What is remission/reversal of type 2?

[AndBreathe]

To be personally, remission would mean being able to eat carbohydrates without being careful about amount and fat to slow release etc, and not spike BG more than a never-diabetic person. If non-diabetic numbers including HbA1c are only achievable by restricting diet then to me that is "diet controlled diabetes" not remission. Which is absolutely fantastic but just not the same thing to me.

I base that understanding on the use of remission when talking about cancer - it does not exclude the possibility of it returning, but means that at that time you are completely clear as far as can be seen on the tests.

I have lost 15kg since diagnosis and 20kg since the highest weight I recorded earlier this year, and in general my BG readings have been good and I am expecting my next HbA1c to be below diabetic level and hoping for below 42. But I can still see post meal spikes above 3 mmol sometimes from relatively low carbohydrate meals if they are also very low in fat, so I don't think that I have achieved remission.

The rise of +2 from a meal is all very well and a general rule of thumb for those living with T2, however, there are various studies that show never-diabetic people having decent spikes of more than +2 baseline. One of the differences seems to be their peaks are short-lived and not lingering as they can be in those with dysregulated metabolic processes.

 

[Deleted member 21371]

I am aware that I will have to eat like this forever, but I am actually having lovely meals whereas previously I woulf often just snack on and off through the day, I feel satisfied and never hungry anymore. I do have a few carbs but stick to under 130g and 1200 calories each day which is managable.

Today I had greek yoghurt and frozen cherries for breakfast, shepherds pie with carrots cauliflower and brocolli for lunch and for dinner Ham salad. Previously a typical day would be skip breakfast and then be so hungry by 11, eat a couple of rounds of cheese and salad cream sandwiches and a packet of crisps, maybe a chocolate bar. I would drink coke zero, coffee or tea and never just water, I would pop out for several cigarettes in a day (smoked about 10 a day), I would then graze a little between lunch and dinner, on cheese, bread, cake, sausage rolls etc, basically whatever I fancied, I would sometimes not eat dinner but go down at 11pm and make a huge bowl of pasta with cheese and sauce or 4 rounds of toast with marmalade or jam. I just added a typical eating day onto my app out of interest and I would eat 4289 calories and 485g of carbs on a typical day, but even then I was always hungry! Now I eat vegetables and proper meals with reduced carbs and no longer feel hungry at all, it was the snacking that got me, so I think I should be able to tolerate normal food but what I ate before was anything but normal. I would have 4 rounds of thickly buttered toast, loads of pasta with cheese and loads of salad cream in my sandwiches. I feel sick thinking about the volume of things I ate before.

"I am aware that I will have to eat like this forever"
What do you mean by that?

I eat a sensible diet now, and I intend to go on that way, I had very bad habits, I lost them, and don't want them back.
But I won't eat to a specific food group, or lack of food group.
I agree with eating to not put weight back on, and generally a Mediterranean diet works for me, but I will eat anything if that's all that is on offer.
Really it's what the NHS push towards, a structured way of eating, breakfast, lunch, dinner, minimal snacks.
So no overload, spaced out smaller meals, and let anyone with reduced insulin or insulin resistance have less load to cope with.
That was well better than the way of eating I had before, minimal food in the day, everything in one go from 6pm onwards.

 

[Deleted member 21371]

The rise of +2 from a meal is all very well and a general rule of thumb for those living with T2, however, there are various studies that show never-diabetic people having decent spikes of more than +2 baseline. One of the differences seems to be their peaks are short-lived and not lingering as they can be in those with dysregulated metabolic processes.

I always thought +2 was a ridiculous rule.
None diabetics can go from 4 to 10, or higher.
As to testing at 1 hour.....
A rule put out to sell books and diets.

 

[Kreator]

I always thought +2 was a ridiculous rule.
None diabetics can go from 4 to 10, or higher.
As to testing at 1 hour.....
A rule put out to sell books and diets.

...Yep I agree, from my perspective, it's normal for anyone to 'spike' post meal - the difference is in T2D, it doesn't come down due to Insulin Resistance - generally 2 hours post meal in non Diabetic people 'can' come back down to baseline, but many other factors can dicate that - stress, intense exercise etc...

The difference is Insulin has either no effect or not enough is produced as a T2D...

