Permission for Remission?

[Anji53]

It's frustrating to think that if you'd known you could have prevented as much as possible. But, you'd done a phenomenal job to bring your hba1c down from 117 to 35 and now 37. When you restricted your carb intake did you cut certain ones out completely or just minimised how often you were having them? Are you still restricting your carbs?

I cut out all bread, pasta etc I know there are carbs in lots of other things so checked labels and bought the lowest e.g noticed full fat crème fresh was lower than half fat
As they have stopped the metformin I’m continuing to restrict carbs as I’m afraid that if I do both ( stop metformin and eat carbs) my readings will go up

 

[Anji53]

stopping completely is like going cold turkey isn't it? I actually thought it's more effective to cut down slowly over a period of time so that you don't experience any withdrawal effects - not that I know there's any withdrawal side effects other than maybe a raise in BS? Have you noticed anything?

that’s exactly what I thought would happen, that they’d halve it again so I’d be taking 500 a day instead of 1000. Seemed to make sense to reduce it gradually rather than stop completely
its not been a week yet but no other effects so far nothing

 

[Eddy Edson]

stopping completely is like going cold turkey isn't it? I actually thought it's more effective to cut down slowly over a period of time so that you don't experience any withdrawal effects - not that I know there's any withdrawal side effects other than maybe a raise in BS? Have you noticed anything?

Met's biggest impact is reducing liver insulin resistance, which means that your liver gets better at knowing when to stop producing new glucose ("gluconeogenesis") because it's better at knowing how much is already running around in your blood.

If you lose weight and reduce visceral fat, hopefully your liver's insulin resistance reduces and the benefits of metformin dwindle away.

The easy rough'n'ready test for this is to check your waking/fasting BG level. If it's "normal" (so <= 5.6 mmol/l) then it probably means your liver hasn't been chugging out glucose all night & so it's probably not insulin resistant.

Metformin can also improve peripheral insulin resistance - ie muscle etc insulin resistance - and this has an impact on post-eating BG levels independent of liver insulin resistance. But the impact is usually pretty minor.

Also, for many people, it seems metformin can actually attenuate the benefits you can get to peripheral insulin resistance from exercise - less benefit with exercise+metformin than from exercise alone (due to ummm some complicated biochemistry stuff possibly involving mitochondria as well).

Anyway, after I zapped my T2D via weight loss I thought I might as well keep taking Met, until I found the exercise studies, and experiment showed that I did do slightly better without it after exercise. Dropping it "cold turkey" was just fine.

 

[Anji53]

Met's biggest impact is reducing liver insulin resistance, which means that your liver gets better at knowing when to stop producing new glucose ("gluconeogenesis") because it's better at knowing how much is already running around in your blood.

If you lose weight and reduce visceral fat, hopefully your liver's insulin resistance reduces and the benefits of metformin dwindle away.

The easy rough'n'ready test for this is to check your waking/fasting BG level. If it's "normal" (so <= 5.6 mmol/l) then it probably means your liver hasn't been chugging out glucose all night & so it's probably not insulin resistant.

Metformin can also improve peripheral insulin resistance - ie muscle etc insulin resistance - and this has an impact on post-eating BG levels independent of liver insulin resistance. But the impact is usually pretty minor.

Also, for many people, it seems metformin can actually attenuate the benefits you can get to peripheral insulin resistance from exercise - less benefit with exercise+metformin than from exercise alone (due to ummm some complicated biochemistry stuff possibly involving mitochondria as well).

Anyway, after I zapped my T2D via weight loss I thought I might as well keep taking Met, until I found the exercise studies, and experiment showed that I did do slightly better without it after exercise. Dropping it "cold turkey" was just fine.

That’s really interesting. My DN has really resisted my testing BG levels She said there is no need and I didn’t know what my readings should be without guidance
I think I will test daily now then at least i can either reassure myself or have evidence for my surgery 3 months seems a long time to wait to see if it was the right decision to stop taking it.

 

[harbottle]

This paper shows the current understanding (In 2016) of Metformin's various actions, but be warned, it's highly technical:

Current Understanding of Metformin Effect on the Control of Hyperglycemia in Diabetes

Metformin is a first line oral anti-diabetic agent that has been used clinically to treat patients with type 2 diabetes for over 60 years. Due to its efficacy in therapy and affordable price, metformin is taken by over 150 million people each year. Metformin ...

www.ncbi.nlm.nih.gov

Mainly it inhibits gluconeogenesis, improves signalling (i.e insulin resistance), and changes the way food is absorbed in the gut.

Collectively, suppression of gluconeogenesis by metformin’s direct effects and the indirect improvement of insulin signaling in the liver will lead to the amelioration of hyperglycemia in patients with type 2 diabetes.

Although my hba1c was 83, my fasting levels were in the low sixes in the morning, which I guess might be an indication I didn't have runaway gluconeogenesis - with 83 I'd have expected a far higher fasting level. (T2s can either have resistance in the liver, resistance in muscles/adipose tissues or both - plus failing beta cells)

I find @Eddy Edson 's comment about exercise as interesting, as I found that when I stopped taking my 500mg of Metformin for a week I found exercise a little easier.

 

[Eddy Edson]

Although my hba1c was 83, my fasting levels were in the low sixes in the morning, which I guess might be an indication I didn't have runaway gluconeogenesis - with 83 I'd have expected a far higher fasting level.

Interesting! I was stock-standard - HbA1c 89 and FPG in the teens.

 

[harbottle]

Interesting! I was stock-standard - HbA1c 89 and FPG in the teens.

Yes. It was the morning after I was diagnosed (I had my last pizza the night before, a supermarket bought sloppy guiseppe!). I bought a testing machine and did some tests, but didn't really know what the values should be. As I stopped testing for 3 months and concentrated on diet, I never thought much about it until I went back and found those old results.

I thought FBG for a hba1c of 83 would be far, far higher than the sixes.

 

[Bubbleblower]

My thoughts are that most GPs haven't a clue about how you would go about achieving remission and in some cases seem to want the thwart it by telling people diabetes is progressive and not to test and not to go low carb and to eat low fat.

Exactly, my endocrinologist strongly opposes what I do and keeps playing the progressive record.

My healthcare professionals didn’t even want me to buy a glucose monitor, but fortunately I did anyway and could see their diet raised my FBG by about 7 points. I never got any good advice or positive reinforcement on my mission for remission.

 

[NeoUser]

Exactly, my endocrinologist strongly opposes what I do and keeps playing the progressive record.

My healthcare professionals didn’t even want me to buy a glucose monitor, but fortunately I did anyway and could see their diet raised my FBG by about 7 points. I never got any good advice or positive reinforcement on my mission for remission.

@Bubbleblower are you trying to put your type 1.5 diabetes into remission? How does the approach differ from type 2 remission? 🙂

 

[louisew]

Looking back, I wish my GP had something to offer re weight loss. (His only comment at DX was, "Try not to lose too much weight". Thanks, mate!)

I lost a lot of muscle mass because I was too clueless, and nobody was advising me, to do some strength/resistance training while I was losing weight.

Me too. I lost muscle mass. Very much DIY with my diabetes nurse.