Great HbA1c, Very Disappointed!

[Guzzler]

Very interesting, thank you. I certainly experienced what I'd call carb addiction when I was doing the carb-and-exercise thing, and really needed to increase the exercise to compensate for the carbs and calories. Which is okay for a non-diabetic but not for me; I could keep the exercise up daily in terms of energy levels, but not in terms of lifestyle.

I'm liley to need to go down the low carb route by the looks of things, so it's nice to hear that the occasional hit of carbs wouldn't be a distaster. I hope to get back into mountaineering next year, and just from a safety perspective, it would be nice to know I can be carrying a lot of fairly fast-acting energy with me! And so far that also seems to be a scenario where I can keep the spikes low, as I'll be using up energy shortly after the carbs.

Re energy levels whilst mountaineering perhaps you would be interested in Prof. Tim Noakes lectures on carb loading v fat fuelling on YouTube. He recounts low carbers winning the Iron Man competitions among other things.

 

[Fleegle]

Thanks for the encouragement, and congratulations on your progress!

I am actually thinking of fully committing to a strict ND using Tesco's UltraSlim and vegetables in the new year, for as long as it takes to get to my target weight. It's probably not a bad time to go radical in terms of minimal calories, as they say weight loss is harder the lighter you get, so might as well use that diet to finish the job.

That's likely to be my final attempt at my definition of remission, then I'll go low-carb and stop whingeing!

I did the ultraslim shakes. I didn't mind them too much. In fact I confess the strawberry ones were really nice indeed.
You will get a load of posts about spiking your blood. They are mixed with semi-skimmed milk but I found a post of someone who watered them down - and they tasted much better and you reduce an amount of the carbs. You then need to think how you get the macro's write in terms of protein, fat and calories that the milk would have given you.
I actually found the vegetables much worse - my goodness they were dull.

But - and I am sure many will point out - you can use normal food like Michael Mosley did in his book the blood sugar diet and someone posted a video with Prof Taylor saying the same.

Now I have also seen a lot of people post that it doesn't matter how long it takes as long a you lose the weight. I personally cannot evidence that but doesn't mean it is not completely true. I have heard him say the important thing to do is to stick to it until the fat is removed from the pancreas - so those two statements seem a bit of a juxtaposition to me.

The thing is - 8 weeks or so on the shakes is not hard at all - really over rated how hard and typically people who have not tried it are typically the first to tell you how bad it is. Also - hunger is not to big a problem. I am on the LCHF diet now for a while and funny enough at times I get a bit hungry on that too. I would probably not do it again - but would do it again and intend to do so at some point on some real food.

Get GP support and make sure you feel well all the time and then if you do - give it a go. If you are going to face into the rest of your life on a very strict LC diet - then what is 8 weeks or so in the grand scheme of things.

BTW - I would absolutely, every now and then love a bacon sandwich maybe once or twice a year maybe. I do worry if I could would I stop at one - but that is what I would call a world class problem to have.

 

[AdamJames]

Re energy levels whilst mountaineering perhaps you would be interested in Prof. Tim Noakes lectures on carb loading v fat fuelling on YouTube. He recounts low carbers winning the Iron Man competitions among other things.

Yes, very interested. Thanks.

 

[AdamJames]

I did the ultraslim shakes. I didn't mind them too much. In fact I confess the strawberry ones were really nice indeed.
You will get a load of posts about spiking your blood. They are mixed with semi-skimmed milk but I found a post of someone who watered them down - and they tasted much better and you reduce an amount of the carbs. You then need to think how you get the macro's write in terms of protein, fat and calories that the milk would have given you.
I actually found the vegetables much worse - my goodness they were dull.

But - and I am sure many will point out - you can use normal food like Michael Mosley did in his book the blood sugar diet and someone posted a video with Prof Taylor saying the same.

Now I have also seen a lot of people post that it doesn't matter how long it takes as long a you lose the weight. I personally cannot evidence that but doesn't mean it is not completely true. I have heard him say the important thing to do is to stick to it until the fat is removed from the pancreas - so those two statements seem a bit of a juxtaposition to me.

The thing is - 8 weeks or so on the shakes is not hard at all - really over rated how hard and typically people who have not tried it are typically the first to tell you how bad it is. Also - hunger is not to big a problem. I am on the LCHF diet now for a while and funny enough at times I get a bit hungry on that too. I would probably not do it again - but would do it again and intend to do so at some point on some real food.

