Once a Diabetic, always a Diabetic?

[Dragonheart]

This paper fails to say what mostly dietary control means. What diet? What does mostly mean?

All the papers I’ve seen comparing outcomes and making the assumptions that type 2 is always progressive seem to do similar or have all medicated patients thus actually showing all “medicated control” merely slows medication increases and likelihood of complications, ie it might give you better hba1c’s but doesn’t altogether stop the problems.

My question is why not? Could it be about hyperinsulemia and insulin resistance still happening whilst the medication mops up afterwards? Ie dealing with symptoms not cause/refilling the bucket without fixing the hole? Insufficient study, time and motivation about the long term effects of that newer approach trying to fix the insulin issues means we can’t be sure but it certainly seems feasible it might give better long term result. Given that we have been shown medicated control (as measured by hba1c) is merely an imperfect brake many of us choose to apply both that (of good hba1c) AND go for the underlying issues around insulin hoping that a dual approach as it were works out better. As more of us do this and it becomes more mainstream hopefully the evidence to turn the status quo tanker will expand. The same might be asked about theories about maintaining personal fat ratios in the organs (which potentially might boil down to insulin control too???)

This paper https://www.directclinicaltrial.org.uk/Pubfiles/Beating Diabetes McCombie 2017 bmj.j4030.full.pdf

seems to be exploring the points I raise pointing out no studies on long term remission had been done at that time and

“In keeping with trends in most medical specialties, diabetes management is beginning to focus on reversible underlying disease mechanisms rather than treating symptoms and subsequent multisystem pathological consequences.3 4 Both (epi)genetic predisposition and ageing have a role in type 2 diabetes, but it is rare without weight gain.
Lowering blood glucose or HbA1c concentrations remains the primary aim of management, as reflected in current clinical guidelines and the actions of licensed drugs. However, management and guidelines focus on use of antidiabetes drugs, with only lip service paid to diet and lifestyle advice.”

 

[beating_my_betes]

In medicine, little is concrete

Ok. But what has that to do with the OP's question? Are you suggesting we cannot determine whether reversal is a thing?

 

[AndBreathe]

Ok. But what has that to do with the OP's question? Are you suggesting we cannot determine whether reversal is a thing?

No individual is assured of remission/reversal/cure or whatever, just as you can have folks living incredibly unhealthy lifestyles (for example, chain smoking and drinking excessive amounts of alcohol), yet living apparently medically untouched lives.

Even for a very small number of folks living with terminal diagnosis of, say, cancer, a very small minority of that population will survive a very long time, or even have their caner's disappear. In life, sometimes probability is a better guide than certainty, but even with that, for every 99% likely, you have the remaining 1% bucking that trend.

Anyway, all of that said, I'm pretty certain your policing of this thread is deflecting more than any individual's responses.

On that note; I'm out of it.

 

[beating_my_betes]

No individual is assured of remission/reversal/cure

That's not what has been asked nor is what's being discussed. The question on the table is whether reversal is possible, not whether if it was it would be possible for everyone.

Anyway, all of that said, I'm pretty certain your policing of this thread is deflecting more than any individual's responses.

Well, I thought it was you who kept trying to stop the conversation. But I hadn't realised I was policing anything.

I'll remain silent from now on

 

[harbottle]

This paper fails to say what mostly dietary control means. What diet? What does mostly mean?

All the papers I’ve seen comparing outcomes and making the assumptions that type 2 is always progressive seem to do similar or have all medicated patients thus actually showing all “medicated control” merely slows medication increases and likelihood of complications, ie it might give you better hba1c’s but doesn’t altogether stop the problems.

My question is why not? Could it be about hyperinsulemia and insulin resistance still happening whilst the medication mops up afterwards? Ie dealing with symptoms not cause/refilling the bucket without fixing the hole? Insufficient study, time and motivation about the long term effects of that newer approach trying to fix the insulin issues means we can’t be sure but it certainly seems feasible it might give better long term result. Given that we have been shown medicated control (as measured by hba1c) is merely an imperfect brake many of us choose to apply both that (of good hba1c) AND go for the underlying issues around insulin hoping that a dual approach as it were works out better. As more of us do this and it becomes more mainstream hopefully the evidence to turn the status quo tanker will expand. The same might be asked about theories about maintaining personal fat ratios in the organs (which potentially might boil down to insulin control too???)

I guess staying overweight and controlling it with large amounts of medication doesn't really remove the health problems caused by being overweight? Excess fats in the bloodstream, insulin resistance, etc.

Talking to a friend who is a GP ("I wish my diabetic patients would lose weight," he told me, when I visited after having shed 3 stone.) I get the impression the majority of people don't make the lifestyle changes and rely on tablets. Which might be why most of the research uses patients who use aggressive medical intervention and are overweight.

 

[JITR]

I guess staying overweight and controlling it with large amounts of medication doesn't really remove the health problems caused by being overweight? Excess fats in the bloodstream, insulin resistance, etc.

I think that's right.

It seems glucose is half the story and lipids (fats) is the other half.

We can control how much glucose goes into our blood by diet. Weight seems to be key to what our body does with it. In other words the efficiency of our digestive system and blood circulation determine our health.

When we were younger our HbA1c was likely in the 32-36. As we put on weight HbA1c goes up to 39 (pre-diabetic in the USA and Germany) and then 42 (prediabetic in the UK and elsewhere). Above those levels glucose dysregulation and lipid dysregulation develop along with 'excess fats in the bloodstream [and the liver], insulin resistance, etc.'

c.2008 Professor Roy Taylor and his Counterpoint team showed that process can be reversed by diet to eliminate excess fat in our liver and pancreas. That is provided too many beta cells in the pancreas have not been damaged in the T2D phase around HbA1c 48 and above.

Harbottle's HbA1c history is a great example of that reversal putting T2D into remission.

 

[childofthesea43]

Here’s my own modest example - weight (kg) and A1c pairings over almost 4 years.

82 kg, 74 mmol/mol
70, 42
67, 40
66, 41
65, 39
67, 42
66, 42
65, 38
65, 41
65, 42
66, 41
67, 40
67, 41
67, 42

Conclusion for me: maintaining weight in range 65-67kg maintains A1c in range 38-42. But for how long, that’s the question …

 

[Drummer]

I guess staying overweight and controlling it with large amounts of medication doesn't really remove the health problems caused by being overweight? Excess fats in the bloodstream, insulin resistance, etc.

Talking to a friend who is a GP ("I wish my diabetic patients would lose weight," he told me, when I visited after having shed 3 stone.) I get the impression the majority of people don't make the lifestyle changes and rely on tablets. Which might be why most of the research uses patients who use aggressive medical intervention and are overweight.

If GPs and other HCPs go on insisting that a healthy diet includes high levels of carbs then a percentage of their patients will find weightloss impossible.
I was in that state for decades as I am so resistant to going from glycolysis to ketosis in a low calorie regime.