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Ydmv

Discussion in 'Other Hot Topics' started by Lisa P., Jun 15, 2011.

  1. Lisa P.

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    I buy it, totally.

    Not that sometimes my kid's diabetes may vary from some other kid's because I don't do as good a job or don't understand insulin or whatever.

    But I totally buy that two people who seem similar and who do exactly the same thing for a week can get vastly different results from their bodies.

    Over three years here, I've read many posts with a smirk. Yeah, right. Usually these were the posts by members with kids who could stay in range 80% of the time, or by folks who could calculate I:C ratios so that 1:20 vs. 1:21 mattered to them. Folks who claimed to be able to feed their kids processed carbs in bulk four times a day and still get an A1C of 6.8 with no serious lows or highs, or people who could bolus off a CGMS and be sure of its accuracy. I figured they were, well, glossing things over a bit.

    It's gone the other way, too. I'll read a post by someone trying hard and "doing all the right things" and still the A1C is 12 or 13 and I'll think -- naw, she must be doing something wrong.

    But I'm here enough that I see more and more posts from all kinds of people. And, yeah, sometimes no doubt the perfect control diabetic is lying about the perfection, and sometimes the way outlier diabetic is there because she doesn't bolus. But I sincerely, truly believe after all I've read that many, many times there are wide, wide variations in the way diabetes treats any given person's body.

    I'm told now that "type 1 diabetes" is probably more of an umbrella for a number of different types. I've also seen enough to know that human bodies are very individualized things, they aren't math equations, they are far too complicated for micro-predictions.

    So, to take the topic over to "hot", I truly believe that no two diabetics have the same physiology regarding blood glucose, insulin use, ketones, etc.
     
  2. StillMamamia

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    I think the theoretical physiology is the same regarding blood glucose, insulin use, ketones, etc, HOWEVER the emotional/psychological/social variables make for the YDMVism of this physiological constant. So, you can have 2 kids, same age, same weight, same dx date, same theoretical insulin needs, not honeymooning, but their bodies won't react the same due to how they react emotionall/ psychologically/socially (stress, high-emotivity, release of high amounts of cortisol/adrenaline,etc,etc).

    Then there's the unknown physiology we don't know about - hypoglycemia threshhold before release of glucagon, are the alpha cells still working or not, is the honeymoon really over or is it doing the web and flow dance.

    So, theoretically, yes, I can buy that the physiology is the same. After all, it's been studied, so somewhere it should be correct. However, we're not only "physical" beings.

    Not agreeing, not disagreeing, just rambling, but I like my opinion.
     
  3. dejahthoris

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    Yes TOTALLY because besides carb intake and insulin dosage there are several hormones that affect blood sugar level that we have absolutely no way of measuring or controlling: cortisol (a stress hormone that is less effective than glucagon) growth hormone, catechelamines (release stored energy in times of stress and protect those with type 1 against hypoglycemia after glucagon response is lost) amylin (usually released with insulin, decreased in those with diabetes and thus results in excessive inflow of insulin after meals) and glucagon while it is still being produced. This all goes without mentioning the possibility of infection or fighting off infection, different types of exercise, adrenalin, the change of the seasons and other variables created by fat, protein and carbohydrate metabolism. And then there is genetics which you mentioned...which I think we are just starting to understand in relation to type 1!
     
  4. Lisa P.

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    I like your opinion, too.

    I'm thinking, though, that all those chemical variables you talk about are the differences in physiology.

    I think about a garden. All tomato plants of X hybrid are the same. So if I plant them all in the same light, dirt, water, feed, etc. they should all grow identically.

    But of course they don't, because they are individuals. There will be variation, and if I plant enough of them there will be huge variation within the lot.

    We can make rules about how often to feed and water and what to feed and water. And if I've got one person in charge of each plant and one grows to 5 feet while the other grows 3 inches, it might be due to mistakes or variation in how well the rules are followed.

    But it also very well might just be the individual plant has internal factors I can't see.
     
  5. Lee

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    Yes AND No.

    There are basic foundations of D Care that are true and should not vary person to person. Things like how carbs affect a kid, running ketones or no ketones, insulin doses, activity - those all vary.

    Things that do not:
    High Bloodsugars = more insulin
    Puberty will screw you up big time
    The more care we give our children and attention we pay to their diabetes, the better their overall A1C is.

    I think each body differs, and yes - that is YDMV - but the foundations of care are the same. Sometimes we say - chalk it up to YDMV and we shouldn't, we should be helping find the root cause. For example, if my kid ran an A1C in the 11's for years, and I asked for help and I was told YDMV, I would be upset or I would use it as a cop-out.

    I try and talk to one family, in the real world - not-cyber world, about this all the time. Oh, she jsut runs high everynight, we never worry about lows...is this a situation for YDMV? No - it is the parent needs to get off her tush and check her child and adjust her insulin. The parent chalks it up to YDMV...
     
  6. StillMamamia

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    My DH is trying to grow orange trees from seedlings.:rolleyes: They get the same care, same soil, are watered at the same time. However, of the 6 pots, 4 are looking healthy, the other 2 are not. Is it individual physiology or is it because he may have put a bit too much or a bit too little of a nano ounce of water for the 2? Or maybe the spot at the window where they all are gets a bit too much or a bit too little sun, or maybe the curtain is touching those 2 and provoking an allergic reaction?:p

    So, no straight answer, but I think it's safe and wise to say YDMV (not for the orange tree seedlings) - it does vary since individuals vary, but there is also a whole lot of commonality, and I think that we can learn from both aspects.
     
