New Member but Diagnosed 11 years Ago. Why no Remission programs available?

M

Memik12

Member
Relationship to Diabetes
Type 2
Hi, new to the forum but not to diabetes unfortunately. Diagnosed as Type 2 11 years ago and managed to lose the weigh and get back to "normal" HbA1c levels but they have dradually increased as I have gotten aolder and unable to move about as much. I was wondering why there is a 6 yrear cut off for the remission programs? IS it because the received wisdom is they are not as efficacious after this? It would seem to be counter-intuitive if it does still work but is not availble to longterm sufferers. Anyone with any knowledge of this and if there are any self sourced or private alternatives?

Thanks.
 
Memik12 said:
Hi, new to the forum but not to diabetes unfortunately. Diagnosed as Type 2 11 years ago and managed to lose the weigh and get back to "normal" HbA1c levels but they have dradually increased as I have gotten aolder and unable to move about as much. I was wondering why there is a 6 yrear cut off for the remission programs? IS it because the received wisdom is they are not as efficacious after this? It would seem to be counter-intuitive if it does still work but is not availble to longterm sufferers. Anyone with any knowledge of this and if there are any self sourced or private alternatives?

Thanks.
Click to expand...
I think the general consensus is that remission is most likely in the early stage of diabetes (or after a big weight loss), but less likely in the later stages. Having said that, many have managed it without being part of any programme, me included.
 
Technical explanation - being overweight or obese may cause a fatty liver. In some people (probably due to genetics) a fatty liver becomes insulin resistant, raising fasting BG levels. A fatty liver may also elevate blood triglyceride (fat) levels. Elevated triglycerides may increase the rate at which fat is deposited in other tissues. Fat in such tissues is called 'ectopic' fat - stored in tissue other than adipose tissue (normal fat cells). In some people (probably due to genetics again) high levels of ectopic fat in the pancreas can cause lipid toxicity in pancreatic beta cells leading to cell dedifferentiation. Translation - fat may poison the cells that produce insulin and switch them off, but not kill them. Over time, elevated triglyceride levels may cause this problem to get worse and worse, with more and more beta cells disabled resulting in worsening insulin response.

Solution - lose a mess of weight. This gets fat out of the liver, which may reduce fasting BG levels. This may also lower triglyceride levels. This should reduce the rate at which fat is deposited in the pancreas. Over time, fat levels in that organ may return to normal, healthy levels. As this occurs, a portion of disabled beta cells may 'wake back up', perhaps restoring insulin response somewhat. The maximum immediate benefit is seen perhaps a few months after triglyceride levels come down, though nobody knows exactly how long it takes for all the cells than can wake up to have done so.

It appears that the longer a person waits to get the weight loss done the less effective it is for most people. Roy Taylor (who established how all this might work) suggests that the resilience of a person's beta cells might, again, be genetic. Some people may have 'robust' cells that recover well from lipid toxicity even after a considerable period of time, others not so much. The more robust the cells the more likely they are to 'wake back up' after a period of time. If they don't, the effects of lipid toxicity appear to become permanent in time.

This is basically the reason the remission programme isn't offered to people who were diagnosed many years ago. It would work very well for some people but perhaps not for most. However in your case, you may have already done it. You lost the weight. Bear in mind - I know absolutely nothing, have just been trying to learn as much as I can. Based on what I've learned so far - you may have fat accumulating in your liver again, which you might observe as slowing rising fasting BG levels. If it reaches a critical point you might see elevated triglyceride levels in your blood test results - a bad thing. Solution - if you have weight do lose, lose some more to get fat out of the liver again. If you drink alcohol, cut way down on it.

Alternatively your BG levels might be rising purely due to the effects of aging. For example - we tend to lose muscle mass as we age and exercise less. This, effectively, raises insulin resistance. Muscle tissue is the biggest consumer of glucose in the body. If there's less of it, with a lowered demand for glucose due to less exercise, then there's less places for the glucose in your blood to go after eating. Insulin is less effective, in a sense, as there are fewer and less responsive cells in the body for insulin to act on. Potential solution - try and get as much exercise are you reasonably can. Also, Metformin might possibly help if you're not taking it already.

