"Remission" expectations & issues

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Eddy Edson

Eddy Edson

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Relationship to Diabetes
Type 2
Great thread from a practitioner on managing T2D remission expectations, probable need for weight-loss meds in the longer term in most cases, issues with med-free as part of "remission" in clinical practice:
https://twitter.com/x/status/1531658601001000960
 
Interesting to see such depth of thought and analysis but the conclusion isn't very cheerful! "Congratulations on achieving remission... don't expect to stay in remission"
 
John D M said:
Interesting to see such depth of thought and analysis but the conclusion isn't very cheerful! "Congratulations on achieving remission... don't expect to stay in remission"
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Yep, it is interesting, however - Roy Taylor also stated that if you can keep the weight 'off' Diabetes in 'unlikely' to return...

So for me, the key has always been remove the excess weight and 'keep' it off...forever...

It stands to reason that if you regain the weight, you will be pushing it - and looks like from what I can see, it doesn't take another 20 or so years for that to happen - we are more suseptable, so inevitable if weight is regained...

No point in being down that he couldn't help his patient, it's the same if I had a over indulgent day of food - so long as it's not indulgent the next day, and day after that, it's fine - it's about balance, and long term - not quick fixes like lose the weight and bingo - it's a long term plan that counts....
 
I have not had diabetic blood readings for three years now. No meds and haven't lost weight to do it and so I am not worried about regaining weight and it going badly again.
I do not eat a restricted diet and in fact eat a high calorie diet and my weight has reduced gently over the three years but as a side effect of my metabolism re-aligning itself. Year on year my numbers improve.

I started off with low carb and then moved to fewer than 20g carbs per day.
I find it easy to maintain because I eat the same way I always did - in fact if anything I eat more and I have more chocolates and desserts and eggs and cream. I no longer binge eat which used to be a problem prior to my diagnosis and I no longer get cravings nor do I have any negative feelings whatsoever around food any more.
These days I know what I enjoy eating and I know it will not spike my blood sugars and I know my blood pressure and liver function is supported by this new way of eating. I doubt I eat fewer than 1800 calories a day but I wouldn't know because I haven't counted a calorie for many years.

It is so easy for me I find it difficult to understand why people put themselves through low calorie diets when just changing some ingredients and techniques for cooking (which are mostly making cooking faster and easier and not more difficult) can make a world of difference and it is sustainable. But we are all different and we all make choices based on our own preferences.
 
Everyone's different and health & life's trials and tribulations mean that not everyone may be able to sustain a significant weight loss and the impression I came away with was that was th conclusion being communicated and that a significant proportion of those achieving remission won't be able to sustain it without doing something different along the lines of a medical intervention
 
John D M said:
Everyone's different and health & life's trials and tribulations mean that not everyone may be able to sustain a significant weight loss and the impression I came away with was that was th conclusion being communicated and that a significant proportion of those achieving remission won't be able to sustain it without doing something different along the lines of a medical intervention
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Yep. Semaglutides and even more effective new med options in the pipeline will become increasingly available, and definitions of "remission" which might be an impediment to their use are not helpful.

The hard fact is that most people regain weight after losing it, not because of lack of will power or whatever, but because that is the way the brain is hardwired.

There is nothing in Roy Taylor's DiRECT study results to make me believe that the prospect of sustained remission via weight loss will do much to counteract that hardwired imperative. Specifically, at the 2 year mark, a bunch of people in the study lost remision because they regained weight. Mildrun is quite likely correct in guessing that a minority of the participants will still be in remission at the 5 year mark.

It's just another indication of the power of the hardwiring. Semaglutides etc reduce that power, allowing "will power" etc to actually work.

EDIT: Obviously it's not the case for everybody. All the major weight loss studies (eg the gold-standard Look AHEAD trial) show a small minority of people able to sustain substantial weight loss for the long term. I seem to be one of them - sustained 20% weight loss for almost 4 years now, and in line with these studies, I weigh myself often, do a fair amount of regular exercise and pay attention to what I eat. But none of that would matter much if I weren't fortunate enough to have pretty weak hardwiring. I surely don't have exceptional will-power or whatever.
 
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It’s about being realistic and managing expectations.
There has been a surge in marketing of diets as “reversing” diabetes where it’s only ever going to hold it in abeyance and he’s a doctor trying to manage those expectations in his patients. I understand his frustrations.
 
NotWorriedAtAll said:
I have not had diabetic blood readings for three years now. No meds and haven't lost weight to do it and so I am not worried about regaining weight and it going badly again.
I do not eat a restricted diet and in fact eat a high calorie diet and my weight has reduced gently over the three years but as a side effect of my metabolism re-aligning itself. Year on year my numbers improve.

