What do you think about the terms ‘Remission’ or ‘Reversal’ of T2D

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everydayupsanddowns

everydayupsanddowns

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... or even sometimes ‘cure’ 😱?

I was at a training event yesterday, and this subject came up (particularly in relation to Diabetes UK’s DIRECT (Newcastle / 800 calorie diet) study.

The suggested definition of ‘remission’ is an HbA1c of below 48mmol/L with no medication.

But what do those terms mean to you? Do you think they are a help or a hindrance? Does that definition sit well with you, and if not how would you define it?

Does it help to challenge the narrative that T2 is ‘inevitably progressive’. Does the prospect of diabetes in remission encourage you?

What about people who continue to need medication, or who can’t hit that ‘cut off’. What about people who ‘go into remission’ and then go back out again. Is there a risk of stigma and blame?

I’d be interested to hear your thoughts, definitions, and take on it...
 
For me it is not so much the exact definition that matters as much as a very clear message that reversal and remission is possible under some circumstances, and that Type 2 Diabetes is not necessarily always progressive. In that context the definition suggested is fine.

As an aside this is a particular ‘hot spot’ issue for me. It started a year or so after diagnosis, when things were not improving. I was told by the GP that metformin dose needed to be increased, and when I got emotional was told to come to terms with having a progressive disease and that meds my would continue to increase.

In retrospect the Doc actually did me a favour as emotion turned to anger and action, I researched and found that there were dietary and lifestyle solutions, and began the journey to reversal.

Any communications that ensure that newly diagnosed people get the positive message that there can be a good solution, in some circumstances needs to be encouraged.
 
I posted some of my take on this the other day. But anyway, FWIW:

I certainly found the prospect of getting to "normal" BG levels in a set'n'forget kind of way to be very, very motivating. Not so much the prospect of going off Metformin or a lamer desire to accrue bragging-rights, but more the "set'n'forget" aspect: if I could become "normal" maybe I wouldn't have to worry much about D any more.

Personally, I'm happy to think of myself as "cured", in the sense that I don't think I'm at much risk of re-developing high BG and other metabolic syndrome nasties if I don't stack weight back on. I think I still have a (genetic, probably) degree of insulin resistance, which doesn't get cured, but so do plenty of "normal" people and I don't think it matters in the absence of weight above the level my bod can cope with.

That's just me, and I certainly don't think my approach will work for every T2D. But I don't really understand the stigma aspect: it's a matter of chance.
 
Speaking solely as a Type 2, to my mind, if you are pre-diabetic, without medication, you are not in remission. You still need to aim to get below 42mmol/mol without medication. To be told you are "in remission" could generate a false sense of security and lead to dietary lapses. Even if you go below 42, I don't consider that "cured", as having been over 41 once you need to be watchful for the rest of your life. I will never consider myself anything but diabetic, regardless of my readings. Sorry - this is a negative post, but how I feel.
 
I look at it that I have diabetes, will always have it and though I work to keep my levels low, remission, reversal or any other name means nothing to me. My levels are good, am on medication and at the moment that’s all I need to know, I don’t want to label myself with anything else or feel pressure to achieve anything more than I have.
I do think that you will get a lot of differing answers as we all look at our diabetes very individually, although obviously we have a lot of things in common as well. Interesting debate!
 
Medicine/Medical.
  1. a temporary or permanent decrease or subsidence of manifestations of a disease.
Remission as defined by dictonary.com

Seems about right for people with diabetes who have got their blood glucose under control.
 
I've been off Metformin for quite a while now, and my surgery were happy to call me 'in remission' when I had had several HbA1c readings of 40 or under (see results listed below). I find it very motivating to try and keep 'in remission' and although it's not always easy, I do try.

It helps me to think of it as being like an alcoholic who has good control by not drinking - I shall always be diabetic but I have good control by not eating starchy carbs.
 
Personally, I detest labels of ny kind, although I do understand why labels apply - to accommodate discussion and common understanding.

Where am I on reversal/remission/whatever? Well, for me, whatever it is, if we are recognising pre-diabetes as a thing, then remission, or whatever, would have to be below those levels, without meds.

