Tips to keep in remission

[Paul Rankin]

I was diagnosed with type 2 - Jan 2022 HbA1c of 77 over the next 4 months this fell to 43 then over the next 2 years has been 38 36 36 37 38.

What did I do? First big weight loss 5 stone over 10 month. Low carb / low sugar diet and exercise nearly everyday I took up running and now run 40 miles plus a week

What helps? track your food with an app learn which foods are high in carbohydrates or sugar and avoid I find if I limit my carbs to under 80g and sugar under 30g I’m good.
But we are all different so you may need to experiment with the amounts.

Exercise fasted in a morning nearly every morning this uses up any excess sugar in my body as fuel and keeps my levels steady.

Foods hacks that really helped me I make my own low carb bread flaxseed / olive oil / eggs as it’s hard to find good shop bought alternatives to bread, will post recipe if anybody wants to try. Try Turnip chips in an air fryer boil them first takes a while to soften them spray with olive oil and salt I like to sprinkle chipotle rub over them to make them really tasty

Main thing stay focused and positive you can beat this and keep beating it.

Hope this helps someone

Paul

 

[Martin.A]

Well done on what you've achieved. It's always good to read about someone's success story. Many of us have developed our own strategies and managed similar results. The only thing that puzzles me is why you feel you need to have a sugar target.

 

[everydayupsanddowns]

Great results @Paul Rankin

Some of the follow-up data from the Direct trial suggests that people who are able to keep the weight off stand the best chance of remaining in remission for 5 years or more.

Good luck with maintaining your remission!

 

[Paul Rankin]

Thanks guys for the support.

Martin well done on your success you are right the sugar target is probably not needed as it’s all carbs. But I’d rather go for complex carbs with more fibre than sugars rather than blowing my 80g on something sweet. It just helped me early days when I was trying to get my head around the right foods to eat.

 

[Burylancs]

Great results @Paul Rankin

Some of the follow-up data from the Direct trial suggests that people who are able to keep the weight off stand the best chance of remaining in remission for 5 years or more.

Good luck with maintaining your remission!

Citation needed.

 

[Admiral Benbow]

How often do you test yourself? Do you use a CGM or fingerpick very often?

 

[everydayupsanddowns]

Citation needed.

Here’s the article I read

Weight loss can put type 2 diabetes into remission for at least 5 years, DiRECT study reveals

UPDATE, 26 FEBRUARY, 2024: This article has been updated following new findings into our landmark DiRECT study which have been published in the Lancet. Results from a three-year extension of our landmark DIRECT study reveal that for some it’s possible to stay in remission of type 2 diabetes for...

www.diabetes.org.uk

Participants in the original trial who were in remission after 2 years stayed in remission after 5 years as long as their weight loss remained. Retaining the weight loss seems to be the tricky part.

 

[PerSpinasAdAstra]

I was diagnosed with type 2 - Jan 2022 HbA1c of 77 over the next 4 months this fell to 43 then over the next 2 years has been 38 36 36 37 38.

What did I do? First big weight loss 5 stone over 10 month. Low carb / low sugar diet and exercise nearly everyday I took up running and now run 40 miles plus a week

What helps? track your food with an app learn which foods are high in carbohydrates or sugar and avoid I find if I limit my carbs to under 80g and sugar under 30g I’m good.

Congratulations! I hope I can one day replicate your success 🙂

Regarding the 80g carbs, I assume that's per day? Do you continue to test your blood regularly after meals?

This procedure may be of interest to you if you want to test whether you still have impaired glucose tolerance according to 'official' metrics. This might not show up readily on an HbA1c seeing as you're on a tightly controlled diet. A short spike after meals would be a blip on your HbA1c results. This test was the 'gold standard' for diagnosing T2 before HbA1c came along, and 75 grams of glucose is a whole lot cheaper than buying a CGM 😉

Glucose tolerance test - Mayo Clinic

www.mayoclinic.org

This is the method I intend to use to test just how firmly in remission I am, if the doctors take me off the medication that is, and to test whether my beta cell function improves or degrades over time. I intend to test around the same time I get my HbA1c tested to determine whether changes in one reflect changes in the other to the same extent, and use the information to determine whether I need to consider lowering (or if it might be safe to raise) my daily carb intake.

 

[Eddy Edson]

Congratulations! I hope I can one day replicate your success 🙂

Regarding the 80g carbs, I assume that's per day? Do you continue to test your blood regularly after meals?

This procedure may be of interest to you if you want to test whether you still have impaired glucose tolerance according to 'official' metrics. This might not show up readily on an HbA1c seeing as you're on a tightly controlled diet. A short spike after meals would be a blip on your HbA1c results. This test was the 'gold standard' for diagnosing T2 before HbA1c came along, and 75 grams of glucose is a whole lot cheaper than buying a CGM 😉

Glucose tolerance test - Mayo Clinic

www.mayoclinic.org

This is the method I intend to use to test just how firmly in remission I am, if the doctors take me off the medication that is, and to test whether my beta cell function improves or degrades over time. I intend to test around the same time I get my HbA1c tested to determine whether changes in one reflect changes in the other to the same extent, and use the information to determine whether I need to consider lowering (or if it might be safe to raise) my daily carb intake.

