The Job of Remission

[mhtyler]

If I can make an observation....

If only Taylor and Co opened by saying that there are many possible reasons for poor automated blood glucose control other than autoimmune destruction of the cells that produce insulin in the pancreas and these come under the umbrella term of T2 diabetes, then that would help.

What they have shown, and shown convincingly, is that excess fat around the liver and pancreas accounts for poor blood glucose control in a significant number of those with a T2 label and taking measures to reduce that fat in those affected is a very effective method of restoring blood glucose control. They tend to make no reference to those with a T2 diagnosis who are not overweight, indeed if I recall correctly they exclude such people from their studies. The way they report things tends, at least in my view, to make it easy to assume that getting rid of non-T1 diabetes only requires losing a bit of fat. That may be the case for a major subset of those with a T2 diagnosis but does not apply to all.

My take on all this is that if you have a T2 diagnosis and you are overweight then loosing that excess weight offers a very good chance of regaining automatic blood glucose control. I prefer the language of risk and uncertainty rather than the implied positivity in Taylor's (other gurus are available) reporting.

As you might guess I am one of those for whom it does not work. T2 label but not overweight, who's auto blood glucose control would be of concern if I did not take some pills and deliberately control my carbohydrate intake. I accept I am in a minority but I suspect I am far from alone.

TOFI's do get T2 for the same reason as the overweight. By the same token, many who are overweight and even obese don't have T2. This is described in depth in Professor Taylor's concept, "Personal Fat Threshold". It has to be disappointing that Taylor's method didn't work for you, although it's worth pointing out that more than 50% of his counterbalance study participants were non-responders. Do you know what the cause of your T2 is?

 

[mhtyler]

@Eddy Edson ... I stand corrected. Must read the detail. Mind you, I am 66" high with a 32" waist and would still have poor blood glucose control without the pills and watching carbohydrate intake.

Either you have an unusual type of diabetes, which is certainly possible, or you're a TOFI with a very low personal fat threshold, or a pancreas who's beta cell function has completely de-diferentiated...which happens. I had T2 for about 8 years, and feared that my pancreas was dead. It turns out it was only (as Miracle Max said in The Princess Bride) only MOSTLY dead.

 

[Docb]

TOFI's do get T2 for the same reason as the overweight. By the same token, many who are overweight and even obese don't have T2. This is described in depth in Professor Taylor's concept, "Personal Fat Threshold". It has to be disappointing that Taylor's method didn't work for you, although it's worth pointing out that more than 50% of his counterbalance study participants were non-responders. Do you know what the cause of your T2 is?

In answer to your question, no. Maybe due to visceral fat, may be due to things wearing out with age, may be due to a deficiency in the system that regulates insulin production in reaction to blood glucose levels. Who knows. No evidence, just surmise and guesswork.

I am not in any way decrying the work by Taylor et al (and don't forget the et al who actually did the work). It has provided a major understanding of one of the primary reasons for the steadily increasing levels of diabetes diagnoses. All ask is that we don't try and account for everybody by using the same model when my experience suggests that there is at least one person in the world who does not easily fit into it.

 

[JITR]

All I ask is that we don't try and account for everybody by using the same model when my experience suggests that there is at least one person in the world who does not easily fit into it.

No one but a fool would do that. Of the 150,000 odd diagnosed with T2D each year it seems as many as 98% come into the 'Dietary T2D category', and about 3,000 do not.

 

[Docb]

No one but a fool would do that. Of the 150,000 odd diagnosed with T2D each year it seems as many as 98% come into the 'Dietary T2D category', and about 3,000 do not.

There are plenty of people about trying to get internet clicks or trying to sell their magic solution to diabetes who are more than happy gloss over such petty fogging details.

Much more interesting is the statistic you quote. Where did you find it?

 

[AndBreathe]

No one but a fool would do that. Of the 150,000 odd diagnosed with T2D each year it seems as many as 98% come into the 'Dietary T2D category', and about 3,000 do not.

For how long do they remain in that "dietary control" group? Were that the case (and it was a successful control mechanism for that 98%) then surely the diabetes crisis would be so much of a crisis?

 

[Eddy Edson]

@Eddy Edson ... I stand corrected. Must read the detail. Mind you, I am 66" high with a 32" waist and would still have poor blood glucose control without the pills and watching carbohydrate intake.

