Physiological differences between those in remission and ‘normies’

[Ade_essex]

There’s an interesting thread on here about whether an individual in diabetic remission is still classified as a diabetic. The answer is clearly an unequivocal ‘yes’ but it begged a question that’s been at the back of my mind for a while now. So I thought I’d ask it in a new thread and not try to hijack the earlier one.

My question is, are there any physiological differences between an individual in diabetic remission and an individual who has never had diabetes and whose blood sugars are well below pre-diabetes levels? Do our organs function differently, are we more likely to maintain our insulin resistance and are we more likely to relapse into diabetes again? So, to put it another way, if a diabetic in remission goes out for an all you can eat ice cream buffet with their otherwise identical twin, will different things be going on in the diabetic’s body as compared to the twin who has never had diabetes?

As I said, I’m not questioning the concept of remission or the long term classification of diabetes. I was just wondering whether there are long term physiological effects of becoming diabetic that I’ll never be able to escape even if I do get into remission.

Thanks

Ade

[Edit. I should say that I used the term normie to stop the title splitting over three rows. I’m not trying to suggest that we’re not ‘normal’as diabetics!]

 

[Eddy Edson]

Over a few years, remission via weight loss on average restores pancreas form, size & function to "near-normie" levels but maybe on average at the lower end of normie. Presumably it depends partly on the extent of damage to the pancreas in the meantime.

Study reveals type 2 diabetes remission can restore pancreas size and shape

New research being presented at the Annual Meeting of the European Association for the Study of Diabetes (EASD), held online this year, demonstrates for the first time that reversing type 2 diabetes can also restore the pancreas to a normal size and shape.

www.eurekalert.org

 

[JITR]

As I recall from research papers I have seen, there may also be a difference in fat cells from those of "normies" who have never had to lose weight. Yours and mine may have a more "voracious appetite" to replenish themselves as "yo-yo" dieters know all too well.

 

[CliffH]

There’s an interesting thread on here about whether an individual in diabetic remission is still classified as a diabetic. The answer is clearly an unequivocal ‘yes’ but it begged a question that’s been at the back of my mind for a while now. So I thought I’d ask it in a new thread and not try to hijack the earlier one.

My question is, are there any physiological differences between an individual in diabetic remission and an individual who has never had diabetes and whose blood sugars are well below pre-diabetes levels? Do our organs function differently, are we more likely to maintain our insulin resistance and are we more likely to relapse into diabetes again? So, to put it another way, if a diabetic in remission goes out for an all you can eat ice cream buffet with their otherwise identical twin, will different things be going on in the diabetic’s body as compared to the twin who has never had diabetes?

As I said, I’m not questioning the concept of remission or the long term classification of diabetes. I was just wondering whether there are long term physiological effects of becoming diabetic that I’ll never be able to escape even if I do get into remission.

Thanks

Ade

[Edit. I should say that I used the term normie to stop the title splitting over three rows. I’m not trying to suggest that we’re not ‘normal’as diabetics!]

This is something that I often ask my medical team, in the context of having had Late Onset Type 1 for the past nine years. My blood sugar's well controlled with insulin and what I never get clear answers to are the questions: "If my blood sugar stays within the normal range, am I still at higher risk of diabetic complications than someone without diabetes? If so, which complications and why?".

 

[Eddy Edson]

This is something that I often ask my medical team, in the context of having had Late Onset Type 1 for the past nine years. My blood sugar's well controlled with insulin and what I never get clear answers to are the questions: "If my blood sugar stays within the normal range, am I still at higher risk of diabetic complications than someone without diabetes? If so, which complications and why?".

Micro- and macrovascular damage from previous high BG periods generally persists and may sometimes continue to progress once the ball has started rolling, even with normalised BG.

 

[CliffH]

Micro- and macrovascular damage from previous high BG periods generally persists and may sometimes continue to progress once the ball has started rolling, even with normalised BG.

Oh well, I'll be thankful for small mercies!

 

[Ade_essex]

Thanks very much for the comments everyone. This isn't something that my healthcare professionals have addressed with me although, to be fair, I've not asked the question of them either. I've been so focused over the last few months on eating and exercising better that I've not really thought about what happens after remission.

Although my glucose levels are coming down, I still need to be very careful about what I eat, when I eat it and how much I eat so as not to spike my levels too much. It's sobering to think that I might be in this for the long haul now even if I do get into remission.

 

[CliffH]

Thanks very much for the comments everyone. This isn't something that my healthcare professionals have addressed with me although, to be fair, I've not asked the question of them either. I've been so focused over the last few months on eating and exercising better that I've not really thought about what happens after remission.

Although my glucose levels are coming down, I still need to be very careful about what I eat, when I eat it and how much I eat so as not to spike my levels too much. It's sobering to think that I might be in this for the long haul now even if I do get into remission.

I think all of us have to face the reality that we are "in this for the long haul".

 

[rebrascora]

I very much doubt health care professionals give a lot of thought (if any) to your question, certainly at primary care level. GPs mostly have a very basic understanding of diabetes and some are still quite old school and believe Type 2 to be progressive and sometimes that Type 1 only develops in children and young adults, so I wouldn't expect them to have much idea about the intricacies of Type 2s who have achieved remission compared to people without diabetes, especially if some don't even believe remission is possible.
At the end of the day I try to compare my lifestyle and diet now compared to how it was before the diagnosis which gave me the kick up the pants I needed to make some healthy changes. I personally believe that those changes have improved my health and therefore my long term outlook, so I really don't worry too much about complications because my former self might just as easily have developed bowel cancer or some other serious disease or illness as a result of my previous unhealthy lifestyle choices.

Not sure if that makes sense, but I can't really see much rationale in comparing my personal risks of complications to someone who doesn't have diabetes but may have smoked for 30 years or been a heavy drinker or been mostly sedentary all their lives or whatever. You can really only compare like with like and in my view, the only way to do that is to assess me pre diagnosis and post diagnosis as at least both those scenarios have the same health and lifestyle history for most of their life. So if I have improved things since diagnosis and I have a healthier lifestyle now, then I see that as reducing whatever risk I was carrying before diagnosis. I can't ever achieve remission because I am Type 1 but I still see my diagnosis as a turning point to becoming healthier because my diagnosis made me focus on and tackle my dietary and lifestyle issues.

 

[JimmyBlue]

As someone who has been told they are in remission I can advise that I still can't eat bread or pasta without my BG rocketing. Remission for me simply means that I have to continue the healthy lifestyle (diet and exercise) that I have settled into and that while I do this, my risks of complications are significantly reduced. My insulin resistance has not gone away even if it has reduced a little.