I don't think the OGTT is a great tool for fine tuning carb intake. Anyway, if you are low carbing there's a good chance you will be temporarily insulin insufficient when confronted with a big carb challenge, and the long-standing guidance is to carb load for a few days before the test to avoid this.

Carbohydrate Intake Prior to Oral Glucose Tolerance Testing

Abstract. With the emergence of glycated hemoglobin as a diagnostic test for diabetes, oral glucose tolerance tests (OGTTs) have become rare in endocrinolo

academic.oup.com

 

[Burylancs]

Here’s the article I read

Weight loss can put type 2 diabetes into remission for at least 5 years, DiRECT study reveals

UPDATE, 26 FEBRUARY, 2024: This article has been updated following new findings into our landmark DiRECT study which have been published in the Lancet. Results from a three-year extension of our landmark DIRECT study reveal that for some it’s possible to stay in remission of type 2 diabetes for...

www.diabetes.org.uk

Participants in the original trial who were in remission after 2 years stayed in remission after 5 years as long as their weight loss remained. Retaining the weight loss seems to be the tricky part.

Thanks for that. Diabetes UK should really take this piece down, it's a Press Release that's a year old about an event that is going to happen a week later. Has a proper academic study of the five year results been published in a reputable medical journal ? It would be good to sink our teeth into a proper study and rather than have make do with anecdotal reporting about it. I seem to remember Eddie E posting a slideshow of the presentation at the Professional Conference they were puffing in this piece.
One is still left aching to penetrate the statistical haze surrounding DiRECT. For example how many of the Intervention Group had HbA1cs under 48 at the 1 year, 2 year and 5 year mark. And how many of the Control Group were under 48 at those dates ? Were the results worse, the same or better in the Control Group following standard procedures ? It's difficult to penetrate the Confirmation Bias in all the DiRECT reporting. Overall the 11 people out of 149 in the original Intervention Group ( 7%) in 'remission' is disappointing at the 5 year mark. The search for Sooty's Magic Wand continues.
Diabetes UK might be well advised to take a step back from DiRECT and test to destruction anything that Taylor comes out with.

 

[PerSpinasAdAstra]

I don't think the OGTT is a great tool for fine tuning carb intake. Anyway, if you are low carbing there's a good chance you will be temporarily insulin insufficient when confronted with a big carb challenge, and the long-standing guidance is to carb load for a few days before the test to avoid this.

Carbohydrate Intake Prior to Oral Glucose Tolerance Testing

Abstract. With the emergence of glycated hemoglobin as a diagnostic test for diabetes, oral glucose tolerance tests (OGTTs) have become rare in endocrinolo

academic.oup.com

Perhaps not a great tool for that as you rightly point out. Honestly, I've avoided fine tuning up to now because part of me just doesn't want to know how changed/restricted my diet would have to be to adhere to the 2 hour BG meal test 'rules'. So far I've reduced carbs as much as I can without major diet upheaval, taken my meds, and hoped weight gain would yield results that would make any 2 hours testing I'd done in the meantime irrelevant. My latest HbA1C (in my sig) suggest big changes following weight loss - the date of the test relative to when I started the meds seems to suggest a bigger change than those meds can explain by themselves at least, particularly given excess over Christmas. I suppose I'm grasping for some some simple way to signal when 2 hour meal testing will result in numbers that will apply quite well over time, and a way to measure any beta cell functional restoration that might be occurring, without waiting another 3 months after stopping meds for a another HbA1c test.

 

[AndBreathe]

Thanks for that. Diabetes UK should really take this piece down, it's a Press Release that's a year old about an event that is going to happen a week later. Has a proper academic study of the five year results been published in a reputable medical journal ? It would be good to sink our teeth into a proper study and rather than have make do with anecdotal reporting about it. I seem to remember Eddie E posting a slideshow of the presentation at the Professional Conference they were puffing in this piece.
One is still left aching to penetrate the statistical haze surrounding DiRECT. For example how many of the Intervention Group had HbA1cs under 48 at the 1 year, 2 year and 5 year mark. And how many of the Control Group were under 48 at those dates ? Were the results worse, the same or better in the Control Group following standard procedures ? It's difficult to penetrate the Confirmation Bias in all the DiRECT reporting. Overall the 11 people out of 149 in the original Intervention Group ( 7%) in 'remission' is disappointing at the 5 year mark. The search for Sooty's Magic Wand continues.
Diabetes UK might be well advised to take a step back from DiRECT and test to destruction anything that Taylor comes out with.

Diabetes UK were major founders of the DiRECT Trial, if I recall.

 

[everydayupsanddowns]

Has a proper academic study of the five year results been published in a reputable medical journal ?

