Remission

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Louisa36

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Type 2
Hi everyone
Hope you’re all doing good.
Been told I’m in remission from type 2 diabetes, but been told to keep taking metformin because the heart can suffer still from the illness, and I still have to have my eyes checked as I’m still prone to retinopathy, so if the diabetes is still affecting my organs how am I in remission??
I don’t get it?
 
This does seem conflicting as the definition of remission is 2 consecutive HbA1c tests below 48mmol/mol without medication.
Some people opt to continue with metformin even when their HbA1C is normal as in below 42mmol/mol.
My HbA1C is normal but I still get eye and foot checks and annual blood tests./
 
Thankyou for your reply I hope it means that because we are keeping our blood sugars low with diet and exercise that we are less likely to get complications from the illness, but I’m not sure if that is the case or not.
 
Louisa36 said:
Hi everyone
Hope you’re all doing good.
Been told I’m in remission from type 2 diabetes, but been told to keep taking metformin because the heart can suffer still from the illness, and I still have to have my eyes checked as I’m still prone to retinopathy, so if the diabetes is still affecting my organs how am I in remission??
I don’t get it?
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Well done if you've met the criteria for being considered to be in remission. In clinical terms remission means no signs or symptoms. Unfortunately It doesn't mean cured, or that your diabetes has gone away, but the symptoms of diabetes and any new damage it can do to your body are on pause as your blood sugar levels can rise again.. I've been in remission for over 4 years but I still consider myself to be diabetic, as does the NHS, since like @Leadinglights I still get diabetic eye screening appointments, foot checks etc.
 
Louisa36 said:
Hi everyone
Hope you’re all doing good.
Been told I’m in remission from type 2 diabetes, but been told to keep taking metformin because the heart can suffer still from the illness, and I still have to have my eyes checked as I’m still prone to retinopathy, so if the diabetes is still affecting my organs how am I in remission??
I don’t get it?
Click to expand...
Diabetes UK used to publish a list of 15 checks you needed a year once dxed with Type 2 Diabetes irrespective of your level of control. They might still publish it. You need to check that out. Type 2 is unremitting and progressive and you have got it to handle every day for the rest of your life at the moment. ‘Remission’ is the currently fashionable label for the traditional ‘Good Control’ that is being foisted on us at the moment but as you can see from your own experience it's not a particularly helpful label since it doesn’t change your genes, Metabolic Syndrome or Insulin Resistance. 85% of Type 2s die of cardio vascular/ heart causes so you definitely need to keep monitoring that. Metformin is heart protective because it has a cascade of minor heart protection effects which together add up to a significant amount of cardio/heart protection
 
My last two HbA1c results have been ‘normal’ but I’m still taking medication and I don’t think I will ever consider myself cured, especially as I’ve just had a rare carby lunch of cheese on crusty white bread and my BG is still 8.7 three hours later!!

It’s a stark reminder, for me at least, that I can never afford to take my eye off the ball when it comes to my diabetes.
 
Remission is a misnomer as it brings to mind other medical conditions to which the term is applied, like cancer. I was taken in by that general understanding of the word shortly after diagnosis, the idea that remission from diabetes was very much similar to a cure. I was disappointed and disheartened when I leaned that this is not the case, though am not at all sorry that I did everything I could to try to achieve it regardless.

Despite the gloomy outlook @Burylancs has on the subject - remission achieved though substantial and sustained weight loss does bring about positive change that goes beyond the simple 'good control' that can be achieved by the standard advice most Type 2s have been offered over the years - modest diet changes, exercise, and taking your meds. There are several regular users of the forum who can attest to more profound positive changes than a modest reduction in HbA1c, and I'm one of them.

That's not to say that I ever hope to be immune from health complications resulting from my diabetes. If I were to eat a big helping of cake right now, or a feast of pizza, my blood glucose would rise higher and stay high for longer than would be the case for a healthy person. That elevated blood glucose might cause me a little harm, which, if I were to eat poorly, frequently over a lifetime would very likely add up to cause or worsen problems with my heart or eyes for example. This would happen even if I were to maintain for life the weight loss that brought my blood glucose levels down to where they are now. I don't actually believe that new damage resulting from T2 can ever really be 'on pause', just limited as best we can. Achieving blood glucose levels in the remission range can make that easier to do however. It certainly is in my case.

Having a HbA1c in the 'remission' range is a great thing and you should be very proud of that. It can only be seen as an excellent achievement. As regards the annual eye checks though - better safe than sorry.
 
PerSpinasAdAstra said:
I don't actually believe that new damage resulting from T2 can ever really be 'on pause', just limited as best we can.
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That is what it actually says on this site's 'Type 2 Remission' page though.
 
Wow, thanks, that makes a lot of sense. I think I was young to get it because it runs in my family, but I’m constantly learning new things and I only had it 2 years, but I got my blood sugars down after first year.
 
Martin.A said:
That is what it actually says on this site's 'Type 2 Remission' page though.
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It does, though I can't bring myself to believe it. I did some testing using a Freestyle Libre 2 last month, by which time I had lost around 17Kg since diagnosis. During the 14 days I intentionally ate a range of foods that I've been largely avoiding and took screenshots of my blood glucose responses to those foods. The plan is to repeat the experiment in June, by which time I hope to hit my target weight, and again early next year. The idea to to determine whether my insulin secretion improves as Roy Taylor documented in his research, by eating a series of repeatable high-carb meals and creating BG graphs I can compare over time. I want to know if I have gained any greater capacity to process carbs over time following weight loss as Taylor suggests is possible, and use the information to guide my eating patterns in future.

