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lost 5kg but hba1c the same

MarcR said:
You could use a percentage like 15-20%.
In the book, someone with a BMI of 24 got type 2 but after losing weight when the BMI got to 20 the diabetes went away.
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As @helli said. Not all us need to lose weight. Diabetes caused me to lose a great deal of weight prior to diagnosis. I actually needed to regain weight and muscle mass.
My calorie intake increased to over 4000 per day and I was still losing weight and looked painfully thin and scrawny. I didn't realise at that time I was diabetic.
I reviewed my diet after diagnosis and went back to 2000 calories per day, with more protein and fats but less carbs.
As my blood glucose reduced I started to gain some weight again. I eat healthy meals but have found reducing carbs has helped reduce my BG along with regular exercise and medication.
 
helli said:
You missed my point - there are people with type 2 who do not have 15kg to lose.
I also think an absolute amount is wrong - it may make sense for someone weighing 100kg but not someone weighing 50kg.
This advice assumes everyone with type 2 is overweight ... or at the top of the "healthy" range.
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To clarify, the 15kg weight loss target applies to the overweight who want to get rid of the excess fat in their liver and pancreas, and thereby put their T2D into 'full remission' (see Note below). It is based on observations by Professor Mike Lean (ML) of Glasgow University and Professor Roy Taylor and his team at Newcastle University (RT):
  1. From the 1990's onwards of people who have put their T2D into remission by losing weight (ML).
  2. From c.2008 in the Counterpoint and other studies (RT).
  3. From the DiRECT study, the precursor to NHS Soups and Shakes programmes (ML, RT)
  4. From the results of the NHS Soups and Shakes programmes.
In fact some of the overweight go into remission after losing only 8kg while others have to lose 20kg or more. Roughly 80% of 'responders' achieve remission after losing 15kg. Thus the 15kg target is an example of the '80:20' rule.

A 'responder' is one whose beta cells in pancreas have the capacity of to recover and secret insulin again. The success rate for prediabetics and newly diagnosed T2Ds appears to be over 90%. It declines to about 50% after 10 years or so. At present I understand the only practical way to find out if you can succeed is to try, but tests may be becoming available.

The NHS Programme reports that around 50% of those losing 15kg-20kg achieved remission, and 55% of those who lost over 20kg.

Please note the studies and programmes have excluded people known to have a damaged pancreas.

The recent ReTUNE study (RT) has shown T2Ds of normal weight can achieve remission by losing (from memory) 6-10kg. Some found it tricky to get their excess liver fat down and 2, 3 or more bouts of a VLCD diet were necessary. There are some indications from other recent studies that some form of Intermittent Fasting could be an effective way of taking several 'bites at the cherry' to reduce excess fat.

In all cases people will have to maintain their lower weight to stay in remission.

Note: while the definition of remission is an HbA1c of 48 or less, an HbA1c of 38 or less indicates 'full remission' to normal. This Glucose Levels meter shows the progression from Normal to Prediabetes to Diabetes.

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In North America and some other countries an HbA1c of 39 is the lower limit for Prediabetes. In the UK and elsewhere the lower limit is set at HbA1c of 42 but some experts refer to HbA1c between 39 and 42 as 'Pre-prediabetes'. Thus HbA1c of 38 or less may be regarded as normal.
 
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silver minion said:
As @helli said. Not all us need to lose weight. Diabetes caused me to lose a great deal of weight prior to diagnosis. I actually needed to regain weight and muscle mass.
My calorie intake increased to over 4000 per day and I was still losing weight and looked painfully thin and scrawny. I didn't realise at that time I was diabetic.
I reviewed my diet after diagnosis and went back to 2000 calories per day, with more protein and fats but less carbs.
As my blood glucose reduced I started to gain some weight again. I eat healthy meals but have found reducing carbs has helped reduce my BG along with regular exercise and medication.
Click to expand...
I used to think that calories was the only important factor but I see now that what we eat, like amount and type of carbs is important too.
 
