February 2021
The year was 1993. The place: Las Vegas, Nevada. It was the site of the ADA Scientific Sessions, and above the roar of the slot machines, the long-awaited results of the DCCT (Diabetes Control and Complications Trial) were finally announced: Glucose control does indeed matter. Keep the A1c down, and the risk of complications drops right along with it. Simple, right? Well, not exactly. We know now that there is more to it. A study just published in Diabetes Medicine looked at the relationship between insulin sensitivity and the development of microvascular (retinopathy/eye disease and nephropathy/kidney disease), and macrovascular (heart disease) complications in people with Type-1 diabetes. Insulin sensitivity and its opposite, insulin resistance, refers to how well the body uses a set amount of insulin to lower blood sugar. Those who are insulin-resistant need larger amounts of insulin to control glucose levels. They also tend to have excess body fat and high blood pressure. The results of the study were dramatic, but not terribly surprising. For subjects with the same A1c, the presence and degree of insulin resistance was directly related to the risk of complications. In fact, the researchers found that an elevated A1c by itself (without insulin resistance) was not associated with complications, but a high A1c with insulin resistance definitely was. What does this mean for those of us living with Type-1 diabetes? We need to pay attention to more than just glucose levels. Just as the DCCT showed that glucose control matters, this new study shows that LIFESTYLE also matters. We need to exercise – physical activity is one of the most powerful tools for improving insulin sensitivity. We need to follow a sensible diet and watch our weight. We need to get enough sleep and keep stress in-check. These all are important for counteracting insulin resistance. In keeping with the state of science & research, Integrated Diabetes Services now offers individualized weight management and lifestyle coaching services, administered by our team of outstanding diabetes care & education specialists. See https://integrateddiabetes.com/diabetes-wellness-weight-management/ for details. As always, I hope you enjoy this complimentary edition of Diabetes Bites. If you would like to discuss any aspect of your diabetes management, please reach out. Together, there is nothing we can’t accomplish! – Gary 
Gary Scheiner MS, CDE Owner & Clinical Director
Just When You Think You Have It All Figured Out…
The year was 1993. The place: Las Vegas, Nevada. It was the site of the ADA Scientific Sessions, and above the roar of the slot machines, the long-awaited results of the DCCT (Diabetes Control and Complications Trial) were finally announced: Glucose control does indeed matter. Keep the A1c down, and the risk of complications drops right along with it. Simple, right? Well, not exactly. We know now that there is more to it. A study just published in Diabetes Medicine looked at the relationship between insulin sensitivity and the development of microvascular (retinopathy/eye disease and nephropathy/kidney disease), and macrovascular (heart disease) complications in people with Type-1 diabetes. Insulin sensitivity and its opposite, insulin resistance, refers to how well the body uses a set amount of insulin to lower blood sugar. Those who are insulin-resistant need larger amounts of insulin to control glucose levels. They also tend to have excess body fat and high blood pressure. The results of the study were dramatic, but not terribly surprising. For subjects with the same A1c, the presence and degree of insulin resistance was directly related to the risk of complications. In fact, the researchers found that an elevated A1c by itself (without insulin resistance) was not associated with complications, but a high A1c with insulin resistance definitely was. What does this mean for those of us living with Type-1 diabetes? We need to pay attention to more than just glucose levels. Just as the DCCT showed that glucose control matters, this new study shows that LIFESTYLE also matters. We need to exercise – physical activity is one of the most powerful tools for improving insulin sensitivity. We need to follow a sensible diet and watch our weight. We need to get enough sleep and keep stress in-check. These all are important for counteracting insulin resistance. In keeping with the state of science & research, Integrated Diabetes Services now offers individualized weight management and lifestyle coaching services, administered by our team of outstanding diabetes care & education specialists. See https://integrateddiabetes.com/diabetes-wellness-weight-management/ for details. As always, I hope you enjoy this complimentary edition of Diabetes Bites. If you would like to discuss any aspect of your diabetes management, please reach out. Together, there is nothing we can’t accomplish! – Gary Gary Scheiner MS, CDE Owner & Clinical Director
