Is it inevitable?

[What the..?]

Hello, I had to see the nurse the other day to dress some scald wounds - a whole other story involving me trying a new method for cooking rice, so three litres of boiling water instead of much less, and me basically chucking the whole lot over myself. Anyway, back to why I'm posting. I mentioned that I was pleased with how they'd healed as I'd heard that can be tricky with diabetics. She said she hadn't realised I was, then checked my notes, and saw the results from my last blood test about six months ago. I had spoken to her on the phone about them then, and she had sounded really reasonable about me not taking medication, (diagnosed at 53, went down to 46 after a couple of months of low carb and increased exercise). Anyway, her parting remark to me as I was leaving was that of course the levels would go up, over time, 'because they always do unfortunately'.
I was literally almost through the door, and just kept walking. At the time I thought - Christ, really? But it was a busy day, I was relieved that my scalds were on the mend, and I was going to meet my husband for a nice lunch as it was his last day at work (after 41 years with Royal Mail) so wanted to concentrate on making it a nice day for him, rather than getting into a 'discussion' with the nurse about what she'd said.
I've been mulling over this, and having been diagnosed by a very unhelpful doctor with Type 2 last November, and finding this forum, I vowed to push back and take control of things. I think I've been doing OK, and have not let it get me down, but am I fooling myself? Is it inevitable that things will get worse over time? I can't believe how negative that remark from the nurse sounded - is it just that she either doesn't believe, or doesn't know about, the mounting evidence about remission? Or is she right, and it is inevitable?

 

[eggyg]

No it definitely isn’t inevitable but what is, is the way HCPs just spout the same c**p over and over again. It’s like a mantra for them. It makes me angry. It sounds like you’ve done really well and taken control. Please don’t let this particular nurse rattle you but politely mention to her next time that she had upset you and maybe a bit of encouragement wouldn’t go amiss.

 

[Robin]

The trouble is, I think nurses see a lot of people who aren’t engaging with their diabetes and trying to kick it into touch, and they forget that occasionally, they do come across someone who is doing all the right things, and will keep it under control or in remission. First time I had a routine appointment with a nurse at the surgery, she perked up when I told her how Is been doing, and said 'Oh if only my other patients would do this!' nodding towards the door where a rather portly, unhealthy looking gentleman had just left.

 

[What the..?]

No it definitely isn’t inevitable but was is, is the way HCPs just spout the same c**p over and over again. It’s like a mantra for them. It makes me angry. It sounds like you’ve done really well and taken control. Please don’t let this particular nurse rattle you but politely mention to her next time that she had upset you and maybe a bit of encouragement wouldn’t go amiss.

Thanks Eggy, I must confess it has, over the weekend, made me angry too. And then the anger turned to self-doubt. I think rattled is a very good way to put it. So far it's one GP and two nurses who have left me feeling worse leaving the surgery than when I went in. At this rate it won't be long before there's nobody left there that doesn't wind me up with their attitudes about diabetes. The good thing is I went on to have a lovely - and actually low carb - meal, not choosing to comfort eat the French bread and fries, which would have been very easy under the circumstances, and instead sticking to salads, veg and protein. But I don't think I would have been able to do that if it wasn't for everything I've read on this forum.

 

[What the..?]

The trouble is, I think nurses see a lot of people who aren’t engaging with their diabetes and trying to kick it into touch, and they forget that occasionally, they do come across someone who is doing all the right things, and will keep it under control or in remission. First time I had a routine appointment with a nurse at the surgery, she perked up when I told her how Is been doing, and said 'Oh if only my other patients would do this!' nodding towards the door where a rather portly, unhealthy looking gentleman had just left.

Hello Robin, the problem with that is it turns into a self-fulfilling prophecy. The response I had from the nurse could easily have set me on a self-destructive path, and I wonder how many people they see who would actually do better if given the sort of useful advice and encouragement that I've benefited from on this forum. Who knows, the 'rather portly, unhealthy looking gentleman' who had just left might have spent his whole life being the butt of unkindness due to his weight, and barely concealed contempt from doctors and nurses, which would, I imagine, do nothing to help his mindset. I am carrying too much weight myself, though much less since my new regime, and I know from bitter experience that it is not quite as easy as some people think.

 

[Pine Marten]

The trouble is, I think nurses see a lot of people who aren’t engaging with their diabetes and trying to kick it into touch, and they forget that occasionally, they do come across someone who is doing all the right things, and will keep it under control or in remission. First time I had a routine appointment with a nurse at the surgery, she perked up when I told her how Is been doing, and said 'Oh if only my other patients would do this!' nodding towards the door where a rather portly, unhealthy looking gentleman had just left.

This is true, I think. When I first impressed my GP with how I was doing, she was similarly complimentary.

 

[Christy]

My GP was the same. Very impressed with the efforts I'd made with weight loss. I think they see a lot of people who can't/won't address it and who are looking for a medical solution (pills etc) so perhaps they have a jaded view of patients.

