A really useful book for newbie T2s

[Burylancs]

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.


View attachment 20694

Quote - ”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.'

Or it could just be the TRUTH Eddy based on 4000 years knowledge and experience of what is currently called Type 2 Diabetes.

 

[Deleted member 21371]

Quote - ”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.'

Or it could just the TRUTH Eddy based on 4000 years knowledge and experience of what is currently called Type 2 Diabetes.

From the bronze age?
They had medicine that advanced?

 

[Burylancs]

From the bronze age?
They had medicine that advanced?

The Ancient Egyptians first diagnosed Diabetes. Perhaps no coincidence that they were a cereal-based culture. The Ancient Greeks gave its current name Diabetes Mellitus ( 'sweet ****') because they sipped the urine to test for it.

 

[Deleted member 21371]

The Ancient Egyptians first diagnosed Diabetes. Perhaps no coincidence that they were a cereal-based culture. The Ancient Greeks gave its current name Diabetes Mellitus ( 'sweet ****') because they sipped the urine to test for it.

I really think things have moved on from there.
Better ways of testing for it for example, no drinking required.
Better ways to treat it.
Insulin.
Then continuous glucose monitoring, and insulin pumps.
Then even in the last decade alone Professor Taylor discovered a way to reverse type 2.
Who knows what they'll find next, but I don't think 4000 years of bronze age history is a reason to stop looking now.

 

[Burylancs]

I really think things have moved on from there.
Better ways of testing for it for example, no drinking required.
Better ways to treat it.
Insulin.
Then continuous glucose monitoring, and insulin pumps.
Then even in the last decade alone Professor Taylor discovered a way to reverse type 2.
Who knows what they'll find next, but I don't think 4000 years of bronze age history is a reason to stop looking now.

Very ironic then that Professor Taylor has rejected modern medicine and is advocating a return to the Ancient Greek approach of just diet and exercise !

 

[Deleted member 21371]

Very ironic then that Professor Taylor has rejected modern medicine and is advocating a return to the Ancient Greek approach of diet and exercise !

If it works, it works.
As you now agree, knowledge increases with time, and experience changes.
Sometimes a fresh opinion is exactly what is needed at times, even if it means going back to the beginning.

 

[Eddy Edson]

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.


View attachment 20694

FWIW, correcting some numbers in that post. In Look AHEAD, actually 27% of "intensive lifestyle intervention" participants had 10%+ weight reduction at year 8; 11% had 15%+; and 50% had 5%+.

So a lot better than the numbers I posted previously (I followed a bad lead) and they certainly contradict the Internet wisdom that "95% of diets fail".

But still only a small minority maintaining the DiRECT target of 15% loss for people with obesity at baseline & the case for weight-loss meds still stands.

 

[Chris Hobson]

I have only just noticed that this item has been reposted in the book section. The thread seems to have derailed into an argument about the book's title which sort of misses the point. My recommendation was based on the fact that the book contains a whole lot of very useful information. When I was first diagnosed I only had a vague idea about what diabetes was. I am far better informed now and, had I read this book earlier, would have found out lots of things much sooner.

As for the argument about diabetes being reversed. I don't think that it is intended to mean that it can be in full remission or cured. It certainly can be turned in a positive direction by watching what you eat and staying active.

 

[Drummer]

For anyone who has read this far and is still concerned about their prognosis - I was diagnosed with type two in 2016.
Having been telling HCPs that I could not deal with carbs for half a century I was not in the least surprized.
I changed my diet back to what I was eating when doing Atkins at no more than 50 gm of carbs a day.
My weight reduced, I barely noticed, my blood glucose went back to normal my energy returned, my Hba1c went down to 41 in 6 months.
There was not a moment of anxiety or concern.
That's it really.
These days I could eat more carbs - just once in a while I do, but it increases my weight and it still takes ages to reduce down again, so I usually stick to under 40 gm of carbs a day.
I am perfectly happy and go out playing music for morris, maypole and longsword dancing.
In the evenings I sit and knit, listen to music and read the diabetes lists, but that is about as much influence type 2 has on my life these days.

 

[Ditto]

I was under the impression that if you caught it in time you could reverse it but if left too long then control would be the thing. 🙂

 

[Burylancs]

I was under the impression that if you caught it in time you could reverse it but if left too long then control would be the thing. 🙂

You've been misled. A secure diagnosis of Type 2 Diabetes, in the present state of knowledge, is a life sentence that cannot be 'reversed'. God knows what's happened to Diabetes UK, It's irresponsible of them to propagate Fake News like this to newbies.

