In remission

[Mrssw21]

Hi
i was diagnosed with Type 2 last January. I didn’t want the medication, so went low carb. After 12 weeks I had lost 9kg and my diabetes was in remission. I had no help whatsoever from my GP
I have continued on low carb, and last August requested a further blood test. I was still in the normal range, in remission
i asked to be referred to a dietician/nutritionist for help, as I am very confused as to what I can now I eat.
this was refused by my GP as I no longer meet the criteria
my question is, has anyone used a private dietician, and would you recommend it
thanks in advance

 

[Leadinglights]

I would say you should just stick with what you have been doing as really your new way of eating is what will maintain your normal level. You could relax a bit for treats and eating out but many find that they cannot go back to previous way of eating otherwise it becomes a slippery slope and blood glucose will increase.

 

[everydayupsanddowns]

Welcome to the forum @Mrssw21

Congratulations on getting your diabetes into remission 🙂

Sounds like the changes you have made have had a very positive effect on your body‘s ability to regulate your glucose levels.

Losing almost 10kg is a brilliant achievement. Some recent research suggests people can have a ‘personal fat threshold’ where losing enough weight (especially visceral fat around the organs) can help reboot the metabolism, and improve the function of liver and pancreas.

How sustainable do you think the menu changes you made are for you long term? Are you feeling overly restricted? Are you still losing weight?

You may be able to find something of a ‘maintenance’ menu to keep the improvements you‘ve seen, but with a little more flexibility?

 

[Spathiphyllum]

Hi
i was diagnosed with Type 2 last January. I didn’t want the medication, so went low carb. After 12 weeks I had lost 9kg and my diabetes was in remission. I had no help whatsoever from my GP
I have continued on low carb, and last August requested a further blood test. I was still in the normal range, in remission
i asked to be referred to a dietician/nutritionist for help, as I am very confused as to what I can now I eat.
this was refused by my GP as I no longer meet the criteria
my question is, has anyone used a private dietician, and would you recommend it
thanks in advance

Your GP's attitude is dysfunctional and counterproductive ... Type 2 diabetes costs the NHS huge sums of money! GPs should be falling all over themselves to support people like you, who have made the tremendous effort to lose weight and put themselves into remission! And who have done it themselves, rather than needing to be put on a special programme paid for by the NHS ...

Really does make me want to throw things ... But that would not be helpful. ; )

However: Calling Diabetes UK-- do you have any campaigns around this? If not, shouldn't you?

Ok, I gather that it has only comparatively recently been demonstrated that Type 2 can be 'put into remission'.

(Or, on the basis of what I've read, I would say cured. The insistence on calling it 'remission' seems to me like: You break your leg. You have it treated, you do lots of hard work in physio, and some months later your leg is fine. But someone says 'Oh no, you can't say your leg is cured, because you could always break it again' ... People who had Type 2 due to excess visceral fat and stop having Type 2 when they lose that excess visceral fat are cured; the fact they could 'break it again' if they gain that fat back seems to me to be beside the point ... )

Now that we know Type 2 can be 'put into remission', though-- surely the NHS needs to develop good programmes for supporting people who need and want support to stay 'in remission'?

 

[Deleted member 21371]

Your GP's attitude is dysfunctional and counterproductive ... Type 2 diabetes costs the NHS huge sums of money! GPs should be falling all over themselves to support people like you, who have made the tremendous effort to lose weight and put themselves into remission! And who have done it themselves, rather than needing to be put on a special programme paid for by the NHS ...

Really does make me want to throw things ... But that would not be helpful. ; )

However: Calling Diabetes UK-- do you have any campaigns around this? If not, shouldn't you?

Ok, I gather that it has only comparatively recently been demonstrated that Type 2 can be 'put into remission'.

(Or, on the basis of what I've read, I would say cured. The insistence on calling it 'remission' seems to me like: You break your leg. You have it treated, you do lots of hard work in physio, and some months later your leg is fine. But someone says 'Oh no, you can't say your leg is cured, because you could always break it again' ... People who had Type 2 due to excess visceral fat and stop having Type 2 when they lose that excess visceral fat are cured; the fact they could 'break it again' if they gain that fat back seems to me to be beside the point ... )

Now that we know Type 2 can be 'put into remission', though-- surely the NHS needs to develop good programmes for supporting people who need and want support to stay 'in remission'?

Yes, l am reversed, not in remission.

 

[harbottle]

There's a difference between actually being able to go back to a 'normal' diet without issues (i.e. insulin secretion has returned to normal levels and first line response is working) and being able to control it with diet and keeping in normal levels. The Newcastle work showed that some people can lose weight and regain lost beta cell functionality.

