Remission; how do you know when you're there?

Status
Not open for further replies.
L

LilLady

Well-Known Member
Relationship to Diabetes
Type 2
Hello all,
I have a question I've been thinking about for a while regarding remission.
When I was diagnosed with diabetes last year my nurse spoke to me about remission being a possibility for me.
She also said she would recommend that I stay on Metformin for life as it has many benefits, protecting the heart being one.
My question is, how can I ever be considered to be in remission if I am still having diabetes medication or can you be in remission and still on Metformin (is it more about your HBA1C)?
If my HBA1C lowered drastically would my healthcare provider recommend stopping my meds or would I just continue unless I decided otherwise?
I've started to experience really low BG's (4.2) eating low carb and taking metformin and I am wondering if my dose is maybe now too high.
My HBA1C was 119 at diagnosis, August 3 months after it was 51, my next one is March.
Thanks
 
There's some information here which says "Remission is when your HbA1c — a measure of long-term blood glucose levels — remains below 48mmol/mol or 6.5% for at least six months. "

However, I've seen other definitions also, ones which say you have to be on no diabetes medication, I'll see if I can find a different one for you - I think the American diabetes organisation agreed one with a European org. Let me have a google.
 
International Experts Outline Diabetes Remission Diagnosis Criteria "Our international group of experts suggest an HbA1c (average blood glucose) level of less than 6.5%* at least three months after stopping diabetes medication as the usual diagnostic criterion for diabetes remission”
So it looks like you have to have stopped your medications, at least with this definition.
If you do get to be in remission, but are still on pills, would that be a bad thing? It's about being as well as you can be, the label is a bonus, but isn't the important thing (in my opinion) if you're getting side benefits from the metformin. You could ask for a reduced dose at your review and see what they say.

*6.5% is equivalent to 47.5mmol/mol
 
Last edited:
Thank you. I Appreciate that. I find so much conflicting information.
I am absolutely fine staying on my metformin and happy to continue taking it.
I know the benefits are great and I don't experience any side effects, so I've no desire to stop. I don't quite understand why so many people are desperate to come off their medication.
The question was more curiosity around, can you physically continue to take this medicine if you maybe don't need to.
Like would my body produce too much insulin? Would by BGs be too low?
 
Metformin doesn't influence the amount of insulin you make, it slows the liver down from squirting out as much glucose (this isn't a technical way of explaining, it's my limited, non medical understanding). So there's less glucose knocking about and the insulin your pancreas makes goes further.
It's probably a question for you to take to the nurse in March, particularly if you're getting low BGs and it's making you feel poorly. If you feel poorly a lot now with your low BG, then make the appointment sooner, and keep some sweeties or glucose tablets or Kendal mint cake, or fruit juice and have some of that to get your BG up so you're feeling better (no penguins!)
Sarah
 
Ha ha. No penguins. Got it.
Well I never knew this about metformin, I thought it helped your body to release insulin.
But saying that, even if that was the case I couldn't make too much could I. I got it my head that I was over producing because it wasn't getting released so there was an excess and then I was releasing too much at once. I just don't understand it all..
Silly me.
Il see how I get on, I am switching things up at bit at the moment and trying to lower my carb intake further. I think I am maybe crashing after eating carb heavy foods.
 
It's not silly not to know, we're all learning, all of the time.

There are medications which encourage your pancreas to make more insulin - gliclazide being the only one I know the name of. Hopefully your GP would have told you if you were on one of these. I'm guessing not as you've not mentioned it.

Best wishes with your lower carb intake diet - hopefully it'll stop the crashing. Sarah
 
I find it odd that these definitions mention being below 48mmol/mol rather than being below 42mmol/mol which would be non diabetic as being between 42 and 47mmol/mol would place one 'at risk' or prediabetic.
I personally feel being below 42 is a safer option.
Medication seems to be prescribed without much explanation of how it works on the body leading to the frequent misconception that all people need to do is take the pills without making lifestyle changes.
 
Windy said:
International Experts Outline Diabetes Remission Diagnosis Criteria "Our international group of experts suggest an HbA1c (average blood glucose) level of less than 6.5%* at least three months after stopping diabetes medication as the usual diagnostic criterion for diabetes remission”
So it looks like you have to have stopped your medications, at least with this definition.
If you do get to be in remission, but are still on pills, would that be a bad thing? It's about being as well as you can be, the label is a bonus, but isn't the important thing (in my opinion) if you're getting side benefits from the metformin. You could ask for a reduced dose at your review and see what they say.

*6.5% is equivalent to 47.5mmol/mol
Click to expand...
In the conditions I read, it said that metformin was allowed. Meaning you could be considered to be in remission yet still taking Metformin. I believe that was the internationally agreed definition of remission, since I recognised major international diabetes remission specialists and organisations on the list of those who had agreed it. Virta, Fung, Unwin etc.
In the other forum many people who've had HbA1C below 40 for several years are still taking Metformin, though not as many as have come off all diabetes meds including Metformin.

As has been already said, the risk of diabetes complications remains elevated even when you get HbA1C down to 'Pre-diabetic' or 'At Risk from Diabetes' levels. Also the US pre-diabetic level cut off is the equivalent of 36 not 42 as it is in the UK. Thus in the USA I would still be considered pre-diabetic, so I'm still aiming to reduce my HbA1C nearer to 30 than 37.
 
Personally, I don't define remission by a number, or what you get there with.

I achieved a lifestyle that suits me and which keeps my BG at a level that doesn't cause diabetic complications. That works for me.
Others achieve the same with diet control, others allow meds in the mix.
Others try to keep BG readings well below the spikes non diabetics see, or drive the numbers down to their own targets.

I was the same as your nurse, I wanted to stay on Metformin as it certainly has other benefits.
Unfortunately, your HCP won't prescribe it once you are no longer diabetic.
It at least mine wouldn't.
So that depends on their view on what makes someone diabetic or not.
 
travellor said:
Personally, I don't define remission by a number, or what you get there with.

I achieved a lifestyle that suits me and which keeps my BG at a level that doesn't cause diabetic complications. That works for me.
Others achieve the same with diet control, others allow meds in the mix.
Others try to keep BG readings well below the spikes non diabetics see, or drive the numbers down to their own targets.

I was the same as your nurse, I wanted to stay on Metformin as it certainly has other benefits.
Unfortunately, your HCP won't prescribe it once you are no longer diabetic.
It at least mine wouldn't.
So that depends on their view on what makes someone diabetic or not.
Click to expand...
This is interesting.
At my diagnosis I was started on the usual 1 tablet a day, week 2 we went to 2.
My nurse said in time once I was tolerating the metformin well, I'd go to 3.
So I had my review with a different nurse and my HBA1C had gone from 119 to 50 in three months, I asked about the third dose and she said you don't need it, to bring your levels down that quickly, it's evident you're on the optimal dose a third would take your BG a little too low and you would feel rubbish.
So she's fully expecting my HBA1C will be down further in March, that Will be 9 months post diagnosis. So if they're really good and continue that way maybe they will just stop prescribing?
 
Status
Not open for further replies.
Back
Top