 

[Burylancs]

Hi. You're doing Ok so don't let them get you down. A diagnosis of T2 usually comes when 50% of the Beta Cells have gone and the Beta Cells continue to head south at a rate of 2% per annum thereafter. So yes it does get harder to run on the spot and maintain control. But you're only at the start and you have kicked off well, giving yourself plenty of time to walk up through the quantity and quality of medication as issues arise in the, hopefully distant, future. But don't be taken in by Fake News about 'remission' - all that's on offer for T2s is more or less ham-fisted CONTROL of the symptoms and complications.

 

[everydayupsanddowns]

I think it’s a heritage thing. The medical profession used to believe that T2 was chronic and inevitably progressive. The idea of long-term management didn’t seem possible, or at least not in the majority of cases.

And I think that perhaps for some subsets of T2, perhaps that is true. But the DIRECT trial has shown that diabetes can be ‘reversed’ or put into remission.

This article in the BMJ about DIRECT opens with the sort of phrase that has been the basis of understanding of T2 for HCPs for decades

“Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the disease...”​

Nutritional basis of type 2 diabetes remission

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the...

www.bmj.com

 

[rebrascora]

Hi. You're doing Ok so don't let them get you down. A diagnosis of T2 usually comes when 50% of the Beta Cells have gone and the Beta Cells continue to head south at a rate of 2% per annum thereafter. So yes it does get harder to run on the spot and maintain control. But you're only at the start and you have kicked off well, giving yourself plenty of time to walk up through the quantity and quality of medication as issues arise in the, hopefully distant, future. But don't be taken in by Fake News about 'remission' - all that's on offer for T2s is more or less ham-fisted CONTROL of the symptoms and complications.

Hi and welcome

I hate to take issue with someone's first post but I'm really not sure your statements above are correct and if they are I think it would be very relevant to consider what dietary advice the subjects who were studied were following. You seem to be painting a similar negative picture to the GPs and Nurses we are criticizing.

Firstly there is rarely any tests done to establish how much insulin production Type 2 diabetics have at diagnosis and following a low carb diet can dramatically take the strain off the remaining production enabling the body to cope very well. If people continue to eat too many carbs then yes eventually their system will need more and more support from medication, but if people make appropriate dietary changes then there is no reason why many can't push their HbA1c down to normal levels and in some cases come off all medication including insulin. The key is having the right dietary advice and that has been sadly lacking from the appropriate bodies including the NHS.

 

[What the..?]

I think it’s a heritage thing. The medical profession used to believe that T2 was chronic and inevitably progressive. The idea of long-term management didn’t seem possible, or at least not in the majority of cases.

And I think that perhaps for some subsets of T2, perhaps that is true. But the DIRECT trial has shown that diabetes can be ‘reversed’ or put into remission.

This article in the BMJ about DIRECT opens with the sort of phrase that has been the basis of understanding of T2 for HCPs for decades

“Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the disease...”​

Nutritional basis of type 2 diabetes remission

Roy Taylor and colleagues explain how type 2 diabetes can be reversed by weight loss and avoidance of weight regain Type 2 diabetes mellitus was once thought to be irreversible and progressive, but a series of clinical studies over the past 12 years have clarified the mechanisms that cause the...

www.bmj.com

Thanks Mike, this is a very useful article. I don't think I ever imagined that my T2 diabetes is something that I could just send packing for ever without being constantly alert to the potential dangers lying in wait. And I think I've managed to take very sensible steps with regard to diet and exercise, which has got to be good for me all round. But I was pulled up short when told actually things are just going to get worse. I think the problem is, as you suggest, that there is a lot of historic thinking about this condition, and unfortunately there are some in the medical profession who don't seem to realise that their words are incredibly powerful. With the right advice and support the 'diabetic crisis' which is now a hot topic, would not be happening. I am someone who has always eaten quite healthily, not been a fast food craver, do not have a sweet tooth, or drink heavily, so I do sometimes bristle at constant references to sugary foods and fast food. My 'sin' has been to be born a heavy baby, progress to being a heavy child, then adult, to work ridiculously long hours sitting at a computer at home, sometimes for days on end with only breaks to sleep and prepare family meals. Chuck in a little more than my fair share of stress for various reasons, and voila, you have Type 2 diabetes. I am choosing to be hopeful about the future, but knowing that I must keep my part of the bargain.

 

[Deleted member 21371]

Hi. You're doing Ok so don't let them get you down. A diagnosis of T2 usually comes when 50% of the Beta Cells have gone and the Beta Cells continue to head south at a rate of 2% per annum thereafter. So yes it does get harder to run on the spot and maintain control. But you're only at the start and you have kicked off well, giving yourself plenty of time to walk up through the quantity and quality of medication as issues arise in the, hopefully distant, future. But don't be taken in by Fake News about 'remission' - all that's on offer for T2s is more or less ham-fisted CONTROL of the symptoms and complications.

Really?

