Reversing Type 2 diabetes.

[TinaD]

I think it would be helpful if there was a clear description of what is meant by "reversing diabetes". At recent GP consulataion was told "you are no longer diabetic". Since I have had 2 HbA1c test showing me well below 48 (most recent was 35) this, in his view, demonstrated a "cure". Since my blood glucose monitor records enthusiastic spikes if I go over 20gms of carbs a day and, when on one naughty day I ate some puff pastry it not only shot up to 13.8 at 2 hours (I stopped testing at that point and put my paws over my eyes) but stayed outside normal limits when measuring FBG for 4 days, I think that is wrong. It might be accurate to say that I had "good control of the disease" or even that I was in "remission" but surely it can only be a "cure" if my body is now able to handle carbohydrates normally? Sadly it isn't and a happy return to roast potatoes/Yorkshire pudding/apple pies etc (let alone pasta, fried rice, naan, meringues, cake and sugar in tea) would put me back to square one. Is it not dangerous to assure a patient that they are "cured" without a) discussing diet sensibly and/or b) carrying out a glucose tolerance test?

 

[pm133]

I would agree with you on this.

I would say that you are not cured if you cannot return to eating normal levels of carbs without your blood glucose spiking.

Personally, I wouldn't even call your situation remission - for the same reason.

You certainly have good control of your diabetes and that's the main thing.

If you returned to normal eating, I suspect your next HBA1c test (if you can persuade them to give you one) would be back into diabetic range. I think they need to be ensuring that after normal eating for 6 months to a year that your HBA1c is normal before they start talking about remission. I'm not sure they can or should ever be using a word like "cure" because your remission could end at any point.

 

[Drummer]

I think you can definitely be certain that anyone who claims a diabetic is cured of the problem doesn't understand it.
I am classed as in remission, and I can eat more carbs without seeing high numbers - but next day there they are on the scales and it takes days to reduce back down again.
Type two diabetes is an inability to deal with carbs, often with very easy weight gain as well, in its simplest form.
I find that I can eat more carbs when they are from low carb veges - my maximum is 40 gm a day, but I spike if I eat the same amount of carbs from ordinary bread or cake - and my insides are really noisy these days too.
Luckily I can make low carb bread for myself as regaining weight would most likely go along with higher Hba1c levels and being back in diabetic numbers very quickly.

 

[TinaD]

There is no cure, but remission is possible for some. However, those in remission still have to stick to a low carb way of eating or they will be back where they started. Once you're diagnosed it's for life. There's no route back to normal.

This attachment explains it very well.

Is it not a shame that so many GPs do not read what is readily available or (sorry, pedantic old lawyer) properly define their terms? I am not of the view one can count as "remission" a state which can only be maintained by strict adherence to a low carb diet. I would take remission to be a period in which, whilst eating a normal mixed diet, blood glucose levels were normal and other symptoms absent. A "cure" would imply that the same state would endure permanently.

 

[TinaD]

Maybe, but in medical terms 'remission' is considered to be the reduction or disappearance of the signs or symptoms of a disease, so it pretty well fits the bill if your HbA1c is back in the normal range and you don't need medication anymore.

Martin

The signs and symptoms would not have disappeared without the "treatment" of restricted carbohydrate consumption. Surely that is good control of diabetes not remission?

 

[trophywench]

Exactly - and TBH I'd rather like to keep the standard annual checks (- not quite the full 15 LOL) possibly for ever!

 

[Clifton]

1. Type 2 diabetes is not curable and is a life-long chronic condition. Any HCP who suggests diabetes T2 can be "cured" is being reckless and unprofessional in my opinion.

2. Remission is achievable for some but that remission requires great control over the critical factors affecting blood glucose. With 40+ factors known to have an affect on blood glucose levels individuals can only do so much - diet and exercise being key.

3. Good blood glucose control is the correct phrase. Keeping BG within parameters which are "safe" could enable remission; a return to habits which will elevate BG levels could negate all the hard work.

That's my take. You've done brilliantly.

