Once a diabetic always a diabetic?

[Admiral Benbow]

Just a question for you all. Do you think the phrase "Once a diabetic always a diabetic" always rings true?

I see plenty of overweight and obese people in western countries and I have no doubt that many of them are prediabetic or diabetic and don't know it, as often the only way of telling if one is on the road to diabetes is a blood test based on a numerical range. Yet if they lose their weight and become more active one could say they appear healthy, and under the hood may be improving -even though we don't know what is going on. So my question is, are diagnoses for diabetes somewhat arbitrary if there are no physical symptoms? Like your over this level on this date, so diabetic for life? If someone takes a test and has high readings initially and then lowers it through diet and exercise, are they truly diabetic and deserving of the label?

On another note, do any of you have any idea when non-invasive continuous glucose monitors are coming out?

 

[Deleted member 21371]

It depends on your definition of diabetic.
Some on here believe it can never be reversed, some believe diet control is an acceptable definition of reversal.

I choose to believe if I can eat, drink, and have a lifestyle as I would without diabetes, I've reversed it.

With it come back?
Like a broken leg, I can always hope not, but if I do the same again, it probably will.

For me, that seems to have been exceeding my "personal fat threshold"
In some, when you exceed your own threshold, internal fat builds up, and your liver and pancreas become out of step.
I was morbidly obese, I reversed that through weight loss, I passed my threshold going down, so I'm now longer diabetic.
Not every has to be obese though.
I prefer to be classed as diabetic, stay in the system, and get regular reviews.
I declare it for insurance, sometimes it alters the premium, sometimes it doesn't.
But I have no symptoms, no complications, and no restrictions in my lifestyle, so that works well for me.

 

[Burylancs]

Just a question for you all. Do you think the phrase "Once a diabetic always a diabetic" always rings true?

I see plenty of overweight and obese people in western countries and I have no doubt that many of them are prediabetic or diabetic and don't know it, as often the only way of telling if one is on the road to diabetes is a blood test based on a numerical range. Yet if they lose their weight and become more active one could say they appear healthy, and under the hood may be improving -even though we don't know what is going on. So my question is, are diagnoses for diabetes somewhat arbitrary if there are no physical symptoms? Like your over this level on this date, so diabetic for life? If someone takes a test and has high readings initially and then lowers it through diet and exercise, are they truly diabetic and des

On another note, do any of you have any idea when non-invasive continuous glucose monitors are coming out?

Yup . At the present time the causes of T1 and T2 are not known so no treatments are possible for either. All that's on offer is less or more hamfisted lifelong management of the symptoms. And T2s are the goose that laid the Golden Egg as far as the Pharmas are concerned so nobody is rushing to unravel T2.

 

[everydayupsanddowns]

My understanding and thinking is that diabetes is complex, multifactorial and simple answers are likely to be compelling, but probably wrong.

One of the biggest challenges is that the internationally agreed classifications don’t always fit an individual’s experience and clinical presentation, and also that some of the categories (perhaps especially T2) are more of an umbrella term for a collection of sub-types. And also that some people who have a classification on their notes (and who may then participate in a clinical trial as a particular ‘type’) may actually have a different form of diabetes entirely.

There’s a lot of fascinating research in this area, and our understanding of the mechanisms that underpin, trigger, and maintain some forms of diabetes is improving all the time.

The Direct study (which some on the forum consider controversial) is a substantial and respected piece of research which has shown that some people with a T2 diagnosis can put their condition into remission through significant weight loss, and has demonstrated the ways by which a build up of visceral fat can impair proper function of liver, pancreas and insulin signalling - which can then be restored (in some participants) when the weight is lost. Even if they were not conventionally overweight to begin with.

Others on the forum have achieved, and maintained glucose homeostasis over many years (or sometimes decades) without medication, by choosing to follow a way of eating that their body can cope with. In particular, by restricting carbohydrate intake to moderate, low or very low levels; and choosing sources of carbohydrate that their metabolism and gut biome seem best equipped to handle.

