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Once a Diabetic, always a Diabetic?

Martin.A said:
Suggest you read this:-

Is there a cure for diabetes?

There isn’t a cure for diabetes right now. But our scientists across the UK are pushing boundaries and taking steps to build a future where diabetes can do no harm. Our scientists are busy with exciting developments. Here, we take a look at the life-changing research taking place both for type...
www.diabetes.org.uk www.diabetes.org.uk
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I've read this kind of thing numerous times, but it doesn't really answer my questions.

How would you define diabetes, and how would your answer clearly delineate between remission and cure?
 
harbottle said:
I don't think any long term studies have been done yet.
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And yet there seems to be an accepted assumption, by some (many?), that tje condition is progressive regardless.

If someone who is obese loses enough weight to fall into normal/expected range, we would say this person is no longer obese. Of course, we'd caution that if they returned to their previous lifestyle they'd likely become obese again. But we don't say they're in remission from obesity. Once obese does not mean always obese. I'm trying to find out what the meaningful difference is that would lead us to conclude that once diabetic, always diabetic.
 
beating_my_betes said:
And yet there seems to be an accepted assumption, by some (many?), that tje condition is progressive regardless.

If someone who is obese loses enough weight to fall into normal/expected range, we would say this person is no longer obese. Of course, we'd caution that if they returned to their previous lifestyle they'd likely become obese again. But we don't say they're in remission from obesity. Once obese does not mean always obese. I'm trying to find out what the meaningful difference is that would lead us to conclude that once diabetic, always diabetic.
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The beta-cell dysfunction aspect of T2D is genetic. You can't choose your grandparents. I believe it was shown some years ago that some people have a gene that causes beta cells to stop working under certain metabolic conditions.
 
beating_my_betes said:
How would you define diabetes
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It's a group of metabolic disorders characterized and identified by the presence of hyperglycaemia in the absence of treatment. The heterogeneous aetio-pathology includes defects in insulin secretion, insulin action, or both, and disturbances of carbohydrate, fat and protein metabolism.
 
This paper is from the study mentioned, but isn't public.


This appears to only look at patients who haven't achieved normal levels, though, after dietary changes, so it'll exclude people like myself who achieved normal levels with weight loss/diet.

I've seen a few other papers from the same study on the effects of metformin, but they seem to only consider overweight patients.
 
I am a few days since diagnosis, 11 years ago, then non-diabetic numbers and A1c, 4 months later.

My GP has marked my record as "Diabetes Resolved", which I don't really thing is quite right, in terms of the percieved definition, but it makes no real difference. I still have at least annual A1cs and eye checks. I don't have foot checks, but then I never had them when on the register, so no change there.

Vis-a-vis the diabeted register, I see this merely as an admin and monetising tool in primary care, which allows GPs to easily take part in the annual diabetes audit and check if their patient pool is hitting the required thresholds of x% of patients with T2 (for example) receiving certain checks.

I'm happy to have serially achieved non-diabetic level HbA1cs and remain in good health, in diabetes terms, but the label doesn't impact me. I either choose to live my life in a way promoting and maintaining decent health or not. (To be clear, I'm not saying anyone not doing similarly doesn't care or isn't trying. I'm talking about me, at this point in my life.)

My steer would be to anyone considering "remission" is to just do their best to achieve a decent healthy panel, whilst still living their lives. In my view, there is a point beyond which an individual body cannot improve, for a plethora of reasons, so get to a point where your numbers are as decent as you can, whilst still living a good life. If that means a bit of medication to help, so be it.

We live this life once, and have to get on with it. Deferring until we've reach x, y or z isn't healthy.

Remission is a word, not a prize, in my view..
 
If you still have the annual checks you've been marked as 'Remission'.
Resolved is for diabetes caused by things like steroids, and the annual checks are not required.
 
harbottle said:
If you still have the annual checks you've been marked as 'Remission'.
Resolved is for diabetes caused by things like steroids, and the annual checks are not required.
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As I understand it, once on the eye screening hamster wheel, there is now way off it. I'm happy to stay on it, from the viewpoint of the additional checks.