 

[42istheanswer]

The rise of +2 from a meal is all very well and a general rule of thumb for those living with T2, however, there are various studies that show never-diabetic people having decent spikes of more than +2 baseline. One of the differences seems to be their peaks are short-lived and not lingering as they can be in those with dysregulated metabolic processes.

I understand that non-diabetic people can have spikes above 3mmol. I just tend to assume that for the average non-diabetic person, who probably consumes 250g+ carbs most days, a meal with 60g carbs would not result in a 2 hour post meal peak more than 3mmol above pre meal BG, and that they would see their higher spikes from larger quantities of carbs consumed in one go. If eating 61g carbs routinely resulted in a higher 2 hour rise than 3 mmol, then the norm would be more than 3 mmol.

 

[Kreator]

I understand that non-diabetic people can have spikes above 3mmol. I just tend to assume that for the average non-diabetic person, who probably consumes 250g+ carbs most days, a meal with 60g carbs would not result in a 2 hour post meal peak more than 3mmol above pre meal BG, and that they would see their higher spikes from larger quantities of carbs consumed in one go. If eating 61g carbs routinely resulted in a higher 2 hour rise than 3 mmol, then the norm would be more than 3 mmol.

So for me, a spike is the spike, and a Carb is a Carb - the difference is how quickly Insulin brings it back down as opposed to how high the spike will be...

Edit: Balanced by your Liver pushing it back up again..

 

[Jenny65]

"I am aware that I will have to eat like this forever"
What do you mean by that?

I eat a sensible diet now, and I intend to go on that way, I had very bad habits, I lost them, and don't want them back.
But I won't eat to a specific food group, or lack of food group.
I agree with eating to not put weight back on, and generally a Mediterranean diet works for me, but I will eat anything if that's all that is on offer.
Really it's what the NHS push towards, a structured way of eating, breakfast, lunch, dinner, minimal snacks.
So no overload, spaced out smaller meals, and let anyone with reduced insulin or insulin resistance have less load to cope with.
That was well better than the way of eating I had before, minimal food in the day, everything in one go from 6pm onwards.

Same as you really but ensure I eat meals rather than just lots of snacks, I will for example eat a mince pie and an after 8 at Christmas x

 

[Kreator]

Same as you really but ensure I eat meals rather than just lots of snacks, I will for example eat a mince pie and an after 8 at Christmas x

I’ve just had a mini mince pie

2 years ago, I’d have had 3 full size ones as well as custard!

 

[Jenny65]

I’ve just had a mini mince pie

2 years ago, I’d have had 3 full size ones as well as custard!

me too and brandy butter too

 

[Deleted member 21371]

...Yep I agree, from my perspective, it's normal for anyone to 'spike' post meal - the difference is in T2D, it doesn't come down due to Insulin Resistance - generally 2 hours post meal in non Diabetic people 'can' come back down to baseline, but many other factors can dicate that - stress, intense exercise etc...

The difference is Insulin has either no effect or not enough is produced as a T2D...

I understand that non-diabetic people can have spikes above 3mmol. I just tend to assume that for the average non-diabetic person, who probably consumes 250g+ carbs most days, a meal with 60g carbs would not result in a 2 hour post meal peak more than 3mmol above pre meal BG, and that they would see their higher spikes from larger quantities of carbs consumed in one go. If eating 61g carbs routinely resulted in a higher 2 hour rise than 3 mmol, then the norm would be more than 3 mmol.

Diabetes is both or either.

So maybe a little less insulin, or maybe less effective, but balancing exercise, good intake, and it's all good.

None diabetics can easily overload the same way, and spike, and it comes down as fast as it comes down.
3mmol isn't a thing, the body has a high and a low, BG runs in a band, between a very much nominal 4 and 8, and that varies with age.
The hormones that control BG have no memory.
And like every system overshoot happens, so if a none diabetic starts at say 4, the body won't be stopping at 7.
They'll do what they do to get back to 8 or less eventually, then settle back around 5ish.

 

[42istheanswer]

So for me, a spike is the spike, and a Carb is a Carb - the difference is how quickly Insulin brings it back down as opposed to how high the spike will be...

Edit: Balanced by your Liver pushing it back up again..

And the spike is sooner than 2 hours... I thought the point of 2 hour post meal readings was to see how quickly your insulin brings it back down. Hence the oral glucose tolerance test with 75g of glucose and nothing to slow absorption

 

[Deleted member 21371]

I’ve just had a mini mince pie

2 years ago, I’d have had 3 full size ones as well as custard!

