Once a Diabetic, always a Diabetic?

[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
67, 41 (yesterday)

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.

 

[JITR]

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
67, 41 (yesterday)

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

Thanks for posting your figures.

Looking for a pattern, I noticed your lowest HbA1c levels (39, 38) coincided with getting your weight down by 2-3 kg. Also that HbA1c then tended to drift up again at the same weight (@65 kg: 38, 41, 42).

My guess is losing weight reduces excess liver fat. After that some of that excess may return, even at the same weight, depending on eating and exercise patterns.

My HbA1c has drifted up from 32 to 39 without much change in weight. I am hoping my 5:2 regime will bring it back to to 32-35 again. A 22 hour fasting window, twice a week, will give glucagon time to kick in and burn some excess liver fat. At least that's the theory.

My waist is a hopeful sign, I can buckle my belt at the last hole for the first time.

 

[rebrascora]

Looking for a pattern, I noticed your lowest HbA1c levels (39, 38) coincided with getting your weight down by 2-3 kg. Also that HbA1c then tended to drift up again at the same weight (@65 kg: 38, 41, 42).

I think there is likely at least an error factor in 1mmol in HbA1c results so between 39 and 41 you can essentially consider them 40. I really don't think you can draw any conclusions from such minor variation if indeed there is any variation at all in those results.

 

[childofthesea43]

I think there is likely at least an error factor in 1mmol in HbA1c results so between 39 and 41 you can essentially consider them 40. I really don't think you can draw any conclusions from such minor variation if indeed there is any variation at all in those results.

I agree, the variations are probably within the expected error interval. I did record, however, that the 38 and 39 each followed spells of extremely labour intensive garden projects extending over many weeks, so maybe that was a factor. I am content with low 40s given that the average non-diabetic of my age has an A1c of about 47.

 

[JITR]

I think there is likely at least an error factor in 1mmol in HbA1c results so between 39 and 41 you can essentially consider them 40. I really don't think you can draw any conclusions from such minor variation if indeed there is any variation at all in those results.

Neither do I, but I want to find a way of getting back from 39 to 35 or less.

At least childofthesea has confirmed there was a reason for the low levels I mentioned; 'extremely labour intensive garden projects extending over many weeks'.

Data always needs interpretation.

 

[childofthesea43]

Neither do I, but I want to find a way of getting back from 39 to 35 or less.

At least childofthesea has confirmed there was a reason for the low levels I mentioned; 'extremely labour intensive garden projects extending over many weeks'.

Data always needs interpretation.

So, a cost-benefit question: does reducing A1c by a few points compensate one for the pain of moving 3 skipsful of earth and hand-mixing 17 tons of concrete? You decide!

 

[JITR]

So, a cost-benefit question: does reducing A1c by a few points compensate one for the pain of moving 3 skipsful of earth and hand-mixing 17 tons of concrete? You decide!

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

I think there are easier ways for many people to reduce A1c than filling skips with earth and mixing 17 tons of concrete. Diet and exercise.

But in answer to the question I'd rather be back at 32-35 than 39 and rising. At 42 it seems insulin resistance and glucose/lipid dysregulation start up again.

 

[childofthesea43]

I think there are easier ways for many people to reduce A1c than filling skips with earth and mixing 17 tons of concrete. Diet and exercise.

But in answer to the question I'd rather be back at 32-35 than 39 and rising. At 42 it seems insulin resistance and glucose/lipid dysregulation start up again.

The rise from 32 to 39 is interesting. I would be interested to know the back story here.

 

[everydayupsanddowns]

So, a cost-benefit question

Very difficult to assess the cost-benefit analysis without factoring in the confounding factor of how pleased you were with the outcome of the hard landscaping.

That would surely add to your QALY (Quality Adjusted Life Years) score?

 

[childofthesea43]

Very difficult to assess the cost-benefit analysis without factoring in the confounding factor of how pleased you were with the outcome of the hard landscaping.

That would surely add to your QALY (Quality Adjusted Life Years) score?

I suppose we’d also need to factor in the costs of the materials, the impact upon neighbours, the carbon footprint and the effect upon the wellbeing of the earthworms. I’m beginning to think that T2D might have some tricky aspects to it …

 

[everydayupsanddowns]

I’m beginning to think that T2D might have some tricky aspects to it …

It’s all pervading! Weaseling its way into every aspect of life!

 

[JITR]

The rise from 32 to 39 is interesting. I would be interested to know the back story here.

In a nutshell, a blood test at my behest in December 2022 came back with A1c over 100 and ferritin over 1200. Panic stations at the Surgery. Read Roy Taylor's 'Life without Diabetes T2'. Set a target loss of 22 kg on a real food version of the Newcastle to get into remission and get back to my 'racing weight'. A1c at 39 in April 2023 (-15 kg) and 32 in July 2023 (-22 kg). A1c still 32 in June 2024 but, to my surprise, 39 in September 2024.

Why the jump? I had regained 3-4 kg since July 2023 but there had been little change this year. My guess is the second 32 result, the one in June this year, was rather low due to a bad tummy bug in April/May. Without that it might have been (say) 35-36 and last month's 39 not so surprising. Corrective action. Backtrack on olive oil and cheese, lose 3 kg and see if that does the trick.

A salutary lesson.

 

[childofthesea43]

In a nutshell, a blood test at my behest in December 2022 came back with A1c over 100 and ferritin over 1200. Panic stations at the Surgery. Read Roy Taylor's 'Life without Diabetes T2'. Set a target loss of 22 kg on a real food version of the Newcastle to get into remission and get back to my 'racing weight'. A1c at 39 in April 2023 (-15 kg) and 32 in July 2023 (-22 kg). A1c still 32 in June 2024 but, to my surprise, 39 in September 2024.

Why the jump? I had regained 3-4 kg since July 2023 but there had been little change this year. My guess is the second 32 result, the one in June this year, was rather low due to a bad tummy bug in April/May. Without that it might have been (say) 35-36 and last month's 39 not so surprising. Corrective action. Backtrack on olive oil and cheese, lose 3 kg and see if that does the trick.

A salutary lesson.

Thank you - can you also indicate your absolute weights in Dec22, July23, June24 and Sept24?