A really useful book for newbie T2s

[Chris Hobson]

I am currently in the process of re-reading the book 'Reverse your diabetes' by Dr. David Cavan. The book has been covered in the Recommended books section on this forum:

https://forum.diabetes.org.uk/boards/threads/reverse-your-diabetes-dr-david-cavan.55224/

But I think that the book really needs a mention on this section. I have noticed that many newcomers seem to be feeling very panicky and disorientated about being newly diagnosed. I wish that I had read this book when I was first diagnosed. The book is really for type twos. It starts by giving a detailed description of what type two diabetes actually is in practice. It does go into some rather unpleasant details about how diabetes can screw up your health if you don't get a grip on it but then goes on to tell you what you can do to avoid this happening to you. Diet and exercise are known ways of dealing with type two diabetes, Dr. Cavan explains in detail what this means in practice.

 

[Cherrelle DUK]

Thanks for sharing this, Chris.

As you mentioned, lots of people worry about what a type 2 diagnosis means and how they can approach things so it's good to have some helpful info to read and assess what may work for you.

 

[Deleted member 34790]

thanks for sharing this @Chris Hobson - some really useful information! 🙂🙂

 

[Proud to be erratic]

Could the thread be retitled to include reference to T2 newbies? Then those newcomers might have a chance of picking up on @Chris Hobson 's suggestion.

 

[Burylancs]

Thanks for sharing this, Chris.

As you mentioned, lots of people worry about what a type 2 diagnosis means and how they can approach things so it's good to have some helpful info to read and assess what may work for you.

Cherrelle please remove the sticky from this post above. A secure diagnosis of Type 2 Diabetes CANNOT be 'reversed'. It is a lifelong condition. Newly dxed T2s on this site should not be misled into believing that it can. Good Control is what they must aim for not fantasy solutions

 

[Windy]

I have to disagree with you Burylancs. You're mixing diabetes remission and good control together, and they are separate.
Good and poor control are defined as:
"Definition of good and poor metabolic control
In the present study, “good metabolic control” was defined as the group of DCCT patients with a mean HbA1c level (until last visit) <=6.87%, a threshold corresponding to the 20th percentile of the overall distribution of HbA1c mean level.
Similarly, “poor metabolic control” was defined as the group of DCCT patients with a mean HbA1c level (until last visit) >= 9.49%, which corresponded to the 80th percentile of the overall HbA1c mean level distribution."
Schectman, J.M., Schorling, J.B. and Voss, J.D., 2008. Appointment adherence and disparities in outcomes among patients with diabetes. Journal of general internal medicine, 23(10), pp.1685-1687.

whereas diabetes remission is defined as:
"Type 2 diabetes remission is defined as a healthy clinical state characterized by achievement of HBA1c below the targeted level, maintained for at least 6 months, with or without continued use of lifestyle modification and/or metformin, provided that this is not due to complications, comorbid conditions or concomitant therapy."
Kalra, S., Singal, A. and Lathia, T., 2021. What’s in a name? Redefining type 2 diabetes remission. Diabetes Therapy, 12(3), pp.647-654.

Holst and Madsbad argue:
"Thus, the generally accepted level of 7.0% for good glycemic control is a compromise, and quite far from a state of remission regardless of how you define it; rather, it defines an “acceptable” treatment result, obtained without unduly increasing the risk of adverse events associated with the therapy itself."
Holst, J.J. and Madsbad, S., 2021. What is Diabetes Remission?. Diabetes Therapy, 12(3), pp.641-646.

I also note that the NHS England guidance on language and diabetes discourages the use of "control".
"‘What’s your diabetes control like? ...’
Avoid the idea of ‘control’ and discuss how diabetes is affecting the person’s life in general."
Cooper, A., Kanumilli, N., Hill, J., Holt, R.I.G., Howarth, D., Lloyd, C.E., Kar, P., Nagi, D., Naik, S., Nash, J. and Nelson, H., 2018. Language matters. Addressing the use of language in the care of people with diabetes: position statement of the English Advisory Group. Diabetic Medicine, 35(12), pp.1630-1634.