I'd have had the box of six and a family sized mini donuts
# Java the Hutt
Actually, diabetes was the wake up call I needed!

 

[harbottle]

I’ve just had a mini mince pie

2 years ago, I’d have had 3 full size ones as well as custard!

I don't like mince pies. I'd be going through boxes of Jammy dodgers or shortbread!

 

[harbottle]

It's a set point system that regulates using 'controllers' (Alpha cells and Beta Cells). The company I work for specialises in modelling such systems to control things like jet engines - you want something to be kept at a fixed point, so the model responds to changes of inputs and makes adjustments to keep the level at the fixed point. If it goes up, something has to be adjusted to bring it down. If it goes down, something is triggered to make it go up. BG is quite complex with a lot of signals and mechanisms (beta cells signalling to alpha cells, beta cells recruiting other cells based on the glucose concentration, hormones like adrenalin, insulin resistance, basal releases to keep things steady, exercise, etc.) but I wonder if anyone has a model where you can simulate things like insulin resistance or insufficient insulin release and see what the effect is (i.e. 'simulate the effects of a welsh cake when insulin secretion is down to 50%)

I guess if you did make a model of this with all the inputs, you'd get cases where the set point rises and comes down slowly over time (i.e. if you're still digesting food and pumping glucose into the blood stream.) and times when it goes up quickly and comes down quickly... or cases where it goes up and doesn't fall and stays high.

Sorry, I'm rambling!

 

[42istheanswer]

I don't like mince pies. I'd be going through boxes of Jammy dodgers or shortbread!

Jaffa cakes.... The non-orange ones like cherry and passion fruit... Open a pack and quicker there would be none left...

 

[Drummer]

Same as you really but ensure I eat meals rather than just lots of snacks, I will for example eat a mince pie and an after 8 at Christmas x

I have never been happier than on 2 meals a day, around 12 hours apart. I really enjoy what I eat, and I could cope with more carbs and once in a while I do - but the vax slightly damaged one foot and I really do not want to have any bother with complications if I can possibly help it, so I just go on as I am and all seems to be well.
I have bought a couple of melons and some iced gingerbread as it is Christmas, but otherwise it will be pretty much the same foods as usual, with perhaps a trifle rather than the jelly with berries but still low carb.

 

[Sussexmax]

Gosh all this talk of mince pies, custard, jaffa cakes, after eights, shortbread etc sets my taste buds going - and worries me in equal measure! This will be my first Christmas since being diagnosed, and I know it’s going to be hard. I think I’ve managed pretty well so far in terms of self-discipline as I’ve had that drummed into me by the DN at the surgery, but everything is so much more at this time of year.

 

[Mike P]

This has been a really interesting thread. I feel that it depends on where you are coming from. For example, my latest HbA1c was 42 which was described by my diabetes nurse as Glucose Intolerant. I was tlold that had the reading been 40 it would have been considered diabetes reversal. What I felt was interesting is my older brother's HbA1c was also 42 he was called pre-diabetic and he was put on a course to understand and correct the situation. I guess that because I already have the diabetes diagnosis and have been reducing my BG I am referred to as Glucose Intolerant rather than pre-diabetic. My brother on the other hand has increased his BG and therefore is labelled pre-diabetic.
Mike

 

[AndBreathe]

I always thought +2 was a ridiculous rule.
None diabetics can go from 4 to 10, or higher.
As to testing at 1 hour.....
A rule put out to sell books and diets.

I think it's a decent rule of thumb, but not an inflexible "law".

Testing at an hour can be helpful to understand the individual's rough bell curve, but for intensive testing the Libre has really trumped finger prick testing, and if finger prick testing is intensive, probably not too much more expensive for many-fold times the data

 

[AndBreathe]

I understand that non-diabetic people can have spikes above 3mmol. I just tend to assume that for the average non-diabetic person, who probably consumes 250g+ carbs most days, a meal with 60g carbs would not result in a 2 hour post meal peak more than 3mmol above pre meal BG, and that they would see their higher spikes from larger quantities of carbs consumed in one go. If eating 61g carbs routinely resulted in a higher 2 hour rise than 3 mmol, then the norm would be more than 3 mmol.

........... unless the non-diabetic person had some other anomaly of their metabolism.

For me, we each have to do our own research, hedge our own bets and get on with it. Were there a full-proof answer there would be no places like this.