  7. Lisa P.

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    Oh, yes, I totally agree that it's hard to tease out what is changable and what is not.
    And there has to be a distinction.
    In your instance above, I would say that if you and I had the "same" kid in the "same" circumstances it is very possible that it might be easier for me to bring the 11 down to an 8 than it is for you to. YDMV wouldn't mean that it's o.k. to stay always at 11, it wouldn't be "fate". It would mean you'd have to manage things differently than I did.
    Yes, overall, it might mean more insulin was needed. But if your kid was extremely insulin sensitive, then it might be harder to give the extra insulin needed without giving too much. I might see lows you might not see. I might decide to run with a 7.5 A1C as a goal instead of a 6.9. That sort of thing. Same tightrope, different width? And bouncing for some (like during puberty)?
     
  8. emm142

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    Well, I agree that YDMV because we do all have different physiology - different genes, different residual insulin production, different levels of other hormones due to all sorts of things. I also agree that YDMV because of the way you choose to treat your diabetes - I really think that there are many "correct" ways for a given person, and the one we choose depends on our circumstances.

    But, if a person with D is running constantly high - that's not because of YDMV. It's because they need more insulin. The amount of insulin we need does vary, but as long as you give the amount that you need, no person with D should be constantly high.

    Some people are bound to have more fluctuation in BG than others. Personally, I think it's in large part down to the I:C : ISF ratio. To use extreme and probably non-realistic examples:

    Person A needs 1U for every 5g CHO, but 1U lowers their BG by 300 points. That means that (assuming all other variables are constant :rolleyes:) if they are only 5g out on the carb count, their BG will be 300 points higher or lower than expected.

    Person B needs 1U for every 50g CHO and 1U lowers their BG by 10 points (yes, I know this is ridiculous :p). Even if they are 50g out on the carb count (assuming all other variables are constant) they will only be 10 points higher or lower than expected.

    Nobody really has numbers like that, but I was talking about this with one of my friends. Her I:C is 1:10, the same as mine, but 1U only lowers her BG 30 points whereas it lowers mine 100. That means that if she's 10g carbs out on the carb count her BG is only 30 points off, whereas mine is 100. I think that's why some people can get by without post-meal checks whereas for other people they are really really necessary.

    So I think that's a really major factor in how accurate a person needs to be with carb counting. Having a high ISF also means that when basal is a teeny bit off it has a massive effect on BG. That also explains why toddlers and young children tend to have more wild BG fluctuations than older children.

    So, in conclusion: I think that everyone's body varies physiologically. I think that every single BG number is scientifically explainable somehow (taking account of all hormones, all endogenous insulin production, etc.) but we just don't know all the science. I think that YDMV is not an excuse for an a1C of 12/13 but I do think that some people experience more post-meal fluctuation than others and some people experience more basal fluctuation.

    As for different types of D, I do believe that one day it will be discovered that there are more subsections than just "type 1" (they already have started, after diagnosing some "T1"s with neonatal D). After all, different people with T1 have different antibodies, some have no antibodies, some still have residual insulin production after 50 years and others have 0 c-peptide after 6 months. There has to be some difference there.

    I also think that being hypo and hyper aware allows a person to have much tighter control (without CGMS). I was able to maintain an a1C in the 6s when I could feel hypos well. Not so much now, unless I've been using the CGMS full-time for the 3 months before the a1C draw.

    ETA: Ketones are also a big one. I've had "large" starvation ketones before just from eating only 50g carbs two days in a row. Other people never seem to get ketones. It also seems that some people go into DKA faster than others.
     
    Last edited: Jun 15, 2011
  9. swellman

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    Personally (and obviously from a different post which I can only assume spawned this one) I feel the variability and "uniqueness" of individuals in relation to a population is overestimated.

    I guess it's all about perception because when I see huge fields of homogenous crops I see millions of identical plants - it's only on the periphery, or where it's obvious that the soil conditions are different, that I see any difference in height, color, etc. (EDIT: Not that I think we are homogenous, but close enough).

    There are certainly a lot of variables - like a boatload, but I still feel the more the variables are understood the more consistent the results.
     
    Last edited: Jun 15, 2011
  10. Lisa P.

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    I do believe every diabetic event is rationally caused by a series of effects. I just don't think we come anywhere close to understanding all those effects much less how they interact with each other.

    We know a lot -- enough to keep our kids alive and healthy, thank God. But I do think there is a world of things we just don't know yet. Kind of exciting, thinking it's still there to learn.
     
  11. hawkeyegirl

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    Well, of course YDMV. I only have a problem with that philosophy when it is used as an excuse and said with a sort of, "Oh well, there's nothing I can do about [insert unfortunate event/result here].

    In my informal observations on this board, "success" (however you define that word w.r.t. diabetes care) within various age groups seems to be largely dependant on the competancy of the person administering the care. Have they read the books, do they understand the terms, do they have the ability to do the calculations, do they generally utilize "best practices?"

    Put another way, I'm hardly ever surprised when a familiar (to me) poster discloses their child's a1C. So I think that while YDMV applies a lot when it comes to individual details, overall I agree that YDdoesn'tVary as much as some would hope to think.

    So when you have a poster who says, "Oh, every time X happens, my child spikes to the 700s," it's much more likely that the parent isn't doing what could be done to prevent the 700s than it is that that child is so very weird and different that NOTHING could be done to prevent the soaring into the 700s.
     
    Last edited: Jun 15, 2011

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