Support for Remission

[crl]

On 16 March 23 I was diagnosed T2 (HbA1c 114). Today my HbA1c was 46. I am very happy with this reduction. I have been keeping my carbs low. My BMI is 23 so I am not overweight. I take 2000 mg of Metformin.
My question is this - where/ how do I get support to get remission? I have been following my own diet, cutting out potatoes and reducing bread to one or two slices per day. My exercise is golf, golf and more golf.
Are there any trials currently running I could join? I am in Scotland.

 

[Leadinglights]

You have done fantastically well in a relatively short time but to be in remission you would need to have 2 consecutive HbA1C tests in normal range without medication which means a dietary regime which you enjoy and thus is sustainable and is your new way of eating.
I followed the principal in this link https://lowcarbfreshwell.co.uk/ where there are low carb meal plans but it is essentially my own new way of eating. I was never on any medication just made dietary changes and am in normal range 2 years on

 

[Martin.A]

I agree with @Leadinglights - you've done fantastically well. You and I started from the same place. My HbA1c was also 114 at diagnosis although by the time I got successive results below 48 my DN had already told me I could stop my Metformin. That's a conversation you might want to have with yours if your next HbA1c is 3 months or more down the line and also below 48.

The current definition of remission - HbA1c remaining below 48 for at least 3 months, without diabetes medication - was agreed by a team from Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes. Since you're heading in the right direction keep doing what you're doing.

I have simply continued with pretty much the same diet & exercise regime that got me to remission in the first place.

 

[GazS]

I can only agree with @Martin.A and @Leadinglights. Well done!
I have recently (20/07) been diagnosed T2. I have ordered a Blood Glucose Monitor to keep an eye on my levels. However, my NHS app indicates that if I am asymptomatic I should have another blood test in four weeks. As they have given me three months to see if I can beat this into remission, I wondered if it was normal to have a blood test every month or does it wait until the third month? My HbA1C was 70 a month ago and 63 last week but I am confident that my lifestyle change will make a good impact.

 

[Leadinglights]

I can only agree with @Martin.A and @Leadinglights. Well done!
I have recently (20/07) been diagnosed T2. I have ordered a Blood Glucose Monitor to keep an eye on my levels. However, my NHS app indicates that if I am asymptomatic I should have another blood test in four weeks. As they have given me three months to see if I can beat this into remission, I wondered if it was normal to have a blood test every month or does it wait until the third month? My HbA1C was 70 a month ago and 63 last week but I am confident that my lifestyle change will make a good impact.

Usually it is 3 months as it takes that long for lifestyle changes to fully take effect, sometime a test will be done after a shorter time if the result is borderline.

What is HbA1c?

HbA1c is your average blood glucose (sugar) levels for the last two to three months. If you have diabetes, an ideal HbA1c level is 48mmol/mol (6.5%) or below. If you're at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol (6%).

www.diabetes.org.uk

 

[Martin.A]

The HbA1c test measures average BG over the previous 10-12 weeks so having another test earlier than 12 weeks later would overlap the earlier test. After 3 months it would be measuring the most recent 10-12 weeks.

 

[GazS]

Thank you @Martin.A and @Leadinglights

Ah, that makes sense - I was under the impression that they would take monthly readings and give an average, but what you both saying makes total sense. Its just a waiting game then!

Thanks again 🙂

 

[NeoUser]

I can only agree with @Martin.A and @Leadinglights. Well done!
I have recently (20/07) been diagnosed T2. I have ordered a Blood Glucose Monitor to keep an eye on my levels. However, my NHS app indicates that if I am asymptomatic I should have another blood test in four weeks. As they have given me three months to see if I can beat this into remission, I wondered if it was normal to have a blood test every month or does it wait until the third month? My HbA1C was 70 a month ago and 63 last week but I am confident that my lifestyle change will make a good impact.

Good luck with things, glad you're feeling confident with making lifestyle changes. Are you trying anything particular or just general healthy eating?

 

[everydayupsanddowns]

Well done in your terrific progress so far @crl

Keep doing what you are going! 🙂

 

[Burylancs]

The HbA1c test measures average BG over the previous 10-12 weeks so having another test earlier than 12 weeks later would overlap the earlier test. After 3 months it would be measuring the most recent 10-12 weeks.

