#A1C levels

[susantaylor01]

How does diabetes affect the eyes?

INTRODUCTION 

Diabetes is a chronic metabolic condition characterized by elevated blood glucose levels. It can lead to various complications affecting different organs and systems within the body, including the eyes. The impact of diabetes on eye health is significant, and if left untreated, it can lead to vision impairment or even blindness. This article explores how diabetes affects the eyes, the specific conditions it can cause, and the importance of early detection and management.

How Diabetes Affects the Eyes

Diabetes affects the eyes primarily through high blood sugar levels that can damage the delicate blood vessels in the retina, the light-sensitive tissue at the back of the eye. This damage can lead to a range of eye conditions, most notably diabetic retinopathy, diabetic macular edema (DME), cataracts, and glaucoma.

Diabetic Retinopathy Diabetic retinopathy is one of the most common eye conditions associated with diabetes and a leading cause of blindness in adults. It occurs when high blood sugar levels cause damage to the tiny blood vessels in the retina. Over time, these blood vessels can weaken, leak fluid or blood, and even close off, leading to a lack of oxygen supply (ischemia) to the retinal tissue. There are two main stages of diabetic retinopathy:

Non-Proliferative Diabetic Retinopathy (NPDR): In the early stage, NPDR is characterized by microaneurysms (small bulges in blood vessels), retinal hemorrhages, and the leakage of fluid into the retina. This stage may not cause noticeable symptoms, but it can progress if not managed properly.

Proliferative Diabetic Retinopathy (PDR): This is the more advanced stage, where new, abnormal blood vessels begin to grow on the surface of the retina.PDR can also lead to the formation of scar tissue, which may result in retinal detachment, a serious condition requiring immediate medical attention.

Diabetic Macular Edema (DME) DME is a complication of diabetic retinopathy and occurs when the macula, the central part of the retina responsible for sharp vision, becomes swollen due to fluid leakage. This condition can lead to blurred vision, difficulty reading, and recognizing faces. Without treatment, DME can result in permanent vision loss.

Cataracts While cataracts can develop in anyone as they age, people with diabetes are at a higher risk of developing them earlier and more rapidly. A cataract clouds the eye's natural lens, causing blurry vision, glare, and difficulty seeing at night. In diabetes, high blood sugar levels can lead to changes in the lens, making it less transparent and more prone to cataract formation. Cataract surgery, where the cloudy lens is replaced with an artificial one, is generally successful, but diabetes can complicate the recovery process.

Glaucoma Glaucoma is a group of eye conditions that damage the optic nerve, often due to increased pressure within the eye (intraocular pressure). Diabetes doubles the risk of developing glaucoma compared to non-diabetics. The most common type associated with diabetes is open-angle glaucoma, which progresses slowly and may go unnoticed until significant vision loss occurs. Glaucoma can turn into irreversible blindness if not treated.

Symptoms and Diagnosis

The early stages of diabetic eye disease may not present any symptoms, making regular eye examinations crucial for early detection. Symptoms are like :

Blurred or distorted vision

Dark spots or floaters in the visual field

Fluctuating vision

Difficulty seeing at night

Loss of vision in one or both eyes

Pain or pressure in the eyes (more common with glaucoma)

If you have diabetes, it’s essential to have a comprehensive dilated eye exam at least once a year. During this exam, an ophthalmologist or optometrist will check for signs of diabetic retinopathy, DME, cataracts, and glaucoma. Early detection is key to preventing vision loss and managing the condition effectively.

Prevention and Management

While diabetic eye diseases can be severe, there are steps you can take to reduce your risk and manage the condition if it develops:

Maintain Blood Sugar Levels: Keeping your blood sugar levels within the target range can significantly reduce the risk of diabetic retinopathy and other complications. Regular monitoring, along with proper medication and lifestyle changes, is essential for managing diabetes effectively.

Control Blood Pressure and Cholesterol: High blood pressure and cholesterol can exacerbate diabetic eye disease. Managing these conditions through medication, diet, and exercise can help protect your vision.

Quit Smoking: Smoking increases the risk of diabetes complications, including eye disease. Quitting smoking can improve overall health and reduce the risk of vision loss.

Regular Eye Exams: Annual eye exams are crucial for detecting early signs of diabetic eye disease.