I started off with low carb and then moved to fewer than 20g carbs per day.
I find it easy to maintain because I eat the same way I always did - in fact if anything I eat more and I have more chocolates and desserts and eggs and cream. I no longer binge eat which used to be a problem prior to my diagnosis and I no longer get cravings nor do I have any negative feelings whatsoever around food any more.
These days I know what I enjoy eating and I know it will not spike my blood sugars and I know my blood pressure and liver function is supported by this new way of eating. I doubt I eat fewer than 1800 calories a day but I wouldn't know because I haven't counted a calorie for many years.

It is so easy for me I find it difficult to understand why people put themselves through low calorie diets when just changing some ingredients and techniques for cooking (which are mostly making cooking faster and easier and not more difficult) can make a world of difference and it is sustainable. But we are all different and we all make choices based on our own preferences.
Click to expand...

Yes, this often gets written whenever weight loss is mentioned.
But, for many of us, it's not about simply having the "right" blood glucose readings.
Even though is the easiest option for you.
Excess weight is bad for many things.
Diabetes made me realise I was a tub of lard on legs.
I prefer not to be fat now.
It that reverses my diabetes as well, it's win-win.
If not after that I still have, as you say, a few easy tweaks I could make.
(I probably literally have my cake and eat it)
 
When I was given a T2 diagnosis and learnt about the possibility of remission I clung to the hope I could rid myself of diabetes. After a couple of years I found I'm actually LADA and remission isn't going to happen. I actually feel better about things now because I'm not chasing the perfect diet and making my life harder chasing the right foods.
I lost weight, got fit and use CGM to keep me on track, I find mentally its a better place to settle to live with my friend diabetes and manage it rather than fight it.
It did me a favour really. I've never felt fitter and eaten so healthy.
My sense is the doctor is trying to manage peoples expectations and not be too obsessed with chasing a dream which may not happen for all
 
@Landrover Jason - you are the first person I have ever seen on a D forum refer to your diabetes as your friend - but that's how I feel about mine. It's been my constant companion for the last 50 years. It's there whether I'm in sexual ecstacy, urinating, playing the trumpet involuntary, peeling spuds, having my bikini line waxed or sleeping. Even when anaesthatised during surgery. You'd hardly want to share all that with your enemy, now would you? Ergo, it must surely be my friend, mustn't it?

It's still like a human friend at times, in that if it feels I'm not paying it enough attention, it plays its face for a bit at which point I have to say Sorry mate! and mean it, so give it a bit more attention to get it back purring along contentedly with me again.
 
How often do you find yrself playing the trumpet involuntarily?? There must be a story about that!
 
I assumed involuntary trumpet playing was a polite way of saying 'Farting'!
 
harbottle said:
I assumed involuntary trumpet playing was a polite way of saying 'Farting'!
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OK, you're probably right, but I still want TW to have a story about involuntarily playing an actual trumpet.
 
Eddy Edson said:
Yep. Semaglutides and even more effective new med options in the pipeline will become increasingly available, and definitions of "remission" which might be an impediment to their use are not helpful.

The hard fact is that most people regain weight after losing it, not because of lack of will power or whatever, but because that is the way the brain is hardwired.

There is nothing in Roy Taylor's DiRECT study results to make me believe that the prospect of sustained remission via weight loss will do much to counteract that hardwired imperative. Specifically, at the 2 year mark, a bunch of people in the study lost remision because they regained weight. Mildrun is quite likely correct in guessing that a minority of the participants will still be in remission at the 5 year mark.

It's just another indication of the power of the hardwiring. Semaglutides etc reduce that power, allowing "will power" etc to actually work.

EDIT: Obviously it's not the case for everybody. All the major weight loss studies (eg the gold-standard Look AHEAD trial) show a small minority of people able to sustain weight loss for the long term. I seem to be one of them - sustained 20% weight loss for almost 4 years now, and in line with these studies, I weigh myself often, do a fair amount of regular exercise and pay attention to what I eat. But none of that would matter much if I weren't fortunate enough to have pretty weak hardwiring. I surely don't have exceptional will-power or whatever.
Click to expand...
I deal with my situation logically. I gained weight over many many years a teeny imperceptible amount at a time. I am shedding it the same way. It is happening because I am reversing the processes that caused my diabetes. A combination of stress, eating too often and too many carbs, and eating food that did not satisfy me or fill me so I kept on eating because I wasn't feeling full or nourished or spoiled, also I had sleep apnoea because I have a little chin and I was undiagnosed autistic which piled on the stress and meant I had high cortisol levels which led to hormone problems. All these things led to weight gain despite eating very low calorie diets and exercising and I got depressed and hated myself for not being able to lose weight even though I was following all the accepted advice - if anything following the advice made my health get worse year on year.

