Numbers looking good at last, but now what?

[childofthesea43]

Yes, I have many issues with BMI as a metric, which is why I'm keeping an eye on some others. My waist to height ratio is 0.51 (from 0.55) and my body roundness index is 0.35 (no baseline, because I only learned about it quite recently). My BMI is 21.8 (rounding error from the midpoint of what the WHO says is ideal), down from 25.7, and falling.

This is reassuring to know. The end of the really hard work may be in sight!

Yep, the days of those last few kilos are numbered!

As a comparison, my waist to height ratio is 0.44. My sculptured hips have opened up a whole new modelling career at age 76 … ermmm … it’s called the stick insect look.

 

[Fox]

As a comparison, my waist to height ratio is 0.44. My sculptured hips have opened up a whole new modelling career at age 76 … ermmm … it’s called the stick insect look.

I am aiming for lean. I am pretty sure there has been an increase in muscle bulk.

 

[Dragonheart]

I don’t know whether my own experience assists your original question or not. I was diagnosed with A1c of 74 nearly four years ago and quickly reduced it to 42 by the standard route of substantial weight loss (16kg). I’ve kept it between 38 and 42 ever since by the obvious expedient of keeping the new weight constant on about 1800 cals a day and 3 miles walking each day. I have tested the effects of varying carbs intake and ascertained that (for me) this is of no significance, which I put down to having fully restored insulin response. I think the latter should be seen as the criterion for remission, not merely suppressing A1c below 48 by becoming a low-carb captive. Normalising the metabolism is the ideal, but will depend on how compromised the pancreas has become while one was ‘diabetic’.

Where as I was diagnosed at just 54mmol. I’d assume I hadn’t been diagnosable for long as I’d had several surgeries in the preceding year and it wasn’t too high. Got it down via very low carb/keto to very low 40’s within 3 months and lost 18kg having a normal bmi from overweight (not obese) and kept it there for 4 yrs remaining low carb and remaining spikey to carbs. Neither the maintenance of an hba1c around 40 or the maintenance of the weight loss changed that sensitivity to carbs or restored my insulin response apparently. I’ve wobbled and lost some of that progress since for reasons unrelated but fundamentally caused by eating more than a very very low amount of carbs (I need to stick to less than 50 at most a day to maintain remission over time).

Remaining “captive” is my only option it seems. Better than deterioration and for my sanity I choose not to see it in the negative way you do. It’s the way to save my health

Type 2 has a number of factors that bring it about beyond simple excess weight. For those that lose weight and are restored that’s great but sadly there’s plenty of us for whom it isn’t the entire answer. Hormones, genetics, gestational diabetes etc all have a role to play too. I firmly believe there are a number of versions of type 2 all lumped under the one umbrella.

 

[childofthesea43]

Where as I was diagnosed at just 54mmol. I’d assume I hadn’t been diagnosable for long as I’d had several surgeries in the preceding year and it wasn’t too high. Got it down via very low carb/keto to very low 40’s within 3 months and lost 18kg having a normal bmi from overweight (not obese) and kept it there for 4 yrs remaining low carb and remaining spikey to carbs. Neither the maintenance of an hba1c around 40 or the maintenance of the weight loss changed that sensitivity to carbs or restored my insulin response apparently. I’ve wobbled and lost some of that progress since for reasons unrelated but fundamentally caused by eating more than a very very low amount of carbs (I need to stick to less than 50 at most a day to maintain remission over time).

Remaining “captive” is my only option it seems. Better than deterioration and for my sanity I choose not to see it in the negative way you do. It’s the way to save my health

Type 2 has a number of factors that bring it about beyond simple excess weight. For those that lose weight and are restored that’s great but sadly there’s plenty of us for whom it isn’t the entire answer. Hormones, genetics, gestational diabetes etc all have a role to play too. I firmly believe there are a number of versions of type 2 all lumped under the one umbrella.

I do not think negatively of low carbs which I readily acknowledge to be a life saver for many, I just think it a better outcome to restore normal metabolism if one can, hence prioritisation of weight loss as primary strategem, as that is what the science clearly demonstrates. I think baseline beta cell reserve is a strong factor in all this too, and that’s pure pot luck at birth. I am not sure of the idea that T2 has many variant pathologies, but I could believe that a single core T2 could manifest many variant outcomes and responses to treatment. Hard to separate.

 

[harbottle]

I have also learned (from another source) that a nondiabetic postprandial response is for glucose to spike to anything up to 8.5-9mmol/L and then return to normal levels (around 4 or 5mmol/L) within 30-45 minutes. I am definitely not there(1),

Not really.
It depends on the food.
Something with fat in will take far longer to fall than something without much fat.