How long these methods of achieving remission are maintained remains to be seen - but the indications are at least promising.

It’s also important not to be lulled into a sense if safety by lack of obvious symptoms. The body is pretty finely tuned to prefer things within certain ranges. But just because a person doesn’t “feel ill” doesn’t necessarily mean there are no negative consequences to levels being out of range. It’s unfortunately the way that some people discover they have had diabetes for some time. For example they go for an eye check for glasses, snd the beginnings of retinopathy are spotted as a result of undiagnosed and unsymptomatic diabetes.

As for non-invasive CGM, I’d have to use the default “when will T1 be cured” estimate of within 5-10 years (just as it has been for all 30+ years of my T1 experience) 😉

 

[bulkbiker]

And T2s are the goose that laid the Golden Egg as far as the Pharmas are concerned so nobody is rushing to unravel T2.

Not sure I completely agree with that.. I mean my butcher is probably better off since I started my meat based diet but pharma hasn't made a penny from me since the pills went in the bin in November 2015.

 

[Admiral Benbow]

It depends on your definition of diabetic.
Some on here believe it can never be reversed, some believe diet control is an acceptable definition of reversal.

I choose to believe if I can eat, drink, and have a lifestyle as I would without diabetes, I've reversed it.

With it come back?
Like a broken leg, I can always hope not, but if I do the same again, it probably will.

For me, that seems to have been exceeding my "personal fat threshold"
In some, when you exceed your own threshold, internal fat builds up, and your liver and pancreas become out of step.
I was morbidly obese, I reversed that through weight loss, I passed my threshold going down, so I'm now longer diabetic.
Not every has to be obese though.
I prefer to be classed as diabetic, stay in the system, and get regular reviews.
I declare it for insurance, sometimes it alters the premium, sometimes it doesn't.
But I have no symptoms, no complications, and no restrictions in my lifestyle, so that works well for me.

Since you reversed your high blood sugar and type 2 diabetes, do you eat things and drink things like before but only to a lesser extent? For example, can you eat fish and chips, go to restaurants like Nando's, and have the occasional pint, spirit, or cocktail? How often are those regular reviews, and do you monitor your own blood at home with fingerpricks and a glucose monitor? (Sorry for asking so many questions)

 

[Burylancs]

My understanding and thinking is that diabetes is complex, multifactorial and simple answers are likely to be compelling, but probably wrong.

One of the biggest challenges is that the internationally agreed classifications don’t always fit an individual’s experience and clinical presentation, and also that some of the categories (perhaps especially T2) are more of an umbrella term for a collection of sub-types. And also that some people who have a classification on their notes (and who may then participate in a clinical trial as a particular ‘type’) may actually have a different form of diabetes entirely.

There’s a lot of fascinating research in this area, and our understanding of the mechanisms that underpin, trigger, and maintain some forms of diabetes is improving all the time.

The Direct study (which some on the forum consider controversial) is a substantial and respected piece of research which has shown that some people with a T2 diagnosis can put their condition into remission through significant weight loss, and has demonstrated the ways by which a build up of visceral fat can impair proper function of liver, pancreas and insulin signalling - which can then be restored (in some participants) when the weight is lost. Even if they were not conventionally overweight to begin with.

Others on the forum have achieved, and maintained glucose homeostasis over many years (or sometimes decades) without medication, by choosing to follow a way of eating that their body can cope with. In particular, by restricting carbohydrate intake to moderate, low or very low levels; and choosing sources of carbohydrate that their metabolism and gut biome seem best equipped to handle.

How long these methods of achieving remission are maintained remains to be seen - but the indications are at least promising.

It’s also important not to be lulled into a sense if safety by lack of obvious symptoms. The body is pretty finely tuned to prefer things within certain ranges. But just because a person doesn’t “feel ill” doesn’t necessarily mean there are no negative consequences to levels being out of range. It’s unfortunately the way that some people discover they have had diabetes for some time. For example they go for an eye check for glasses, snd the beginnings of retinopathy are spotted as a result of undiagnosed and unsymptomatic diabetes.

