I was type 2 but my HbA1c is now 43. What am I?

[CityMan]

I was diagnosed with Diabetes a little under 3 months ago, with an associated HbA1c of 87. I was prescribed Metformin and since I was a big bloke, I immediately went onto a 1000 cal/day diet with very very low carb levels. I've lost 3 stones (from 18.5st down to 15.5st and shrinking) Now, my latest HbA1c is 43 - in the pre-diabetic range, but only just. It's a pretty fair bet that if I keep this up I will drop below 42 on HbA1c in a very short space of time.

So what am I? Am I Diabetic treated with Metformin. Am I prediabetic with Metformin? Curious to know how I should describe myself whether in medical questionnaires, life insurance or other situations.

Would love to hear your thoughts.

 

[Pumper_Sue]

You are a well controlled type2 🙂
My A1c is the same as yours so I'm classed as a well controlled type 1 🙂

 

[pm133]

I was diagnosed with Diabetes a little under 3 months ago, with an associated HbA1c of 87. I was prescribed Metformin and since I was a big bloke, I immediately went onto a 1000 cal/day diet with very very low carb levels. I've lost 3 stones (from 18.5st down to 15.5st and shrinking) Now, my latest HbA1c is 43 - in the pre-diabetic range, but only just. It's a pretty fair bet that if I keep this up I will drop below 42 on HbA1c in a very short space of time.

So what am I? Am I Diabetic treated with Metformin. Am I prediabetic with Metformin? Curious to know how I should describe myself whether in medical questionnaires, life insurance or other situations.

Would love to hear your thoughts.

Can't disagree with what Pumper Sue says.
You are still diabetic but now you have your blood glucose under good control and that is the most important thing so that is good news.
If you stopped the medication and starting eating normal carbs again your HBA1c would start rising (probably very fast) again, hence my saying that you are still diabetic.

 

[CityMan]

Thanks to both of you. Being a bit of a newbie to the entire world of Diabetes, I guess I was wondering at what point I have 'reversed' Diabetes or am said to be no longer suffering from it. Is it an HbA1c below 42 without Metformin?

I see that the NICE range for controlled Type 2 is said to be 48-59. Obviously at 43 I am well below that.

 

[pm133]

Thanks to both of you. Being a bit of a newbie to the entire world of Diabetes, I guess I was wondering at what point I have 'reversed' Diabetes or am said to be no longer suffering from it. Is it an HbA1c below 42 without Metformin?

OK so that distinction creates a bit of discussion on the forum so I'll give my view but others will definitely differ.

For me, remission means you are (at least temporarily) able to eat carbs you want without requiring any medical treatment of any kind for it.

For this to turn into a cure, that remission would need to last many years. How many is open to debate but for me it would be more than a decade. The diabetes could return at any time and I believe it often does.

To have "reversed" your diabetes, I think that is the same thing as "remission".

Now the confusion over words comes when you consider those who can control their blood glucose without medication. Many of those people use the words remission or reversed. For me they have achieved neither because if they started eating normal carbs again their blood glucose levels would go through the roof again. So for me, this is just a state of having your blood glucose under very good control with the added very real advantage of not having to worry about taking pills. People in that situation however, have to stick to very strict low carb diets to maintain that state.

Type 1s are a different story and other than extreme low carbers (we have some on here), we all require insulin with no current hopes of every being relieved of that burden. Research is ongoing though.
There are Type 2s who also use insulin but I'm less sure about that area. Someone else will be able to help you here.

Others will definitely disagree with my definitions but I hope that helps paint an overall picture for you.

 

[rebrascora]

Firstly, well done on the fantastic weight loss and HbA1c reduction!

I believe remission is considered to be 2 consecutive HbA1c results in the normal range ie below 42, without the use of medication, so cutting back on your Metformin would probably be the next step if that is what you are aiming for. Obviously this should be done in consultation with your Health Care Professional. I think you will probably find that the low carb way of eating and weight loss is having a much bigger impact on your levels than the Metformin anyway, so don't be worried about taking that next step .... and of course you can always go back to it if your levels do rise too much. I think Metformin takes a week or so to clear the system and for your body to then adjust to it's absence. During that time some people notice a slight upward drift in their BG before it settles again. Good luck!

 

[CityMan]

Attached is something that explains quite well what 'remission' means, which you might find useful in terms of where you go next. Well done on what you've managed so far.

Very helpful Martin. Thank you both to you and for the other replies.

 

[Deleted member 21371]

Attached is something that explains quite well what 'remission' means, which you might find useful in terms of where you go next. Well done on what you've managed so far.

Whose definition of "remission" is that?
There seems to be no reference, date, or author on it?

 

[Deleted member 21371]

I was diagnosed with Diabetes a little under 3 months ago, with an associated HbA1c of 87. I was prescribed Metformin and since I was a big bloke, I immediately went onto a 1000 cal/day diet with very very low carb levels. I've lost 3 stones (from 18.5st down to 15.5st and shrinking) Now, my latest HbA1c is 43 - in the pre-diabetic range, but only just. It's a pretty fair bet that if I keep this up I will drop below 42 on HbA1c in a very short space of time.

So what am I? Am I Diabetic treated with Metformin. Am I prediabetic with Metformin? Curious to know how I should describe myself whether in medical questionnaires, life insurance or other situations.

Would love to hear your thoughts.

Congratulations, that is an amazing result.
Have a look at the work of Prof. Taylor and the Newcastle diet.
It is indeed possible to reverse diabetes from a very low calorie diet, and weight loss.

