The diabetes fairy is at it .....

[Docb]

Dunno what is going on but I am struggling to get my BG up! In the 4's all day despite jelly babies and biscuits on top of the sort of things I have been eating for the last couple of weeks. Battered fish and a couple of hundred grams of chips pushed it up to 7.1 early evening but it is back to 4.4 at bed time. Spoke to DN and have agreed to cut the gliclizide to 40mg from tomorrow.

As an amateur in this game my first though is that there has been a step change in pancreas function - it has suddenly started to work a bit better than it was. Is that reasonable?

 

[Madeline]

She paid me a visit last week too, and now it’s all gone wonk. As another rank amateur, I’ve no clue why either.

 

[Ljc]

It sure sounds as though what you’ve been doing has worked really well. Congrats on the med reduction.
I suggest you ensure your at a good safe level before bed to allow for dropping down and hopefully tomorrow you won’t be fighting the low fours .

 

[trophywench]

@Docb - your BODY had a reason and OK so when it does that NONE of us know why which is exactly why that blessed fairy was personified. She's still going to be up to her normal tricks - but just visiting them on someone else now she'd toyed with you for a bit, she bores very easily once the whole forum gets on her case, along with her host, usually !

Pleased you're able to cut down the Glic though! Must be a bit frustrating having to make one bit of you run faster in order to stand still, I always think.

 

[Eddy Edson]

Sure, it's possible to see step-changes in insulin production and/or insulin sensitivity. Clearing fat from the pancreas can restart beta cells, and clearing fat from the liver can kick-start insulin sensitivity.

http://m.clinmed.rcpjournal.org/content/19/1/37.full.pdf

I think that's what happened with me, last Aug/Sep - pretty much overnight step-change from generally "pre-diabetic" to generally "normal" BG levels, coincident with weight loss, and in-line with Taylor et al's conceptual model of a "personal fat threshold".

 

[Deleted member 21371]

Have you lost weight recently?
It started more exercise?

 

[Docb]

Travellor, answers are no and no. I tend to have routines (ruts if you like) and nothing has changed. DN warned me about watching weight with my carb reduction because of risk of losing weight and increasing efficiency of the cliclazide but it has stayed at 72+/-1 kg since I started on this rollercoaster.

Thanks for the pointer to the article Eddy. I'll look at it later.

I'll see what happens in the next few days with the reduced gliclazide - thanks for the pat on the back Ljc.

 

[Docb]

Eddy, had another look at the Taylor et al paper. Have nowhere near got to the bottom of it, and probably never will, but a couple of things strike me. First is the lack of information about the subjects of the study. One of the selection criterion was that they should be able to lose 15Kg suggesting they started out overweight, if not obese at some level. Means that people like me would not be included in the study. If I lost 15kg I would be considered underweight and approaching anorexic. This leads me to the second point and that is their conclusion that all type 2 diabetes is due to fat accumulation in liver and pancreas. It may well be that is the conclusion you can draw from their cohort of subjects but translating that to all type 2's is pushing it from their work. What little I have read about the Newcastle work, which seems to reach a similar conclusion, does tend to contain the sensible caveat that whereas it is an important mechanism in causing T2 and offers the potential for reversal in many, it does not necessarily apply to all.

 

[Eddy Edson]

Eddy, had another look at the Taylor et al paper. Have nowhere near got to the bottom of it, and probably never will, but a couple of things strike me. First is the lack of information about the subjects of the study. One of the selection criterion was that they should be able to lose 15Kg suggesting they started out overweight, if not obese at some level. Means that people like me would not be included in the study. If I lost 15kg I would be considered underweight and approaching anorexic. This leads me to the second point and that is their conclusion that all type 2 diabetes is due to fat accumulation in liver and pancreas. It may well be that is the conclusion you can draw from their cohort of subjects but translating that to all type 2's is pushing it from their work. What little I have read about the Newcastle work, which seems to reach a similar conclusion, does tend to contain the sensible caveat that whereas it is an important mechanism in causing T2 and offers the potential for reversal in many, it does not necessarily apply to all.

It is the Newcastle work, essentially. Taylor is co-lead researcher on that.