Adopt a Healthy Lifestyle: A balanced diet, regular physical activity, and weight management are vital for overall diabetes management and reducing the risk of complications, including those affecting the eyes.

Treatment Options

If diabetic eye disease is detected, several treatment options are available depending on the severity and type of condition:

Laser Therapy: Laser treatment can seal or shrink leaking blood vessels, preventing further damage to the retina.

Intravitreal Injections: Medications injected directly into the eye can reduce inflammation and swelling, particularly in cases of DME and proliferative diabetic retinopathy.

Vitrectomy: In more severe cases, such as when there is significant bleeding or retinal detachment, a vitrectomy may be necessary. This surgical procedure removes the vitreous gel from the eye and replaces it with a clear solution to improve vision.

Conclusion

Diabetes is a complex disease that requires comprehensive management to prevent complications, including those that affect the eyes. Diabetic eye disease is a leading cause of vision loss, but with proper care, regular eye exams, and early treatment, the risk can be minimized. By understanding the impact of diabetes on eye health and taking proactive steps, individuals with diabetes can protect their vision and maintain a good quality of life.

[meeda]

health update- **cw for weight mention and body dysmorphia**

so I finally got prescribed metformin for my prediabetes, and it should also help with weight management. I’ll be picking it up tomorrow and starting it on Sunday. I’m trying to temper my expectations (regarding the weight loss aspect) but i can’t help but feel excited about the possibility of losing weight. I’ve made a lot of progress with learning to accept my bigger body these last few weeks, especially with help from the ED programs I was placed in. But im sure it will be nice to get back to the weight I was at previously, before I got put on antipsychotics.

Also, I really like my doctor, she’s very bubbly and friendly and I’ve had her for about a decade now and don’t plan on finding a new one. but I think she has a lot to learn about how to talk to someone struggling with body image issues lol. Because it lowkey triggered me hearing her say things like “you used to be so skinny!” like idk, that felt really unprofessional on her part even though im sure she didn’t mean for it to come across that way. It just kinda stings, you know?

im trying not to let it get to me though, and I’m trying not to see the metformin as a “weight loss pill.” Thats not the main purpose of it. It’s a diabetes drug first and foremost, and if it happens to help me shed some pounds in the process, well, I won’t complain.

[kj-yikes]

(Cw mild medical stuff in the tags)

We’re having Christmas with my in laws this weekend and everyone’s staying at our house even though they live two miles away and today my pancreas has apparently decided to not do its fucking job so this is bound to be the GREATEST time

[xxxemilyg1996]

"Take this medicine twice a day, with breakfast and with dinner" bruh that requires eating both breakfast and dinner, and like, at the relatively same time every day. 2 days ago, I forgot to eat for the whole day. How am I supposed to make sure I eat 2x a day? That's ridiculous

[the2amrevolution]

Chronic diarrhea can fuck up your pancreas too. You body wants to get energy from you food. If you don't give it time to absorb all the nutrients, all it gets is the easiest to digest stuff - sugar.

Your blood sugar will lower short term because your pancreas is still sending out a normal amount of insulin while you aren't getting much of the more complex sugars, proteins, and fats. You'll lose weight short term from dehydration, but also from malnutrition as you body starts to burn off fat stores and muscle to get the missing nutrients.

However, your body 1) wants to live and 2) doesn't want to eat itself if it doesn't have to. So what will happen is your pancreas will start sending out higher amounts of insulin so that it can get more sugar broken down before the food passes through your system. This causes blood sugar spikes, extra sugar being stored as fat when you body can make it, and still loss of muscle because you still need proteins to make energy. You will also be constantly hungry because you aren't getting enough nutrients per stomach emptying. You may even develop what appears to be pre-diabetes or type 2 diabetes, and your doctor will tell you to reduce your sugar and overall carb intake, but doing that won't help you if you are still having chronic diarrhea.

It absolutely boggles my mind that the standard first medication given to people who have an A1C above normal range is metformin aka the "you're going to shit yourself" drug. It allegedly is supposed to decrease your insulin levels and thus your blood sugar. What happens to a very large amount of people is anything they eat runs right through them. It may work short term just like "diet cleanses" do, but then you'll just have a compounding problem if your high A1C wasn't caused by high motility to begin with because now your pancreas is going to try to send out even more insulin to get sugar faster so you can actually produce energy. If you already had high motility, metformin will just make you more miserable.