I have blood tests for other conditions that I live with these days, and even if I didn't ask for it, my Endo sometimes just runs a mega panel because of family medical histories, so I reckon I'd have an A1c annually anyway by that route.
 
If your medical record has been marked as 'diabetes resolved' then you won't get called in for an eye test. This code is used when there's been a misdiagnosis or a temporary reason for diabetes.

GPs use 'remission' when normal levels are achieved through some sort of intervention such as diet, weight loss or bariatric surgery.
 
harbottle said:
You'll have to do that yourself. I haven't got time to go through them for you.
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Why would you need to go through them again. This is a position you seem to uphold, so just link me to whatever evidence convinced you.
 
Martin.A said:
It's a group of metabolic disorders characterized and identified by the presence of hyperglycaemia in the absence of treatment. The heterogeneous aetio-pathology includes defects in insulin secretion, insulin action, or both, and disturbances of carbohydrate, fat and protein metabolism.
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Is this your personal definition?
 
Burylancs said:
The z in characterized should tell us it's been written in American English.
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Not necessarily so - the ending 'ize' has been in use in UK English for centuries. Both 'ise' and 'ize' are considered correct for many words. Colin Dexter in the plot of a Morse mystery decided a murderer was lying about his education at Harrow because he used 'ise'.

You might find it interesting to look up use of 'ize' and 'ise'.
 
pjgtech said:
If people do achieve "remission" and are able to lose weight, control their diet and come off Diabetic meds, are they still considered to be a Diabetic?
Thinking more about medical peeps really, GP, Diabetic nurse, etc, do you remain on their books as a Diabetic and still get the feet, eye checks, etc?
I assume there is no "cut off" time, when you are assumed to have beaten it.
I would imagine that you are always still at risk of getting Diabetic symptoms at some point, so still need to be monitored.
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I would say yes to the question of whether a person is still considered to be diabetic, though there are odd exceptions. The question of being 'misdiagnosed' for example. I've read two accounts so far on Reddit where people were told they were Type 2, immediately lost a lot of weight, and were then told by their doctors that they were misdiagnosed. In the US (not sure how it works in the UK and Ireland) it takes two HbA1c tests taken several months apart in order for a 'secure' Type 2 diagnosis to be established. A fasting blood glucose test in conjunction with a HbA1c test can also yield a secure diagnosis, though the fasting test is rarely done. Those people who briefly entered the diabetic range but immediately lost weight have been historically declared as non-diabetic. The diagnosis a mistake. Were those people actually diabetic or did they get the fat out of their pancreas quickly enough to avoid long-term damage? Nobody knows, because the criteria for establishing a secure diagnosis assume that it's irreversible, inevitably progressive, and that weight loss cannot ever 'reverse' it. Those people are invisible in all existing research - declared to have never been diabetic in the first place - misdiagnosed. As a wise person once said - 'Assumption is the mother of all F*&k ups'.

In all other circumstances I believe a person who has sustained damage to the pancreas due to lipid toxicity will always be a diabetic, even in remission. Even if everything possible is done to achieve and sustain remission they will probably not regain an entirely 100% healthy first-phase insulin response. Weight gain or a few few months of lacking exercise while feasting on pizza regularly will likely push them back above the diabetic threshold on the HbA1c test. The seed has been firmly planted, so to speak.
 
silentsquirrel said:
Not necessarily so - the ending 'ize' has been in use in UK English for centuries. Both 'ise' and 'ize' are considered correct for many words. Colin Dexter in the plot of a Morse mystery decided a murderer was lying about his education at Harrow because he used 'ise'.

You might find it interesting to look up use of 'ize' and 'ise'.
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Yes it can be ise or ize in English English but in American English the convention is to use ize. Remember Churchill's aphorism that America and Britain are two nations separated by a common language.
 
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