 

[Felinia]

My GP surgery made it clear to me that diabetes is for life and I would be monitored for the rest of mine. I was told I could reduce my blood glucose through diet, exercise and weight loss but even if I got my HbA1c below 42, I would just be a well controlled diabetic, not "cured". Remission was never mentioned by the surgery.

 

[AndBreathe]

To be honest, I think the concept that diabetes can be progressive in both directions (worse/better) is relatively new to the medical community, and unless there are several published, peer reviewed and validated papers, it's almost like it can never exist. It takes a very long time for the professions to catch on to change, in my view.

There are some people for whom returning to their former ways of eating are OK, but usually their improvement is accompanied with a significant weight loss, and a somewhat more efficient metabolic process. For those who achieve that situation, it isn't very clear yet how long they might be able to maintain that, given at any time in our lives there are a lot of factors in play, in terms of our health - some we can control, some we can try to manage and some which are not in our control.

Personally, my medical records show my status as "Diabetes Resolved". I still have an annual A1c and retinal screening. I don't have diabetes reviews or my feet tickled, but then, I've only had either of those once each. I do keep an eye on myself (in terms of self-monitoring) and I do take great care of my feet.

There is work going on in academia with people who have found themselves resolved/reversed/in remission/cured, or any other name you like to use to describe those who have had a diagnosis of T2, then serial A1cs below the diagnostic threshold. Of course, it'll take time for the outcomes of that research to be know, but some of it is, in my view, very exciting indeed.

Bottom line is, in my view, that T2 is quite a grown up problem, and we have to take a grown up approach to it and try our vary hardest not to lose sight of the potential consequences if we choose to be ultra gung-ho or ignore any warning signs.

Full disclosure: I have signed several non-disclosure agreements relating to parts of this academic word, so please don't ask me to tell you all about it.

 

[Clifton]

Hi there. My brother is a medical professional and is involved in advanced endocrinological research at a well known university. He'd also I am sure dispute some of the assertions made but a debate is always welcomed in the advancement of diabetes management.

 

[everydayupsanddowns]

Contratulations on your diabetes management @TinaD - you certainly seem to have found an approach that works for you.

I think a large part of the problem here is that T2 is really an umbrella term for a collection of related, but slightly different metabolic disorders. Official estimates vary as to the number of different shades, but I’ve seen 70+ being suggested in a presentation at a conference!

We have members on the forum who have achieved the ‘remission’ state as defined in the DiRECT trial (multiple A1cs below 48 with no medication) through significant weight loss, and this seems to have ‘rebooted’ their metabolism such that they can indeed now eat carbohydrates ‘normally’ with no adverse effects on their BG levels.

Others like you Tina, achieve their results by constant, consistent and ongoing management. And I completely agree that remission and certainly ‘cure’ seems inappropriate terminology in your case.

 

[TinaD]

Yes, Newcastle seems to have demonstrated potential reversal by unclogging liver and pancreas of fat through strict diet and loss of usually 15kg. However they do not refer to this as a cure. https://www.ncl.ac.uk/media/wwwncla...centre/files/2020 Information for doctors.pdf identifies that they do not claim a complete cure but say that reversal (otherwise described as remission) endures as long as weight is not regained. (The bariatric surgeons claim multiple "cures" but I assume that the same caveat applies. ) Interestingly the paper notes that success is relevant to insurance but that annual and retinal checks should be continued.

Meanwhile I am happy to report that furusemide seems to be dealing slowly with the heart failure related oedema - have lost 5kgs since Wednesday! I think I can safely say that I am off what I had originally perceived as a "plateau" and am merrily coasting downhill again. Can't wait to get into the next size down...

 

[TinaD]

Hmm. Have lost a further 2.2kilos in 6 days - and the legs are still swollen, although somewhat reduced, with red skin and purple blotches up to mid calf.
Got a message to make an appointment to speak to GP (oh,joy) so rang to be told I couldn't make an appointment until Monday as it was after 11a.m. (had been ringing since 8.30 but unable to get through). Managed to get receptionist to read out the consultant's letter which had precipitated this - apparently consultant has changed and he/she wants to change the drug....(Patient confidentiallity - who expects it with today's NHS).
Am now into the size down, BMI 23.5....like the wicked witch of the west "I'm melting, I'm melting". Didn't expect the tummy shrink - thought it would just be legs.
FBG a smidgeon higher - averaged over 7 days 5.58 - which could be related to increased calorific intake (eating more 'cos a tad bothered) - but also walking an extra 2.5 kilometres each day (as dog has taken to escaping from garden and chasing my sheep so has to go "walkies" on a lead).
.

