Targeting remission !

[FoggyPhil999]

Hi all, having woken up and smelt the coffee… my target now is to go into remission, so any pointers would be appreciated. The latest twist was to get a CGM (DEXCOM) which has highlighted what damage I was doing to myself. The last HB1AC was 60, has been 90 before !! I am due another test soon and predict a reading of under 40 as I have got to drops with this problem. I am taking Metformin and gliclazide but have stopped taken gliclazide in the evenings as I was getting hypos. I think once the GP sees my latest figures, that my medication will be reviewed. Question: what does remission mean in terms of medication ? Does it mean I shouldn’t be on medication or continue having to take it but at maybe reduced quantities ?

 

[Eddy Edson]

The formal definition of remission is this:

Type 2 diabetes remission is when your long-term blood sugars fall below the diabetes level and stay there for at least three months, without the need for glucose-lowering medication.

In medical terms, this means having a HbA1c below 48mmol/mol or 6.5%. This definition has been agreed by a team of international experts from here at Diabetes UK, the American Diabetes Association, and the European Association for the Study of Diabetes.

What is type 2 remission?

Type 2 diabetes remission is when your long-term blood sugars fall below the diabetes level and stay there for at least three months, witho

www.diabetes.org.uk

But it wouldn't be smart to get too hung up on the goal of stopping meds. Eg if you're taking an SGLT2i then it might have additional cardiorenal benefits beyond anything to do with blood glucose. And of course the "remission" question shouldn't factor in to whether you keep taking non-BG-related meds, like statins or BP meds.

 

[FoggyPhil999]

Very helpful, thank you. I think I was keen on dropping Metformin and gliclazide but will obviously be guided by my GP
Phil.

 

[PerSpinasAdAstra]

I've certainly drawn hope and purpose from my efforts to achieve remission, and I wish you the very best of luck. From everything I've read there are three pillars to achieving remission - weight loss, diet, and exercise. Almost every account I've read of people achieving remission has involved at least two of the three.

Weight loss - According to Prof. Roy Taylor a person should aim to lose at least 15Kg (around 2.5 stone) or 15% of their body weight, whichever is the smaller number. Any weight loss may help but according to Taylor this is a reasonable target to aim for in order to empty your liver of fat and prevent it from re-accumulating. Reducing liver fat may reduce insulin resistance in that organ and lead in time to reduced fat in the pancreas, which may improve levels of insulin secretion.

Diet - Lowering how much carbohydrate you eat will reduce your blood glucose levels in the hours after eating. To illustrate the point I've attached two modified screenshots from my own CGM, which I've been experimenting with. The first shows the effect of eating a relatively low-carb breakfast (an omelette with yellow peppers and tomatoes followed by a small orange) and the second shows the effect of eating a higher-carb dinner (chicken stir fry with white rice). You can see that there is a big difference in how high my blood glucose levels got after eating.

Exercise - Working your muscles improves their insulin sensitivity and causes them to sponge up more glucose from the bloodstream. Exercise at any time of day helps, but the third screenshot illustrates the significant effect of moderate exercise beginning about 30 minutes after eating. I had Asian food delivered, which I ordered with brown rice. The rice portion is generous and usually I wouldn't eat it all, but as an experiment I ate the lot, waited for digestion to get well underway, and went for a 3 mile brisk walk. The idea was to be moving during the time my blood glucose levels should be peaking after the meal. The meal was high in carbs, equivalent to more than three slices of bread, but you can see that exercise actually reduced my blood glucose levels at a time when they would otherwise be getting very high. If you can incorporate exercise into your daily routine then this will likely reduce your average blood glucose levels and your HbA1c.

Do keep in mind that if you switch to a low-carb diet while on gliclazide you may need the dose reduced or even stopped depending on how low you go with carbohydrate intake, in order to prevent hypos. Experiment with care, and the very best of luck!

 

[Eddy Edson]

Weight loss - According to Prof. Roy Taylor a person should aim to lose at least 15Kg (around 2.5 stone) or 15% of their body weight, whichever is the smaller number.

Just to note that the ~15kg / 15% target arises from the DiRECT trial, which focused on people with overweight/obesity.

For people with sub 27 BMI, the target arising from the ReTUNE trial is more like ~10kg. That's what worked for me.

 

[FoggyPhil999]

Very informative, good tips in your comments. I too, have lost the weight, getting plenty of exercise. Also mindful of carb and sugar intake. Will try the walking after eating, theory sounds good.
Thank you.

 

[JITR]

In general T2D upsets the balance of hormones, enzymes and signalling in the body. Whatever their aims Metformin and other medications recommended by NICE create further disruption. Achieving remission by diet, and exercise where possible, should be recommended to all newly diagnosed T2Ds. In fact the aim of the diet is to reverse fatty liver and pancreas it should be recommended to all prediabetics as well. The main issue is achieving a consensus on what diets are best for achieving and sustaining long term remission. The New Dawn project is a step in the right direction. Still the 150,000 odd newly diagnosed every year and the estimated million waiting in the wings need better guidance. A Concerted Action could achieve that.