But I suspect we don't agree on this Burylancs, despite the research papers giving definitions. It would be a boring world if we all agreed. Sarah

 

[Burylancs]

I have to disagree with you Burylancs. You're mixing diabetes remission and good control together, and they are separate.
Good and poor control are defined as:
"Definition of good and poor metabolic control
In the present study, “good metabolic control” was defined as the group of DCCT patients with a mean HbA1c level (until last visit) <=6.87%, a threshold corresponding to the 20th percentile of the overall distribution of HbA1c mean level.
Similarly, “poor metabolic control” was defined as the group of DCCT patients with a mean HbA1c level (until last visit) >= 9.49%, which corresponded to the 80th percentile of the overall HbA1c mean level distribution."
Schectman, J.M., Schorling, J.B. and Voss, J.D., 2008. Appointment adherence and disparities in outcomes among patients with diabetes. Journal of general internal medicine, 23(10), pp.1685-1687.

whereas diabetes remission is defined as:
"Type 2 diabetes remission is defined as a healthy clinical state characterized by achievement of HBA1c below the targeted level, maintained for at least 6 months, with or without continued use of lifestyle modification and/or metformin, provided that this is not due to complications, comorbid conditions or concomitant therapy."
Kalra, S., Singal, A. and Lathia, T., 2021. What’s in a name? Redefining type 2 diabetes remission. Diabetes Therapy, 12(3), pp.647-654.

Holst and Madsbad argue:
"Thus, the generally accepted level of 7.0% for good glycemic control is a compromise, and quite far from a state of remission regardless of how you define it; rather, it defines an “acceptable” treatment result, obtained without unduly increasing the risk of adverse events associated with the therapy itself."
Holst, J.J. and Madsbad, S., 2021. What is Diabetes Remission?. Diabetes Therapy, 12(3), pp.641-646.

I also note that the NHS England guidance on language and diabetes discourages the use of "control".
"‘What’s your diabetes control like? ...’
Avoid the idea of ‘control’ and discuss how diabetes is affecting the person’s life in general."
Cooper, A., Kanumilli, N., Hill, J., Holt, R.I.G., Howarth, D., Lloyd, C.E., Kar, P., Nagi, D., Naik, S., Nash, J. and Nelson, H., 2018. Language matters. Addressing the use of language in the care of people with diabetes: position statement of the English Advisory Group. Diabetic Medicine, 35(12), pp.1630-1634.

But I suspect we don't agree on this Burylancs, despite the research papers giving definitions. It would be a boring world if we all agreed. Sarah

And you are mixing 'remission' and 'reversal' together. They are inimical contradictory concepts. The book in question is talking about 'reversal' of Type 2 diabetes not 'remission'.

 

[AndBreathe]

To be honest, when diagnosed I was told my diabetes was a progressive condition. I was determined the progression would at worst be slow, but in reality I reversed the progression, so I do think reverse is as appropriate a word as any.

Anyone being diagnosed with any condition must be advised that not everyone reacts the same or has the same outcomes, but I believe it is important that messaging surrounding a diagnosis of T2 includes some form of hope. It's no surprise that those given total gloom and doom think, "If this is as good as it gets, pass the cake/biscuits/chips/pizza or whatever".

@Burylancs , I know nothing of you, but if your experiences have been less positive, or you have had a pretty rough ride from it all, I'm sorry that has been your experience, but in life, hope if important.

(My general stats are in my signature.)

 

[Deleted member 21371]

Saying as I reversed my diabetes, personally I'm good with the term.

 

[Windy]

Reversed is also the term that Roy Taylor uses in the title of one of his books, and on the cover of the other book. He doesn't use it in his scientific papers, which makes me think "reversed" is aimed at the general public, whilst "remission" is the term used within the scientific community.
But either way, the stuff I've read, and the experiences of other people on this forum makes me think it's real and worth a try for people with type 2. I'd rather travel hopefully, even if I don't get my diabetes reversed or in remission. I assume other type 2s are similar.
Sarah

 

[Eddy Edson]

The DUK page is a bit confusing on this "remission" vs "reversal" business: https://www.diabetes.org.uk/diabetes-the-basics/type-2-reverse

Reversing type 2 diabetes​

We don’t call it diabetes reversal [but you just did!], because this might sound like it's permanent, and there’s no guarantee that your diabetes has gone forever.​

But yes, it may be possible to put your type 2 diabetes into remission. This is when your blood sugar levels are below the diabetes range and you don’t need to take diabetes medication anymore. This could be life-changing.

