To prescribe such stuff and let 'er rip'? Is a crying shame and opens doors no one here likes to see. At the same time, while your offer of help is kind and well meant. What if YOU get it wrong? That's why folks here often preface w/ the "I'm NO doc, merely a patient' phrase. Help is one thing, MEDICAL help is a much more squirrelley kind of thing. Don't know about you, but I want no squirrell bites at all - they HURT!..I've been squirrell bitten and can assure you of this!

I do believe you all get my point here.

Alkymst IF you can find stuffs on that Aussie program I'd be interested to see how the protocols are similar, parrallel or diverse..You know?

Hugs to all- keep warm or cool as needed! - j

All I did was go to the Lantus Website and I emailed her the video of how to use the Solostar Pen.

I would never tell her how to use a pen because I don't have that particular kind of Lantus item.

Her doctor told her NOTHING. Even the pharmacist was shocked. He said "he didn't give you any information??" And he didn't even write a prescription for the little needles that you change every time you use the injectible pen.

She has absolutely no idea how to use this. So, knowing that Lantus has a website that has videos ON EVERYTHING, sure enough, I watched the video, then I emailed the site to her. She's watching it now and she's learning. And if she can't do it, then she'll call her physician.

I did exactly what I was supposed to do.

mel

It sounds to me like this lady needs a referral to a diabetic educator or nurse. A person should never be put on Insulin and not have substantial education on how to use it. I did a lot of diabetic education as a home care nurse, and it took several visits to my patients before most of them were allowed to draw up and give their own injections. She needs to learn more than just injection technique, where to inject, how to rotate sites, how to monitor injection site, she needs to learn how to recognize and handle hypoglycemia!

She should give her doctor's office a call and ask for diabetic education. Her doc must have been stressed or mentally out to lunch (which happens with human beings). I can not imagine that he would not be mortified that he forgot to give her a referral for education. Docs do not generally do that education part, but refer to their office nurse, or to a home care nurse or to a diabetic educator.

This is what her doctor told her when she said she wanted to go and see an endocrinologist. He said; 'You will just make a fool of yourself".

It seems that, because she's morbidly obese, and he's convinced that if she lost weight, (and she won't do this), that THIS IS WHY SHE IS DIABETIC.

So he has no patience with her. She watched the video. She won't call up any diabetic educator or anything like that. And her husband won't let her take the insulin until Monday because as he put it, "what if you get a reaction over the weekend".

I told her to contact her health care provider, the Lantus people, etc, to get further information and this would make her more comfortable with the whole injectible pen thing.

But, it's her body, her insulin and her husband. But if my husband ever told me not to take a med, he'd be eating his dinner in the bathroom.

Her doctor, well, it's appalling what he said to her. I asked her 'do you think it was acceptable of him to speak to you this way?' and she said: "oh he always does this".

So I gather she is used to him.

Those Pens are too complex to learn by video.

I would never return to a doctor that said that to me.

Losing weight would help her diabetes, but it is not an excuse for her doctor to treat her badly.

Sounds like a tough situation, but I would do all I could to improve my health, use all my resources, before things get so bad that the options are limited.

That's exactly why I went into the Accord program. I fought the "you need to go on insulin speech", for years. One day, my former health care provider (who I liked and who liked me), well he told me "Melody, I want you off of all this oral crap and go on Lantus". I never even heard of Lantus.

But that was the week I enrolled in the ACCORD program. That was NOT the week I changed my diet however. That took time. A long long time. I went to nutritionists, I read, and I came on these forums. I've been diabetic for almost 20 years without actually learning what the heck that meant.

But I educated myself. Unfortunately, my friend will not educate herself. She has already been diagnosed with a diabetic stomach. She told the doctor 'what the hel* do yo know"? I said "are you serious"? They put her on regulan for her stomach. And cholesterol meds (for prevention they told her). She told me "now I can eat whatever I want because I'm on the cholesterol med".

When I went into the ACCORD program, she could have gone with me. She did not want to change her eating habits or be told that she might have to go on insulin. So fast forward 3 years later, she's almost 300 lbs and will start insulin on Monday.

She gained 14 pounds since her last appointment. And since one can put on weight when one takes insulin, what the heck is going to happen to this woman. I mean, they never tell you that. I was not told that weight gain was a side effect of taking insulin. I did read the insert when I went on Lantus but I must have been in deep denial. I really had to change EVERYTHING I ate to be able to lose what I lost. And it took me a LONG LONG time.

It's like a double edged sword. She'll take the insulin, it might stabilizer her sugar, she'll think she's fine, she'll eat more, and gain even more.

But when a person doesn't want to listen, well, they have to learn the hard way. Her first endo appointment is scheduled for June. The office told her "let's see what your a1c is next month, and if it's high, we'll reschedule you and see you sooner??"

My god, what kind of doctors book you 4 months in advance and tell you "come in if you get worse". ????? Isn't the whole idea of going to an endocrinologis supposed to be to check you out, check out thyroid, check out glucose levels, I mean, BE ON TOP OF THINGS???

She already has neuropathy in her stomach, (she doesn't believe this). She once told me "just because you have neuropathy, you think everybody has neuropathy". I said nothing, because you can't talk to her when she's not in a receptive mood. There's a lot of fear going on here.

I only hope that she decides to start eating healthy and doesn't bop the next physician over the head. I mean, when he told her she had a diabetic stomach (and he never used the word gastroparesis), but then again, this guy is a regular primary guy doctor, not any kind of specialist, well, she just doesn't believe him. And she now has foot problems. and problems with her big toe. Hopefully the endo guy will sit her down and really explain what diabetes does to a body. I mean, that's exactly how I learned.

Oy vey!!!!