HbA1c doesn't measure average BG. It measures something else entirely and there is a complicated formula for working out how HbA1c and bgs relate each other. In addition the HbA1c is weighted towards the last ten days. And it's a complicated dance, some blood cells lose the attached glucose over the three months and some that didn't have glucose attached to start with, gain it. Some argue that the HbA1c is given too much weight - it's value is that it's just an easy symptom to measure.

 

[Drummer]

I had a Hba1c just at the top end of normal for some time, eating no more than 50gm of carb a day.
I thought I would try to push it down into the 30s, so ate no more than 40gm of carb a day for a year, and my Hba1c was unaltered.
There might be a connection for some, but not everyone.

 

[Martin.A]

HbA1c doesn't measure average BG.

You'd better tell Diabetes UK that their webpage is wrong then:-

What is HbA1c?

HbA1c is your average blood glucose (sugar) levels for the last two to three months. If you have diabetes, an ideal HbA1c level is 48mmol/mol (6.5%) or below. If you're at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol (6%).

www.diabetes.org.uk

 

[everydayupsanddowns]

You'd better tell Diabetes UK that their webpage is wrong then:-

What is HbA1c?

HbA1c is your average blood glucose (sugar) levels for the last two to three months. If you have diabetes, an ideal HbA1c level is 48mmol/mol (6.5%) or below. If you're at risk of developing type 2 diabetes, your target HbA1c level should be below 42mmol/mol (6%).

www.diabetes.org.uk

HbA1c measures glucosylated haemoglobin, which is a reflection of general glucose concentrations over the life of circulating red blood cells (approx 120 days).

So for most forum members, and healthcare professionals (and national Diabetes charities) it is clear enough to say that it gives a measure by which you can assess average glucose levels over the past 3-4 months.

There is no direct mathematical way to convert fingerstick BG values to HbA1c, but an average of fingerstick values would be reflected in HbA1c. The higher the average glucose levels, the more red blood cells will be affected, and the higher the HbA1c.

I thought your post was clear and helpful @Martin.A 🙂

 

[GazS]

Good luck with things, glad you're feeling confident with making lifestyle changes. Are you trying anything particular or just general healthy eating?

Thanks @NeoUser
As my sciatic pain has subsided my wife and I have increased our regular walking (avg 4.5 - 5 miles a night).
My wife was already eating a really good diet, so I've taken some tips from her to compliment my own tastes etc.

 

[GazS]

@everydayupsanddowns So….generally speaking, assuming for the most part you are staying within healthy parameters for the fingerprick test, then you should be moving towards a healthier HbA1C? Or, if you are unable to achieve fingerprick tests within limits then medication is probably a given?

 

[everydayupsanddowns]

@everydayupsanddowns So….generally speaking, assuming for the most part you are staying within healthy parameters for the fingerprick test, then you should be moving towards a healthier HbA1C? Or, if you are unable to achieve fingerprick tests within limits then medication is probably a given?

That has been my experience. In general terms a lower average fingerstick glucose level associates with a lower HbA1c, but it’s less easy (almost impossible) to predict one from the other with any degree of accuracy - even if you have 24hr sensor glucose average data.

 

[crl]

I agree with @Leadinglights - you've done fantastically well. You and I started from the same place. My HbA1c was also 114 at diagnosis although by the time I got successive results below 48 my DN had already told me I could stop my Metformin. That's a conversation you might want to have with yours if your next HbA1c is 3 months or more down the line and also below 48.

The current definition of remission - HbA1c remaining below 48 for at least 3 months, without diabetes medication - was agreed by a team from Diabetes UK, the American Diabetes Association and the European Association for the Study of Diabetes. Since you're heading in the right direction keep doing what you're doing.

I have simply continued with pretty much the same diet & exercise regime that got me to remission in the first place.

An update on my remission journey. I started at an HbA1c of 114. Then 46. Then 44. I joined Nuffield gym and as part of the joining program my HbA1c was measured and it was 41. I have lost 3 stone. My cholesterol is down. My blood pressure is not down unfortunately.
At what point do I come off metformin? Is there an HbA1c value which would indicate that I should not be taking it any more.

 

[Martin.A]

At what point do I come off metformin? Is there an HbA1c value which would indicate that I should not be taking it any more.

Not that I'm aware of but there's no harm in you having that conversation with your GP/DN.

Well done on your progress to date.

 

[harbottle]

Great progress.
I was told to half my dose when I got hba1c in the 30s (From 1000mg to 500mg)
I was then told ‘there’s a case for stopping it and seeing what happens’ but as I was having no side effects I decided there was no harm in carrying on with 500mg
Halving it made no difference.