How do you reverse diabetes? [Did it again!]​

...

Could probably do with an edit.

 

[Burylancs]

The DUK page is a bit confusing on this "remission" vs "reversal" business: https://www.diabetes.org.uk/diabetes-the-basics/type-2-reverse

Reversing type 2 diabetes​

We don’t call it diabetes reversal [but you just did!], because this might sound like it's permanent, and there’s no guarantee that your diabetes has gone forever.​

But yes, it may be possible to put your type 2 diabetes into remission. This is when your blood sugar levels are below the diabetes range and you don’t need to take diabetes medication anymore. This could be life-changing.

How do you reverse diabetes? [Did it again!]​

...

Could probably do with an edit.

Yes its typical of the confusion and contradictions in this area. Clearly if you claim to have 'reversed' your Type 2 Diabetes you cannot be a T2 in 'remission' and if you claim to be a Type 2 in 'remission' you clearly haven't 'reversed' it.
And yet two contradictory terms are being run as synonyms. They all just making it up as they go along, as is evidenced by the competing definitions of 'remission' that Windy has found. All Type 2s are going to have to consider how every morsel of food will affect their bgs for the rest of their lives. Which in turn suggests that neither 'reversal' or 'remission' are fundamentally possible in any meaningful sense of those terms.

 

[Eddy Edson]

All Type 2s are going to have to consider how every morsel of food will affect their bgs for the rest of their lives.

I don't think so.

 

[AndBreathe]

Yes its typical of the confusion and contradictions in this area. Clearly if you claim to have 'reversed' your Type 2 Diabetes you cannot be a T2 in 'remission' and if you claim to be a Type 2 in 'remission' you clearly haven't 'reversed' it.
And yet two contradictory terms are being run as synonyms. They all just making it up as they go along, as is evidenced by the competing definitions of 'remission' that Windy has found. All Type 2s are going to have to consider how every morsel of food will affect their bgs for the rest of their lives. Which in turn suggests that neither 'reversal' or 'remission' are fundamentally possible in any meaningful sense of those terms.

I don't believe I consider every morsel of food. My life is changed. I don't think about bread, cakes and whatever. They don't enter my head space, aside from when I am buying them for my OH who does have them.

In my old world, pre-T2, I had routines and habits. I still have routines and habits, but some of them are different to pre-October 2013. I don't rail against or resent my new normal.

I'm not picking any sort of fight. I'm merely explaining my experiences appear to differ to yours.

I am

 

[Windy]

They all just making it up as they go along, as is evidenced by the competing definitions of 'remission' that Windy has found.

I only gave one definition of remission.
However there are others in the scientific literature if you care to look for them. I can recommend searching in Google Scholar if you want to see papers with the other definitions, but they're much of a muchness. Google scholar is a search tool for scientific papers, and I've found it an excellent resource in the past.

 

[Leadinglights]

Reversal, remission, resolved by whatever means to a non diabetic blood glucose level which is maintained without medication does not necessarily mean cured. But credit should be given to those who do get to that point so they can live their new normal life.

 

[Deleted member 21371]

All Type 2s are going to have to consider how every morsel of food will affect their bgs for the rest of their lives.

Nah.
Once it's reversed any food is good.
(Admittedly I am currently on a quest for artisan pies, and artisan sausages, and artisan bread, and craft beer, so I do have some standards)

 

[Eddy Edson]

The DUK page is a bit confusing on this "remission" vs "reversal" business: https://www.diabetes.org.uk/diabetes-the-basics/type-2-reverse

Reversing type 2 diabetes​

We don’t call it diabetes reversal [but you just did!], because this might sound like it's permanent, and there’s no guarantee that your diabetes has gone forever.​

But yes, it may be possible to put your type 2 diabetes into remission. This is when your blood sugar levels are below the diabetes range and you don’t need to take diabetes medication anymore. This could be life-changing.

How do you reverse diabetes? [Did it again!]​

...

Could probably do with an edit.

Just because it's kind of interesting, philosophically ... This is from Joslin's "can it be reversed" page:

Can Type 2 Diabetes Be Reversed?

