For most im guessing a diagnosis of type 2 diabetes is a fairly significant life event. But we all react differently and my reaction has been to research as much as possible. I've had two years of prediabetes and a few weeks ago my hba1c came back at 53 and then 51 mmol. So that's the threshold passed - 'please come back in to chat about your diagnosis'. I've started to make the changes, I guess it's good that's it still relatively low. So if we're diagnosed with type 2 diabetes that's it for life, with all the potential for complications that we're aware of. Harsh. But type 2 is a lifestyle issue, insulin resistance from diet. An epidemic because of sugar and carbs, sedentary lifestyles, processed foods. And in most cases we can change our ways and lower our blood sugars to a healthy level. So there are a few things rattling around my head. There's some clinical guidance from the diabetes clinic in Exeter - 'if a patient is diagnosed with diabetes then drops their hba1c level below the threshold without medication then strictly speaking they are no longer diabetic', similarly, as far as I understand if you are under 48 on your follow up hba1c test you are not diagnosed as diabetic. When the NHS met to discuss implementation of the WHO guidelines, they initially suggested setting the diagnostic threshold at 50 mmol because it was easier to remember. I don't understand enough about the biology but I can't really understand why someone at 47 mmol is not diabetic but someone at 48 is. I understand that someone who is overweight, fatty liver, insulin resistance issues, high blood glucose is at increased risk to cardiovascular issues, kidney issues etc. but that's the same if your 47 mmol or 48 mmol. For me the diagnosis is something of a relief, a motivation, ill have some focus on sorting the issue out but i can't get my head round the term. It puts me in mind of alcoholism. The dangers of excessive alcohol consumption are well know. I quit years ago as it did me no favours. But I wouldn't consider myself an alcoholic although I'm probably at higher risk than some of alcohol dependency and the potential health issues of that. Sorry for the long post, I've got an appointment with a diabetes nurse in a few weeks. Just trying to get my head clear.
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What is a type 2 diagnosis
- Thread starter edeaston
- Start date
harbottle
Well-Known Member
- Relationship to Diabetes
- Type 2
There is far more to it than just insulin resistance - a whole host of metabolic problems come with it. By the time the diagnosis comes it's reckoned up to 60% of the beta cells in the pancreas have stopped producing insulin. The reason for this is possibly genetic, as it's known that under certain conditions there are genes that cause the cells to stop working (High fat). Some people can change diet to keep it under control, even with reduced beta cells function. and some people appear to be able to bring back some beta cell functionality by losing weight.
The 47 threshold was chosen because this is the point at which the risk of damage to the eyes increases, but it's believed that even in the 40s the beta cells have already started to fail and the risks of other health problems increase even in the low 40s.
If you get it down to < 48 without medication your medical record will be updated to diabetes (in remission) but you'll still be called in for annual checks because the condition can come back.
The 47 threshold was chosen because this is the point at which the risk of damage to the eyes increases, but it's believed that even in the 40s the beta cells have already started to fail and the risks of other health problems increase even in the low 40s.
If you get it down to < 48 without medication your medical record will be updated to diabetes (in remission) but you'll still be called in for annual checks because the condition can come back.
Leadinglights
Well-Known Member
- Relationship to Diabetes
- Type 2
I know what the guidelines say but my personal opinion is the being considered in remission when you have an HbA1C that would be the diagnostic level, not even prediabetic, there seems too much risk that people will let up on their diabetic management and find themselves back to where they started. Being below 42 mmol/mol for me is a much more comfortable place to be.
Drummer
Well-Known Member
- Relationship to Diabetes
- Type 2
I knew that my ability to deal with carbs was impaired from a very early age - I left home at 18 and from then on faced a barrage of 'eat those healthy carbs' - even though I reported how ill it made me feel.
By 65 I was huge, and very diabetic - that was when they told me, but 10 years earlier high glucose was flagged up - solved by not doing the test again.
I knew that low carb eating made me feel so much better almost at once, but doing Atkins might just as well have been a death sentence the way my GPs carried on.
The eventual labelling of me as diabetic was pretty inevitable, but I did my best, I think, in the face of all those who told me they knew better.
By 65 I was huge, and very diabetic - that was when they told me, but 10 years earlier high glucose was flagged up - solved by not doing the test again.
I knew that low carb eating made me feel so much better almost at once, but doing Atkins might just as well have been a death sentence the way my GPs carried on.
The eventual labelling of me as diabetic was pretty inevitable, but I did my best, I think, in the face of all those who told me they knew better.
Thank you for replies. Jason Fung is very interesting in how he explains the relationship between insulin and glucose. I daresay others have different ideas, such is the way with human biology. I'm going down the low carb, increased activity route until my appointment in 4 weeks. I might try some 'beginners' fasting too. Hoping I can get things managed sooner rather than later, if that means a very low cal diet for a couple of months then so be it.