As for non-invasive CGM, I’d have to use the default “when will T1 be cured” estimate of within 5-10 years (just as it has been for all 30+ years of my T1 experience) 😉

Direct is a 'substantial ... piece if research'. You're kidding right ? Even Taylor admits in his recent pronunciamento in Eddie Edson's latest thread in the News section, that Direct was INSUBSTANTIAL and not much credence should be given to its claimed results ...'The small numbers included in randomised trials such as DiRECT, which randomised 302 participants, are insufficient to quantify these categories; large observational studies are a better study design.'

( And of course the assertion that Direct 'randomised 302 participants' is simply untrue.)

 

[helli]

Just a question for you all. Do you think the phrase "Once a diabetic always a diabetic" always rings true?

It certainly does for someone with Type 1 diabetes. This has nothing to do with being overweight or obese but to do with no currently solution for recreating insulin producing cells once the boidy has decided it is going to kill them all off. THere have been some transplants done but that requires a cocktail of drugs to be taken for the rest of your life to make sure the transplant is not rejected. So, in my mind, that is not a cure.

My gut feel is that a "cure" for Type 1 diabetes is very unlikely. However, I feel that we will discover a way to stop it from occurring. There has been research into discovering how is at risk and how to delay on the onset of Type 1. So taking this to the next step of stopping it happening does not feel too much of a jump. However, what that means for those of us who already have it is little research into a cure.

I have Type 1 diabetes for life. I have come to terms with this and not allowing it to have a great impact on my life by managing it as well as I can without it taking over.

 

[bulkbiker]

If someone takes a test and has high readings initially and then lowers it through diet and exercise, are they truly diabetic and deserving of the label?

Interesting question.

I have "passed" every diagnostic test to say I no longer have T2 diabetes apart from sightly elevated insulin resistance (but that was a few years ago).
HbA1c, FBG and OGTT.
However that is down to how I now eat.
I'm sure that if I went back to eating a baguette for breakfast, pasta and potatoes for dinner I'd soon be morbidly obese and diabetic once again.
Which begs the question once you have put T2 into remission is it a good thing to go back to eating what put you in that situation to start with?
Some here claim that they can eat "anything" with no adverse effects (although if they aren't testing regularly they probably can't know that for sure). Maybe for one or two meals it may be ok.
Is "fish and chips" really part of the best diet for humans?
These days I'd say not and would have grilled fish with butter on the side.

 

[Admiral Benbow]

Interesting question.

I have "passed" every diagnostic test to say I no longer have T2 diabetes apart from sightly elevated insulin resistance (but that was a few years ago).
HbA1c, FBG and OGTT.
However that is down to how I now eat.
I'm sure that if I went back to eating a baguette for breakfast, pasta and potatoes for dinner I'd soon be morbidly obese and diabetic once again.
Which begs the question once you have put T2 into remission is it a good thing to go back to eating what put you in that situation to start with?
Some here claim that they can eat "anything" with no adverse effects (although if they aren't testing regularly they probably can't know that for sure). Maybe for one or two meals it may be ok.
Is "fish and chips" really part of the best diet for humans?
These days I'd say not and would have grilled fish with butter on the side.

Yeah, I guess another way of asking the question is how is blood sugar any different than blood pressure which goes up and down? Surely, someone who has been hypertensive once in their life isn't labeled as hypertensive forever. Yes, it can go back up for pretty much the same factors that blood sugars would, namely eating poor, being overweight, not exercising, etc.

 

[helli]

Is "fish and chips" really part of the best diet for humans?

I find battering and frying fish is a fantastic way to "steam" a lovely cod fillet.
I have never enjoyed the batter and usually don't bother eating it. Some people cook "en papillotte" and very few eat the paper. My paper is batter.