Type 2 diabetes (formerly known as adult-onset or non-insulin-dependent diabetes) can be a life-long, chronic disease in which the body either does not produce enough insulin or the cells in out body doesn’t respond to insulin correctly. Because of these two problems, there isn’t enough insulin...

www.joslin.org

According to recent research, type 2 diabetes cannot be cured, but individuals can have glucose levels that return to non-diabetes range, (complete remission) or pre-diabetes glucose level (partial remission) The primary means by which people with type 2 diabetes achieve remission is by losing significant amounts of weight.

We talk of remission and not a cure because it isn’t permanent. The beta cells have been damaged and the underlying genetic factors contributing to the person’s susceptibility to diabetes remain intact. Over time the disease process reasserts itself and continued destruction of the beta cells ensues. An environmental insult such as weight gain can bring back the symptomatic glucose intolerance.

You have to respect Joslin but there are things in this which seem dubious on different levels. Most abstractly, the idea that because an "insult" such as weight gain can bring back glucose metabolism problems, you can't talk of a "cure".

I really don't get that. By analogy, you could never talk of a "cure" for anthrax, because if you are exposed to another anthrax spore "insult" you may well get it again.

If I retain a healthy weight I avoid recurrence of glucose metabolism problems; if I avoid anthrax spores I avoid anthrax; if I avoid unhealthy behaviours I avoid health problems. Susceptability to developing health problems with unhealthy behaviours surely isn't by itself a sign of an underlying, dormant disease.

And there is absolutely no reason to suppose that necessarily "over time the disease process reasserts itself and continued destruction of the beta cells ensues." That just seems to be a rhetorical survival from when it was thought that T2D was indeed necessarily progressive.

But anyway, all of this might tend to distract from the important issue: how to maintain weight loss, and in this sense, Joslin is more on the mark, because people will indeed tend in general to regain weight and offer their metabolisms renewed "insults".

The "gold standard" for intensive lifestyle interventions (counseling etc) for weight loss is I think the big long-term Look AHEAD trial.

In that, about 30% lost >10% of body weight (mean ~15%) after 1 year. At 8 years, just 39% of those 30% had retained >10% loss. So despite intensive ongoing interventions, only about 12% of the total particpants managed to retain >10% reduction long term.

There is as far as I know no reason to suppose that the NHS' "Newcastle" interventions, which are similar or perhaps less intensive, will achieve better results long term.

Trying to address weight issues via behavious modification for many is like trying to get people to consciously breathe at a particular rate, always - you're addressing a deep subconscious process with inadequate tools.

Not that the less than optimal long term outcomes have no value - in Look AHEAD about 20% of people maintained at least 5% loss long term, which is supposed to be enough for significant benefits. But for full "reversal" in a majority of people with the relevant type of T2D, you probably need meds like Wegovy/Ozempic or the new drugs in the pipeline.

 

[Windy]

There is as far as I know no reason to suppose that the NHS' "Newcastle" interventions, which are similar or perhaps less intensive, will achieve better results long term.

I suspect the answer is ongoing monitoring, support and mini-Newcastle style interventions if the weight starts to creep up again. I think there was a trial ongoing for this, run by Roy Taylor's team, but can't seem to find it at the moment.

The beta cells have been damaged and the underlying genetic factors contributing to the person’s susceptibility to diabetes remain intact.

I thought that Taylor had proved using MRI scans that the pancreas recovers over two years after weight loss. As you say, this seems to be a hangover from the past and Joslin doesn't seem to acknowledge it.

 

[Deleted member 21371]

I suspect the answer is ongoing monitoring, support and mini-Newcastle style interventions if the weight starts to creep up again. I think there was a trial ongoing for this, run by Roy Taylor's team, but can't seem to find it at the moment.

I thought that Taylor had proved using MRI scans that the pancreas recovers over two years after weight loss. As you say, this seems to be a hangover from the past and Joslin doesn't seem to acknowledge it.

I find it quite easy to simply do a few diet shakes if my weight does start to creep up.

Being obese sort of happened slowly, I didn't really notice until one day, it was there, now I'm much more observant.
And being thin makes my lifestyle better, so I'm staying with it.