Pre-diabetes Threshold Lowered

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Revised Diabetes Guidelines Lower Threshold for Impaired Fasting Glucose
CME

News Author: Laurie Barclay, MD
CME Author: D?sir?e Lie, MD, MSEd
Authors and Disclosures

Release Date: October 24, 2003; Valid for credit through October 24, 2004


Oct. 24, 2003 ? An international expert committee on the diagnosis and
classification of diabetes mellitus has published revised guidelines, which
incorporate new data since the last report of 1997, in the November issue of
Diabetes Care. Decreasing the cutoff for impaired fasting glucose from 110
mg/dL to 100 mg/dL could increase diagnoses of prediabetes by approximately
20%.

"Lowering the threshold should help pick up more people who are at increased
risk for developing diabetes," Committee Chair Saul Genuth, MD, from Case
Western Reserve University in Cleveland, Ohio, says in a news release.
"What's important about that is that we now know ? through studies such as
the Diabetes Prevention Program (DPP) and the Finnish Diabetes Study ? that
we can prevent or delay the progression to diabetes from impaired glucose
tolerance, the original component with the term pre-diabetes, through
intensive lifestyle treatment, such as exercise and diet therapy. We hope,
but don't yet know, that intervening earlier might also reduce the risk of
diabetic complications, including cardiovascular complications."

Modest weight loss and regular exercise can prevent or delay the development
of type 2 diabetes by up to 58%, based on results of the DPP and other
studies.

Criteria for the diagnosis of diabetes remain unchanged, and the committee
recommended against using the HbA1C as a routine diagnostic test for
diabetes. Although clinical evidence is currently inadequate for superiority
of either the fasting plasma glucose (FPG) test or the oral glucose
tolerance test (OGTT), the committee prefers the FPG because of its greater
convenience and lower cost.

The American Diabetes Association (ADA) recommends that individuals aged 45
years or older, especially those who are overweight or obese, be screened
for diabetes/prediabetes and retested every three years if normal.
Individuals at increased risk because of obesity, family history,
gestational diabetes, or other recognized risk factors for diabetes should
be considered for screening every few years, according to Dr. Genuth.

Unanswered questions mandating further research include defining the best
approach to diabetes detection, understanding the pathophysiology and risks
of IPG and glucose tolerance, and determining to what extent cardiovascular
risk can be lowered by starting treatment of glycemia earlier.

"The answers to these and other questions will necessitate regular
surveillance and reconsideration of new data that may lead to appropriate
revisions to the diagnostic and classification criteria for diabetes over
time," the authors write.

Diabetes Care. 2003;26:3160-3167

Learning Objectives
Upon completion of this activity, participants will be able to:
List the changes in recommendations for the diagnosis of diabetes since the
1997 Expert Committee report of the ADA.
Describe the updated criteria for prediabetes and diabetes screening.
Clinical Context
The 1997 International Expert Committee was convened to examine the
classification and diagnostic criteria of diabetes, based on the 1979 report
of the National Diabetes Data group and the World Health Organization (WHO)
study group. The WHO criteria for diagnosing diabetes is FPG of 126 mg/dL or
higher or two-hour plasma glucose (PG) of 200 mg/dL or higher in the OGTT
after a 75 g oral glucose challenge. The criteria were adopted by the ADA in
1997. The two-hour PG has been considered the de facto "gold standard"
because it is a better predictor of all-cause mortality or cardiovascular
mortality than an elevated FPG value. The FPG cutoff value is based on the
prediction of retinopathy beginning at approximately 126 mg/dL. Impaired
glucose tolerance is defined as FPG of 110 mg/dL or higher when two-hour PG
after a 75 g oral glucose challenge is 140 to 199 mg/dL. The lack of a
suitable marker of diabetes has led to a reliance on metabolic abnormalities
such as hyperglycemia t!
o determine risk and diagnosis of diabetes.

Currently, diabetes and prediabetes screening is recommended by the ADA for
patients with risk factors for the disease including obesity, age 45 years
or older, family history, or gestational diabetes. If the test is normal,
retesting is recommended every three years. If prediabetes or impaired
glucose tolerance is diagnosed, there is a higher risk of developing
diabetes within 10 years and lifestyle modification is recommended.