If you are having diarrhea with or without cramping, nausea, hot flushing, etc. frequently - during menses is fairly normal, but outside of that, it shouldn't be more than maybe once or twice a month if you ate something weird or had a high stress situation/adrenaline rush - then something abnormal is going on. It could be a food sensitivity/intolerance (a shortage or lack of a specific digestive enzyme), a mast cell reaction (an immune system reaction without the presence of antibodies), a medication/supplement side effect, or a neurological motility problem (to many contraction signals or overly sensitive to them).

If you can do it, a food and symptom diary and/or an elimination diet can help you ID if there is a specific food that is causing you problems. Don't do these things without professional guidance and supervision if you have a history of eating disorders, and don't forget that the goal of an elimination diet is to add back any food that doesn't cause you symptoms. No foods are good or bad across the board. You just want to figure out if there's something that doesn't agree with your body personally and stop eating that while still eating everything else you want.

If you have chronic migraines with nausea/diarrhea, make note of what you ate not just directly before but for several meals leading up to the symptoms. A digestive enzyme problem is typically fairly quickly after eating the problem food (your classic lactose intolerance reaction). Mast cell reactions can be smaller and cause a build up of histamine until a threshold is crossed and symptoms are triggered, so you have to consider all histamine sources including muscular exertion.

For example, pork is one of my mast cell triggers. I also have true allergies. If I eat something containing pork, I may not have a negative effect right away. If I then have turmeric or rub my face against one of my cats or if ragweed levels are high or if I do something that requires physical exertion or if it's too hot out or go get my allergy immunotherapy shots or a combination of any of those or a myriad of other things, I may have a migraine with diarrhea 16-24 hours after I ate the small amount of pork. If I have something entirely pork based or cooked in bacon grease, I will have severe reflux, a migraine, etc. much sooner, but it's possible to have reactions from things that you would never consume in a high enough amount on it's own, like food dyes and additives, to make a connection without keeping close track of all histamine sources.

If nothing changes with an elimination diet, then the problem is more likely from a medication/supplement, which you can research yourself or talk to a doctor or pharmacist about to see if any stand out as a possible cause, or a more complex issue that requires medical testing.

i hate the diet industry as a whole, but there’s something so DEEPLY insidious about how “cleanses” and the marketing thereof is pathologizing… digestion.  like, basic concept of it – the process of eating food, extracting nutrients over time, and removing anything indigestible by pooping at the end.

your digestive system should not ever be “clean”.  it is full of bacteria.  it contains bile and shit and mucus.  this is normal and healthy.  you do not have “pounds of toxic sludge” in your body, that is partially digested food and unless you are constipated, it is supposed to be there.  your organs are still extracting nutrients from it.  

your intestines are not meant to be 100% empty.  you should have food moving through your system– you deserve to eat, and you deserve to digest that food as best you can (digestive problems gang, how’s it going?).

you are not losing fat tissue when you take laxative teas, you are losing water, nutrients, electrolytes, healthy bacteria.  and even if you were?  fuck that.  fat people shouldn’t be bullied into taking laxatives.  constant diarrhea is not pleasant or healthy or better than being fat.  let us fucking eat and digest our fucking food.

[harmeet-saggi]

Understanding The Hemoglobin A1c (HbA1c) Test For Diabetes

The HbA1c test is used to measure how well your blood sugar levels have been controlled over the past 2-3 months. It’s a good indicator of your diabetes control and can help you and your healthcare team make decisions about your treatment. The test is usually done every 3 or 6 months, but may be done more often if you’re having problems controlling your blood sugar levels.

[susantaylor01]

HbA1c in prediabetes 

Haemoglobin A1c (HbA1c) is a form of haemoglobin that is produced through the non-enzymatic glycation of haemoglobin A. To understand its structure, it helps to first review the basic components of haemoglobin and then how HbA1c forms.

Basic Haemoglobin Structure:

1. Haemoglobin A: This is the most common type of haemoglobin in adults and consists of four subunits:

Two alpha (α) chains.

Two beta (β) chains.

Each chain is associated with a heme group that contains an iron atom capable of binding oxygen.

2. Heme Group: Each of the four subunits contains a heme group, which is a cyclic organic molecule with an iron atom at its centre. The heme group binds oxygen, enabling haemoglobin to transport it through the bloodstream.