You can usually find a list of the published papers on the Direct Trial website, but that seems to be down for maintenance at the moment - it has been up long enough for Google to provide links though.

Press releases from April 2023 in several places (Newcastle and Glasgow University sites) refer to results having been announced, whuch seems likely to have involved journal publication and perhaps associated conference presentation.

 

[Drummer]

To stay in remission I avoid high carb foods, selecting full fat versions if that is relevant.
I'll probably come to the attention of the nurse who keeps weighing scales in her room before long and get an update, but I am pretty sure that my weight - or perhaps it would be more accurate to term it fat content - has reduced each year since diagnosis.
I really do not feel any hardship is involved in eating steak and stirfry and drinking coffee with cream.

 

[JITR]

Thanks for that. Diabetes UK should really take this piece down, it's a Press Release that's a year old about an event that is going to happen a week later. Has a proper academic study of the five year results been published in a reputable medical journal ? It would be good to sink our teeth into a proper study and rather than have make do with anecdotal reporting about it. I seem to remember Eddie E posting a slideshow of the presentation at the Professional Conference they were puffing in this piece.
One is still left aching to penetrate the statistical haze surrounding DiRECT. For example how many of the Intervention Group had HbA1cs under 48 at the 1 year, 2 year and 5 year mark. And how many of the Control Group were under 48 at those dates ? Were the results worse, the same or better in the Control Group following standard procedures ? It's difficult to penetrate the Confirmation Bias in all the DiRECT reporting. Overall the 11 people out of 149 in the original Intervention Group ( 7%) in 'remission' is disappointing at the 5 year mark. The search for Sooty's Magic Wand continues.
Diabetes UK might be well advised to take a step back from DiRECT and test to destruction anything that Taylor comes out with.

I'd suggest you follow the results of the NHS Path to Remission programme. It's based on the DiRECT trial. 90%+ of the participants who achieve the target weight loss go into remission. Those who maintain their lower weight stay in remission year by year. That's because they are keeping the fat in their liver and pancreas down to normal levels.

Haven't seen the 5 year report yet, but here are links to:
- a proof of the DiRECT 2 year results paper: https://www.ncl.ac.uk/media/wwwnclacuk/newcastlemagneticresonancecentre/files/DiRECT - 2 year results.pdf
- Primary care weight-management for type 2 diabetes:the cluster-randomised Diabetes Remission Clinical Trial (DiRECT): https://core.ac.uk/reader/196576423?utm_source=linkout

Meanwhile, here is a recent presentation by Professor Roy Taylor:

and Professor Mike Lean, Diabetes No More: lessons from the DiRECT trial and beyond:

plus another from a GP on achieving the weight loss necessary to achieve full remission, 'The nuts & bolts of drug free T2 diabetes remission by Dr David Unwin':

 

[Bubbleblower]

Has a proper academic study of the five year results been published in a reputable medical journal ?

No, 5-year results have still not been published anywhere, unlike the 1- and 2-year results which are everywhere.

Participants in the original trial who were in remission after 2 years stayed in remission after 5 years as long as their weight loss remained.

Where can we find this information?


Meanwhile in my document about this topic I have 3 pages with 52 tips each,
I wouldn't know where to start and don't want to hijack this thread either.

 

[PerSpinasAdAstra]

Meanwhile in my document about this topic I have 3 pages with 52 tips each,
I wouldn't know where to start and don't want to hijack this thread either.

If you have 3 pages of knowledge about remission I'd be delighted to read it. Could you perhaps put it up on Substack or a similar free blogging platform and share the link? I'm finding Substack easy to learn and use - currently writing up everything I've learned about losing weight in case someone out there finds it useful.

 

[JITR]

Mike Lean talks about the design and results if DiRECT from about 17:20 in the Diabetes - No More video above. He and Roy Taylor were partners leading the study. The results exceeded expectations.

 

[Dragonheart]

The results exceeded expectations.

7% remission at 5 yrs with all the extensive support being part of a trial provides is exceeding expectations?

 

[PerSpinasAdAstra]

7% remission at 5 yrs with all the extensive support being part of a trial provides is exceeding expectations?

Yup. When they set out they set a target for a primary care based intervention that, if exceeded, would make it a worthwhile program to roll out. From Taylor's book:

"We planned DiRECT with the aim of achieving a clinically important result. We decided that releasing one in five people from diabetes, off all tablets, at one year, would be very useful - important for each individual, and important for the costs of providing healthcare".

They did that much and more, and the support wasn't particularly extensive. There was support yes, but the aim of the study was to test if it could be done in a primary care setting and so *without* extensive and thus expensive support.

I think they did a pretty good job for a first time effort. Personally I wonder what would happen if you repeated it but put everyone on Ozempic to help them keep the weight off and to push HbA1c down a bit more than is strictly necessary to go off the tablets. That would be an expensive programme though, at least for the time being, and unlikely to get an NHS rollout.