The expert committee was reconvened for this position statement to
reconsider the questions of (1) cut point of the FPG and two-hour PG for
diabetes diagnosis, (2) reduction of the lower limit for impaired fasting
glucose from 110 mg/dL to 100 mg/dL, (3) inclusion of the HbA1C as a
diagnostic criterion for diabetes, and (4) use of the two-hour PG in
addition to the FPG for diagnosis of diabetes. The recommendations are based
on new studies that have emerged since 1997.

Study Highlights
The cut point for FPG and 2-hour PG will remain unchanged from 1997. There
is no consistent difference in the prevalence of diabetes across populations
observed by using the 1997 criteria. Recent studies have not shown an
advantage for reducing the 2-hour PG cut point to 180 mg/dL. It was noted
that the 2 tests measure slightly different constructs and result in
different prevalence of diabetes.
In patients with a new diagnosis of diabetes, a confirmatory test is
recommended after the initial test.
The cut point for impaired fasting glucose was reduced from a definition of
110 mg/dL to 100 mg/dL. Impaired fasting glucose is now redefined as an FPG
of 100-125 mg/dL. This is based on observations that the receiver operator
characteristic curve closest to the ideal of 100% sensitivity and
specificity for the glycemic range of 81-126 mg/dL was 103 mg/dL in a Dutch
population, 97 mg/dL in a Pima Indian population, 94 mg/dL in a Mauritius
population, and 94 mg/dL in a San Antonio population, all values below the
older 110 mg/dL cut point.
This proposed new definition for impaired fasting glucose will increase the
number of individuals with prediabetes and thus increasing the number of
people who may benefit from intensive lifestyle modification such as weight
reduction and exercise to prevent diabetes onset.
HbA1C is not recommended as an additional criterion for the diagnosis of
diabetes. The reasons are lack of international standardization of reference
ranges and the confounding effect of other conditions (such as pregnancy,
uremia, hemoglobinopathies, blood transfusion, and hemolytic anemia). HbA1C
is still recommended as an indicator of therapeutic response.
Both FPG and 2-hour PG may be used for diagnosis, but the FPG has the
benefits of ease of testing (no waiting and better tolerated), better
reproducibility and reliability, and lower cost. There is inadequate
evidence to show that either test is superior.
The 2-hour PG is recommended after an abnormal FPG, and, if abnormal, will
lead to lower blood pressure and lipid goals compared with nondiabetic
individuals.
It is uncertain from current evidence whether treating asymptomatic elevated
2-hour PG or changing the cut points for impaired fasting glucose and
impaired glucose tolerance will reduce mortality from cardiovascular
disease, and more research is needed in this area.
Pearls for Practice
The cut point for FPG has been reduced from 110 to 100 mg/dL, which will
increase the number of individuals diagnosed with prediabetes.
There is inadequate evidence to choose between the FPG and 2-hour PG tests,
and judgment may be based on test feasibility, reliability, and
reproducibility. Both may be performed in any one patient to confirm
diabetes diagnosis.


http://www.medscape.com/viewarticle/463433
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Sounds good to me.

I wonder if they will follow suit in Australia. At the moment
"pre-diabetes" is defined at an A1c of 6.5%

I'm not all that certain that the FBG is a good indication of
impaired glucose tolerance either. I still think that the PG is the
best indicator. But I guess this IS progress.

Annette

"Cookie Cutter" wrote in message
...
This article notification service provided by
http://www.medscape.com

Revised Diabetes Guidelines Lower Threshold for Impaired Fasting
Glucose
CME

News Author: Laurie Barclay, MD
CME Author: D?sir?e Lie, MD, MSEd
Authors and Disclosures

Release Date: October 24, 2003; Valid for credit through October
24, 2004


Oct. 24, 2003 ? An international expert committee on the diagnosis
and
classification of diabetes mellitus has published revised
guidelines, which
incorporate new data since the last report of 1997, in the
November issue of
Diabetes Care. Decreasing the cutoff for impaired fasting glucose
from 110
mg/dL to 100 mg/dL could increase diagnoses of prediabetes by
approximately
20%.

"Lowering the threshold should help pick up more people who are at
increased
risk for developing diabetes," Committee Chair Saul Genuth, MD,
from Case
Western Reserve University in Cleveland, Ohio, says in a news
release.
"What's important about that is that we now know ? through studies
such as
the Diabetes Prevention Program (DPP) and the Finnish Diabetes
Study ? that
we can prevent or delay the progression to diabetes from impaired
glucose
tolerance, the original component with the term pre-diabetes,
through
intensive lifestyle treatment, such as exercise and diet therapy.
We hope,
but don't yet know, that intervening earlier might also reduce the
risk of
diabetic complications, including cardiovascular complications."