The remission programme is mostly just a weight-loss programme. With advice from a doctor and/or nutritionist for safety, you could get that done yourself. This document describes the Newcastle Diet approach, which is what the NHS remission programme is loosely based on - Newcastle Diet PDF. Again though, if taking that approach, do speak to your doctor first as medications might need stopping or very frequent adjustment. Very rapid weight loss is not essential for remission though - any weight loss that is achieved at a reasonably healthy pace will get the liver fat out.

If you do not have significant weight to lose then it may perhaps be time to discuss adjusting medications with your doctor, if you haven't already. Pushing your diabetes back for so many years is a great achievement, one I hope to emulate myself, though none of us are immune to the effects of aging.

Very best of luck!

Edit - typos
 
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Memik12 said:
Would you be able to share some of your secrets Martin?
Click to expand...
No secrets, just the usual low carb diet, being more active and losing weight. I was 87kg at diagnosis with my BMI 26.6, so not obese but a little overweight. I'm now 72kg and my BMI is a healthy 22. I went on a low carb diet, ie less than 130g per day, and I'm still on it. I also walk to places now rather than always jumping in the car, and I've taken up swimming again, doing 20 lengths of our local pool twice a week. It's a tough regime but it got my BG back into normal range and it's stayed there so far, though I'm well aware it could go the other way sometime in the future.
 
Memik12 said:
Hi, new to the forum but not to diabetes unfortunately. Diagnosed as Type 2 11 years ago and managed to lose the weigh and get back to "normal" HbA1c levels but they have dradually increased as I have gotten aolder and unable to move about as much. I was wondering why there is a 6 yrear cut off for the remission programs? IS it because the received wisdom is they are not as efficacious after this? It would seem to be counter-intuitive if it does still work but is not availble to longterm sufferers. Anyone with any knowledge of this and if there are any self sourced or private alternatives?

Thanks.
Click to expand...
Those programs tend to be aimed at those with a very high HbA1C who also have a lot of weight to lose and who may not be motivated to make dietary changes without some support.
It sounds as if you managed to get your numbers more 'normal' before so may just need to look at a new approach as ideas for managing Type 2 have changed in the years since your original diagnosis.
I followed the principals in this link https://lowcarbfreshwell.com/ and adopted a low carb approach, I reduced my HbA1C form 50 mmol/mol to 42 in 3 months and to below 40 in another 6 and have kept it there by making that low carb a new way of eating.
I am not as mobile as I was, lingering problems with my knee from an accident and arthritis in my shoulders so I keep as active as I can with gardening (we have an allotment) and church bell ringing but it does seem more of an effort to do everything.
 
I suspect that the people in charge simply do not believe that doing something which runs counter to all their teaching and beliefs should be encouraged even if it works. Maybe especially if it works as it would throw a big spanner into the cogs.
 
Yes, the focus is on choosing nutritiously dense foods (i.e. protein with natural fat) and non-starchy vegetables, then eating to satiety but not overeating. Calories take care of themselves. Better explained in the article.

I still record what I eat in Cronometer. It says my carbs come out around 75-100 a day.
 
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I just cut out the high carb foods and ate anything else, except seed oils.
With less fibre to deal with I need less and less to eat - I was wondering why I ate so little on low carb, but recently I was reading that fibre tends to carry away nutrients with it. I do not restrict calories, but I can extract more nourishment from what I do eat.
I hit normal numbers almost 8 years ago now, so a lot of what I do might not be relevant for those newly diagnosed, but a lot of what I found to work goes against accepted wisdom.
 
PerSpinasAdAstra said:
Technical explanation - being overweight or obese may cause a fatty liver. In some people (probably due to genetics) a fatty liver becomes insulin resistant, raising fasting BG levels. A fatty liver may also elevate blood triglyceride (fat) levels. Elevated triglycerides may increase the rate at which fat is deposited in other tissues. Fat in such tissues is called 'ectopic' fat - stored in tissue other than adipose tissue (normal fat cells). In some people (probably due to genetics again) high levels of ectopic fat in the pancreas can cause lipid toxicity in pancreatic beta cells leading to cell dedifferentiation. Translation - fat may poison the cells that produce insulin and switch them off, but not kill them. Over time, elevated triglyceride levels may cause this problem to get worse and worse, with more and more beta cells disabled resulting in worsening insulin response.