 

[Dragonheart]

I do not think negatively of low carbs which I readily acknowledge to be a life saver for many, I just think it a better outcome to restore normal metabolism if one can, hence prioritisation of weight loss as primary strategem, as that is what the science clearly demonstrates. I think baseline beta cell reserve is a strong factor in all this too, and that’s pure pot luck at birth. I am not sure of the idea that T2 has many variant pathologies, but I could believe that a single core T2 could manifest many variant outcomes and responses to treatment. Hard to separate.

Sure if I could restore normal metabolism I would too. I think my point was weight loss alone isn’t always enough though. The science (presumably the Newcastle studies) does show roughly 50% achieve remission at the end of one year. 5 yrs down the line with all the support etc only 7% of the original cohort were still in remission. So yes good results for those it does work for definitely and certainly a tool to be recognised and much to be learnt from it but hardly a long term solution on its own for most.

Possibly beta cell reserves are relevant. It sounds logical. Not sure how that could ever be monitored or established though or how that knowledge would effect strategy.

Variable responses/outcomes and indeed causes is pretty much what I mean by different versions. Many similarities but important differences nonetheless

 

[childofthesea43]

Sure if I could restore normal metabolism I would too. I think my point was weight loss alone isn’t always enough though. The science (presumably the Newcastle studies) does show roughly 50% achieve remission at the end of one year. 5 yrs down the line with all the support etc only 7% of the original cohort were still in remission. So yes good results for those it does work for definitely and certainly a tool to be recognised and much to be learnt from it but hardly a long term solution on its own for most.

Possibly beta cell reserves are relevant. It sounds logical. Not sure how that could ever be monitored or established though or how that knowledge would effect strategy.

Variable responses/outcomes and indeed causes is pretty much what I mean by different versions. Many similarities but important differences nonetheless

It is true that after 5 years the Direct remission prevalence had dropped dramatically. More generally, one study showed that of those who attain remission only 1 in 14,000 will maintain it for 5 years. I had an exchange with Prof Taylor about those in the Direct cohort who had lost remission and he said that in every single case they had regained weight. Furthermore he told me that in all his experience everyone he had ever encountered who had lost remission had regained weight. So the message is, we must not lose the plot.

 

[Dragonheart]

It is true that after 5 years the Direct remission prevalence had dropped dramatically. More generally, one study showed that of those who attain remission only 1 in 14,000 will maintain it for 5 years. I had an exchange with Prof Taylor about those in the Direct cohort who had lost remission and he said that in every single case they had regained weight. Furthermore he told me that in all his experience everyone he had ever encountered who had lost remission had regained weight. So the message is, we must not lose the plot.

Whereas I lost remission then regained weight. Others do likewise. Exact opposite of the original that I achieved normal glucose then lost weight.

Taylor’s comments do not clarify which way round these things occur, merely a summary of the position at end of each year which misses the granular detail perhaps.

Again for clarity I’m not suggesting weight loss doesn’t matter. Just that it doesn’t happen the same way for all and many find weight is driven by glucose control, or lack of.

 

[childofthesea43]

Whereas I lost remission then regained weight. Others do likewise. Exact opposite of the original that I achieved normal glucose then lost weight.

Taylor’s comments do not clarify which way round these things occur, merely a summary of the position at end of each year which misses the granular detail perhaps.

Again for clarity I’m not suggesting weight loss doesn’t matter. Just that it doesn’t happen the same way for all and many find weight is driven by glucose control, or lack of.

Was the original remission just owed to going low carb? Throwing less fuel on the fire is bound to reduce the flames but not necessarily reduce any fat in the pancreas. There is certainly a need for greater clarity about the mechanisms.

 

[childofthesea43]

Whereas I lost remission then regained weight. Others do likewise. Exact opposite of the original that I achieved normal glucose then lost weight.

Taylor’s comments do not clarify which way round these things occur, merely a summary of the position at end of each year which misses the granular detail perhaps.

Again for clarity I’m not suggesting weight loss doesn’t matter. Just that it doesn’t happen the same way for all and many find weight is driven by glucose control, or lack of.

I think that Taylor would be very interested in your experience - perhaps you could ask for his view?

 

[JITR]

Whereas I lost remission then regained weight. Others do likewise. Exact opposite of the original that I achieved normal glucose then lost weight.

Taylor’s comments do not clarify which way round these things occur, merely a summary of the position at end of each year which misses the granular detail perhaps.