 HbA1c Formation:

1. Glycation: HbA1c is formed when glucose in the blood reacts with the N-terminal valine of the β-chain of haemoglobin. This reaction is non-enzymatic and occurs over time. The glucose molecule attaches to the haemoglobin molecule through a stable covalent bond.

2. Structure of HbA1c:

Modification: The primary structural change in HbA1c is the addition of a glucose molecule to the β-chain. This modification occurs at the N-terminal valine residue of each β-chain. This attachment is often referred to as a "glycation" or "glycosylation" of haemoglobin.

  Forms: HbA1c can exist in various forms depending on the degree of glycation and the type of glucose involved. However, in standard tests, it is usually measured as a percentage of total haemoglobin.

Characteristics of HbA1c:

Stable: Once formed, HbA1c is stable in the red blood cells throughout their lifespan (approximately 120 days). This stability allows it to serve as a reliable marker for average blood glucose levels over the past 2-3 months.

Proportion: The percentage of HbA1c relative to total haemoglobin increases with higher average blood glucose levels. This makes it a useful marker for assessing long-term glucose control in individuals with diabetes.

In summary, HbA1c is a glycated form of haemoglobin A that forms when glucose molecules attach to the β-chain of haemoglobin. Its structure includes this glucose modification, and its measurement provides valuable information about long-term blood glucose levels.

Haemoglobin A1c (HbA1c) is a form of haemoglobin that is used primarily to monitor long-term glucose control in individuals with diabetes. 

Measurement: HbA1c levels are measured as a percentage of total haemoglobin. For example, an HbA1c of 7% means that 7% of the haemoglobin in the blood has glucose attached to it.

Clinical Use: The HbA1c test is used to assess long-term glucose control over the past 2-3 months. It provides a better overall picture of average blood glucose levels compared to daily blood glucose tests.

Normal and Diabetic Ranges: 

Normal HbA1c levels typically range from about 4% to 5.6%.

Levels from 5.7% to 6.4% indicate prediabetes.

An HbA1c of 6.5% or higher is indicative of diabetes.

Prediabetes is a critical health condition characterised by elevated blood glucose levels that are higher than normal but not high enough to be classified as diabetes. It serves as an important warning sign that an individual is at an increased risk of developing type 2 diabetes. Diagnosis typically involves blood tests that measure glucose levels. The most common tests used include the fasting plasma glucose test, which measures blood glucose after an overnight fast, and the HbA1c test, which reflects average blood glucose levels over the past 2-3 months. According to diagnostic criteria, prediabetes is diagnosed when the fasting plasma glucose level is between 100 and 125 mg/dL, or the HbA1c level ranges from 5.7% to 6.4%. Additionally, an oral glucose tolerance test, which measures blood glucose levels after consuming a glucose-rich drink, can be used; a result between 140 and 199 mg/dL is indicative of prediabetes. Identifying and addressing prediabetes through lifestyle changes such as improved diet, increased physical activity, and weight management can significantly reduce the risk of progressing to type 2 diabetes and associated complications.

Haemoglobin A1c (HbA1c) is a pivotal biomarker for assessing long-term glucose control and diagnosing prediabetes. In prediabetes, HbA1c levels are elevated, reflecting higher-than-normal average blood glucose concentrations, but not to the extent that they meet the criteria for diabetes. Specifically, an HbA1c level between 5.7% and 6.4% is indicative of prediabetes. 

Mechanism:

HbA1c is formed when glucose molecules non-enzymatically bind to the N-terminal valine of the β-chain of haemoglobin in red blood cells. Since red blood cells have a lifespan of about 120 days, the HbA1c level provides a historical perspective on blood glucose levels over this period. Elevated HbA1c levels suggest that, on average, blood glucose has been higher than the normal range.

Diagnostic Criteria:

HbA1c Range for Prediabetes: An HbA1c level from 5.7% to 6.4% is classified as prediabetes. This indicates that blood glucose levels are elevated but not sufficiently high to be diagnosed as diabetes.

Comparative Values:

Normal HbA1c: Below 5.7%.

Diabetes: HbA1c of 6.5% or higher.

Clinical Implications:

Risk Assessment: Elevated HbA1c levels in the prediabetic range signify an increased risk of developing type 2 diabetes. Individuals with prediabetes have a significantly higher likelihood of progressing to diabetes compared to those with normal glucose levels.

