A type 1 diabetic mystery is why do some Type 1s get complications and others seem to never get them? A massive Japanese study of Type 1 diabetics found that those with fulminant diabetes developed complications much faster and more severely than those with non-fulminant diabetes.

The difference between fulminant and non-fulminant is the speed and intensity at which the disease develops. Fulminant Type 1 diabetes typically develops suddenly with near total loss of beta cell function. This type of diabetes is confirmed with testing c-peptide levels. Non-fulminant type 1 diabetes has residual c-peptide levels that eventually taper to undetectable. Sometimes this is seen through many years of the Honeymoon Period.

This study may be the antithesis of conventional wisdom for preventing complications. Staking all hopes on blood sugar control is heavily optimistic. Yes controlling blood sugar does lessen the workload for existing beta cells, and thus extends the lifespan of each beta cell. Research suggests that c-peptide offers protection to beta cells, both from apoptosis (cell death) and encourages new cell growth. This new cell growth applies to beta cells and other cells of the body that endure long-term Type 1 diabetes complications.

Diabetics are instructed that maintaining normal blood sugars is the Holy Grail of preventing long-term complications. Yes and no. The truth is controlling your blood sugar will not allow complications of Type 1 diabetes to develop as quickly, presuming you still had some level of beta cell function upon diagnosis (i.e., c-peptide). That doesn't sound like a reward as much as it does a delayed punishment. I'd like c-peptide with my insulin, please. It's off the à la carte menu? That's fine - serve it up! I want to thank Klausen for bringing this study to my attention.

Change appears to be coming for diabetes care. The HbA1c test may not be the safest approach for diabetics to follow in preventing complications. Instead, experts are saying the average blood glucose level per individual will add clarity to diabetic patients looking to manage their disease.

A study supporting the change showed a close correlation between average glucose and HbA1c levels. So the myth, busted is: maintaining an average blood sugar is a safer approach for diabetes management -- NOT CHASING A UNIFORM HbA1c value. The fluctuation in blood sugar is what causes complications in the small vessels of the eyes, kidneys and peripheral nerve endings. For example - sustaining a blood sugar of 200 mg/dL is a lot safer than waking at 240 and ushering a boatload of sugar into your cells to drop your sugar to 80 mg/dL. It is the transfer of glucose into the cell that causes the injury to cell membranes and resulting complications.

Think of it like the movement of the ocean. High tide to low tide happens gradually, over the course of many hours throughout the day. When a storm hits - the waves become turbulent, crashing against the shore causing erosion. Is the human body any different? I'm not a doctor -- but I did stay at a Holiday Inn Express last week.