It's good to know what you don't know. Part of our mission here at our Saturday diabetes advice column, Ask D'Mine, is to peek behind the curtains of just about everything — as oftentimes conventional wisdom is not as wise as it may seem.

Well, just read today's column and you'll get the gist. Say hello to our host Wil Dubois, a veteran type 1, diabetes author and community educator who's seen it all at the clinic where he works in New Mexico.

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Lacey from New Jersey, type 1, asks: Where do all these target numbers we are supposed to meet come from? Who chooses our blood glucose, blood pressure, and cholesterol targets? It seems like they are always changing! Are there actually some studies to back up these numbers?

Wil@Ask D'Mine answers: Spoiler Alert: I'm here to shatter everyone's innocence. If you still want to believe in unicorns, fairies, pure unbiased medical research and the Great Pumpkin—read no further. Sorry, Virginia. There is no Diabetes Claus.

Right after your question came in, I was attending an internet seminar taught by one of the nation's leading cardiologists. I put your question to him. For reasons that will soon become clear, he asked me not to quote him by name.

All of our major targets, A1C, lipids, blood pressure, and even finger-stick meter numbers, I'm told, are not based on specific scientific studies that result in proof that these numbers are superior; but are selected by expert consensus panels. These panels issue "consensus statements" on the targets that doctors should use as treatment goals.

Quoting from the American Diabetes Association here a consensus statement "represents the panel's collective analysis, evaluation, and opinion based, in part, on the conference proceedings." (Emphasis added by me.) They go on to state, "The need for a consensus statement arises when clinicians or scientists desire guidance on a subject for which there is a relative deficiency of 'evidence' that might otherwise allow for a more definitive statement to be made."

So in other words, when there are no facts, the experts collectively make them up.

Of course, it's really not as bad as I make it sound. For instance, we know from real studies that higher blood sugar is more dangerous than lower blood sugar. And we know from real studies that very much higher blood pressure is more dangerous than lower blood pressure.

How much lower is ideal in either case, however, is rarely studied. So the experts just pick some numbers.

To clarify that this's as big pile of horse shit as it sounds like, I said to this leading cardiologist: "So what you're telling me is that a group of guys just basically sits down and uses an Ouija Board to choose our target numbers?"

He asked me to repeat my question.


Then there was a very lonnnnnnnnnnnnnnnnnnnng silence, and then he said, "No, we use multiple Ouija boards. And we're not just any group of guys." As if to say—how could so many smart people in one room be wrong?

Learned men used to think the earth was flat. And they said men would never fly.  That  going into space would be impossible. The personal computer would never catch on.

Need I go on about the collective wisdom of smart men?

A couple of days later I called around and found an endo who's sat on multiple expert consensus panels. He too, asked not to be identified by name, but told me that expert panels generally consist of grey-haired white men "who sit around and pontificate all day long until 4pm. Then they realize it's time for martinis and quickly pull some numbers out of the air."

At this point I flirted with the idea of stopping all of my meds except insulin.

Dr. H. Gilbert Welch, author of Over-Diagnosed, is extremely critical of the expert consensus system, and points out that changing blood pressure targets by even 10 points nets Big Pharma millions of new customers-for-life. He also points out that the type of experts who sit on these panels are also commonly the type of experts who are compensated members of Big Pharma Speakers' Bureaus.

Not that he's suggesting any sort of conflict of interest, or anything like that.

So. Lacey. Sorry. What's a diabetic to do? May today's experts be wrong? Will tomorrow's experts look down their haughty noses at today's standards? Probably.

But it's all we've got. And we're better off today than 50 years ago. Right? We live longer. Healthier.

Looks like maybe the "experts" got a thing or two right after all. I guess I'll keep taking my meds... for now.


Ray from Texas, type 1, writes: I love flying and going on trips and never have issues. However, I have never done international travel before and I am not sure what to expect I am planning on bringing scripts, doctor's notes, BG low snacks, water, normal snacks, and extra supplies, but I am still not sure what to expect. Anything I should know about or prepare for?

Wil@Ask D'Mine answers: First and foremost, make sure you have a passport, or your trip will end at the airport. And yes. I know someone who nearly forgot her passport when leaving for an overseas journey. (And as you have never traveled overseas before, you do have a passport, don't you?)

The good news is that according to the CDC, by 2050 one out of every three TSA airport security screeners will have diabetes, making travel much easier for PWDs. Yep. Traveling with the Big-D is going to get nothing but easier!

Seriously, assuming you are not going around the world in 80 days, international travel is much like domestic travel, only with the irritation and hassles super-sized. Assuming your trip is less than a month, make sure you have enough of all of your medications and testing supplies. I'd pack all of this in my carry-on, if I were you. Ditto pump supplies, if you use a pump. In fact, I'd pack a margin of error for more of everything than you need, if I were you.

Ask your health care provider to give you paper copies of all of your medication prescriptions. This isn't for airport security but to help you attempt to secure more supplies in case, oh... I don't know... a volcano or something goes off in Iceland and you can't fly home as scheduled. A letter from your Doc summarizing your medical conditions, gear, and meds can also help smooth over any potential airport security hassles.

As for hypo snacks, I haven't been overseas for a while, but recently flew half way across the country for a conference, and packed about two dozen bottles of Dex4 fluid. I got some raised eyebrows from the security folks, but no hassles. In your case, you really just need to carry enough for the flights (which could be many hours). Once you are at your destination, discovering local high-carb snacks to treat low blood sugar is half the fun of traveling.

If you think you need water, ya gotta buy it (for only slightly less per ounce than French Perfume) inside the security gates. You won't be allowed to carry water through airport security.

And of course, always visit the TSA website shortly before your journey to double check for any changes. If Al-Qaeda puts an insulin pump bomb on a plane, train, or automobile, none of us PWDs will ever be able to travel again.

Bon Voyage!




This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.



Disclaimer: Content created by the Diabetes Mine team. For more details click here.


This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.