Lifestyle Interventions: Addressing prediabetes involves implementing lifestyle changes such as a balanced diet, regular physical activity, and weight management. These measures can help lower HbA1c levels and reduce the risk of progression to diabetes. Studies have shown that losing 5-10% of body weight and increasing physical activity can lead to significant improvements in glucose control.

Monitoring and Management:

Regular Testing: For individuals diagnosed with prediabetes, periodic monitoring of HbA1c is crucial to track changes in glucose levels and evaluate the effectiveness of lifestyle modifications or medical interventions.

Preventive Measures: Early and proactive management of prediabetes through lifestyle changes or medications, if necessary, can delay or prevent the onset of type 2 diabetes and its associated complications, such as cardiovascular disease, neuropathy, and retinopathy.

Conclusion:

In conclusion, HbA1c is an essential tool for diagnosing and managing prediabetes, offering a clear picture of long-term glucose control. With HbA1c levels between 5.7% and 6.4% signalling prediabetes, this biomarker provides valuable insight into an individual's risk of developing type 2 diabetes. Early detection through HbA1c testing enables timely lifestyle modifications—such as improved diet, increased physical activity, and weight management—that can effectively lower glucose levels and mitigate the risk of progression to diabetes. Ongoing monitoring and proactive intervention are crucial for managing prediabetes and preventing associated complications, ultimately contributing to better long-term health outcomes.

[fatliberation]

I saw a comment on your blog that says 'the way you eat does not cause diabetes'...are you able to expand on that or provide a source I could read? I've been told by doctors that my pre-diabetes was due to weight gain because I get more hungry on my anti psychotics and I'd like to fact check what they've told me! Thank you so much!

Pre-diabetes was rejected as a diagnosis by the World Health Organization (although it is used by the US and UK) - the correct term for the condition is impaired glucose tolerance. Approximately 2% of people with "pre-diabetes" go on to develop diabetes per year. You heard that right - TWO PERCENT. Most diabetics actually skip the pre-diabetic phase.

There are currently no treatments for pre-diabetes besides intentional weight loss. (Hmm, that's convenient, right?) There has yet to be evidence that losing weight prevents progression from pre-diabetes to T2DM beyond a year. Interestingly, drug companies are trying to persuade the medical world to start treating patients earlier and earlier. They are using the term “pre-diabetes” to sell their drugs (including Wegovy, a weight-loss drug). Surgeons are using it to sell weight loss surgery. Everyone’s a winner, right? Not patients. Especially fat patients.

Check out these articles:

Prediabetes: The epidemic that never was, and shouldn’t be

The war on ‘prediabetes' could be a boon for pharma—but is it good medicine?

Also - I love what Dr. Asher Larmie @fatdoctorUK has to say about T2DM and insulin resistance, so here's one of their threads I pulled from Twitter:

1️⃣ You can't prevent insulin resistance. It's coded in your DNA. It may be impacted by your environment. Studies have shown it has nothing to do with your BMI.

2️⃣ The term "pre-diabetes" is a PR stunt. The correct term is impaired glucose tolerance (or impaired fasting glucose) which is sometimes referred to as intermittent hyperglycemia. It does not predict T2DM. It is best ignored and tested for every 3-5yrs.

3️⃣ there is no evidence that losing weight prevents diabetes. That's because you can't reverse insulin resistance. You can possibly postpone it by 2yrs? Furthermore there is evidence that those who are fat at the time of diagnosis fair much better than those who are thin.

4️⃣ Weight loss does not reverse diabetes in the VAST majority of people. Those that do reverse it are usually thinner with recent onset T2DM and a low A1c. Only a tiny minority can sustain that over 2yrs. Weight loss does not improve A1c levels beyond 2 yrs either.

5️⃣ Weight loss in T2DM does not improve macrovascular or microvascular health outcomes beyond 2 years. In fact, weight loss in diabetics is associated with increased mortality and morbidity (although it is not clear why). Weight cycling is known to impacts A1c levels.

6️⃣ Weight GAIN does NOT increase the risk of cardiovascular OR all causes mortality in diabetics. In fact, one might even go so far as to say that it's better to be fat and diabetic than to be thin and diabetic.

Dr. Larmie cites 18 peer reviewed journal articles (most from the last decade) that are included in their webinar on the subject, linked below.

