https://intensivedietarymanagement.com/ukpds-futility-blood-sugar-lowering-t2d/
Hey everyone, I just wanted to share this as a half-hearted defense of physicians treating people with type II diabetes. I hear Richard almost every podcast mention that with each % increase in HbA1C there is an increase in risk for diabetic complications and then state that as physicians our goal is to only lower the blood sugar to an HbA1C of 7 because we are concerned for hypoglycemia and malpractice lawsuits. While there may be some truth to that the whole story is much more complicated and I think is worth knowing especially if you are on medications for the treatment of Type II diabetes.
The fact of the matter as most of you intelligent folks on these forums probably know Type II diabetes is a disease of hyperinsulinemia (elevated insulin levels) but is usually treated by physicians as a disease of hyperglycemia (elevated blood sugar levels). After metformin the majority of medications used to treat type II diabetes (until very recently) do so by increasing insulin levels or supplementing insulin directly. This makes sense if you are treating a disease of hyperglycemia but not if you are treating a disease of hyperinsulinemia. Because of this when we control blood sugars more tightly with medications that increase insulin we worsen mortality. This is the reason that physicians donāt try to lower your HbA1C with medications lower than 7-8 depending on your age and other medical problems. It is not as much fear of hypoglycemia (although that is an issue) but instead fear of worsening your overall mortality. If you are taking medications other than metformin (especially insulin) you should not be trying to lower your HbA1C lower than 7 instead you should be titrating off of those medications before lowering your blood sugar further.
This is completely different than lowering your blood sugar through a ketogenic diet and/or intermittent fasting which also lowers your insulin levels and therefore will improve your mortality. Once you are off the other diabetes medications then go hog wild and lower that HbA1C as low as you want!
I hope this is helpful to people out there, I just threw this post together quickly as Iām in a rush but I will check back later to engage in any conversation/questions people have. I love the podcast and the community here on the forums!