Solution - lose a mess of weight. This gets fat out of the liver, which may reduce fasting BG levels. This may also lower triglyceride levels. This should reduce the rate at which fat is deposited in the pancreas. Over time, fat levels in that organ may return to normal, healthy levels. As this occurs, a portion of disabled beta cells may 'wake back up', perhaps restoring insulin response somewhat. The maximum immediate benefit is seen perhaps a few months after triglyceride levels come down, though nobody knows exactly how long it takes for all the cells than can wake up to have done so.

It appears that the longer a person waits to get the weight loss done the less effective it is for most people. Roy Taylor (who established how all this might work) suggests that the resilience of a person's beta cells might, again, be genetic. Some people may have 'robust' cells that recover well from lipid toxicity even after a considerable period of time, others not so much. The more robust the cells the more likely they are to 'wake back up' after a period of time. If they don't, the effects of lipid toxicity appear to become permanent in time.

This is basically the reason the remission programme isn't offered to people who were diagnosed many years ago. It would work very well for some people but perhaps not for most. However in your case, you may have already done it. You lost the weight. Bear in mind - I know absolutely nothing, have just been trying to learn as much as I can. Based on what I've learned so far - you may have fat accumulating in your liver again, which you might observe as slowing rising fasting BG levels. If it reaches a critical point you might see elevated triglyceride levels in your blood test results - a bad thing. Solution - if you have weight do lose, lose some more to get fat out of the liver again. If you drink alcohol, cut way down on it.

Alternatively your BG levels might be rising purely due to the effects of aging. For example - we tend to lose muscle mass as we age and exercise less. This, effectively, raises insulin resistance. Muscle tissue is the biggest consumer of glucose in the body. If there's less of it, with a lowered demand for glucose due to less exercise, then there's less places for the glucose in your blood to go after eating. Insulin is less effective, in a sense, as there are fewer and less responsive cells in the body for insulin to act on. Potential solution - try and get as much exercise are you reasonably can. Also, Metformin might possibly help if you're not taking it already.

The remission programme is mostly just a weight-loss programme. With advice from a doctor and/or nutritionist for safety, you could get that done yourself. This document describes the Newcastle Diet approach, which is what the NHS remission programme is loosely based on - Newcastle Diet PDF. Again though, if taking that approach, do speak to your doctor first as medications might need stopping or very frequent adjustment. Very rapid weight loss is not essential for remission though - any weight loss that is achieved at a reasonably healthy pace will get the liver fat out.

If you do not have significant weight to lose then it may perhaps be time to discuss adjusting medications with your doctor, if you haven't already. Pushing your diabetes back for so many years is a great achievement, one I hope to emulate myself, though none of us are immune to the effects of aging.

Very best of luck!

Edit - typos
Click to expand...
Thanks for taking the time to reply with such an in-depth explanation. I wouldn't have got to that conclusion with what I know so far. I am about 16 stone with a fair but of muscle. Triglcerides are low - can't remember but are good. I guess resources play a big part in the decision who to offer it to (i.e. someone may get a benefit from it but even if diagnosed a while ago but trying to decide who it would benefit is onerous so easier to offer it to a demographic who have shown it can benefit).
 
Martin.A said:
No secrets, just the usual low carb diet, being more active and losing weight. I was 87kg at diagnosis with my BMI 26.6, so not obese but a little overweight. I'm now 72kg and my BMI is a healthy 22. I went on a low carb diet, ie less than 130g per day, and I'm still on it. I also walk to places now rather than always jumping in the car, and I've taken up swimming again, doing 20 lengths of our local pool twice a week. It's a tough regime but it got my BG back into normal range and it's stayed there so far, though I'm well aware it could go the other way sometime in the future.
Click to expand...
Thanks Martin - one step at a time so to speak.
 
Leadinglights said:
Those programs tend to be aimed at those with a very high HbA1C who also have a lot of weight to lose and who may not be motivated to make dietary changes without some support.
It sounds as if you managed to get your numbers more 'normal' before so may just need to look at a new approach as ideas for managing Type 2 have changed in the years since your original diagnosis.
I followed the principals in this link https://lowcarbfreshwell.com/ and adopted a low carb approach, I reduced my HbA1C form 50 mmol/mol to 42 in 3 months and to below 40 in another 6 and have kept it there by making that low carb a new way of eating.
I am not as mobile as I was, lingering problems with my knee from an accident and arthritis in my shoulders so I keep as active as I can with gardening (we have an allotment) and church bell ringing but it does seem more of an effort to do everything.
Click to expand...
I'm not as mobile as I once was either so that will play a part as well. Thanks for the link, I wil check it out.
 