[wellhealthhub]

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[healthybit]

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[wannabanauthor]

What if Tommy and Eddie discussed the breakup, and it goes from serious to funny?

So Eddie goes to Tommy's house and is like "I'm here to check on you, let's get a beer."

Tommy tries to refuse, but Eddie says, "You broke my best friend's heart, so the least you could do is explain your reasoning to me."

Tommy reluctantly goes. After a few beers, he starts rambling.

"I fucked up, and I don't know how to fix it or even if I should fix it. I was falling in love with him, and it snuck up on me. I didn't expect for it to get more serious," Tommy says. "I thought it was just going to be fun for awhile, and we'd go our separate ways."

"Your second date with him was to his sister's wedding," Eddie points out.

"Oh so sue me! It's not my fault I caved. He gave me these pleading puppy eyes, and I found myself agreeing."

Eddie rolls his eyes. "Well, if you never expected it to get serious and didn't want it to get serious, then why haven't you found your rebound yet? It's been weeks. Even Chimney and Maddie are telling Buck to start dating again."

Tommy groans into his hands and then rubs his temples. "Fucking traitors."

"Well, I know this hot priest-"

"Been there, done that," Tommy says and takes a swig of his beer.

Eddie looks at him with a bewildered look on his face. "What?"

"What?" Tommy responds with a shrug. "I was raised Catholic. Guilt about sexuality is easy to spot, but he made the first move."

"Do I even want to know how?"

"Ever had sex in a confession booth?"

Eddie's eyes are wide and horrified. "Please don't tell me-"

"It was an old booth in storage, but it was still pretty hot. Once I admitted to myself that I was gay, I had a lot of catching up to do."

Then Tommy goes quiet and gets sad again. "I'll never meet another Evan in my life. I think he's ruined me for other men."

"Don't say that. While, I prefer you two together, you can always find someone else."

Tommy snorts in disbelief. "Yeah, not gonna happen. At least when it comes to sex. His adorable face and cheery smile haunt my dreams, and his proficiency with dick makes it impossible for me to get it up even when watching porn."

"Oh no, I need more alcohol for this," Eddie says and orders some shots.

He and Tommy go through a couple of them.

Tommy's tongue gets looser. "His dick is fantastic. Perfect length, thickness, and stamina. I know my body pretty well, and let me tell you, the prostate orgasms from him were out of this world. I barely lasted five minutes before coming just from him fucking me."

Eddie is drunk enough that he's not even fazed.

"Not to mention he has this slight curve that makes him hit the spot every time, and goddamn, I miss that dick and the dork attached to it," Tommy continues. "He made me feel comfortable and safe and cherished. Being around him was effortless, mostly, and I miss him so much."

Tommy starts sniffling, and then tears roll down his cheeks. "Fuck, I don't want to cry."

Eddie puts a comforting hand on Tommy's shoulder. "Call him. He's a mess and miserable without you. He's been baking so much that the entire station's hemoglobin A1C levels are pre-diabetic. We had to force him to focus on savory cooking."

Tommy shakes his head. "He doesn't want to hear from me. I broke his heart. I'm the last person that should be contacting him."

"He does want to hear from you. He's only been baking and cooking so much to stop himself from contacting you because he wants to give you space and respect your boundaries post-breakup."

"What would I even say? That I panicked and ran? I told him he would break my heart if we moved in together. There's no coming back from that."

Eddie sighs and sets his drink down. "Listen, the first time you ended things with Buck, I told him he was an idiot but to call you anyway. Now it's your turn to be the idiot. Go get your man back. Call him. Talk to him. He'd settle for a text. Just do something! You both are suffering without each other. You don't have to move in with him. He just wants you back in his life."

More tears run down Tommy's face and it turns into full sobs. Eddie scoots closer to him and gives him a hug. Tommy clings to him, sobbing even harder.

After drinks, they stop by a taco place and sober up while eating delicious birria tacos. They go back to Tommy's place, and Eddie sleeps on the couch just to make sure Tommy is alright. Before he falls asleep, he texts Buck.

"If Tommy contacts you, go easy on him. He's an idiot too."

When Tommy wakes up the next morning, he nearly stops breathing when he sees that Evan texted him.

"I miss you." was all it said.

Tommy cradles his phone in his hands for several minutes before pressing the call button. He holds his breath until Evan answers.

"I miss you too," Tommy says.

