There is more to type 2 than weight and exercise

[JamietDE6]

After diabetes diagnosis six months ago ( type unknown), I have experienced treatment as type 1 and type 2. I am now very fed up with the constant stereotyping of T1 is a childhood disease and T2 is a weight and exercise issue.
The final straw today, I open my copy of balance and there is an article promoting a shake and soup diet managed by the NHS. There is more to this disease than weight and exercise. For goodness sake stop trotting out the same old line. Do some real research into why so many adults that are normal weight who exercise also get diabetes. Plenty of T1 are overweight too….
I am currently doing a diabetes expert course. One of the delegates has lost 12 stone. Yes 12 stone. Their HBa1 c has gone up!
There is no doubt that what we eat affects the glucose in our body. Anyone who wears a monitor can work this out quite rapidly. The real question is why do I get diabetes when someone else does not. My DSN was not able to offer any opinion.
Another point about this condition that constantly annoys me. Why on earth do the NHS not promote the use of monitoring. The current course I am on does not promote any type of monitoring. How on earth would you know the affect of what you eat otherwise, wait for an HBa1 c test once every six months - ridiculous!

 

[geordie]

Totally agree. I am at lower end of bmi and am a regular walker of up to 10 miles. I am an insulin injecting type 2.I have no doubt that lifestyle factors play their part in some cases but I get fed up with the lazy stereotyping of type 2s.More research is needed about this illness instead of just labelling it a lifestyle choice

 

[trophywench]

Yep.

You must surely to goodness have noticed, by now, that you're preaching to the converted on this forum?

And, that even though the ancient Greeks were aware of the terrible wasting disease that sweetness was somehow connected with, discovering the role that insulin plays in it, is truly still comparatively new. I can assure you that shedloads more has been and is being discovered about it all the time since 1972 when I was diagnosed, and I'm as sure as I can be (not being personally involved in medical research except how diabetes affects me myself I) that shedloads more continues to be discovered. I have had to learn to be a more patient patient - and that certainly don't come any easier with time!

 

[RichardsUsername]

After diabetes diagnosis six months ago ( type unknown), I have experienced treatment as type 1 and type 2. I am now very fed up with the constant stereotyping of T1 is a childhood disease and T2 is a weight and exercise issue.
The final straw today, I open my copy of balance and there is an article promoting a shake and soup diet managed by the NHS. There is more to this disease than weight and exercise. For goodness sake stop trotting out the same old line. Do some real research into why so many adults that are normal weight who exercise also get diabetes. Plenty of T1 are overweight too….
I am currently doing a diabetes expert course. One of the delegates has lost 12 stone. Yes 12 stone. Their HBa1 c has gone up!
There is no doubt that what we eat affects the glucose in our body. Anyone who wears a monitor can work this out quite rapidly. The real question is why do I get diabetes when someone else does not. My DSN was not able to offer any opinion.
Another point about this condition that constantly annoys me. Why on earth do the NHS not promote the use of monitoring. The current course I am on does not promote any type of monitoring. How on earth would you know the affect of what you eat otherwise, wait for an HBa1 c test once every six months - ridiculous!

Easy target mate. Also, easy to play the blame game instead of doing something practical to help.

 

[Razorb64]

After diabetes diagnosis six months ago ( type unknown), I have experienced treatment as type 1 and type 2. I am now very fed up with the constant stereotyping of T1 is a childhood disease and T2 is a weight and exercise issue.
The final straw today, I open my copy of balance and there is an article promoting a shake and soup diet managed by the NHS. There is more to this disease than weight and exercise. For goodness sake stop trotting out the same old line. Do some real research into why so many adults that are normal weight who exercise also get diabetes. Plenty of T1 are overweight too….
I am currently doing a diabetes expert course. One of the delegates has lost 12 stone. Yes 12 stone. Their HBa1 c has gone up!
There is no doubt that what we eat affects the glucose in our body. Anyone who wears a monitor can work this out quite rapidly. The real question is why do I get diabetes when someone else does not. My DSN was not able to offer any opinion.
Another point about this condition that constantly annoys me. Why on earth do the NHS not promote the use of monitoring. The current course I am on does not promote any type of monitoring. How on earth would you know the affect of what you eat otherwise, wait for an HBa1 c test once every six months - ridiculous!