 

[Docb]

You've been misled. A secure diagnosis of Type 2 Diabetes, in the present state of knowledge, is a life sentence that cannot be 'reversed'. God knows what's happened to Diabetes UK, It's irresponsible of them to propagate Fake News like this to newbies.

I think you have a point @Burylancs but go too far in making it. I think we both have an inherent distaste for assigning labels where the label is imprecise and can be interpreted in different ways. Gets even worse when somebody uses the label in a strap line to attract attention, to sell a book or to support a particular point of view.

I have come to the conclusion that there is no way you can beat it and the only thing to do is to gently remind people that many things are nowhere near as clear and most ideas are nowhere near as universal as some would have you believe. There ought to be a label for that approach but I will not suggest one because I don't like labels. 😉

 

[grovesy]

I was under the impression that if you caught it in time you could reverse it but if left too long then control would be the thing. 🙂

Even the research done by the Newcastle team, only about half achieved remission.

 

[Deleted member 21371]

I was under the impression that if you caught it in time you could reverse it but if left too long then control would be the thing. 🙂

Definitely.
But I guess you have to accept the path that makes you happy, personally.
As someone once said,

" "Is that possible?" I never ask that question until after we've done it"

 

[Chris Hobson]

Nobody here is claiming that diabetes can be cured. Reversed doesn't mean cured. Something that I have learned from reading this forum is that people's metabolisms are different and things that work for one person don't necessarily work for others. Endurance sports aren't for everyone but I found that doing them keeps my blood glucose levels under control while allowing me to have a relatively normal diet and mostly without medication. By a normal diet I mean avoiding refined sugar and avoiding anything that has a more than 50% carb content. This as opposed to the really low carb diets that some other members use. Am I cured? No. Have I reversed my diabetes? Considering the state that I was in when first diagnosed, most certainly.

 

[Burylancs]

Nobody here is claiming that diabetes can be cured. Reversed doesn't mean cured. Something that I have learned from reading this forum is that people's metabolisms are different and things that work for one person don't necessarily work for others. Endurance sports aren't for everyone but I found that doing them keeps my blood glucose levels under control while allowing me to have a relatively normal diet and mostly without medication. By a normal diet I mean avoiding refined sugar and avoiding anything that has a more than 50% carb content. This as opposed to the really low carb diets that some other members use. Am I cured? No. Have I reversed my diabetes? Considering the state that I was in when first diagnosed, most certainly.

The correct statement is in the middle of your post where you state that your regime allows you to keep 'my blood glucose levels under control'. If you are having to control it you clearly haven't 'reversed' it.

 

[Chris Hobson]

"If you are having to control it you clearly haven't 'reversed' it."

If I'm having to control it I clearly haven't cured it. On the other hand, prior to my diagnosis in 2013 I ached all the time, had no energy, and was having bouts of faintness. After diagnosis I was using insulin for about nine months and linagliptin for some time after that. Now I use no medication. In 2017 I did an ironman and this morning I swam five miles. That my condition is less serious now then it was previously is beyond doubt. Prior to diagnosis my condition was getting progressively worse, since diagnosis it has been getting progressively better. It is going in the opposite direction to what it was which I would describe as a reversal. I doubt that it can continue to improve indefinitely obviously, and I will have to exercise and watch what I eat for the rest of my life. I'm certainly not going to let diabetes stop me from living it to the max.

 

[helli]

Thank you @Chris Hobson for clearly stating this is for T2 in your subject.
It's a shame that the book title is not so clear.
I really feel for those diagnosed as T1 and see all these headlines and books about how it is possible to reverse (and I am not going to discuss what that means) diabetes only to discover they are referring to a different disease.
One of the worst things about my diagnosis was knowing I will have it for life (a cure for Type 1 has always been 10 years away) and there is nothing I can do about it. The false hope from these stories would have been horrible.

 

[Chris Hobson]

I think that the most promising development for T1s is high tech insulin pumps which may eventually be able to mimic the actions of a healthy pancreas to some degree. You are right to point out that the book title doesn't specify type two but it is stated clearly on the cover.

 

[helli]

I think that the most promising development for T1s is high tech insulin pumps which may eventually be able to mimic the actions of a healthy pancreas to some degree. You are right to point out that the book title doesn't specify type two but it is stated clearly on the cover.

Unfortunately, pumps won't be able to mimic the actions of a healthy pancreas until we are able to manufacture insulin that works as fast as the stuff a healthy pancreas produces and a CGM which works in real time rather than with a 15 minute delay which we attempt to make up for with a prediction.
Pumps today are great but they can't react fast enough to a rise in blood sugars to release insulin. They still need to rely on carb counting for eating and manual suspension when exercising.