For me, there has to be something after diagnosis - something to strive for. Something to be recognised, and most importantly of all, to give the patient, when newly diagnosed, hope. I believe hugely in hope. Not expectati, but hope.

When I had my one and only diabetic level A1c, I left the surgery thinking, "is this as good as it gets from here in?" " Is t all downhill from here?"

Since then my A1c has never been above 37, and my last at 27. I can pass a OGTT, and get very good numbers if I eat plenty carb, although that is rare.

My GP took me off the diabetes register, after we had a very direct "chat" about attributing everything to diabetes. I just wasn't having it. My challenge to her was cover that one line in my medical record, and how would today's appointment have gone? She took a moment and too kind my point.

So, call it Doris for all I care, but a bit of hope and something to strive for can work wonders.

Of course, the uncomfortable reality is not everyone's body can recover as well as some, and for some other co-morbidities ramp the challenge even more, but I do believe we have to stop automatically coining T2 diabetes as being inevitably progressive, unless we are all clear progressive can mean progressively improved.
 
whilst I think the term in remission is a good motivational tool, and shows that with hard work a good HbA1c can be achieved and meds stopped, that is fine as long as it is not used as @ grovsey says as a stick with which to beat those of us who still have to rely on medication and be made to feel like failures.

Absolutely right that people who can and have achieved this should be congratulated and rightly proud of themselves.
 
everydayupsanddowns said:
The suggested definition of ‘remission’ is an HbA1c of below 48mmol/L with no medication.
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Well, I though in terms of a figure lower than that. Otherwise, yes that's what I think of as remission. And I don't have a problem with it.
everydayupsanddowns said:
... or even sometimes ‘cure’ 😱?
Click to expand...
Now that I have a problem with, as there isn't one. And people refer to cured. I had one person say, straight to my face, that you could cure diabetes by just loosing weight.
Reversed: whenever someone says that you've always to ask what they mean. Too often they mean cured.
everydayupsanddowns said:
Do you think they are a help or a hindrance?
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Reverse is a problem, cause of the connotations (at best) of cured.
And if cured is used the coversation has gone badly. (Unless it's "they've been promising a cure in 10 year forever!")
everydayupsanddowns said:
Does the prospect of diabetes in remission encourage you?
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I hadn't considered the possibility of getting anywhere near remission.
 
Docb said:
Medicine/Medical.
  1. a temporary or permanent decrease or subsidence of manifestations of a disease.
Remission as defined by dictonary.com

Seems about right for people with diabetes who have got their blood glucose under control.
Click to expand...
Yes, that.
 
I like the idea of remission. It speak to a feeling of agency that you have once you've done some research on the things we can do to change the usual passage of deterioration. So I'm all for it, personally I feel very motivated by the idea of being in remission. But I think we all need to accept that we will always have the condition, even if it's mostly dormant.
 
Sorry Mike @everydayupsanddowns for being pedantic but the heading of this thread might make some mistakenly think that they can reverse other types of diabetes e.g. Type 1 when it isn’t a possibility, and get false hope. Just wondered if it could be made clearer which type(s) you’re referring to in this thread?
 
everydayupsanddowns said:
... or even sometimes ‘cure’ 😱?

I was at a training event yesterday, and this subject came up (particularly in relation to Diabetes UK’s DIRECT (Newcastle / 800 calorie diet) study.

The suggested definition of ‘remission’ is an HbA1c of below 48mmol/L with no medication.

But what do those terms mean to you? Do you think they are a help or a hindrance? Does that definition sit well with you, and if not how would you define it?

Does it help to challenge the narrative that T2 is ‘inevitably progressive’. Does the prospect of diabetes in remission encourage you?

What about people who continue to need medication, or who can’t hit that ‘cut off’. What about people who ‘go into remission’ and then go back out again. Is there a risk of stigma and blame?