Absolutely. Diagnosed as type 2 13 years ago and my weight then was 11st 7. My weight now is 11st 9….not bad in 13 years.
Just started injecting insulin 3 weeks ago and I’m finding it tough to deal with.
I also run 5k 3 times a week…..
so why am I diabetic and it seems to be getting worse if I’m now injecting both Basel and Bolus insulins? I’m 58 years of age.

 

[Burylancs]

Absolutely. Diagnosed as type 2 13 years ago and my weight then was 11st 7. My weight now is 11st 9….not bad in 13 years.
Just started injecting insulin 3 weeks ago and I’m finding it tough to deal with.
I also run 5k 3 times a week…..
so why am I diabetic and it seems to be getting worse if I’m now injecting both Basel and Bolus insulins? I’m 58 years of age.

The old joke ... if you are dxed with Type 2 Diabetes you just made a poor choice of grandparents.

 

[Burylancs]

After diabetes diagnosis six months ago ( type unknown), I have experienced treatment as type 1 and type 2. I am now very fed up with the constant stereotyping of T1 is a childhood disease and T2 is a weight and exercise issue.
The final straw today, I open my copy of balance and there is an article promoting a shake and soup diet managed by the NHS. There is more to this disease than weight and exercise. For goodness sake stop trotting out the same old line. Do some real research into why so many adults that are normal weight who exercise also get diabetes. Plenty of T1 are overweight too….
I am currently doing a diabetes expert course. One of the delegates has lost 12 stone. Yes 12 stone. Their HBa1 c has gone up!
There is no doubt that what we eat affects the glucose in our body. Anyone who wears a monitor can work this out quite rapidly. The real question is why do I get diabetes when someone else does not. My DSN was not able to offer any opinion.
Another point about this condition that constantly annoys me. Why on earth do the NHS not promote the use of monitoring. The current course I am on does not promote any type of monitoring. How on earth would you know the affect of what you eat otherwise, wait for an HBa1 c test once every six months - ridiculous!

Yes Type 2 Diabetes has been institutionally belittled and dismissed over the 31 yrs I've been dxed. The latest fad for 'remission' is the latest institutionalised belittling of Type 2 - just something and nothing a crash diet will sort out. And the fact that Diabetes UK is still allowing talk of 'reversal' is just criminal on their part.

 

[DaveB]

I'm afraid the medical profession often don't like change which is why you see the same old stuff trotted out. One day they will realise that viruses do have an important part to play in late onset T1. It's not just an autoimmune disease. As we all know there are more T1s in later life than childhood but the medics still say it's that auto-immune condition - why does everyone say that when the facts indicate otherwise? I think it's true that overweight T2s can blame insulin resistance but there are many other factors involved and your genes are part of that. One explanation for overweight T1s is the mantra that T1s can eat anything as long as they inject enough - wrong. As a LADA if I eat too many carbs my BS skyrockets and I lose control regardless of injected amounts of insulin. My weight also rises of course. Finally the reason the NHS doesn't encourage monitoring is largely due to cost which I can understand; it's also a bit of 'the Dr knows best' and 'this tablet will manage the condition' so you don't need to test or measure.

 

[childofthesea43]

After diabetes diagnosis six months ago ( type unknown), I have experienced treatment as type 1 and type 2. I am now very fed up with the constant stereotyping of T1 is a childhood disease and T2 is a weight and exercise issue.
The final straw today, I open my copy of balance and there is an article promoting a shake and soup diet managed by the NHS. There is more to this disease than weight and exercise. For goodness sake stop trotting out the same old line. Do some real research into why so many adults that are normal weight who exercise also get diabetes. Plenty of T1 are overweight too….
I am currently doing a diabetes expert course. One of the delegates has lost 12 stone. Yes 12 stone. Their HBa1 c has gone up!
There is no doubt that what we eat affects the glucose in our body. Anyone who wears a monitor can work this out quite rapidly. The real question is why do I get diabetes when someone else does not. My DSN was not able to offer any opinion.
Another point about this condition that constantly annoys me. Why on earth do the NHS not promote the use of monitoring. The current course I am on does not promote any type of monitoring. How on earth would you know the affect of what you eat otherwise, wait for an HBa1 c test once every six months - ridiculous!