 

[Spathiphyllum]

...went low carb. After 12 weeks I had lost 9kg and my diabetes was in remission. ... I am very confused as to what I can now I eat. ...

In the meantime, in immediate practical terms: I think maybe what's most needed is clarity about the distinction between managing Type 2 and 'going into remission from' Type 2.

As I understand it, the distinction is as follows:

Type 2 is caused by excess visceral fat making your body's cells 'insulin resistant'. Insulin resistance is the defining characteristic of Type 2 diabetes. Most of your body's cells need insulin in order to use the glucose in your blood. So, if your cells become insulin resistant, they don't absorb enough glucose from your blood, and therefore you have persistently, abnormally high blood-sugar levels.

Type 2 diabetics can often manage this by eating a low carbohydrate diet. This will have the result that, even though they still have the excess visceral fat, so their bodies are still insulin resistant-- meaning they are still unquestionably Type 2 diabetics-- their blood sugar levels stay low. (Because your digestion turns carbohydrates into glucose and pumps that into your blood. So, if you eat very little in the way of carbohydrates, you won't have high levels of glucose in your blood in the first place-- so it won't matter so much if your body's cells are still reluctant to suck up that glucose.)

'Going into remission' from Type 2-- or 'reversing' or curing Type 2-- means losing the excess visceral fat so your body stops being insulin resistant. In that case, you don't need to eat a very low-carb diet anymore: your cells have returned to normal, responding normally to the insulin your body produces and sucking the glucose out of your blood properly.

You do however have to keep the weight off, and especially keep from gaining excess visceral fat again. The key to keeping the excess visceral fat from coming back is exercise. So you need to do regular exercise, and also keep your calorie consumption moderate. (It is possible to be overweight and not have excess visceral fat-- but of course if you are overweight you're far more likely to have excess visceral fat.)

If you have the kit for testing your blood-glucose levels, you can experiment with this yourself. Try some higher carbohydrate-- but still healthy and not too high-calorie-- meals, and see how your blood-glucose levels respond. This will show you whether you have really 'gone into remission' yet, or whether you still need to stick to a low-carb diet while losing more weight and getting more exercise.

 

[Spathiphyllum]

There's a difference between actually being able to go back to a 'normal' diet without issues (i.e. insulin secretion has returned to normal levels and first line response is working) and being able to control it with diet and keeping in normal levels. The Newcastle work showed that some people can lose weight and regain lost beta cell functionality.

Type 1 is about "lost beta cell functionality". Type 2 is about insulin resistance: all Type 2s start off with normal or even higher than normal insulin production-- beta cells (the insulin-producing cells in your pancreas) functioning normally or even working harder than normal.

For some Type 2s: their beta cells spend years and years pumping out more and more insulin to try to overcome the insulin resistance, until finally their beta cells get exhausted and give up! At that point, these Type 2s have to start injecting insulin, like Type 1s. But insulin resistance is the key characteristic of Type 2, and losing weight helps with that, not with beta cell function.

 

[harbottle]

It's more about regaining the lost beta cell functionality. Weight loss helps with insulin resistance (As does lowering triglycerides and LDL and raising HDL, which can happen with weight loss) which is inability of cells (Liver and muscles mainly) to interact with insulin to take up glucose.

In the Newcastle work they looked at Beta cell mass and insulin secretion before and after and found that in some patients it returned to normal levels.

The loss of beta cells also affects the first insulin response to meals, which stops the liver from producing glucose. As glucose is coming in from the food and also via the liver's mechanism, it causes high blood sugar. T2 diabetics generally don't have this first line response.

 

[harbottle]

Type 1 is about "lost beta cell functionality". Type 2 is about insulin resistance: all Type 2s start off with normal or even higher than normal insulin production-- beta cells (the insulin-producing cells in your pancreas) functioning normally or even working harder than normal.

For some Type 2s: their beta cells spend years and years pumping out more and more insulin to try to overcome the insulin resistance, until finally their beta cells get exhausted and give up! At that point, these Type 2s have to start injecting insulin, like Type 1s. But insulin resistance is the key characteristic of Type 2, and losing weight helps with that, not with beta cell function.

No it's not.

T2 diabetes is a combination of insulin resistance and lost beta cell functionality, either by Apoptosis (Cell Death) or de-differentiation (Returning to a non-insulin producing state.) The loss of beta cell function is what leads to the higher blood glucose levels as the body has stopped producing enough insulin to deal with it.