@Dragonheart

You say, "Whereas I lost remission then regained weight" and "I achieved normal glucose then lost weight". Have you detailed the sequence of events and HbA1 levels in another post?

 

[Fox]

Something that has come up in my reading, although I have done so much reading at this point it's going to be difficult to find the reference, although it may be one well known around here, is that there is an assumption that weight gain causes T2 diabetes. This assumption is untested, and I have seen it suggested that the causative relationships may be all wrong - i.e. either that diabetes causes weight gain or that some third factor causes both diabetes and weight gain. This is compounded by the heterogeneity of diabetes, which makes it at least plausible that different causative factors may be implicated for different people.

None of this contradicts the observation that weight loss and remission have an association.

 

[childofthesea43]

Something that has come up in my reading, although I have done so much reading at this point it's going to be difficult to find the reference, although it may be one well known around here, is that there is an assumption that weight gain causes T2 diabetes. This assumption is untested, and I have seen it suggested that the causative relationships may be all wrong - i.e. either that diabetes causes weight gain or that some third factor causes both diabetes and weight gain. This is compounded by the heterogeneity of diabetes, which makes it at least plausible that different causative factors may be implicated for different people.

None of this contradicts the observation that weight loss and remission have an association.

Even so, if diabetes caused weight gain it would take some explaining as to why proactive weight loss should reverse diabetes.

 

[Fox]

Even so, if diabetes caused weight gain it would take some explaining as to why proactive weight loss should reverse diabetes.

Not if the actions involved in weight loss, which will incidentally alter blood glucose levels, also have effects on insulin response.

I want to emphasise that I'm not taking a position on this. I simply don't know, and I have not thought around the implications - yet.

 

[childofthesea43]

Something that has come up in my reading, although I have done so much reading at this point it's going to be difficult to find the reference, although it may be one well known around here, is that there is an assumption that weight gain causes T2 diabetes. This assumption is untested, and I have seen it suggested that the causative relationships may be all wrong - i.e. either that diabetes causes weight gain or that some third factor causes both diabetes and weight gain. This is compounded by the heterogeneity of diabetes, which makes it at least plausible that different causative factors may be implicated for different people.

None of this contradicts the observation that weight loss and remission have an association.

In particular, if there is some other cause of diabetes then why should that cause become ameliorated by weight loss, as though miraculously?

 

[childofthesea43]

Not if the actions involved in weight loss, which will incidentally alter blood glucose levels, also have effects on insulin response.

I want to emphasise that I'm not taking a position on this. I simply don't know, and I have not thought around the implications - yet.

Perhaps another example is that cirrhosis of the liver has some unknown cause and incidentally creates alcohol addiction.

 

[Fox]

Again, more in the interest of kicking an idea around rather than taking a position, and absolutely not wanting to get into an argument over something I have exactly no intellectual or other investment in, and acknowledging that the idea may be completely and utterly wrong, with the fixation on insulin, what else is going on with the other types of islet cells? These are also involved with satiety, fat storage and so on. Is a few grams of fat in the pancreas (in some? all? diabetic people) messing up more than insulin production and response. Do we see prolonged glucose spikes because, for example, glucagon homeostasis is impaired? This might explain why, for example, in combination with impaired insulin homeostasis, we see some forms of exercise raising glucose levels.

I have done no reading on this, and have questions, but not answers. Yet. I'm not raising this for the sake of argument, merely for the sake of wondering where the thought experiment might lead.

 

[harbottle]

Whereas I lost remission then regained weight. Others do likewise. Exact opposite of the original that I achieved normal glucose then lost weight.

Taylor’s comments do not clarify which way round these things occur, merely a summary of the position at end of each year which misses the granular detail perhaps.

Again for clarity I’m not suggesting weight loss doesn’t matter. Just that it doesn’t happen the same way for all and many find weight is driven by glucose control, or lack of.

Interesting. How did you lose remission? Did you try to return to a 'normal' diet after getting it under control?

 

[Fox]

Perhaps another example is that cirrhosis of the liver has some unknown cause and incidentally creates alcohol addiction.

I think that's pretty cut and dried. Apologies. I replied to the wrong post earlier by accident.

 

[childofthesea43]

I think that's pretty cut and dried. Apologies. I replied to the wrong post earlier by accident.

It’s ok, I knew what you meant. On the diabetes cause-vs-effect question I think we’ll just have to await further science to produce more clarity. Meanwhile we know empirically that major weight loss fixes the majority of cases and maintaining that loss keeps the beast at bay in most cases.