I also think that they risk getting ahead of themselves in statements that you can take as saying the fat-in-tripes thing is always the cause of T2 - I think that's probably not true, but I also think it might well be the case that it's usually the cause. And apart from anything else, if it persists too long, then the research says it can at some point become too late to restart things.

Re 15kg: Note that there's now a follow-on study looking at non-overweight or slightly-overweight subjects - the "ReTUNE" trial.

https://www.diabetes.org.uk/researc...yorkshire/retuneing-type-2-diabetes-remission

https://www.ncl.ac.uk/magres/research/diabetes/newstudy-retune/

I guess setting a fixed target like "15kg" doesn't really fit very well with the approach, which of course is based conceptually on "personal fat threshold". In Taylor's 2017 notes for GP's he says this:

Everyone must know exactly what is to be achieved and a sustained effect is then essential. It is most important that body weight is decreased to target and then maintained steady. An individual target can be agreed on the basis of body weight and is usually 15kg lower than starting weight. Some individuals will have type 2 diabetes with a BMI only just above the normal range, and for them a low normal BMI is an appropriate target. For others, a BMI substantially less than that present, can be agreed with the patient as a target. Both motivation for the individual patient and support from both family and the diabetes care team will be important.

https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/2017 Information for doctors.pdf

FWIW, I started with weight 82kg and BMI of 25 at DX. My best guess is that I achieved "re-start" of my glucose homeostasis or whatever after losing around 8kg, at a BMI around 23. I'd dearly love to have had an MRI record to check that my pancreas and liver were cleared of fat at that time, but I think it is consistent with my blood test records, as far as liver inflammation-type markers go.

I really don't get why they harp on about the 15kg target. It's true that at this level they were getting IIRC ~90% "remission" in the (obese) DiRECT study. But at 10kg they were getting about 50%, and I would have thought you might expect the thresholds to decrease as baseline BMI decreases.

Anyway, it'll be interesting to see what happens with ReTUNE.

 

[AndBreathe]

Eddy, had another look at the Taylor et al paper. Have nowhere near got to the bottom of it, and probably never will, but a couple of things strike me. First is the lack of information about the subjects of the study. One of the selection criterion was that they should be able to lose 15Kg suggesting they started out overweight, if not obese at some level. Means that people like me would not be included in the study. If I lost 15kg I would be considered underweight and approaching anorexic. This leads me to the second point and that is their conclusion that all type 2 diabetes is due to fat accumulation in liver and pancreas. It may well be that is the conclusion you can draw from their cohort of subjects but translating that to all type 2's is pushing it from their work. What little I have read about the Newcastle work, which seems to reach a similar conclusion, does tend to contain the sensible caveat that whereas it is an important mechanism in causing T2 and offers the potential for reversal in many, it does not necessarily apply to all.

I didn't do the ND, but I have read, watched and listened to information and data on it closely, and have corresponded with Professor Taylor in the past.

He holds a belief that each individual have a "personal fat threshold". Nobody knows what that is, else we could predict accurately who would develop T2. Some people need to trim an incredibly small amount of weight to achieve remission, and others much, much more.

For those slim on the outside (unless scans are done the inside it is harder to be certain about the insides), they may have surprising levels of visceral fat, have a very low personal fat threshold or be a T2 with inadequate natural insulin secretion levels.

Not everyone needs to do the full term ND. There just had to be a term, in order to define the study a the outset.

I'm not trying to persuade you to do the ND, and I feel you were to consider it, you would very likely need to formulate a plan for your Gliclazide, in order not to enter full time hypo city, but that aspect would be between you and your medical advisors.

 

[Docb]

Thanks Eddy, it had not occured to cross check the names of the authors! Still loads to learn - for some reason, maybe the style, I assumed wrongly that this was an American paper. I will check out the other references.

AndBreathe - not going anywhere near any specific diet until I understand a lot more! Also would need some assurance that aging non-obese subjects had been included in the supporting studies.

 

[Deleted member 21371]

It's interesting what has been attributed to Dr Taylor.
Official comments have actually been few and far between, as initially it was a very small scale study, and only recently results from an expanded study have been finalised, but still not greatly analysed for the ramifications.