As I said before, the work done in Newcastle showed some people can restore that lost function.

The Newcastle work showed that losing weight helps regain beta cell functionality. Maybe you should try reading it. Here's a quote from their website:

It was clear from that time onwards that type 2 diabetes is caused by too much fat building up within liver, then overspilling to the rest of the body - including the pancreas. This starts up a second vicious cycle inside the pancreas, with the fat actually switching off normal insulin production.

 

[Spathiphyllum]

No it's not.

T2 diabetes is a combination of insulin resistance and lost beta cell functionality, either by Apoptosis (Cell Death) or de-differentiation (Returning to a non-insulin producing state.) The loss of beta cell function is what leads to the higher blood glucose levels as the body has stopped producing enough insulin to deal with it.

As I said before, the work done in Newcastle showed some people can restore that lost function.

The Newcastle work showed that losing weight helps regain beta cell functionality. Maybe you should try reading it. Here's a quote from their website:

What I said was that insulin resistance can lead to loss of beta-cell functionality, but the problem starts with insulin resistance.

I have read some of the Newcastle papers. They say the problem in Type 2 diabetes starts with insulin resistance, and then you get loss of beta-cell functionality. Their big thing was showing that, in Type 2, this loss of beta-cell functionality is not irreversible (unlike in Type 1).

For practical purposes, though, the message from the Newcastle research is the same as what I said: For Type 2 diabetics, the key is losing enough weight, in particular losing the excess visceral fat; if you do that, your beta cells can recover more functionality and your other cells can recover insulin sensitivity. (And they also emphasise the importance of exercise in all this.)

 

[Mrssw21]

Welcome to the forum @Mrssw21

Congratulations on getting your diabetes into remission 🙂

Sounds like the changes you have made have had a very positive effect on your body‘s ability to regulate your glucose levels.

Losing almost 10kg is a brilliant achievement. Some recent research suggests people can have a ‘personal fat threshold’ where losing enough weight (especially visceral fat around the organs) can help reboot the metabolism, and improve the function of liver and pancreas.

How sustainable do you think the menu changes you made are for you long term? Are you feeling overly restricted? Are you still losing weight?

You may be able to find something of a ‘maintenance’ menu to keep the improvements you‘ve seen, but with a little more flexibility?

Thanks for your comments
how could I find a more flexible menu

 

[Leadinglights]

Thanks for your comments
how could I find a more flexible menu

It partly depends on what you are having at the moment.
If you have a blood glucose monitor, you then test to see if the things you are introducing into your menu are keeping you at the blood glucose level to keep you where you are so you can see how much you can push your luck with the extras.

 

[Mrssw21]

No I don’t have a monitor

 

[Leadinglights]

No I don’t have a monitor

Gosh you have done well to get your blood glucose back to normal without the benefit of a home testing monitor, many find it tremendously helpful.
It could give you more flexibility if you did test to see what food you could safely introduce. If you did want to get one then the GlucoNavii or Spirtit TEE2 are ones with the cheapest strips available online.

 

[Mrssw21]

Thank you

 

[Eddy Edson]

In the Newcastle work they looked at Beta cell mass and insulin secretion before and after and found that in some patients it returned to normal levels.

I think you'll find that the studies showed insulin response generally improved enough to regulate BG to non-diabetic levels, but the response remained lower than in the "normal" control group.

It's the only objective reason I can see for not seeing weight loss as offering an actual "cure" in those for whom it works - ie there's actually a measurable physical effect that remains, not just
some mysterious hidden diabetes demon waiting to pounce if you eat a banana or whatever.

But it's not much of a reason.

 

[everydayupsanddowns]

Thanks for your comments
how could I find a more flexible menu

There are some ideas you could consider here

Meal plans and diabetes

Eating nutritious, healthy and downright delicious food is that bit easier with our meal planners. We've created multiple different weekly meal plans to suit all types and tastes. They're nutritionally balanced, are calorie and carb counted, and can help if you want to lose weight. They also...

www.diabetes.org.uk

Based on different approaches (different strategies work for different people 🙂 )

And some general thoughts on food in this free ‘enjoy food’ download from Diabetes UK

https://www.diabetes.org.uk/resources-s3/2020-02/enjoy-Food-june-2019.pdf

But as @Leadinglights says, it can be very helpful to “ask your meter” whether various different meals and sources of carbs suit you as an individual by checking BG immediately before eating and looking for a rise of no more than 2-3mmol/L by 2hrs after the first bite 🙂