I’d be interested to hear your thoughts, definitions, and take on it...
Click to expand...
Hi all, so as many of you aware my son James is classed as in remission and we fully understand that this is not a cure but rather to hopefully stop the progression, and find a sustainable lifestyle regarding diet and exercise that will help maintain a normal Hba1c without medication. However I appreciate that if he reverted to his previous lifestyle his diabetes would return. I do not judge in anyway those who are unable to do this, and it is early days so it may still appear again as James has other issues with hypothyroidism and poor muscle tone which probably contributed. However the term does offer motivation and hope to those newly diagnosed and without hope I feel we would be left feeling that to try anything would be pointless. I must add again that he was discouraged in trying to achieve remission by the practice nurse who stated it was not possible for him. That was the single lowest point for both of us, but then I found this forum and the support has been tremendous. I now try to help others at the beginning of their journeys but do not wish to appear patronising or judge those who still struggle as everyone is different. For us the term remission is positive and enables us to feel hope and proud. I also hope that indeed T2 can be proven to be dormant for a long time if all the elements needed are in place.
 
I’d be interested to hear your thoughts, definitions, and take on it...[/QUOTE]

remission (n.)
c. 1200, "forgiveness or pardon (of sins)," from Old French remission "forgiveness (of sins), relief" (12c.), from Latin remissionem (nominative remissio) "relaxation, diminishing," lit. "a sending back, sending away," noun of action from past participle stem of remittere "slacken, let go, abate" (see remit). Used of diseases since early 15c.


reverse (adj.)
c. 1300, from Old French revers "reverse, cross, opposite" (13c.), from Latin reversus, past participle of revertere "turn back, turn about, come back, return" (see revert). Reverse angle in film-making is from 1934. Reverse discrimination is attested from 1962, American English.
 
grovesy said:
I worry that those that don't achieve remission/reversal for what ever every reason, then feel they have either failed or blame themselves.
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I think this is a legitimate concern @grovesy. Especially if questionable media coverage gives the impression that reversal is possible for every T2, and by inference, those that don’t reach it are doing something wrong.
 
Eddy Edson said:
I certainly found the prospect of getting to "normal" BG levels in a set'n'forget kind of way to be very, very motivating
Click to expand...

I think that’s one of the potential confusions/misconceptions. Reach ‘remission’ with a quick intense diet... and then you can go back to eating just like you did before.

Whereas what the definition is really seems to be reaching for is long-term med-free diabetes management, such as we have seen in many members of the forum over the years. But these members suggest that ongoing BG management through individually adjusted and moderated carb intake is part of keeping that going.
 
DebbieC said:
I must add again that he was discouraged in trying to achieve remission by the practice nurse who stated it was not possible for him. That was the single lowest point for both of us, but then I found this forum and the support has been tremendous. I now try to help others at the beginning of their journeys but do not wish to appear patronising or judge those who still struggle as everyone is different. For us the term remission is positive and enables us to feel hope and proud. I also hope that indeed T2 can be proven to be dormant for a long time if all the elements needed are in place.
Click to expand...

I am so sorry you had that experience. What a demotivating thing to say.

Toucan said:
For me it is not so much the exact definition that matters as much as a very clear message that reversal and remission is possible under some circumstances, and that Type 2 Diabetes is not necessarily always progressive.
Click to expand...

I think that’s an important factor. That glimmer of hope (or as you show, a defiant wish to ‘not let it beat you’) seems much more likely to equip you for concerted effort and action than the suggestion that progression is inevitable.

And yet... I rather like the reduction of complication risk, I think the possibility of remission is a bit of a double-edged sword. Because for some people, no matter how hard they try, or what they do, perhaps it won’t be possible (or complications may unfairly arrive despite a persons best and most exhaustive efforts).
 
I definitely feel the information I found on the internet about remission was my drive to take my high HbA1c (117) down to pre-diabetic level (41). This was achieved by diet and exercise and I'm determined to continue on this path for the rest of my life. Diabetes will not define me I will fight the condition like many others to stay in remission and keep moving for a better future. I have a constant reminder of how devastating Diabetes is with Retinopathy in both eyes and Neuropathy across my body but still I am determined to make a stand. I won't let the condition swamp and drown me so a positive message for newbies like myself is encouraging and hopefully help them to strive for low HbA1c's. I feel so much better reading all different messages on this forum but positive message has helped my progress over the four months. Thanks to everybody keep posting the good work.
 
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