 

[Deleted member 21371]

Hello, I had to see the nurse the other day to dress some scald wounds - a whole other story involving me trying a new method for cooking rice, so three litres of boiling water instead of much less, and me basically chucking the whole lot over myself. Anyway, back to why I'm posting. I mentioned that I was pleased with how they'd healed as I'd heard that can be tricky with diabetics. She said she hadn't realised I was, then checked my notes, and saw the results from my last blood test about six months ago. I had spoken to her on the phone about them then, and she had sounded really reasonable about me not taking medication, (diagnosed at 53, went down to 46 after a couple of months of low carb and increased exercise). Anyway, her parting remark to me as I was leaving was that of course the levels would go up, over time, 'because they always do unfortunately'.
I was literally almost through the door, and just kept walking. At the time I thought - Christ, really? But it was a busy day, I was relieved that my scalds were on the mend, and I was going to meet my husband for a nice lunch as it was his last day at work (after 41 years with Royal Mail) so wanted to concentrate on making it a nice day for him, rather than getting into a 'discussion' with the nurse about what she'd said.
I've been mulling over this, and having been diagnosed by a very unhelpful doctor with Type 2 last November, and finding this forum, I vowed to push back and take control of things. I think I've been doing OK, and have not let it get me down, but am I fooling myself? Is it inevitable that things will get worse over time? I can't believe how negative that remark from the nurse sounded - is it just that she either doesn't believe, or doesn't know about, the mounting evidence about remission? Or is she right, and it is inevitable?

As a HCP said to me, yes, it's progressive, but the trick is to slow it down enough so you die of something else first.
Preferably old age.

I took it on board, and reversed my type 2.
It's not to say it can't come back one day, but I was diagnosed ten years ago, and am perfectly healthy still, no diabetes, and no complications, so that'll do me.

 

[Leadinglights]

As a HCP said to me, yes, it's progressive, but the trick is to slow it down enough so you die of something else first.
Preferably old age.

I took it on board, and reversed my type 2.
It's not to say it can't come back one day, but I was diagnosed ten years ago, and am perfectly healthy still, no diabetes, and no complications, so that'll do me.

Whenever I am questioned about family medical history, I have to say I don't know because neither of my parents lived long enough to develop those conditions so I suppose that tells the story in itself.

 

[Maca44]

My GP was the same. Very impressed with the efforts I'd made with weight loss. I think they see a lot of people who can't/won't address it and who are looking for a medical solution (pills etc) so perhaps they have a jaded view of patients.

You have hit the nail on the head exactly what I was thinking.

 

[happydog]

I was diagnosed in September 2012 and given a very pessimistic picture by my GP who said if i lived for 10 years I would be very fortunate and that I must go straight onto insulin injections. I said no and there was a lot of opposition. I am still controlling it with diet and exercise. Yes it is hard work but very worthwhile. I have rather ignorant staff at the surgery where I go who are dead keen on medication and see it as the only way forward. You have done brilliantly and just keep at it. If eventually you have to take medication at least you will have had some good years. Good luck!

 

[Ljc]

No it is not inevitable!
Yes T2 can be progressive but it’s not inevitable.

Your nurse has probably seen an awful ot if people who just take the meds and maybe follow standard nhs dietary advise , which doesn’t work for many of us or those who just blindly don’t make any effort .
Also sadly most T2s don’t come to forums such as this one ,so they don’t get the opportunity of several hundred decades of combined experience .

And if in the future you do need to go on medication, please don’t ever see it as a failure , because with you it won’t have been , because you would have done your very best!

 

[What the..?]

As a HCP said to me, yes, it's progressive, but the trick is to slow it down enough so you die of something else first.
Preferably old age.

I took it on board, and reversed my type 2.
It's not to say it can't come back one day, but I was diagnosed ten years ago, and am perfectly healthy still, no diabetes, and no complications, so that'll do me.

And actually I could be hit by the proverbial London bus tomorrow! It's a very sensible way to view it, thanks for your input, and well done on what you have, and still are, achieving.

 

[What the..?]

I was diagnosed in September 2012 and given a very pessimistic picture by my GP who said if i lived for 10 years I would be very fortunate and that I must go straight onto insulin injections. I said no and there was a lot of opposition. I am still controlling it with diet and exercise. Yes it is hard work but very worthwhile. I have rather ignorant staff at the surgery where I go who are dead keen on medication and see it as the only way forward. You have done brilliantly and just keep at it. If eventually you have to take medication at least you will have had some good years. Good luck!

My God Happy Dog, I thought I had it bad with insensitive medics! How awful that must have been for you. It must have taken a lot of strength, particularly when feeling pretty shocked I would imagine, to refuse the injections. Well done on your determination, and thanks so much for your thoughtful reply.

 

[What the..?]

No it is not inevitable!
Yes T2 can be progressive but it’s not inevitable.

Your nurse has probably seen an awful ot if people who just take the meds and maybe follow standard nhs dietary advise , which doesn’t work for many of us or those who just blindly don’t make any effort .
Also sadly most T2s don’t come to forums such as this one ,so they don’t get the opportunity of several hundred decades of combined experience .

And if in the future you do need to go on medication, please don’t ever see it as a failure , because with you it won’t have been , because you would have done your very best!

Thanks Lin, I appreciate your perspective. You're right of course. If it has to happen then so be it, but it won't be because I haven't done everything I can to at best prevent, or at worst delay it. And, as you say, several hundred decades of combined experience is an incredible resource which I'll continue calling on in the future.