The CarbScale

[beating_my_betes]

Yes, that’s true. And yet the term ‘reversal’ is highly emotive for some members here. Diabetes was once believed to be inevitably progressive. Now it has become clear that it can be held in stasis (at least for a while - several years, even a decade or more).

For me it’s along the lines of the Language Matters project.

It’s obliquely akin to the differences between ‘diabetic’ or ‘person with diabetes’, of ‘diabetes control’ vs ‘management’. And many other terminological options.

There are subtle differences, nuances in the way some of these terms are understood, and what they convey, or may be believed to be conveying or implying.

And the terms we use do have a pervasive power to affect our thinking, and even in some cases our actions.

I understand the idea of 'Language Matters' and the idea of choosing non-personal and avoiding potentially blaming language, but i dont think this would fall under it, nor should it. The terms 'remission', 'cure', 'reversal' etc. are not personal terms, but terms used to refer to states or stages of medical issues. With LM we might say one has fat rather than one is fat. In both cases "fat" exists. It only becomes offensive when it is used in a way that suggests personal blame for the situation or that it is an absolute, never changeable trait of one's being.

But that doesn't apply in the context of this thread. Those that are getting angry about the use of the term reversal seem to be quibbling about the (mis)use of the term itself, not how it could be deemed a personal slant.

I'm definitely not a "this is political correctness gone mad"' kinda bloke. And while I would refer to myself as a fat diabetic, rather than someone replete with extra weight and sugar issues, I do understand the need to be more inclusive with language in a forum such as this. I just don't think the reverse/remission thing qualifies.

Incidentally, similar thing as LM comes up on vegan forums quite often. In this case, pertaining to animal themed idioms 😉

https://www.peta.org/teachkind/lesson-plans-activities/animal-friendly-idioms/

 

[everydayupsanddowns]

@beating_my_betes my recalling Language Matters (and I tried to be clear that the reference was oblique) is that the words we use matter. That they convey, or communicate, or imply certain things.

And it is good tone careful about the terms we use. Such as choosing to avoid the term ‘cure’ when talking about remission. And understanding that reversal and remission can mean the same thing and be interchangeable to one person, while simultaneously communicate slightly different things, promises, and expectations to another person.

 

[beating_my_betes]

@beating_my_betes my recalling Language Matters (and I tried to be clear that the reference was oblique) is that the words we use matter. That they convey, or communicate, or imply certain things.

And it is good tone careful about the terms we use. Such as choosing to avoid the term ‘cure’ when talking about remission. And understanding that reversal and remission can mean the same thing and be interchangeable to one person, while simultaneously communicate slightly different things, promises, and expectations to another person.

Thanks! But this still doesn’t make anything clearer.

Words mean things, and in most cases aren’t open to interpretation. Even if you could define remission and reversal such as they'd be clearly distinct, that would still leave the question of why those of us who would prefer to be able to reverse their diabetes should be given clear reasoning as to why reversal is either not possible, or acknowledge that it is but tell us to not refer to the word.

Unfortunately the person who seems most offended by its use isn’t willing to discuss it.

 

[harbottle]

Untrue. I certainly have read Taylor's work even in the early days. And praised his assertion even before DiRECT that a diagnosis of Type 2 should be treated as a medical emergency. Last year I simply asked JITR for a list of Taylor's work so I could check out some points again.

Someone made a comment about the 'first phase insulin response' being restored, and you asked 'where does it say this?' (Or something similar.) It felt very much like you had not realised this was a key part of his research and the reason why the participants who 'responded' gained remission.

 

[Burylancs]

The Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes was published in 2021. It explains why 'remission' and 48 mmol/mol were chosen. Roy Taylor and Douglas Twenefour (Diabetes UK) were members of the international expert group.

Quote: The group also made suggestions for active observation of individuals experiencing a remission and discussed further questions and unmet needs regarding predictors and outcomes of remission.

1. The four bodies responsible for this definition were all political lobby/pressure groups. No medical or scientific body was involved. As such the result is a social definition of ‘ remission’ not a medical or scientific one . They should have left it to the WHO.

2. Diabetes UK should not have got involved in this. Making would-be medical decisions and definitions is not in its remit.