 

[trophywench]

More like boiled rather than steamed to me, hate it! Any chippy that lightly coats the fish in batter so you don't boil the fish, gets my vote. And, much to my surprise cos we only went there cos we happened to be in the vicinity after all the ruddy hoo ha had died down so you could drive straight onto the carpark and no queue of cars along the main road - Binley Mega Chippy serves their fish like that, or it did that evening, anyway, and was blooming great.

I'm well in favour of salmon being steamed en papillote but no way Pedro would I want a chunky fish like either cod or haddock steamed. Plaice or sole - well maybe.

 

[bulkbiker]

how is blood sugar any different than blood pressure which goes up and down? Surely, someone who has been hypertensive once in their life isn't labeled as hypertensive forever.

Indeed not. I used to be hypertensive too along with T2 .. now I wouldn't be diagnosed with either but each has a "range" that is considered "heathy", once you go outside that range then...

 

[trophywench]

Anyway - I accepted some time ago that for some unknown reason - and it's still unknown - I inherited the diabetes gene(s) if it is that - rather than the cancer ones that metastased and killed dad and sister. I could still get cancer of course - but as having T1 has never whatever prevented me from doing anything I've ever actually wanted to do, for me by this age I'm not bothered whether they find a cause or not - however discovering a way to prevent it happening in future would be good.

If nowt else it would mean we have a greater understanding of the human body.

 

[Deleted member 21371]

Since you reversed your high blood sugar and type 2 diabetes, do you eat things and drink things like before but only to a lesser extent? For example, can you eat fish and chips, go to restaurants like Nando's, and have the occasional pint, spirit, or cocktail? How often are those regular reviews, and do you monitor your own blood at home with fingerpricks and a glucose monitor? (Sorry for asking so many questions)

Yes.

Have a look at my last couple of days on

https://forum.diabetes.org.uk/boards/threads/food-ideas-with-photos.101929/page-23#post-1242438

There are three posts in all, carrying on from that one.
However, I don't recommend it, it's probably my downfall in the first place!
But, it fulfills a need at times.

Ask yourself, are there some days you work late, and stop at a chippy?
Or do you try to find a raw steak, or a raw fish, and try to cook it in a car or hotel room?

 

[Leadinglights]

Yes.

Have a look at my last couple of days on

https://forum.diabetes.org.uk/boards/threads/food-ideas-with-photos.101929/page-23#post-1242438

There are three posts in all, carrying on from that one.
However, I don't recommend it, it's probably my downfall in the first place!
But, it fulfills a need at times.

Ask yourself, are there some days you work late, and stop at a chippy?
Or do you try to find a raw steak, or a raw fish, and try to cook it in a car or hotel room?

Not so far fetched, I think it was Hairy Bikers who cooked a fish on their bike engine in the middle of nowhere. Freshly caught of course.

 

[everydayupsanddowns]

Yeah, I guess another way of asking the question is how is blood sugar any different than blood pressure which goes up and down? Surely, someone who has been hypertensive once in their life isn't labeled as hypertensive forever. Yes, it can go back up for pretty much the same factors that blood sugars would, namely eating poor, being overweight, not exercising, etc.

Well one of the conclusions from the initial Direct results, and later follow studies (which as I suggested earlier, and you can see from some responses, is somewhat controversial to some members here) was that diabetes need considered an ‘inevitably progressive’ condition - which it was widely accepted as being among healthcare professionals for a long time.

”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. We now know that the processes that cause type 2 diabetes can be returned to normal functioning by restriction of food energy to achieve weight loss of around 15 kg.1 Around half of people who are within the first 10 years of diagnosis and manage to follow food energy restriction can stop all diabetes medication and return to non-diabetic glucose control.”

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

How long these promising results last, and how vulnerable they are to relapse (eg from weight regain) remains to be seen.

 

[Burylancs]

Well one of the conclusions from the initial Direct results, and later follow studies (which as I suggested earlier, and you can see from some responses, is somewhat controversial to some members here) was that diabetes need considered an ‘inevitably progressive’ condition - which it was widely accepted as being among healthcare professionals for a long time.