I am now unravelling all that as it all led to my liver being overtaxed. First thing I got a CPAP machine which led to consistent good rest and no more nights where my body thought I was being suffocated which meant immediately my cortisol levels began to drop. Then I was able to identify myself as autistic which meant I could alter how I lived my life and reduce stress. Then these were not enough because I was diagnosed with type 2 diabetes and then added a keto lifestyle into the mix. I am fairly confident that my approach is easily sustainable in my particular situation.

I have seen how other people approach keto and I would never be able to follow it in a million years because they do it to lose weight and then do all sorts of complicated calculations for macros and stuff. I have never done any of that. I just keep carbs down to 20g -ish per day and eat whatever I like. So far so good. I have always preferred to chomp on half a cucumber than an orange and I keep an eye on the nutritional balance of what I eat rather than calories or macros. Works for me. I have never been bothered about my diabetes because I decided from day 1 not to allow it to cause me any damage - I am lucky that my kind of diabetes is the sort that I have control over it. Fingers crossed it doesn't change.
 
Eddy Edson said:
Yep. Semaglutides and even more effective new med options in the pipeline will become increasingly available, and definitions of "remission" which might be an impediment to their use are not helpful.

The hard fact is that most people regain weight after losing it, not because of lack of will power or whatever, but because that is the way the brain is hardwired.

There is nothing in Roy Taylor's DiRECT study results to make me believe that the prospect of sustained remission via weight loss will do much to counteract that hardwired imperative. Specifically, at the 2 year mark, a bunch of people in the study lost remision because they regained weight. Mildrun is quite likely correct in guessing that a minority of the participants will still be in remission at the 5 year mark.

It's just another indication of the power of the hardwiring. Semaglutides etc reduce that power, allowing "will power" etc to actually work.

EDIT: Obviously it's not the case for everybody. All the major weight loss studies (eg the gold-standard Look AHEAD trial) show a small minority of people able to sustain weight loss for the long term. I seem to be one of them - sustained 20% weight loss for almost 4 years now, and in line with these studies, I weigh myself often, do a fair amount of regular exercise and pay attention to what I eat. But none of that would matter much if I weren't fortunate enough to have pretty weak hardwiring. I surely don't have exceptional will-power or whatever.
Click to expand...
I wonder if the hard wiring is part of evolution dealing with famines and lack of food in the past? It would be advantageous to be more food focussed if food is scarce and you'd be more likely to survive and pass on your genes to the next generation in times of scarcity.
The problem comes now when there's loads of food about (if you can afford to buy it) and it's not always the best sort of things to eat (burgers, pizzas, chocolate etc), but you still feel tempted to eat it anyway.
I know I struggle with my will power and will have to be on some sort of diet, probably calorie restricted, forever, to keep on the straight and narrow. And I have a sedantry job, so am unlikely to burn off weight with my vigourous typing and phone answering.
But I keep trying, even if I fall short sometimes, and short of having a gastric band fitted, there's not much else I can do about it.
 
Windy said:
I wonder if the hard wiring is part of evolution dealing with famines and lack of food in the past? It would be advantageous to be more food focussed if food is scarce and you'd be more likely to survive and pass on your genes to the next generation in times of scarcity.
The problem comes now when there's loads of food about (if you can afford to buy it) and it's not always the best sort of things to eat (burgers, pizzas, chocolate etc), but you still feel tempted to eat it anyway.
I know I struggle with my will power and will have to be on some sort of diet, probably calorie restricted, forever, to keep on the straight and narrow. And I have a sedantry job, so am unlikely to burn off weight with my vigourous typing and phone answering.
But I keep trying, even if I fall short sometimes, and short of having a gastric band fitted, there's not much else I can do about it.
Click to expand...
Stephen Guyenet's "The Hungry Brain" is worth a read, on how & why evolution has given us the hardwiring. I think it's pretty much the mainstream view now amongst experts in the field.

And see this for his good article explaining how the new weight-loss meds fit with that picture: https://forum.diabetes.org.uk/boards/threads/guyenet-on-weight-loss-meds.95831/
 
travellor said:
Yes, this often gets written whenever weight loss is mentioned.
But, for many of us, it's not about simply having the "right" blood glucose readings.
Even though is the easiest option for you.
Excess weight is bad for many things.
Diabetes made me realise I was a tub of lard on legs.
I prefer not to be fat now.
It that reverses my diabetes as well, it's win-win.
If not after that I still have, as you say, a few easy tweaks I could make.
(I probably literally have my cake and eat it)
Click to expand...
I lost 11.5kg - have put 1kg back on and that is on eating low carb and only 1000 calories a day. I want to lose 15kg so will have to have another go at the 700cal a day shakes diet.
I have a tendancy to put on weight it appears even on low carb.
 
Eddy Edson said:
How often do you find yrself playing the trumpet involuntarily?? There must be a story about that!
Click to expand...
Some people can be too pedantic for their own good. Harbottle is perfectly correct in his interpretation. I think nobody in the world would be able to triple tongue with their arse!
 
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