3. Roy Taylor should have recused himself from this exercise. As a leading advocate of ’Remission of Diabetes’ he could not offer an objective or unbiased view of it.
Douglas Twenefours was a low carb enthusiast.

Although, interestingly enough, this Consensus rejected Taylor's definition of remission. In DiRECT he had defined 3 factors for remission ; the two here plus no anti-hypertensive medication. Of course high BP has to be treated aggressively in Type 2 so the group was probably right to kick that feature of Taylor's version of remission into touch.

 

[Burylancs]

Thanks! But this still doesn’t make anything clearer.

Words mean things, and in most cases aren’t open to interpretation. Even if you could define remission and reversal such as they'd be clearly distinct, that would still leave the question of why those of us who would prefer to be able to reverse their diabetes should be given clear reasoning as to why reversal is either not possible, or acknowledge that it is but tell us to not refer to the word.

Unfortunately the person who seems most offended by its use isn’t willing to discuss it.

It's simply a matter of Logic BMB - if you claim to be in 'remission' from Type 2 Diabetes you clearly haven't 'reversed' it. And if you claim to have 'reversed' it you clearly can't still be in 'remission' from it. The two terms are contradictory and mutually exclusive. Don't use either, go back to the age old terminology of Good Control. That was always good enough until the last few years

 

[beating_my_betes]

It's simply a matter of Logic BMB - if you claim to be in 'remission' from Type 2 Diabetes you clearly haven't 'reversed' it. And if you claim to have 'reversed' it you clearly can't still be in 'remission' from it. The two terms are contradictory and mutually exclusive. Don't use either, go back to the age old terminology of Good Control. That was always good enough until the last few years

Thanks! But none of this seems relevant to what I'm asking, nor does it really explain why you were angered in the way you were.

So far, it seems to be the case that remission is used because even though we've come to accept that T2D is not necessarily always a progressive disease, we're supposed to believe that it can't be healed/cured/reversed. The idea seems to be that because diagnosis is taken from a (seemingly arbitrary) sliding scale, rather than a binary state, that it's possible, depending on when your bloods are taken, to switch between beign diabetic and in remission with every incoming season.

But if we instead see T2D as the inability to deal with carbs, via insulin resistance, then that gives us a clearer metric by which we can judge whether we are diabetic or not, and whether we have reversed the condition of not being able to effectively metabolise carbs.

 

[harbottle]

"Good enough until the last few years"

It may have been, but it seems the view of the condition has changed in recent years.

Remission is used to acknowledge no medication and absence of diagnosable diabetes. However, it's not 'cured' as the risk it can return is still there. Hence why you still get the annual checks.

I was told on diagnosis that losing weight and changing lifestyle can get it in remission for some people. Which is what I did, and one reason the term was introduced was to encourage people to make these changes and try to avoid medication.

 

[harbottle]

But if we instead see T2D as the inability to deal with carbs, via insulin resistance, then that gives us a clearer metric by which we can judge whether we are diabetic or not, and whether we have reversed the condition of not being able to effectively metabolise carbs.

Type 2 diabetes is a combination of insulin resistance and dysfunctional beta cells.
Even if you reverse the insulin resistance, if beta cells do not start working again, you will struggle to metabolise carbs.
Hence the 'non responders' in the Direct trial.

 

[beating_my_betes]

Type 2 diabetes is a combination of insulin resistance and dysfunctional beta cells.
Even if you reverse the insulin resistance, if beta cells do not start working again, you will struggle to metabolise carbs.
Hence the 'non responders' in the Direct trial.

But in that case, those people wouldn't be able to achieve reversal. That doesn't mean that nobody can reverse the condition.

 

[harbottle]

But in that case, those people wouldn't be able to achieve reversal. That doesn't mean that nobody can reverse the condition.

I never said that.

 

[Eddy Edson]

I call it "cured". Not very fussed what anybody else prefers.