Modest weight loss and regular exercise can prevent or delay the
development
of type 2 diabetes by up to 58%, based on results of the DPP and
other
studies.

Criteria for the diagnosis of diabetes remain unchanged, and the
committee
recommended against using the HbA1C as a routine diagnostic test
for
diabetes. Although clinical evidence is currently inadequate for
superiority
of either the fasting plasma glucose (FPG) test or the oral
glucose
tolerance test (OGTT), the committee prefers the FPG because of
its greater
convenience and lower cost.

The American Diabetes Association (ADA) recommends that
individuals aged 45
years or older, especially those who are overweight or obese, be
screened
for diabetes/prediabetes and retested every three years if normal.
Individuals at increased risk because of obesity, family history,
gestational diabetes, or other recognized risk factors for
diabetes should
be considered for screening every few years, according to Dr.
Genuth.

Unanswered questions mandating further research include defining
the best
approach to diabetes detection, understanding the pathophysiology
and risks
of IPG and glucose tolerance, and determining to what extent
cardiovascular
risk can be lowered by starting treatment of glycemia earlier.

"The answers to these and other questions will necessitate regular
surveillance and reconsideration of new data that may lead to
appropriate
revisions to the diagnostic and classification criteria for
diabetes over
time," the authors write.

Diabetes Care. 2003;26:3160-3167

Learning Objectives
Upon completion of this activity, participants will be able to:
List the changes in recommendations for the diagnosis of diabetes
since the
1997 Expert Committee report of the ADA.
Describe the updated criteria for prediabetes and diabetes
screening.
Clinical Context
The 1997 International Expert Committee was convened to examine
the
classification and diagnostic criteria of diabetes, based on the
1979 report
of the National Diabetes Data group and the World Health
Organization (WHO)
study group. The WHO criteria for diagnosing diabetes is FPG of
126 mg/dL or
higher or two-hour plasma glucose (PG) of 200 mg/dL or higher in
the OGTT
after a 75 g oral glucose challenge. The criteria were adopted by
the ADA in
1997. The two-hour PG has been considered the de facto "gold
standard"
because it is a better predictor of all-cause mortality or
cardiovascular
mortality than an elevated FPG value. The FPG cutoff value is
based on the
prediction of retinopathy beginning at approximately 126 mg/dL.
Impaired
glucose tolerance is defined as FPG of 110 mg/dL or higher when
two-hour PG
after a 75 g oral glucose challenge is 140 to 199 mg/dL. The lack
of a
suitable marker of diabetes has led to a reliance on metabolic
abnormalities
such as hyperglycemia t!
o determine risk and diagnosis of diabetes.

Currently, diabetes and prediabetes screening is recommended by
the ADA for
patients with risk factors for the disease including obesity, age
45 years
or older, family history, or gestational diabetes. If the test is
normal,
retesting is recommended every three years. If prediabetes or
impaired
glucose tolerance is diagnosed, there is a higher risk of
developing
diabetes within 10 years and lifestyle modification is
recommended.

The expert committee was reconvened for this position statement to
reconsider the questions of (1) cut point of the FPG and two-hour
PG for
diabetes diagnosis, (2) reduction of the lower limit for impaired
fasting
glucose from 110 mg/dL to 100 mg/dL, (3) inclusion of the HbA1C as
a
diagnostic criterion for diabetes, and (4) use of the two-hour PG
in
addition to the FPG for diagnosis of diabetes. The recommendations
are based
on new studies that have emerged since 1997.