MarcR said:
Hello, I was diagnosed with type 2 diabetes in July with a hba1c of 100, my weight was about 92kg. I was given Metformin and Atorvastatin (I declined to take gliclizide which was offered later). I went on a diet, two 800 calorie meals a day, breakfast and lunch, cut out junk food, Roy Taylor's book helped. By mid November had lost 10.5kg and a hba1c test and was 43. I continued with my diet and lost a further 5kg, I think in total about 16kg of weight loss and on 21st of February had a fructosamine test which was 268 which they said was a hba1c of 43, but when I checked online said 44? I requested this test as I have minor thalassaemia and it’s supposed to be more accurate, although it might not be significantly different. I'm pleased my hba1c has come down to the prediabetic range but puzzled why it didn't get any lower after a further 5kg of weight loss? I have decided to cut carbs, as previously I was eating a lot of carbs and some of that was refined carbs, hoping that might help. I'm seeing a consultant soon for advice, but just wondered if anyone has any thoughts?
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Here are my reading I think I’ve done quite well IMG_1149.jpeg
 
MarcR said:
Hello, I was diagnosed with type 2 diabetes in July with a hba1c of 100, my weight was about 92kg. I was given Metformin and Atorvastatin (I declined to take gliclizide which was offered later). I went on a diet, two 800 calorie meals a day, breakfast and lunch, cut out junk food, Roy Taylor's book helped. By mid November had lost 10.5kg and a hba1c test and was 43. I continued with my diet and lost a further 5kg, I think in total about 16kg of weight loss and on 21st of February had a fructosamine test which was 268 which they said was a hba1c of 43, but when I checked online said 44? I requested this test as I have minor thalassaemia and its supposed to be more accurate, although it might not be significantly different. I'm pleased my hba1c has come down to the prediabetic range but puzzled why it didn't get any lower after a further 5kg of weight loss? I have decided to cut carbs, as previously I was eating a lot of carbs and some of that was refined carbs, hoping that might help. I'm seeing a consultant soon for advice, but just wondered if anyone has any thoughts?
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HbA1c is a fairly squidgy measure. Two people can have the same average blood glucose but very different HbA1c's (due mainly to differences in avergae age of their red blood cells).

The wikipedia page for HbA1c reproduces data from one of the original studies which were used to determine the relationship between BG and HbA1c. https://en.wikipedia.org/wiki/Glycated_hemoglobin

Check the table about at around the two-thirds mark on the page. Say your HbA1c were actually 42 mmol/mol. There would be a 95% chance that yr average BG is in the range 5.5 mmol/l to 8.5 mmol/l. But that overlaps with the 95% range for HbAc = 31 mmol/mol, which is 4.2 mmol/l to 6.7 mmol/l. So it's quite possible that somebody with the same average BG as you might have an HbA1c in the low 30's.

If you want to get more insight into what your average BG actually is, you could wear a Libre or whatever for a couple of weeks.

Anyway, Roy Taylor would count a "pre-diabetic" level as a win. Sod all chance of complications, and no reason to expect things to get worse if you keep the weight off.
 
Eddy Edson said:
HbA1c is a fairly squidgy measure. Two people can have the same average blood glucose but very different HbA1c's (due mainly to differences in avergae age of their red blood cells).

The wikipedia page for HbA1c reproduces data from one of the original studies which were used to determine the relationship between BG and HbA1c. https://en.wikipedia.org/wiki/Glycated_hemoglobin

Check the table about at around the two-thirds mark on the page. Say your HbA1c were actually 42 mmol/mol. There would be a 95% chance that yr average BG is in the range 5.5 mmol/l to 8.5 mmol/l. But that overlaps with the 95% range for HbAc = 31 mmol/mol, which is 4.2 mmol/l to 6.7 mmol/l. So it's quite possible that somebody with the same average BG as you might have an HbA1c in the low 30's.

If you want to get more insight into what your average BG actually is, you could wear a Libre or whatever for a couple of weeks.

Anyway, Roy Taylor would count a "pre-diabetic" level as a win. Sod all chance of complications, and no reason to expect things to get worse if you keep the weight off.
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I wasn't aware of that. I've been looking on Google and it seems to suggest fasting blood glucose is more accurate for the moment but hba1c is good for an average level over 2-3 months and it the gold standard test for most people.
 
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