Just to note, FWIW, that trouser size isn't the same as waist size. To measure waist size:

• Find the middle point between your lowest rib and your hip bone. This should be roughly level with your belly button.
• Wrap the tape measure around this middle point, breathing naturally and not holding your tummy in.

Obesity

Read about obesity and how it can seriously affect your health. Ways to lose weight safely include eating a healthy, reduced-calorie diet and exercising regularly.

www.nhs.uk

 

[Docb]

Just to note, FWIW, that trouser size isn't the same as waist size. To measure waist size:

• Find the middle point between your lowest rib and your hip bone. This should be roughly level with your belly button.
• Wrap the tape measure around this middle point, breathing naturally and not holding your tummy in.

Obesity

Read about obesity and how it can seriously affect your health. Ways to lose weight safely include eating a healthy, reduced-calorie diet and exercising regularly.

www.nhs.uk

Ah! My waist is 35in which makes my height to waist to height ratio 0.55 - a bit above 0.5. Is that within the "OK" error bar or an indication that I might be bunged up with visceral fat?

 

[Eddy Edson]

Ah! My waist is 35in which makes my height to waist to height ratio 0.55 - a bit above 0.5. Is that within the "OK" error bar or an indication that I might be bunged up with visceral fat?

I've been trying to find again a recent study I came across which showed amazing sensitivity & specificity for waist-2-height as a prognostic for T2D, at a threshold of 0.53. .

So assuming that study is kosher, then the answer is very likely "yes". Which would be consistent with the insulin resistance you seem to have, at least according to the rough'n'ready TyG metric, as per a previous discussion.

(It doesn't take much visceral fat to screw things up.)

 

[Proud to be erratic]

For how long do they remain in that "dietary control" group? Were that the case (and it was a successful control mechanism for that 98%) then surely the diabetes crisis would be so much of a crisis?

A very astute point @AndBreathe. There are c.4million T2s, and increasing annually. The NHS periodically tells the Nation that Diabetes is a considerable part of the overall NHS budget. If T2 was straightforward, even if not simple - as so many non-diabetic commentators glibly inform anyone stupid enough to listen - THEN as you so rightly infer: "what crisis?"

But it's not straightforward, not simple and that short label of T2 has many permutations creating a true quandary over what or why is (are) the cause(s) and how best to treat.

Routinely prescribing CGM to any T2 who might sensibly be able to make good use of such tech, never mind test meters and strips, could/would save longer term health problems and lives. Such up front expenditure could save a fortune in the longer term. It is modest in relation to those longer term costs. We never hear about the follow on costs of Diabetic health problems nor the social service costs of providing things like, for example, wheelchair access both up to the front door as well as inside a property. These social service costs are also immense. The NHS is a massive organisation, as is Social Services and the 2 organisations are inextricably intertwined. Rant over.

But I wish people would stop assuming one size fits all and we already know the answers.

 

[mhtyler]

All ask is that we don't try and account for everybody by using the same model when my experience suggests that there is at least one person in the world who does not easily fit into it.

Sorry, but if there's only one person out there in the entire world who doesn't fit in, they can shift for themselves.

 

[JITR]

The NHS periodically tells the Nation that Diabetes is a considerable part of the overall NHS budget.

Waiting after a Covid jab the other day I came across an "NHS" leaflet.

It included this gem of situation summary:
1 - National problem with insufficient detection and diagnosis
2 - Low patient awareness and understanding
3 - Incomplete knowledge amongst healthcare professional

A concerted action to fix those three problems would reduce the NHS T2D budget no end. #2 and #3 are two sides of the same coin. The target for #1 shoud be fatty liver and prediabetes.

P.S. The leaflet was about heart atrial fibrilation and stroke, but might as well have been about diabetes.

 

[mhtyler]

Waiting after a Covid jab the other day I came across an "NHS" leaflet.

It included this gem of situation summary:
1 - National problem with insufficient detection and diagnosis
2 - Low patient awareness and understanding
3 - Incomplete knowledge amongst healthcare professional

A concerted action to fix those three problems would reduce the NHS T2D budget no end. #2 and #3 are two sides of the same coin. The target for #1 shoud be fatty liver and prediabetes.

P.S. The leaflet was about heart atrial fibrilation and stroke, but might as well have been about diabetes.

Interestingly, significant weight loss in many cases reverses atrial fibrillation as well. It has in my case. At least I haven't had any apparent case of it in nearly a year. Excess weight, and in particular visceral and ectopic fat are very bad boys.