 

[pm133]

Bottom line is, in my view, that T2 is quite a grown up problem, and we have to take a grown up approach to it and try our vary hardest not to lose sight of the potential consequences if we choose to be ultra gung-ho or ignore any warning signs.

I'm genuinely confused by this paragraph.
I have no idea what you mean.

 

[pm133]

Hmm. Have lost a further 2.2kilos in 6 days - and the legs are still swollen, although somewhat reduced, with red skin and purple blotches up to mid calf.
Got a message to make an appointment to speak to GP (oh,joy) so rang to be told I couldn't make an appointment until Monday as it was after 11a.m. (had been ringing since 8.30 but unable to get through). Managed to get receptionist to read out the consultant's letter which had precipitated this - apparently consultant has changed and he/she wants to change the drug....(Patient confidentiallity - who expects it with today's NHS).
Am now into the size down, BMI 23.5....like the wicked witch of the west "I'm melting, I'm melting". Didn't expect the tummy shrink - thought it would just be legs.
FBG a smidgeon higher - averaged over 7 days 5.58 - which could be related to increased calorific intake (eating more 'cos a tad bothered) - but also walking an extra 2.5 kilometres each day (as dog has taken to escaping from garden and chasing my sheep so has to go "walkies" on a lead).
.

That is well over a stone you've lost in a week and a half which is really unusual.
Are you exercising significantly more than normal?

 

[TinaD]

That is well over a stone you've lost in a week and a half which is really unusual.
Are you exercising significantly more than normal?

Not really - have added in the 2.5 kilometres for the dog - but I am normally pottering about checking sheep, pony, chickens, and gardening or fixing things. I am pretty sure it is water which is now being lost and which had built up in the tissues as a result of the failing heart. I had been irritated to be stuck on a plateau despite strict keto, then as the oedema got worse I actually gained a couple of kilos, which with accompanying red, stretched, shiny skin had me hot footing it to the GP. The diuretic has reduced the oedema significantly but still far from normal. 7.2 kilos of water is 7.1 litres of the stuff which is quite a lot to ram into a pair of legs and as tum has shrunk I assume there was some more stored in that location. Hope the Consultant's appointment comes through soon and can explain it.

 

[AndBreathe]

I'm genuinely confused by this paragraph.
I have no idea what you mean.

I mean it (T2) is a condition not to be toyed with or ignored. You can try to ignore it, but be aware, it won't be ignoring you. It'll be getting on potentially doing harm.

For those who have achieved remission/reversal/resolution/cure/whateveryouwanttocall it, it is wise to be mindful that without vigilance it can romp back into our lives.

 

[Clifton]

It killed a good friend of mine in his 50s a decade ago. You can be sure I still see the anguish on the face of his widow...

As @AndBreathe rightly says, without vigilance and continual awareness, the beast will return with a vengeance all of us can do without.

 

[Deleted member 21371]

I'm "cured"
Normal BG, I eat carbs.
It does seem there are two approaches.
Low carb, which from the previous responses, certainly only appears to mask the symptoms, or targeted treatment, such as very low calorie diets, which does seem to achieve a reset, and enable a normal diet again.

 

[TinaD]

I think that LowCarb does not "mask the symptoms" but prevents them being present and causing harm whilst the weight loss is achieved. Even Newcastle study does not claim 100% from signicant weight loss (more like 46%) nor does it appear from other research that a very low calorie diet is regarded as a "targeted treatment". Instead it seems that any dietary or surgical intervention which clears visceral fat, particularly fat clogging up liver and pancreas, restores those organs to close to normal function, thus permitting carb consumption. Sadly the research so far indicates a) it doesn't work for everybody b) the situation can reverse if the weight (otehr than a v. small amount) is regained.