Leadinglights
Well-Known Member
- Relationship to Diabetes
- Type 2
My daughter gave me the Diabetes Code by Jason Fung and I found what he said made a lot of sense. I know some disagree.
@edeaston know what you mean about getting the diagnosis. Mine came out of the blue about 2-3 weeks ago and after seeing the diabetes nurse, I made the move to a low carb diet, upped my exercise levels (four runs a week if possible) and managed to get agreement to not have to take the metformin until my 14 days on a CGM is complete as I have managed to get my levels down to about 6.x per day before meals and <7.4 two hours after.
I was accepting of my diagnosis because I knew that it was caused by me doing stupid things (major sweet tooth) and have used the anger to focus on targeting remission as soon as possible. Fortunately I have the support of a great woman who has supported me with the lifestyle changes and makes me run after her when we go for a run.
I also know someone who has pre-diabetes and thinks that the ranges are made up or selected at random, but having pointed out the damage to me feet due to never being tested for a while I think they are reconsidering their position.
For information, I have found that this forum has been brilliant and full of great suggestions and support from people in varying degrees of similarity to my own position.
I was accepting of my diagnosis because I knew that it was caused by me doing stupid things (major sweet tooth) and have used the anger to focus on targeting remission as soon as possible. Fortunately I have the support of a great woman who has supported me with the lifestyle changes and makes me run after her when we go for a run.
I also know someone who has pre-diabetes and thinks that the ranges are made up or selected at random, but having pointed out the damage to me feet due to never being tested for a while I think they are reconsidering their position.
For information, I have found that this forum has been brilliant and full of great suggestions and support from people in varying degrees of similarity to my own position.
Hi Jimmy
Thats interesting. If you don't mind me asking what was your hba1c number? Is it standard that they prescribe Metformin and give you a cgm?
My HbA1c on my first blood test was 92, the second 86. I think they wanted to put me on Metformin because a finger test when I saw the nurse was 12 mmol//L about 2 hours after I ate. I think the CGM was to enable them to see the impact of the Metformin.
I have a meeting with the nurse again next week to review my figures. Hopefully they will continue to agree that I don't have to take the Metformin as my numbers are now coming down to a more reasonable level.
I have a meeting with the nurse again next week to review my figures. Hopefully they will continue to agree that I don't have to take the Metformin as my numbers are now coming down to a more reasonable level.
BobbleHat
Well-Known Member
- Relationship to Diabetes
- Type 2
- Pronouns
- She/Her
Welcome to the forum. As I've said before on here, the two most useful things I did after my diagnosis in July was to join here and download the Freshwell App. Both of these have helped me a lot.
My story is similar to yours. I knew I was pre-diabetic a year ago but then was diagnosed this year with an hba1c of 56 followed by confirmation at 52. And exactly you, my coping strategy is to read and research and gather information. As my hba1c wasn't >60, my practice nurse was happy for me to trial diet control for 3-4 months before repeat testing. I didn't find their dietary advice very useful for me: it's the Eatwell plate which is too carby heavy for my blood sugars. I eat low carb now and I fast 16:8 - I don't eat until lunchtime and I try to stick to 2 good sized meals and not snacks. It's working for me. I don't weigh much but I'm more than 20lbs down and my blood sugar is lovely and stable (I've had a free trial of a Dexcom and a Libre).
I hope being here helps you to get your head clear.
Good luck. Sounds like you're on the right track. I don't know much about Metformin, or anything yet really!, but Jason Fung has some interesting points about medication and the historical approach of treating the blood sugar levels, where they are just the symptom, rather than the underlying issue. If you're getting your hba1c down naturally then it seems to be much better than with medication because youre treating your condition. I'll have to have a look at the info on Metformin before my appointment. At 51 mmol they might not suggest the medication quite yet.
Leadinglights
Well-Known Member
- Relationship to Diabetes
- Type 2
I should hope not if you are committed to making dietary changes, you should get a repeat HbA1C after three months to see if your actions are being successful.
I think the CGM was a free trial that the poster applied for, most GPs won't even prescribe a monitor let alone a CGM for Type 2/
- Relationship to Diabetes
- Type 1
- Pronouns
- He/Him
The point at which Drs recommend starting Metformin to help with diabetes management seems quite personal and variable between HCPs. Some prefer to give people at lower HbA1cs a few months on Diet and Exercise to see how they go. Others follow the research findings that early support from meds can improve outcomes long-term (or perhaps are just cynical in their belief that most people won't make changes to their diet?).
Adding a CGM (Libre) is quite unusual unless a basal:bolus insulin regimen is being offered I think. See the NICE recommendations under 1.6.17 here
Jason Fung is something of a controversial figure. One of a number of people with a book to sell, some slightly unusual ideas, and whose theories haven't always been backed by available research/study evidence.