There is a lot of anecdotal comments made by others that have exchanged the odd email, or spoken in passing, and possibly it's because Dr Taylor is quite forthcoming about discussing possibilities, as any scientist would be.
But apart from stating losing weight, which appears to move internal fat, from overweight diabetics that may respond to this, he's has not actually expanded, officially, on any other point, apart from to say it's happened to some of his trial subjects.
15kg appears to be the amount of weight lost in the studies, in 8 weeks, but even that is variable.
Maybe some can stop sooner, maybe others need to carry on longer.

Personally, that wasn't my result.
I lost more than that, slowly initially, and didn't fully reverse my diabetes.
I did the diet, from a now normal BMI, to a below average, and did.
So, personally, for me, it involved the rapid weight loss, not the slow weight loss.
Or was my personal threshold very low?
I've put some weight back on since, and I'm still reversed though.

All I could say, with certainty, was doing the Newcastle diet, exactly to the book, worked.
I couldn't see any downside of losing weight, I was more than happy to be my own test subject, so I just did it.

 

[Docb]

The comments have made me look again at my own stats. BMI currently 25 (ie slightly overweight) but was amazed to see that loosing 15kg would only drop it to 19/20 which is still within the healthy weight category. Don't have any records from when I was first diagnosed 11 years ago but if my memory is correct I lost a little weight at the time, maybe a couple of kg, and that might have had something to do with the decent control I had for such a long time. That said, I did not suddenly increase weight last autumn when my quiescent T2 went out of control.

I'm always a bit wary of of solutions which promise that if you do this or that then everything will be hunky dory for everybody but I am less concerned than I was about letting my weight drift downwards as a result of heading for a lower carb diet. Not lost anything in the first three weeks or so, so maybe think a little about compensatory calories. Interesting to see where it goes.

On the other point I made, I see that there was a 70 years old cut off point for inclusion in their study. Bloody ageism.

 

[Eddy Edson]

The comments have made me look again at my own stats. BMI currently 25 (ie slightly overweight) but was amazed to see that loosing 15kg would only drop it to 19/20 which is still within the healthy weight category. Don't have any records from when I was first diagnosed 11 years ago but if my memory is correct I lost a little weight at the time, maybe a couple of kg, and that might have had something to do with the decent control I had for such a long time. That said, I did not suddenly increase weight last autumn when my quiescent T2 went out of control.

I'm always a bit wary of of solutions which promise that if you do this or that then everything will be hunky dory for everybody but I am less concerned than I was about letting my weight drift downwards as a result of heading for a lower carb diet. Not lost anything in the first three weeks or so, so maybe think a little about compensatory calories. Interesting to see where it goes.

On the other point I made, I see that there was a 70 years old cut off point for inclusion in their study. Bloody ageism.

They also say "diagnosed within last 5 years" or something like that, so who knows?

My attitude when I first learned about this stuff was, well, no harm in losing a few kilos, let's see what happens.

 

[Deleted member 21371]

The comments have made me look again at my own stats. BMI currently 25 (ie slightly overweight) but was amazed to see that loosing 15kg would only drop it to 19/20 which is still within the healthy weight category. Don't have any records from when I was first diagnosed 11 years ago but if my memory is correct I lost a little weight at the time, maybe a couple of kg, and that might have had something to do with the decent control I had for such a long time. That said, I did not suddenly increase weight last autumn when my quiescent T2 went out of control.

I'm always a bit wary of of solutions which promise that if you do this or that then everything will be hunky dory for everybody but I am less concerned than I was about letting my weight drift downwards as a result of heading for a lower carb diet. Not lost anything in the first three weeks or so, so maybe think a little about compensatory calories. Interesting to see where it goes.

On the other point I made, I see that there was a 70 years old cut off point for inclusion in their study. Bloody ageism.

He doesn't make promises.
He's been very clear on the results from a specific group of people to a set of requirements to be included that underwent the trial.
Probably based on the inital premise that the results were first observed on pre bariatric surgery patients, so using the same group to study, to see if results were initially repeatable.
He hasn't speculated on what would happen if these variables were changed, but is increasing the scope of the trials.

Other's have jumped in behind him admittedly, and spun their own books, and dressed up their own diets with different terminology, but he has no association with them.