However, if you don't test your insulin response to eating carbs, and stay on a low carb diet, it is possible to mask any symptoms.
It's worth discussing your results with your doctor, and agree a way forward with them.

 

[Deleted member 21371]

The definition that's in general use was agreed by a team of international experts from Diabetes UK (this site), the American Diabetes Association and the European Association for the Study of Diabetes.

I can't remember where the attachment came from but it's probably from a screen grab off www.healthline.com which I converted into a PDF. However, you could have a look at this, which is much closer to home:-

Type 2 diabetes remission

Type 2 diabetes remission is when your blood sugar levels return to a safe, non-diabetes level long-term, without the need for glucose-lowering medication. It stops diabetes in its tracks and boosts your chances of a healthy future. When you are in remission, you reduce the risk of diabetes...

www.diabetes.org.uk

Thanks.
The updated one clarifies some of the points in the previous one.
Things seem to have come on in a short space of time, which is always good.

 

[AndBreathe]

Attached is something that explains quite well what 'remission' means, which you might find useful in terms of where you go next. Well done on what you've managed so far.

Do you have a source for that information, or is it something you put together yourself?

 

[pm133]

Only in the sense that it's at odds with what remission is generally considered to mean.

I don't agree with it but I do understand that I'm at odds with that definition.

 

[AndBreathe]

I suspect the source was the US website www.healthline.com but it would have been a screen grab not a download. As I often do I copied and pasted into Word, edited it (for example to refer to GP and DN instead of whatever was there before) and then saved it as a PDF.

Personally, I like to see statements like that attributed appropriately.

I can't say I agree with the definitions of remission used in either your attachment or indeed by Diabetes UK. Periods of 6 or 12 months are just too brief, in my personal opinion, but then I'm not the policy maker in that sphere.

 

[Drummer]

I went down to the top end of normal and after a couple more similar results was told I would have in remission added to my notes - no explanation so I wasn't absolutely sure that I would get the eye foot or even blood tests done.
My GP surgery can be a bit - well - I have been told that I have had health checks every year for decades - I am 70 now. News to me.
I HAVE had annual blood tests for my failed thyroid, but as far as I am aware, nothing else was ever included. Not even cholesterol (Lucky escape there)

 

[Becka]

I was wondering at what point I have 'reversed' Diabetes or am said to be no longer suffering from it.

When you can stop taking any medication, put all that weight back on, and your glucose levels remain in the normal range.

A chronic disease is one you have for the rest of your life. It could be out of control, managed, or in remission, but is one which could flare up at any time. Fortunately in the case of type 2 diabetes, if you can control it well enough that it goes into remission you may be able to keep it there. It is not something which just flares up of its own accord as can happen with other diseases.

Although your body could become more insulin resistant or produce less insulin that such management gets more difficult and may be impossible without medication. Everyone is different that there are no fixed rules where following a set of instructions will guarantee a particular outcome. What works for one person will not for another. You can only do the best you can.

It is better to think of diabetes (as with other chronic diseases) as not being the symptoms but the susceptibility. Based on your results, if you keep that level of control you will probably be able to stop the tablets and may well be able to keep your levels in a normal range through your diet.

But if you put that weight back on and eat the way you used to, it is likely your levels will rise again. The diabetes has not gone away as you remain susceptible to it, it is just well controlled that you are not experiencing the symptoms and effects of it. So it is something you will need to manage for the rest of your life, even if only by a keeping to a suitable lifestyle rather than needing medication.

People can and will quibble over the technical definitions of terms like "remission" and "reversed" but other than very few exceptions, you cannot get your levels back down and then just forget about it and do what you like. It will always be there, you will always be "suffering" from it, although whether it actually is suffering is very personal to how you feel about the steps you need to take to manage it.

 

[Deleted member 21371]

.............................People can and will quibble over the technical definitions of terms like "remission" and "reversed" but other than very few exceptions, you cannot get your levels back down and then just forget about it and do what you like. It will always be there, you will always be "suffering" from it, although whether it actually is suffering is very personal to how you feel about the steps you need to take to manage it.

Well, apart from actively not putting 5 stones back on, I have forgotten about it, and done what I liked for about 7 years now. I can't say I'm suffering.
Possibly I won't eat a family size box of Krispy Kremes in one go any more, but I think it's more the fact my tastes have changed, and I prefer being slim again as well.

 

[Becka]

Well, apart from actively not putting 5 stones back on, I have forgotten about it, and done what I liked for about 7 years now.

You have so forgotten about it you are still visiting diabetes sites?

 

[rebrascora]

You have so forgotten about it you are still visiting diabetes sites?

And you, @travellor, also mentioned on other recent posts that you are dieting again to lose weight, so this is still all about maintenance to keep you in remission. If you put enough weight back on you will become diabetic again. I am not sure how this differs from maintaining a low carb diet for life to control diabetes as oppose to eating "normally" or "whatever you want" most of the time and then cutting back when you put on a few lbs to trim it back down.... micro yoyoing if you like.

 

[Deleted member 21371]

And you, @travellor, also mentioned on other recent posts that you are dieting again to lose weight, so this is still all about maintenance to keep you in remission. If you put enough weight back on you will become diabetic again. I am not sure how this differs from maintaining a low carb diet for life to control diabetes as oppose to eating "normally" or "whatever you want" most of the time and then cutting back when you put on a few lbs to trim it back down.... micro yoyoing if you like.

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