Get GP support and make sure you feel well all the time and then if you do - give it a go. If you are going to face into the rest of your life on a very strict LC diet - then what is 8 weeks or so in the grand scheme of things.

BTW - I would absolutely, every now and then love a bacon sandwich maybe once or twice a year maybe. I do worry if I could would I stop at one - but that is what I would call a world class problem to have.

Thanks for all that!

I did actually try it for about a week, some time ago now. I have to say, after about 3 days, I also didn't find the hunger a problem! I didn't consider water instead of milk, I'll give that ago. What I remember doing was comparing it to the Optifast ingredients and balance of carbs/protein/fat, and thinking that they are actually quite similar. The Optifast appears to have a lot less sugar at first, but then I checked the main ingredient, and while it wasn't sugar, apparently it's just as fast-acting as glucose, so both shakes were likely to get the same sort of spikes, and that clearly didn't scupper things for the 11 people on the first trial! I remember thinking that effectively the Ultraslim shakes had just a little bit more fast-acting carbs than the Optifast, so they were a pretty good match.

Re the vegetables, first I tried boiling them in stock and eating them like that (least favourite option), then I tried raw (second favourite option) then as soup, by boiling them in stock and blending the result. It was great that the "allowed additions" included stock cubes and garlic! The soups were my favourite way of getting the vegetables down, I was amazing at just how big a mound 200 cals of vegetables is!

Did you have ... erm... constipation issues? That's what stopped me in the end. I don't mean constipation as in not going to the toilet for days, I mean as in ... how can I put this ... the attempts to evacuate became positively damaging due to the consistency of the parcels?

I mean, I don't want to go into detail, but, here it is:

It was like mars bars made out of house bricks, with malteser-sized balls sticking out of the sides of them, except made out of steel, and all scraping against one's insides, in an it's-2-in-the-morning-I-wonder-if-accident-and-emergency-is-busy kind of a way?

If so did you have a solution?

In all seriousness it was this and this alone which made me stop.

I'd never heard of Fybogel before, but I think it may have saved my life!

 

[Guzzler]

What a pity to think someone is testing readings and another is that all you do all day, life is short, for goodness sake, you must be driving yourself a little crazy, I think people have a wrong idea about diabetes and making it something much worse than it it is when extremes are going this far. I cannot understand people who are testing, 2,3,6,.8,9 times a day, what good is that only putting oneself in a depression if the numbers are higher than they want, the body raises and lowers its normal, diabetic people or not, so why put yourself through hell.......??

Test less life and enjoy instead, you may get a surprise...

Mallorca

"Life is short" and "....something much worse than it is" are statements that baffle me tbh. Indeed, Life is short and even shorter if you suffer a Diabetes induced heart attack for lack of good control. As for being of the opinion that some people make out that T2 is much worse than it really is have you not seen the posts on this forum from members suffering the threat of going blind, of facing dialysis or even the few posts I have seen from members facing amputation? These are real risks that we face so testing is a very effective tool in actually lowering anxiety and stress and promotes a sense of well being and of a continuing reminder that we are doing the right stuff. If you choose not to test for whatever reason then that is fine but yours is an approach that I, personally, could never take.

 

[Biggles2]

I also struggle with those definitions. According to that, I have been in complete remission for 3 and a half years, but only due to my low carb diet. I doubt I could maintain it if I went back to "normal" food. I am not in remission. I am well controlled by diet.

The consensus statement addressed this (without mentioning diet per se):

"Remission is defined as achieving glycemia below the diabetic range in the absence of active pharmacologic (anti-hyperglycemic medications, immunosuppressive medications) or surgical (ongoing procedures such as repeated replacements of endoluminal devices) therapy."​

By their definition I am in remission too, and like you, I am controlled by diet.

 

[Grateful]

To us combatants down in the trenches, remission means that we no longer have the condition and don't have to take any special measures related to that condition.

I disagree. What you have described is what I would call a "cure." If you "no longer have the condition" (your phrase) that to me is synonymous with being "cured."

In my opinion, "remission" means that you still have the disease, but it is in abeyance (perhaps forever!).

Having said all of that, it doesn't matter that much, because it is to some extent playing with words (although words are important!). As long as we can agree on the facts of our medical conditions ... that is a bit more important than the "form of words."