JITR said:
Yes, the focus is on choosing nutritiously dense foods (i.e. protein with natural fat) and non-starchy vegetables, then eating to satiety but not overeating. Calories take care of themselves. Better explained in the article.
Click to expand...
Satiety can be an important part of the puzzle, but it's a much more nuanced discussion than most seem to be having The same goes for nutritional density. How might you explain these two ideas?
 
Memik12 said:
Hi, new to the forum but not to diabetes unfortunately. Diagnosed as Type 2 11 years ago and managed to lose the weigh and get back to "normal" HbA1c levels but they have dradually increased as I have gotten aolder and unable to move about as much. I was wondering why there is a 6 yrear cut off for the remission programs? IS it because the received wisdom is they are not as efficacious after this? It would seem to be counter-intuitive if it does still work but is not availble to longterm sufferers. Anyone with any knowledge of this and if there are any self sourced or private alternatives?

Thanks.
Click to expand...
Because Type 2 is a progressive condition too many underlying changes and potential damage has occurred by the six year mark. By six years the average T2 is on some or all of a panoply of medication to manage the hazards of the condition - metformin to manage glucose, a sulfonylurea ( gliclazide) to help the pancreas, one or two anti-hyperintensives to manage blood pressure, an ace inhibitor to protect the kidneys ( a '-pril'), statin to control diabetic dyslipidemia and possibly meds to control weight. There are about 3.7 million Type 2s in England and Wales and 250,000 are dxed every year ( 1.5 million in six years). The six year rule means that 'remission' is not relevant to 60% of T2s in England and Wales. They have gone past the stage where simplistic fad diets are of benefit. Of the 40% for whom the concept of 'remission' is relevant, the latest NHS report shows it's not achievable by the vast majority of the participants in the scheme ( the 32% figure touted in the media is just gaslighting).
The search for Sooty's Magic Wand continues.
 
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Burylancs said:
Because Type 2 is a progressive condition too many underlying changes and potential damage has occurred by the six year mark. By six years the average T2 is on some or all of a panoply of medication to manage the hazards of the condition - metformin to manage glucose, a sulfonylurea ( gliclazide) to help the pancreas, one or two anti-hyperintensives to manage blood pressure, an ace inhibitor to protect the kidneys ( a '-pril'), statin to control diabetic dyslipidemia and possibly meds to control weight. There are about 3.7 million Type 2s in England and Wales and 250,000 are dxed every year ( 1.5 million in six years). The six year rule means that 'remission' is not relevant to 60% of T2s in England and Wales. They have gone past the stage where simplistic fad diets are of benefit. Of the 40% for whom the concept of 'remission' is relevant, the latest NHS report shows it's not achievable by the vast majority of the participants in the scheme ( the 32% figure touted in the media is just gaslighting).
The search for Sooty's Magic Wand continues.
Click to expand...
Every day is a school day. If even 15-20% were able to benfit from the schemes awould that now still be worthwhile from a monetary and resource perspective I wonder.
 
Memik12 said:
Every day is a school day. If even 15-20% were able to benfit from the schemes awould that now still be worthwhile from a monetary and resource perspective I wonder.
Click to expand...
I doubt it. Besides which promoting a programme which you know is going to fail 90% of participants is morally and ethically reprehensible. But yes the care of T2s in Britain is all about money. The '2' in Type 2 meaning '2nd Class Citizen' when it comes to medical care.
 
@Memik12 - do you take medication to help manage your diabetes? If you are on certain types of medication - like insulin or others that make you produce more insulin, then you need to be careful about making big changes to eating patterns.

If that is the case, it could be as simple as a tweak to your meds, but better safe than sorry.
 
beating_my_betes said:
Satiety can be an important part of the puzzle, but it's a much more nuanced discussion than most seem to be having The same goes for nutritional density. How might you explain these two ideas?
Click to expand...
Briefly, meat and fats make you feel full so you eat less overall. For a proper explanation please have a look at Marty Kendall's posts about Satiety, such as this one and others at optimisingnutrition.com. What he says is based on analysis of consumption records recorded by several thousand people on Cronometer, a highly rated nutrient tracking app.
 
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