[blackmoldmp3]

i don’t have diabetes for the zillionth time in a row 🙌

vitamin d deficient yet again 🙌

[scientia-rex]

I've been trying to figure out what the deal is with prediabetes so I can write a meaningful response to an ask I got about it, and I just keep going wait--okay--here's one paper--but here's another one--here's a Cochrane review--but here's a different meta-analysis--and here's newer data from an RCT...

It's nuts! It's bananas. And anybody who says we have good, crisp, clear guidelines around what prediabetes even IS, much less what to do about it, is FULL OF SHIT.

What I really need to know in order to feel more confident about my handle on whether to medicate pre-diabetes is the population incidence. Not prevalence. Because if I take the most optimistic studies about medication as an intervention, specifically, I could be looking at about a 30-40% reduction in risk of progression to diabetes. But! How many people is that, actually? Because medication is not without its harms! We need to compare number needed to treat with number needed to harm, we need to have high-quality evidence that says yes, if we give this medication to everyone who meets X level of criteria for pre-diabetes (it's different in different sources AND it's changed repeatedly over our lifetime!), we will see a level of benefit sufficient to justify making these other people who would not have progressed to diabetes without it endure the hassle and side effects of taking a medication for the rest of their lives.

AND HERE'S THE REAL FUN PART: we don't really know where tissue damage begins! We thought we did! 6.5-7ish A1c. But it turns out there is a marked risk of retinopathy beginning at 5.5! Which is considered normal. AND ALSO we should probably be thinking of it as at least three separate disease based on our current ability to measure--A1c is a broad marker that collapses multiple forms of dysregulated blood sugar, and when we use more fine-grained tests, we see meaningful distinctions that probably affect preferred treatments between people who have impaired fasting glucose, people who have abnormal values on an oral glucose tolerance test, and people who have both. We should treat these groups differently because they reflect different underlying pathways: elevated fasting glucose means your liver is breaking down too much glycogen while you sleep, which is one issue, while elevated post-prandial glucose means your skeletal muscles (OR SOMETHING ELSE they're not totally sure) are behaving abnormally in response to insulin. IT'S NOT THE SAME THING and people with both impaired fasting glucose and abnormal post-prandial glucose are at higher risk of progression to diabetes/tissue damage than people with just one of those. AND WHILE WE'RE AT IT, what is diabetes? What's the best cutoff? What's the best measure? How many underlying pathophysiologies are getting collapsed into the same group????

THE MORE I LEARN ABOUT THIS THE MORE QUESTIONS I HAVE and experts are all being serenely confident while contradicting each other so I have to actually dig in the data a lot harder than I usually do. I've been meaning to do this for months, but one of the presenters this morning made a comment about the benefits of putting prediabetics on metformin that made me go "hm, do I need to start doing that?" and I've gone from my kneejerk answer being "no, we studied this and it doesn't help" to "I don't fucking know and neither does anyone else."

...as always, Cochrane is probably right.

[lilcowzia]

Are you pre-diabetic at all? What are your doctors visits like?

i was! i havent been checked in awhile but my blood sugar (A1C?) was prediabetic when i was diagnosed with PCOS. i didn't wanna take metformin in case it had negative side effects like we*ght loss so i started taking myo inositol supplements for months and then my levels were normal and then i was like "hmm its probably fine" and stopped taking the supplements and i have not been tested in like a year. but personally i think the diagnosis of prediabetes is like a weird scare tactic thing and not an actual useful medical thing. and i got my doctor degree from Puppy MD Academy so yknow.

[ohello0]

If I have to hear the name ozempic one more fucking time…..

I have a friend who’s diabetic and she told me that her doctor keeps trying to get her to go on ozempic…but her a1c levels are fine. My friend said she’d rather just get straight insulin shots if it’s that bad but her doc said she didn’t need it…

Then the mf started yapping about bmi and it clicked. My friends levels are fine. Her diabetes is under control. Her doctor just thinks she’s too fat so wants to put her on a medication to help lose weight even though it has atrocious gastrointestinal side effects

Diabetics that genuinely do need ozempic can’t fucking get it bc there’s a national shortage due to random mfs that were already 110 soaking wet with rain boots on snatching up the supply. Fatphobia in medicine isn’t just dangerous it kills, either through encouraging and allowing harmful behavior or neglecting the vulnerable.