 

[Grateful]

What a pity to think someone is testing readings and another is that all you do all day, life is short, for goodness sake, you must be driving yourself a little crazy, I think people have a wrong idea about diabetes and making it something much worse than it it is when extremes are going this far. I cannot understand people who are testing, 2,3,6,.8,9 times a day, what good is that only putting oneself in a depression if the numbers are higher than they want, the body raises and lowers its normal, diabetic people or not, so why put yourself through hell.......??

Test less life and enjoy instead, you may get a surprise...

Mallorca

I disagree, and I am one of those people who does *not* self-test. We are all different. Deciding to avoid self-testing is a choice, just as much as deciding to do it. Failing to self-test is a calculated risk. Some people don't like taking the risk, and given the points made by @Guzzler about the complications of diabetes, their risk-avoidance is rational. Some, such as myself, take the risk -- but it should only be made as an informed decision and fully cognizant of the risks (in my case, leaving open the option of self-testing later if circumstances warrant).

 

[Grateful]

Concerning OGTT: I am considering doing it, following @bulkbiker's example. But like him, even if I passed it with flying colors I would not consider myself "cured." It would be just one more piece of evidence of "good control."

Cured? That would be: I go on a three-month carb binge, like "normal" people. After that carb binge, my HbA1c is still "normal." Rinse and repeat, for several years at least. THAT is what I mean by a "cure." Am I prepared to risk it? I don't think so.

 

[Guzzler]

I disagree, and I am one of those people who does *not* self-test. We are all different. Deciding to avoid self-testing is a choice, just as much as deciding to do it. Failing to self-test is a calculated risk. Some people don't like taking the risk, and given the points made by @Guzzler about the complications of diabetes, their risk-avoidance is rational. Some, such as myself, take the risk -- but it should only be made as an informed decision and fully cognizant of the risks (in my case, leaving open the option of self-testing later if circumstances warrant).

I know you do not test. You come from a different starting point re your A1c and you seem to be well controlled but I wonder sometimes if you have taken into account the aging process which in itself can diminish our capacity to deal with foodstuffs such as the beer and wine you are capable of coping with now.

I did say in my comment that an individual can choose not to test and that is fine for them but it would definitely not be my approach. Given my stats can you blame me or say that I am obsessed by testing when I say I test four times per day i.e pre and post prandial on two meals per day? I think not.

 

[Biggles2]

I think some of the confusion may because certain words have a different context to Health Care Professionals.
"In remission" to an HCP can mean that all symptoms of the condition are no longer apparent with no medication being taken.

Exactly @LittleGreyCat! The ADA consensus group was a group of physicians from various medical specialty areas. The group discussed and debated many of the semantics issues raised by @AdamJames. The challenges inherent in defining 'remission' and 'cure' was very much front and center to their discussions:

“However, defining remission or cure of diabetes is not as straightforward as it may seem. Unlike “dichotomous” diseases such as many malignancies, diabetes is defined by hyperglycemia, which exists on a continuum and may be impacted over a short time frame by everyday treatment or events (medications, diet, activity, intercurrent illness). The distinction between successful treatment and cure is blurred in the case of diabetes. Presumably improved or normalized glycemia must be part of the definition of remission or cure. Glycemic measures below diagnostic cut points for diabetes can occur with ongoing medications (e.g., antihyperglycemic drugs, immunosuppressive medications after a transplant), major efforts at lifestyle change, a history of bariatric/metabolic surgery, or ongoing procedures (such as repeated replacements of endoluminal devices). Do we use the terms remission or cure for all patients with normal glycemic measures, regardless of how this is achieved?”​

The group addressed the issue of the need for a sustained remission in their definition:

“In a patient with type 2 diabetes, for example, improved or normal glycemia that occurs after only a few days of a stringent diet should certainly not be considered remission. Otherwise, patients could be in and out of remission constantly.”​

And they addressed the challenge inherent in using the word ‘cure’:

“Additionally, if cure means remission that lasts for a lifetime, then by definition a patient could never be considered cured while still alive. Hence, it may make sense operationally to consider prolonged remission of diabetes essentially equivalent to cure.”
http://care.diabetesjournals.org/content/32/11/2133​

It is really important from a policy perspective to have a standard definition for remission. Scarce NHS funds need to be directed to where they will do the most good.