Study Highlights
The cut point for FPG and 2-hour PG will remain unchanged from
1997. There
is no consistent difference in the prevalence of diabetes across
populations
observed by using the 1997 criteria. Recent studies have not shown
an
advantage for reducing the 2-hour PG cut point to 180 mg/dL. It
was noted
that the 2 tests measure slightly different constructs and result
in
different prevalence of diabetes.
In patients with a new diagnosis of diabetes, a confirmatory test
is
recommended after the initial test.
The cut point for impaired fasting glucose was reduced from a
definition of
110 mg/dL to 100 mg/dL. Impaired fasting glucose is now redefined
as an FPG
of 100-125 mg/dL. This is based on observations that the receiver
operator
characteristic curve closest to the ideal of 100% sensitivity and
specificity for the glycemic range of 81-126 mg/dL was 103 mg/dL
in a Dutch
population, 97 mg/dL in a Pima Indian population, 94 mg/dL in a
Mauritius
population, and 94 mg/dL in a San Antonio population, all values
below the
older 110 mg/dL cut point.
This proposed new definition for impaired fasting glucose will
increase the
number of individuals with prediabetes and thus increasing the
number of
people who may benefit from intensive lifestyle modification such
as weight
reduction and exercise to prevent diabetes onset.
HbA1C is not recommended as an additional criterion for the
diagnosis of
diabetes. The reasons are lack of international standardization of
reference
ranges and the confounding effect of other conditions (such as
pregnancy,
uremia, hemoglobinopathies, blood transfusion, and hemolytic
anemia). HbA1C
is still recommended as an indicator of therapeutic response.
Both FPG and 2-hour PG may be used for diagnosis, but the FPG has
the
benefits of ease of testing (no waiting and better tolerated),
better
reproducibility and reliability, and lower cost. There is
inadequate
evidence to show that either test is superior.
The 2-hour PG is recommended after an abnormal FPG, and, if
abnormal, will
lead to lower blood pressure and lipid goals compared with
nondiabetic
individuals.
It is uncertain from current evidence whether treating
asymptomatic elevated
2-hour PG or changing the cut points for impaired fasting glucose
and
impaired glucose tolerance will reduce mortality from
cardiovascular
disease, and more research is needed in this area.
Pearls for Practice
The cut point for FPG has been reduced from 110 to 100 mg/dL,
which will
increase the number of individuals diagnosed with prediabetes.
There is inadequate evidence to choose between the FPG and 2-hour
PG tests,
and judgment may be based on test feasibility, reliability, and
reproducibility. Both may be performed in any one patient to
confirm
diabetes diagnosis.


http://www.medscape.com/viewarticle/463433
To access the article, click on this Web address, or cut and paste
it into a
browser window.

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http://www.medscape.com




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Why do they insist on calling it pre-diabetes or impaired glucose tolerance?
Call a spade a spade: it's diabetes!

Calling these other softened names just helps feed the denial machine. People
need to be properly terrified. I wish I'd been more terrified 10 years ago when
they said I MIGHT get diabetes. Fear is a great motivator.

When you all tell the hopeful newbies that it can't be reversed - a hope they
all come in with (me too!) - it's not that they can't reverse the disease. It's
that they had it before they were diagnosed. They've been diabetic all along.
Yes, they might reverse some of the symptoms to an earlier state (if they're
early enuff). But that earlier state was also diabetic.

It isn't that once you have diabetes, you will always have it! Once you have
diabetes, you find out you always had diabetes..

Jon

"Jon Kaplan" wrote in message
...
Why do they insist on calling it pre-diabetes or impaired glucose
tolerance?
Call a spade a spade: it's diabetes!

Calling these other softened names just helps feed the denial
machine. People
need to be properly terrified. I wish I'd been more terrified 10
years ago when
they said I MIGHT get diabetes. Fear is a great motivator.

When you all tell the hopeful newbies that it can't be reversed -
a hope they
all come in with (me too!) - it's not that they can't reverse the
disease. It's
that they had it before they were diagnosed. They've been
diabetic all along.
Yes, they might reverse some of the symptoms to an earlier state
(if they're
early enuff). But that earlier state was also diabetic.

It isn't that once you have diabetes, you will always have it!
Once you have
diabetes, you find out you always had diabetes..

Jon


Jon, I'm not so sure about that.

Was there a time when *I* didn't have diabetes?

Taken to it's logical conclusion, what you are saying is that I was
born with it.

Here's how I understand the situation.
Diabetes is actually defined when the condition becomes
irreversable. And that usually that happens when the death of beta
cells exceeds the rate of re-generation. In T1, the loss of beta
cells ends up being total. In T2, it's slower, but again, seems to
be irreversable. There is a line that is crossed that one cannot
reverse. If however, the progression is stopped early enough, then
there is a good chance that frank diabetes will never eventuate.

One of the goals of science is to restore beta cells. When and if
they succeed, then there will truly be a cure for diabetes.