Could you kindly indicate who you are urging to do this real research? Scientists? Doctors? Patients? DUK? Forum members? As a scientist of 41 years I’d be interested to know.

 

[everydayupsanddowns]

The final straw today, I open my copy of balance and there is an article promoting a shake and soup diet managed by the NHS. There is more to this disease than weight and exercise. For goodness sake stop trotting out the same old line. Do some real research into why so many adults that are normal weight who exercise also get diabetes.

Interestingly, that approach came directly from an extensive research project that have been happening over the past 6 years or more, with multiple papers published in peer-reviewed journals.

You can find out more about the DIRECT trial, and the studies here if you are interested:

https://www.directclinicaltrial.org.uk/

It is one of the first clinical trials to show that diabetes does not necessarily have to be seen as an inevitably progressive condition, and for some people can be put into remission and that state can continue if the weight loss is maintained. We have members here who have put their diabetes into remission with a short-term very low calorie approach focussing on removing visceral fat. And others who meet the remission criteria used in DIRECT by following a low carbohydrate approach.

 

[JamietDE6]

Could you kindly indicate who you are urging to do this real research? Scientists? Doctors? Patients? DUK? Forum members? As a scientist of 41 years I’d be interested to know.

Evening
I would suggest a good place to start would be the NHS as they have access to a large cohort of recently diagnosed. A study that includes diet, monitoring,GAD and C peptide tests and looking at lifestyle factors such as mental health, hereditary links etc and links to recent viral illness.
Instead of just looking at a diet and some exercise as a magic bullet as unfortunately it may not be the reason or the cure for all of us.

 

[Bruce Stephens]

It is one of the first clinical trials to show that diabetes does not necessarily have to be seen as an inevitably progressive condition, and for some people can be put into remission and that state can continue if the weight loss is maintained.

About 1/3 of those in the trial at the 2 years point. Which isn't nothing and they say it's better than usual lifestyle interventions, but it's definitely not everyone (so nobody should feel too guilty if it doesn't work for them, even though it looks like it's worth trying).

 

[childofthesea43]

About 1/3 of those in the trial at the 2 years point. Which isn't nothing and they say it's better than usual lifestyle interventions, but it's definitely not everyone (so nobody should feel too guilty if it doesn't work for them, even though it looks like it's worth trying).

Roy Taylor told me that in every single case he had seen where someone achieved remission by weight loss and did not regain that weight, they remained in remission. So preventing regain is key here. I have found it easy to keep my weight down at constant 64kg for two and a half years and kept A1c no higher than 42 (best was 38). I know my weight will not rise but whether A1c will stay stable only time will tell. The poster is right that more research is needed to help us understand these relationships and Roy Taylor is one of many trying to do exactly that. They already know that weight loss is not a universal panacea and they are doing “real” research.

 

[Burylancs]

Roy Taylor told me that in every single case he had seen where someone achieved remission by weight loss and did not regain that weight, they remained in remission. So preventing regain is key here. I have found it easy to keep my weight down at constant 64kg for two and a half years and kept A1c no higher than 42 (best was 38). I know my weight will not rise but whether A1c will stay stable only time will tell. The poster is right that more research is needed to help us understand these relationships and Roy Taylor is one of many trying to do exactly that. They already know that weight loss is not a universal panacea and they are doing “real” research.

But this 'remission' is just circular reasoning based on two random bits of anecdotal evidence - not taking anti-hyperglycemic meds and a A1c Under 48. When you ask what this 'remission' actually means, there is no clinical, medical or scientific substance to it. It's just meaningless circular reasoning - if you don't take anti-hyperglycemic meds and are under 48 a1c you are in 'remission' and what is 'remission', it means you don't take anti-hyperglycemic meds and your a1c is under 48. Let's get Back to reality and talk about 'Good Control'. And of course you can't put Type 2 into any meaningful sense of 'remission' by low carbing because low carbing is an acknowledgement that you're stuck with it and have to take control measures all the time.