 

[Drummer]

All my adult life I have had problems with carbs - before that, at home, we ate low carb because that was how all my mother's sisters and one of her brothers kept house.
The whole family - I now realise, become wider as they age if they do not watch the carbs - I can easily claim to have reversed my diabetes as I have gone back to what I should have been doing all my life.
If I began to follow the advice I got from my early 20s onwards and ate a high carb low fat diet, I would be fine for a few weeks - maybe for some months until the wrong diet caught up with me and I started out on the road to high glucose, more fat, less energy.
I have this particular metabolism, DNA - whatever - which cannot cope with carbs in the amounts recommended as 'healthy'. I am never going to be other than I am, but I am not classed as diabetic simply because I do not follow the advice, the scolding, the insults, the sneers or the blame game any longer.
I am potentially, 'a very bad diabetic' - direct quote from the diagnosing GP.
The term used is totally irrelevant, to my way of thinking.
I had background retinopathy at the first test, I did not at the second test.
I had high blood glucose, I do not have that now.
My Hba1c was 91, and now it is in the 40s.
I was massively overweight, now I need smaller clothes about once a year.
If it is called remission, reversal, I'd even go for recovery - it is just a word, it is where I am it is where I will stay if at all possible - I have that this is the hill I will die on mentality which has exasperated many in my time - but arguing over a word to describe a successful treatment seems a bit of a waste of energy, to be honest.

 

[Docb]

I call it "cured". Not very fussed what anybody else prefers.

And I call it controlled, deliberately never using reversal or remission, but see no point in going to the barricades if somebody else wants to use those terms.

Taking my moderators hat off, I have a bit of a suspicion that @Burylancs might have a bit of a point in that maybe unnecessary words are being invented in order to claim ownership of the phenomenon and enhance a brand image - not unusual in academic circles.

 

[effayjay]

View attachment 35620
From the Amazon 'Read sample' of Katie and Giancarlo Caldesi's The Reverse Your Diabetes Cookbook.
Tip: follow the link and click 'Read sample' under the cover image (top left).
Includes a useful introduction to low carb from Jenny Phillips, a dietitian.

This book was one of two that took me from HbA1C of 89 to 30 in a matter four months. Terminology relatively unimportant, at least from my perspective.

 

[Burylancs]

This book was one of two that took me from HbA1C of 89 to 30 in a matter four months. Terminology relatively unimportant, at least from my perspective.

Hi,
How are things now ?
You were on Metformin as well and were in two minds about whether to continue with a low dose. Did you give up the metformin in the end ? Have you a link to Prof Spector's work on the benefits of low dose metformin please ?

 

[harbottle]

He takes it because his blood glucose was 'near' pre-diabetics levels, I believe, but I don't think he's done any studies on it. He takes it because of evidence it can help prevent the progression to diabetes/pre-diabetes.

I read a book by him where he was surprised to see his BG go over 10 when he had oats for breakfast.

So I guess he's not in 'remission' from his non-diabetes as he's taking a dose of Metformin. 🙂🙂🙂🙂

 

[effayjay]

Hi,
How are things now ?
You were on Metformin as well and were in two minds about whether to continue with a low dose. Did you give up the metformin in the end ? Have you a link to Prof Spector's work on the benefits of low dose metformin please ?

I had a blood test in March and HbA1C was 29. Haven’t had a review with the DN yet so still popping 1x 500g metformin a day when I remember. If you google Tim Spector metformin lots of articles appear but many behind a paywall eg The Times. It doesn’t cause me any noticeable side effects so, given the possible benefits, I’m not pushing to come off then.

 

[effayjay]

He takes it because his blood glucose was 'near' pre-diabetics levels, I believe, but I don't think he's done any studies on it. He takes it because of evidence it can help prevent the progression to diabetes/pre-diabetes.

I read a book by him where he was surprised to see his BG go over 10 when he had oats for breakfast.

So I guess he's not in 'remission' from his non-diabetes as he's taking a dose of Metformin. 🙂🙂🙂🙂

Is metformin a wonder drug? - Harvard Health

Metformin, a medicine prescribed to treat type 2 diabetes, also has cardiovascular benefits and is used off-label to treat other conditions. Interest is growing in its potential to help lowe...

www.health.harvard.edu

My understanding is that he takes because of his interest in the possible benefits as alluded to in articles such as this one.

 

[Burylancs]

He takes it because his blood glucose was 'near' pre-diabetics levels, I believe, but I don't think he's done any studies on it. He takes it because of evidence it can help prevent the progression to diabetes/pre-diabetes.

I read a book by him where he was surprised to see his BG go over 10 when he had oats for breakfast.

So I guess he's not in 'remission' from his non-diabetes as he's taking a dose of Metformin. 🙂🙂🙂🙂

Who ?