Annette



---
Outgoing mail is certified Virus Free.
Checked by AVG anti-virus system (http://www.grisoft.com).
Version: 6.0.537 / Virus Database: 332 - Release Date: 6/11/03

I'm sorry Jon, but I think I am going to have to disagree with your
statement.
I have Impaired Glucose Tolerance and was diagnosed a little over a year
ago. Fear **did** motivate me into dropping nearly 90 pounds. My fasting
numbers are still in the IGT levels, not diabetic. I know all about
complications from watching my mother die of kidney failure four years ago
at the age of 68 and her father, who died of heart problems and diabetes
when he as 65. My friend just lost a toe from complications. I am
sufficiently terrified.
My new internist pronounced me a "diet-controlled diabetic" which freaked me
out a little. I asked my endocrinologist and she said I had impaired glucose
tolerance, controlled by diet. Semantics? Maybe. I know that it's a matter
of time before I become a member of your club, but I think my total
lifestyle changes have made full-blown diabetes a little further away.
I have learned so much about diabetes from visiting and posting to this
newsgroup.
I am just vain enough to love it when people come up to me who don't
recognize me. Everybody wants to know how I lost so much weight and I do
tell them I was motivated by fear of diabetes. For me Impaired Glucose
Tolerance was a gift of a few extra months or years to learn how to live
with the inevitable that is most likely my future.

--Judy

"Jon Kaplan" wrote in message
...
Why do they insist on calling it pre-diabetes or impaired glucose
tolerance?
Call a spade a spade: it's diabetes!

Calling these other softened names just helps feed the denial machine.
People
need to be properly terrified. I wish I'd been more terrified 10 years
ago when
they said I MIGHT get diabetes. Fear is a great motivator.

When you all tell the hopeful newbies that it can't be reversed - a hope
they
all come in with (me too!) - it's not that they can't reverse the disease.
It's
that they had it before they were diagnosed. They've been diabetic all
along.
Yes, they might reverse some of the symptoms to an earlier state (if
they're
early enuff). But that earlier state was also diabetic.

It isn't that once you have diabetes, you will always have it! Once you
have
diabetes, you find out you always had diabetes..

Jon

On Sat, 8 Nov 2003 19:44:32 +1100, "Annette"
wrote:

"Jon Kaplan" wrote in message
...

[snip]

It isn't that once you have diabetes, you will always have it!
Once you have
diabetes, you find out you always had diabetes..
Jon

Jon, I'm not so sure about that.

Was there a time when *I* didn't have diabetes?
Taken to it's logical conclusion, what you are saying is that I was
born with it.

People are born with a pre disposition towards diabetes.
That does not necessarily mean they will become diabetic or
in fact GIT. Many do eventually but there are many who do
not. There is no way of knowing - well there is but it is
socialy unacceptable to genetically test a Foetus or a born
child for possible 'predispositions'.

Here's how I understand the situation.
Diabetes is actually defined when the condition becomes
irreversable.

Wrong, diabetes is not reverseable.
It might be better to say that it is the point at or beyond
which bodily damage begins due to a malfunction of the
systems that control glucose in the body.

And that usually that happens when the death of beta
cells exceeds the rate of re-generation.
In T1, the loss of beta
cells ends up being total. In T2, it's slower, but again, seems to
be irreversable. There is a line that is crossed that one cannot
reverse.

Do tell me - what is it that can be reversed?

[snip]

Pete



Diagnosed 20/03/03 Type II D&E + Metformin + Gliclazide
+ Asprin 210lbs at Dx to target 174lbs achieved.
Now 171lbs. To mail: aspen3 at freeuk.com

Pete schrieb:

[...]
And that usually that happens when the death of beta
cells exceeds the rate of re-generation.
In T1, the loss of beta
cells ends up being total. In T2, it's slower, but again, seems to
be irreversable. There is a line that is crossed that one cannot
reverse.

Do tell me - what is it that can be reversed?

Insulin resistance can be reversed, to a certain degree. If that happens
while the beta cells are still undamaged, full-blown diabetes might
never develop.

Thorsten

--
"Nothing in biology makes sense, except in the light of evolution"

(Theodosius Dobzhansky)

All of my early life, my fasting blood sugar was around 88.

In my middle years, I saw it begin to creep up. When it
started coming in at 105, I began to realize that I was
heading for some serious problems. After educating myself
to the glycemic index of carbs and moderating the total
amount of carb I ate, my fasting blood sugar is back to
90.

You could say that I still have the problem - - that if I ate
the way I was eating before, then my blood sugar response
would be the same. I think you are right. But I have to
point out that food - - and what is considered "normal"
and healthy eating - - has changed tremendously between
the time my blood sugar was 88 and when it was 105. I
returned to a way of eating that was closer to my eating
patterns back when I was at 88.