 

[Grateful]

I know you do not test. You come from a different starting point re your A1c and you seem to be well controlled but I wonder sometimes if you have taken into account the aging process which in itself can diminish our capacity to deal with foodstuffs such as the beer and wine you are capable of coping with now.

I did say in my comment that an individual can choose not to test and that is fine for them but it would definitely not be my approach. Given my stats can you blame me or say that I am obsessed by testing when I say I test four times per day i.e pre and post prandial on two meals per day? I think not.

I would say you and I are 100 percent in agreement. Did I criticize anyone who tests? Far from it.

 

[Guzzler]

I would say you and I are 100 percent in agreement. Did I criticize anyone who tests? Far from it.

We can agree to disagree quite comfortably. My point was that pollensa's comment/opinion did not sit well with me but your comment said (the way I interpretd it) that you agreed with that one whilst disagreeing with my own. It was for the reasons that the commenter gave rather than anything else that I found wanting.

 

[AdamJames]

Exactly @LittleGreyCat! The ADA consensus group was a group of physicians from various medical specialty areas. The group discussed and debated many of the semantics issues raised by @AdamJames. The challenges inherent in defining 'remission' and 'cure' was very much front and center to their discussions:

“However, defining remission or cure of diabetes is not as straightforward as it may seem. Unlike “dichotomous” diseases such as many malignancies, diabetes is defined by hyperglycemia, which exists on a continuum and may be impacted over a short time frame by everyday treatment or events (medications, diet, activity, intercurrent illness). The distinction between successful treatment and cure is blurred in the case of diabetes. Presumably improved or normalized glycemia must be part of the definition of remission or cure. Glycemic measures below diagnostic cut points for diabetes can occur with ongoing medications (e.g., antihyperglycemic drugs, immunosuppressive medications after a transplant), major efforts at lifestyle change, a history of bariatric/metabolic surgery, or ongoing procedures (such as repeated replacements of endoluminal devices). Do we use the terms remission or cure for all patients with normal glycemic measures, regardless of how this is achieved?”​

The group addressed the issue of the need for a sustained remission in their definition:

“In a patient with type 2 diabetes, for example, improved or normal glycemia that occurs after only a few days of a stringent diet should certainly not be considered remission. Otherwise, patients could be in and out of remission constantly.”​

And they addressed the challenge inherent in using the word ‘cure’:

“Additionally, if cure means remission that lasts for a lifetime, then by definition a patient could never be considered cured while still alive. Hence, it may make sense operationally to consider prolonged remission of diabetes essentially equivalent to cure.”
http://care.diabetesjournals.org/content/32/11/2133​

It is really important from a policy perspective to have a standard definition for remission. Scarce NHS funds need to be directed to where they will do the most good.

That's really interesting stuff. I didn't realise a professional body had agonised over the definitions in this way.

 

[Grateful]

We can agree to disagree quite comfortably. My point was that pollensa's comment/opinion did not sit well with me but your comment said (the way I interpretd it) that you agreed with that one whilst disagreeing with my own. It was for the reasons that the commenter gave rather than anything else that I found wanting.

It looks like I owe you an apology. I said that the reasons you gave for self-testing (among them, the risk of D complications) were rational, but perhaps I wasn't clear enough!

 

[Guzzler]

It looks like I owe you an apology. I said that the reasons you gave for self-testing (among them, the risk of D complications) were rational, but perhaps I wasn't clear enough!

That is perfectly alright, as it stands we are in agreement that testing is a personal choice.

 

[Notwithstanding]

I haven’t read all the replies to your post, but I guess that they must pretty much agree with me (or I with them) that you have been extremely successful. Don’t worry about it & keep on doing what you have been doing. Well done !

 

[Triffo]

I too will never be cured. I can get away with the odd high carb meal or treat, but only if I exercise (cycling is the best). I have also gone from the red to green zone. It’s taken 4 years but I now have a good HBA1C and good weight loss, although my cholesterol is giving concern but I cannot in any way consider myself cured. The minute I even look at an item containing carbs I’m sure my BG rises. I’ve done it by loosely following Michael Mosley’s Blood sugar diet regime. I do find it tiresome some times that I can’t let go of the daily control, that can get a little tiresome. Although I do occasionally get the odd nice surprise when I eat a lovely dessert and nothing happens. Makes all the hard graft worth it.