During the 14 days of testing I had numerous big BG spikes, as you'd expect, but the calculated HbA1c for the two weeks remained very low. HbA1c is a good blood test but it is a reflection of average BG over several weeks to months. Big BG spikes make hardly a dent on HbA1c so long as they only last a few hours of the day. For this reason I don't trust that a series of low HbA1c test results would give me carte blanche to eat whatever I like - I don't trust remission-level blood test results to protect my eyes in the hours after a pizza feast. Maybe BG spikes are irrelevant in the context of a generally low average BG level. Maybe not. I just can't bring myself to believe that a low HbA1c result means that any potential harm from eating masses of carbs in one sitting is now 'on pause' so long as my next HbA1c is also low, if that make sense.
 
PerSpinasAdAstra said:
I just can't bring myself to believe that a low HbA1c result means that any potential harm from eating masses of carbs in one sitting is now 'on pause' so long as my next HbA1c is also low, if that make sense.
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It makes complete sense, which is why I still exclude anything high carb from my diet (not had a pizza since diagnosis, for example) even after more than 4 years of my BG being back into normal range.
 
PerSpinasAdAstra said:
It does, though I can't bring myself to believe it. I did some testing using a Freestyle Libre 2 last month, by which time I had lost around 17Kg since diagnosis. During the 14 days I intentionally ate a range of foods that I've been largely avoiding and took screenshots of my blood glucose responses to those foods. The plan is to repeat the experiment in June, by which time I hope to hit my target weight, and again early next year. The idea to to determine whether my insulin secretion improves as Roy Taylor documented in his research, by eating a series of repeatable high-carb meals and creating BG graphs I can compare over time. I want to know if I have gained any greater capacity to process carbs over time following weight loss as Taylor suggests is possible, and use the information to guide my eating patterns in future.

During the 14 days of testing I had numerous big BG spikes, as you'd expect, but the calculated HbA1c for the two weeks remained very low. HbA1c is a good blood test but it is a reflection of average BG over several weeks to months. Big BG spikes make hardly a dent on HbA1c so long as they only last a few hours of the day. For this reason I don't trust that a series of low HbA1c test results would give me carte blanche to eat whatever I like - I don't trust remission-level blood test results to protect my eyes in the hours after a pizza feast. Maybe BG spikes are irrelevant in the context of a generally low average BG level. Maybe not. I just can't bring myself to believe that a low HbA1c result means that any potential harm from eating masses of carbs in one sitting is now 'on pause' so long as my next HbA1c is also low, if that make sense.
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It was Always said that spikes were highly damaging and to be avoided and that was the thinking behind the Low Glycemic Index and Glycemic Load diets.
 
Burylancs said:
It was Always said that spikes were highly damaging and to be avoided and that was the thinking behind the Low Glycemic Index and Glycemic Load diets.
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If you say so, though as far as I've been able to gather it's not proven in humans. I haven't been able to find any good research along these lines performed on subjects who have had fasting blood glucose levels restored to normal (or where it was never impaired) and so can focus on spikes specifically. I imagine it would be difficult to separate new damage as a result of spikes from previous damage sustained while fasting BG may have been impaired (or due to other causes) - particularly cardiovascular damage.

I did read of a study where otherwise healthy rats were basically injected repeatedly with glucose to produce 'spikes', and those rats developed higher rates of cardiovascular-type health problems. That's the best analogue I've been able to find so far but it's compelling enough, along with the common-sense notion that big BG spikes lasting an hour or more are probably bad, that I still haven't touched pizza since diagnosis. Remission meaning damage is 'on pause' so long as a person eats carbs conservatively relative to their condition - maybe; it's at least plausible. 'On pause' meaning it's perfectly fine to order in from Dominos without any risk of consequences - I don't buy it.
 
Thankyou for all the reply’s. I feel I have a better understanding of my remission diagnosis now. I’m going to be careful after what you all said, and make sure I don’t eat too many carbs and get a spike. I don’t want to suffer unnecessarily when I’m older. This disease is really more serious than I thought, and need better management than I have been told by my nurse. I am glad this forum is here, I don’t feel so alone now and confused.
 
Martin.A said:
That is what it actually says on this site's 'Type 2 Remission' page though.
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I think there are a lot of semantic issues coming to the fore with the term, "remission". I don't see it as a misnomer, It just means you're asymptomatic. It doesn't mean anything else. That is why cured and remission aren't the same thing. I am in remission because my A1c is in the mid 5's. I have to work hard to stay that way by counting calories, carbs, and exercising daily. I can't say (with a straight face) that I no longer have diabetes. I think there are some people who can catch their illness early on and effectively cure themselves, I'm just not one of them.
 
mhtyler said:
I think there are a lot of semantic issues coming to the fore with the term, "remission". I don't see it as a misnomer, It just means you're asymptomatic. It doesn't mean anything else. That is why cured and remission aren't the same thing. I am in remission because my A1c is in the mid 5's. I have to work hard to stay that way by counting calories, carbs, and exercising daily. I can't say (with a straight face) that I no longer have diabetes. I think there are some people who can catch their illness early on and effectively cure themselves, I'm just not one of them.
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You and I are in pretty much the same place, so I couldn't agree more. I have no signs, no symptoms and take no meds - but I still consider myself to be diabetic and I know all those gains would be lost if, like you, I don't maintain my diet & exercise regime.
 
I don't know what state I am in. At a hba1c of 83, it means BG was averaging around 13 and I felt absolutely awful at the time.

I've had meals with 70g of carbs since losing weight and getting it back to a normal range, and tend to see a max around 8 before it falls back to normal.

I've never seen double figures (*).
Having said that, I stick to the same low carb diet apart from the odd 'treat' on holiday. I've got no intention of going back to 2021.

(*) Except for when I forget to wash my hands after peeling an orange.
 
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