Cookie


--
############
"JCG" wrote in message
...
I'm sorry Jon, but I think I am going to have to disagree with your
statement.
I have Impaired Glucose Tolerance and was diagnosed a little over a year
ago. Fear **did** motivate me into dropping nearly 90 pounds. My fasting
numbers are still in the IGT levels, not diabetic. I know all about
complications from watching my mother die of kidney failure four years ago
at the age of 68 and her father, who died of heart problems and diabetes
when he as 65. My friend just lost a toe from complications. I am
sufficiently terrified.
My new internist pronounced me a "diet-controlled diabetic" which freaked
me
out a little. I asked my endocrinologist and she said I had impaired
glucose
tolerance, controlled by diet. Semantics? Maybe. I know that it's a matter
of time before I become a member of your club, but I think my total
lifestyle changes have made full-blown diabetes a little further away.
I have learned so much about diabetes from visiting and posting to this
newsgroup.
I am just vain enough to love it when people come up to me who don't
recognize me. Everybody wants to know how I lost so much weight and I do
tell them I was motivated by fear of diabetes. For me Impaired Glucose
Tolerance was a gift of a few extra months or years to learn how to live
with the inevitable that is most likely my future.

--Judy

"Jon Kaplan" wrote in message
...
Why do they insist on calling it pre-diabetes or impaired glucose
tolerance?
Call a spade a spade: it's diabetes!

Calling these other softened names just helps feed the denial machine.
People
need to be properly terrified. I wish I'd been more terrified 10 years
ago when
they said I MIGHT get diabetes. Fear is a great motivator.

When you all tell the hopeful newbies that it can't be reversed - a hope
they
all come in with (me too!) - it's not that they can't reverse the
disease.
It's
that they had it before they were diagnosed. They've been diabetic all
along.
Yes, they might reverse some of the symptoms to an earlier state (if
they're
early enuff). But that earlier state was also diabetic.

It isn't that once you have diabetes, you will always have it! Once you
have
diabetes, you find out you always had diabetes..

Jon

"JCG" wrote in message
...
I'm sorry Jon, but I think I am going to have to disagree with
your
statement.
I have Impaired Glucose Tolerance and was diagnosed a little over
a year
ago. Fear **did** motivate me into dropping nearly 90 pounds. My
fasting
numbers are still in the IGT levels, not diabetic. I know all
about
complications from watching my mother die of kidney failure four
years ago
at the age of 68 and her father, who died of heart problems and
diabetes
when he as 65. My friend just lost a toe from complications. I am
sufficiently terrified.
My new internist pronounced me a "diet-controlled diabetic" which
freaked me
out a little. I asked my endocrinologist and she said I had
impaired glucose
tolerance, controlled by diet. Semantics? Maybe. I know that it's
a matter
of time before I become a member of your club, but I think my
total
lifestyle changes have made full-blown diabetes a little further
away.
I have learned so much about diabetes from visiting and posting to
this
newsgroup.
I am just vain enough to love it when people come up to me who
don't
recognize me. Everybody wants to know how I lost so much weight
and I do
tell them I was motivated by fear of diabetes. For me Impaired
Glucose
Tolerance was a gift of a few extra months or years to learn how
to live
with the inevitable that is most likely my future.

--Judy


I hope you never get there (become truly diabetic). I wish you all
the best for your future.
Whatever happens.

Annette



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Outgoing mail is certified Virus Free.
Checked by AVG anti-virus system (http://www.grisoft.com).
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On Sat, 08 Nov 2003 21:23:13 +0100, Thorsten Schier
wrote:

Pete schrieb:
[...]
And that usually that happens when the death of beta
cells exceeds the rate of re-generation.
In T1, the loss of beta
cells ends up being total. In T2, it's slower, but again, seems to
be irreversable. There is a line that is crossed that one cannot
reverse.

Do tell me - what is it that can be reversed?

Insulin resistance can be reversed, to a certain degree. If that happens
while the beta cells are still undamaged, full-blown diabetes might
never develop.
Thorsten

I think you are getting two words mixed up. Reverse and
Reduced.

Pete


Diagnosed 20/03/03 Type II D&E + Metformin + Gliclazide
+ Asprin 210lbs at Dx to target 174lbs achieved.
Now 171lbs. To mail: aspen3 at freeuk.com