 

[Eddy Edson]

Roy Taylor told me that in every single case he had seen where someone achieved remission by weight loss and did not regain that weight, they remained in remission. So preventing regain is key here. I have found it easy to keep my weight down at constant 64kg for two and a half years and kept A1c no higher than 42 (best was 38). I know my weight will not rise but whether A1c will stay stable only time will tell. The poster is right that more research is needed to help us understand these relationships and Roy Taylor is one of many trying to do exactly that. They already know that weight loss is not a universal panacea and they are doing “real” research.

I've kept at ~65kg, BMI ~20, W-Ht ~0.44 for coming up to 5 years now and my HbA1c has been stable at 33-35 mmol/mol.

Just consistent with all the data showing that remission persists with weight loss maintenance.

Which doesn't mean that clinically a behavioural program like the DiRECT implementation is hugely effective, because most people put weight back on. But anyway it's at least as effective as eg low-carb - although that's hard to assess because there isn't long-term controlled data for low carb; closest is a VIRTA PR giving their 5 year results, which looked a bit worse than the DiRECT 5 year numbers.

 

[childofthesea43]

But this 'remission' is just circular reasoning based on two random bits of anecdotal evidence - not taking anti-hyperglycemic meds and a A1c Under 48. When you ask what this 'remission' actually means, there is no clinical, medical or scientific substance to it. It's just meaningless circular reasoning - if you don't take anti-hyperglycemic meds and are under 48 a1c you are in 'remission' and what is 'remission', it means you don't take anti-hyperglycemic meds and your a1c is under 48. Let's get Back to reality and talk about 'Good Control'. And of course you can't put Type 2 into any meaningful sense of 'remission' by low carbing because low carbing is an acknowledgement that you're stuck with it and have to take control measures all the time.

You seem not to acknowledge that significant weight loss has been shown to eliminate fat from the liver and pancreas, and that in most such cases there is a very significant restoration of beta-cell function. These outcomes are reversing the pathology. I dispute your view that there is circularity in the remission definitions. Pulling A1c down to below 48 provably reduces greatly the risk of diabetic complications. Below 38 would be even better. But although there is room to argue about the best such threshold to aim for, the choosing is for objectively observable outcomes and entails no circular or tautological reasoning, nor randomness, nor anecdote.

 

[everydayupsanddowns]

I think it depends on how you understand remission doesn’t it @Burylancs ? You’ve made it pretty clear in your posts that you find the notion of remission in T2 quite upsetting / irritating - but I’d be interested to hear your definition of what a meaningful framing of remission in T2 would look like?

This is where my thinking is:

We have gone from a position where T2 was thought by HCPs to be an inevitably progressive condition, where an ever increasing concentration of meds was required up to and including insulin, and where complications of high glucose levels were more or less inevitable over time to two possible alternatives…

In T2 diabetes, glucose levels are not kept within an optimal range when people eat a normal balanced diet, without taking glucose-lowering medication (and sometimes it doesn’t happen even with meds)

But now this can be changed in a subset of people either where significant weight loss (particularly visceral fat around the organs) ‘reboots’ the pancreas. These responders can then return to eating a normal balanced diet and maintain good glucose levels without medication providing their weight loss is maintained. The data are still emerging of course, and we can’t know how long this will last, but for the time being responders can have normoglycaemia for 5 years and counting.

OR

Some people find that by adjusting their diet, and reducing the amount of carbohydrate in their menu, they are able to maintain normoglycaemia without diabetes medication. I am in contact with people who have adjusted their way of eating to better suit their metabolism and who have seen no progression of their diabetes and needed no medication for 10 years and counting. For this group it seems it is not so much the maintenance of weight loss that is important, as the maintenance of the lower carb menu.

But for both groups, satisfactory outcomes and glucose levels are maintained, which halt their T2 diabetes, and they see no progression, and no need for diabetes medication.

Remission seems to be a perfectly appropriate description of these situations to me, because we aren’t talking about diabetes being cured. We are just talking about it not progressing.

Incicentally, many T1s steer towards ‘good management’ rather than ‘control’, because there are many factors which affect glucose outcomes that we cannot directly influence, and just have to accommodate or work around. And because ‘control’ might suggest that if you kept doing exactly the same things every day you would get identical outcomes - which isn’t the case with diabetes management!

What would remission look like for you @Burylancs - what would need to happen for the term to be meaningful to you?