My own viewpoint was once you cut through all the claims, and opinions, and guru's pushing diets, this was the only one with any studies, and published results from someone with a reputable qualification.

Like Eddy, even when I was down to a normal BMI, from being morbidly obese, I figured losing a few more kilos couldn't hurt either way.

 

[Docb]

My comment about cure alls was not directed at the Newcastle group, far from it, the Note to Doctors is a great example of how to put a perspective on a possible way forward. It's what I call the "hangers on" that irritate me in the same way they irritate you.

 

[Eddy Edson]

My own viewpoint was once you cut through all the claims, and opinions, and guru's pushing diets, this was the only one with any studies, and published results from someone with a reputable qualification.

That was absolutely my view also.

Here's hoping that Taylor & Lean never publish a Miracle Diabetes Cure book 🙂

 

[AndBreathe]

He doesn't make promises.
He's been very clear on the results from a specific group of people to a set of requirements to be included that underwent the trial.
Probably based on the inital premise that the results were first observed on pre bariatric surgery patients, so using the same group to study, to see if results were initially repeatable.
He hasn't speculated on what would happen if these variables were changed, but is increasing the scope of the trials.

Other's have jumped in behind him admittedly, and spun their own books, and dressed up their own diets with different terminology, but he has no association with them.

My own viewpoint was once you cut through all the claims, and opinions, and guru's pushing diets, this was the only one with any studies, and published results from someone with a reputable qualification.

Like Eddy, even when I was down to a normal BMI, from being morbidly obese, I figured losing a few more kilos couldn't hurt either way.

Does writing the foreword to Michael Moselys book not count?

 

[AndBreathe]

@Docb , it isn't my job, or anyone else's for that matter to persuade you to do or not to do anything you choose for your health, however, if your preference would be for something more akin to real food, then doing some reading around Dr David Unwin and his work could be worthwhile.

Dr Unwin has done a lot of work utilising a lower carb approach with his patients, and achieves about 50% remission rate. He is also the author of the Royal College of General Practitioners recent elearning module on Type 2 diabetes and diet.

There is also a newly approved App in the NHS App library for a structured educational programme for T2 diabetes. You can straightforwardly download the app, although there is a subscription payable if you do that. Alternatively your GP can prescribe it for you.

You seem to be managing to bring down your bloods on your own. Maybe all you need is some good support to ensure you're not having to eat to "feed" your meds.

 

[Deleted member 21371]

@Docb , it isn't my job, or anyone else's for that matter to persuade you to do or not to do anything you choose for your health, however, if your preference would be for something more akin to real food, then doing some reading around Dr David Unwin and his work could be worthwhile.

Dr Unwin has done a lot of work utilising a lower carb approach with his patients, and achieves about 50% remission rate. He is also the author of the Royal College of General Practitioners recent elearning module on Type 2 diabetes and diet.

There is also a newly approved App in the NHS App library for a structured educational programme for T2 diabetes. You can straightforwardly download the app, although there is a subscription payable if you do that. Alternatively your GP can prescribe it for you.

You seem to be managing to bring down your bloods on your own. Maybe all you need is some good support to ensure you're not having to eat to "feed" your meds.

It's odd how Doctor Unwin's original diet seems to have propagated as something it never really appeared to be in the first instance.
I do remember the original diet write up.

Is this the module?

"Type 2 diabetes is an increasingly common and progressive disease, the progression of which can sometimes be paused or even reversed using a low glycaemic-index (GI diet). Many patients with type 2 diabetes are on multiple drugs, yet are still not well controlled. This module describes the use of a low GI diet as an adjunct treatment for diabetes, using a case study of a real patient registered at the author's practice. The physiology and evidence behind a low glycaemic-index diet are described, as well as how to implement it in real life."

This seems to be more in line with the original description at the time?
It also seems to suggest it's merely a therapy to be used along side the primary therapy, but I must admit, I've not really seem anything after the initial news reports.


I can't remember any great studies for either that one, or the one you can pay for however, or any follow up studies, or diets suggested afterwards for either?

But personally, I would say a low GI diet did aid me, and is definitely an excellent starting point.

So I would agree, the RCGP seems worth a read, and it appears to be free, always a bonus.