”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. We now know that the processes that cause type 2 diabetes can be returned to normal functioning by restriction of food energy to achieve weight loss of around 15 kg.1 Around half of people who are within the first 10 years of diagnosis and manage to follow food energy restriction can stop all diabetes medication and return to non-diabetic glucose control.”

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

How long these promising results last, and how vulnerable they are to relapse (eg from weight regain) remains to be seen.

And yet by excluding T2s of longer than 6 years from his Direct study ( obviously he's not daft , he didn't anybody in Direct who might prove him wrong) Taylor tacitly accepted that T2 is progressive.

 

[everydayupsanddowns]

T2s of longer than 6 years from his Direct study

I don’t think I view that as a cynical way of structuring the study to skew the results though. Even if it was a deliberately chosen starting point to evaluate a hypothesis. The ‘accompanying commentary’ linked here is behind a paywall, which is annoying, but it does look like even early on in 2019 the findings were considered by some to be possibly applicable to a number of candidates who have a longer duration of diabetes.

The findings have been simultaneously published in The Lancet Diabetes & Endocrinology, in which Paul Aveyard (University of Oxford, UK) and co-authors of an accompanying commentary suggest that the DiRECT results might apply more widely, such as to people with a longer duration of diabetes, and that even greater weight loss could further increase the chances of diabetes remission.

Diabetology

Journals, news and training, tailored for doctors specialized in preventing and treating the various types of diabetes and their secondary complications.

diabetes.medicinematters.com

This was a few years back - I’m not sure what has emerged in the interim.

At the end of the day I see it as promising and encouraging research, and I’m pleased that we have some members here who have used some aspects of the trial intervention for themselves with positive results for them.

It’s not intended to be a silver bullet that works for everyone, any more than any of the options that folks on the forum use to good effect for their own diabetes management are - but I’m glad it is an option that works for some people 🙂

It’s a bit like the ‘cures’ for T1 which are beginning to break new ground. I would love those studies to continue and to be able to publish data with positive outcomes for a proportion of people within a few years of a T1 diagnosis - even though I’ve had T1 far too long for any of that to apply to me. I still want it for other people - even if it’s only a tiny minority 🙂

 

[Jenny65]

It depends on your definition of diabetic.
Some on here believe it can never be reversed, some believe diet control is an acceptable definition of reversal.

I choose to believe if I can eat, drink, and have a lifestyle as I would without diabetes, I've reversed it.

With it come back?
Like a broken leg, I can always hope not, but if I do the same again, it probably will.

For me, that seems to have been exceeding my "personal fat threshold"
In some, when you exceed your own threshold, internal fat builds up, and your liver and pancreas become out of step.
I was morbidly obese, I reversed that through weight loss, I passed my threshold going down, so I'm now longer diabetic.
Not every has to be obese though.
I prefer to be classed as diabetic, stay in the system, and get regular reviews.
I declare it for insurance, sometimes it alters the premium, sometimes it doesn't.
But I have no symptoms, no complications, and no restrictions in my lifestyle, so that works well for me.

I like the comparison with a broken leg 🙂

I think of it like this, if I drink lots of alcohol I will get drunk, but that doesn't mean I am always a drunk. In a similar way if I overdo the carbs I will raise my BS and may end up in the diabetic HbA1c level again, so in the same way if I only drink in moderation, if I only have carbs in moderation, I should be fine, if I go on binges and regain 5 stone I would definitely be back where I started. I also beleive there are many people who have diabetes that are unaware, walking through town the other day and people watching, so many are similar to how I was, very big stomach and obese, I imagine if like me they keep ignoring it, when they reach later life they too may find themselves as diabetic if they are not already. Its sad but I really feel this is a growing problem, like a ticking time bomb, more and more people are getting diagnosed that previous years, it could be connected to lifestyle, less active over lockdown etc, (sorry gone off subject here) I suppose what I am trying to say, is whether you consider yourself as 'always' a diabetic or not, is how you perceive this condition, I do consider myself diabetic still, in the same way my son is still an asthmatic even though its under control, its a predisposal to a condition.