Question. Is it inevitable that Type2 will have to go on Insulin???

[jack412]

From what I read, it really depends on how many pancreas cells are still working, once the insulin resistance goes.

 

[Brunneria]

In fact this does apply to me.

I was overweight when diagnosed - a rapid weight loss from 14.5 stone to 14 stone (shudder) triggered the blood test and diagnosis.

I quite quickly reduced my weight to 13.5 stone (well, just over 'good' BMI but I have large bones) and cleared the scary high BG but still definitely diabetic.

Trimmed down to 13 stone and considered myself one of the unlucky normal weight diabetics with nowhere to go.
I found myself resenting the obese T2s who could drop a few stone and reverse diabetes.

Having read various papers coming out of the Newcastle Study I realised that midpoint of normal BMI was a better target and perhaps 'slim' T2s did have an option.

I am now down to 11 stone 12 pounds which for 6' tall is still not mid point BMI but my BG has gone from diabetic to pre-diabetic over the last 3 months.

I am having a bit of a battle but I intend to get down below 11 stone 7 lbs and see what my HbA1c is then.

So I am a slim Type 2 and I know all about scarily low weights.
Getting there - I weighed 11 stone 7 lbs when I was 16.
I do wonder if a general target should be to weigh the same at 60 as you did at 16.

So - my personal view is that T2s should aim to be at or below the mid point of 'normal' BMI which is probably a scary number for most people who think they are a 'normal' weight.

Body image is a very strange thing.
I thought I was quite slim at 13 stone.
My family started to worry about me when I got down to 12 stone 7 lbs - thought I had gone far enough.
Now at 11 stone 12 lbs I realise that I am not a stick insect but am still carrying quite a bit of fat.
I am aware that anorexia is a thin person looking in the mirror and seeing a fat person, but hopefully I will know when to stop!

Cheers

LGC

Thank you - that explained a lot.

 

[AndBreathe]

@LittleGreyCat - I believe as your weight lowers, so will your perception of yourself. During your period of weight loss, have you ever felt you looked "a bit drawn", as we Scottish people might say, only to find a short while later you looked fine again? It looks like your BMI is still in the upper/mid range, so you have a way to go before your weight would be a health concern; provided your weight loss regime is not starvation.

Others'' view, in terms of your changing appearance is much more complex. Some others will find your changing image a challenge, and some even potentially a threat.

Anorexia is an extremely complex range of conditions, of which body dystrophic disorder is a tiny part, and only present in a proportion of cases. And, at the more mature end of the spectrum, and male, you are significantly unlikely to be affected. Of course, there are exceptions to all perceived rules.

 

[AndBreathe]

I didn't carry a huge amount of weight at diagnosis, and am now within 2kg of the bottom of the BMI range for my gender, age and height. My numbers are good, and my aim is to avoid medication, never mind insulin, for the remainder of my life.

I'm considering self-funding a c-peptide test in order to confirm or disprove my belief I became diabetic due to a fairly modest fat threshold breaching my diabetic tipping point. Subject to the result, I would know I have to, absolutely have to maintain a slight weight and frame for the longer term.

 

[connie104]

I would class myself as a slim type 2 . I was diagnosed in hospital after having a stroke. I am 5 fit 5ins and weigh just under 9 stone. I probably would have never known I was diabetic if I had not had the stroke . I think I must have had it for a while as I have neuropathy in my leg glaucoma in my eyes suffered frozen shoulder seems like any diabetic side effects I get ! I think I control it quite well but would love to be med free diet controlled and am working on it. I have never even considered the thought of needing insulin at some stage but who knows what the future holds !


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[JohnD54]

Many thanks for all the replies, as always most informative and interesting.

I will take the information here and since I am a pint is always half full sort of person, take it that you can live without going onto insulin if you maintain a healthy diet and do some extra exercise.

My Personal short journey so far.

Diagnosed Mid May, after my annual blood tests came back with an average reading 9.5 , told to take Met 1 x 500 per day, increase to 2 x 500 after 2 weeks increase again in 2 weeks to 4 x 500 per day. Started dong some research into what the
Met did and also the NHS diet sheet, the obvious was the sugars were out. Was very lucky to find this forum on 2/6 and read as much as I could. Decided on my version, I think we all have our own of the LCHF. Basically no more than 50g of carbs per day and no more than 1200 calories. Also decided to only take 2 x Met per day with the aim to come off them as soon as possible.

Result so far,
Weight at diagnosis 14st 11 lbs
Weight now 13st 3lbs
BG at diagnosis 9.5
This weeks average out of bed under under 5, testing before meals average under 6 after under 7. Highest reading 7.2

I realise I have a long way to go before I even begin to understand Diabetes let alone have it under control, but onward and upward with the support of my fellow forum members I am sure things will improve.

Sorry to have waffled on.


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[LittleGreyCat]

So is there hope for a T2 who has reduced BMI from 31 to 23 since diagnosis but still in pre-diabetic range with no more weight to lose? This is me, and am I likely to stall as far as BS goes?

With a BMI of 23 you still have scope to lose weight.

A BMI of 19-20 is still well within the normal range.

No promises, but if you have improved to pre-diabetic then you might improve further.
Even if you don't I suspect that long term BG control will be better.

Cheers

LGC

 

[Bluetit1802]

With a BMI of 23 you still have scope to lose weight.

A BMI of 19-20 is still well within the normal range.

No promises, but if you have improved to pre-diabetic then you might improve further.
Even if you don't I suspect that long term BG control will be better.

Cheers

LGC

I am already skin and bone at BMI of 23. I have a big frame, large bones and naturally broad shoulders. However, I could try losing enough to get me to 22 but no less. Thanks for the response LGC.

 

[Brunneria]

I am already skin and bone at BMI of 23. I have a big frame, large bones and naturally broad shoulders. However, I could try losing enough to get me to 22 but no less. Thanks for the response LGC.

BMI is a very inaccurate gauge, because it doesn't take your frame and build into account, just your height and weight. I should go with your gut feeling, Blue, and be a comfortable weight.

Not everyone is going to cure their D by skinnifying, just as not everyone is diabetic because they have a fatty liver.

And being obsessed with weight (whether high, or low) is just as much of a disease as diabetes.
So says the anti-slimmer.

 

[Alan S]

The answer is no. I refuse to accept inevitability of things like insulin, although I do not fear it. My goal is to avoid complications, not meds or insulin. If eventually it is necessary I will add it to the regimen.

The statistics are not based on pro-active type 2s using the web and other information sources to do more than the minimum than the doctors prescribe.

No-one has ever done the statistics for people like us. I added metformin after three years. Nothing else since. Still no complications after 12 years.

 

[jack412]

You eat a diet you can live with for the rest of your life
BG good = Aok
BG bad = look at diet
BG bad = take med
BG good = Aok
BG bad or gets bad over time = take more med
Tablets don't keep BG good = injections
BG good = Aok

 

[Harpar]

I think I agree with everything you've said.

But when I read comments like this 'So I suspect that if you manage to get your weight down to a level where your symptoms are minimised or disappear (which may be a scarily low weight) then you stand a good chance of avoiding having to take insulin'

Such comments always make me wonder about the slim type 2s. I think they are about 20% of type 2s (though I can't remember where I got that figure from).

They are often less diagnosed, because a lot of doctors are expecting late onset D to come with a spare tyre. So I assume that they have often been running for quite some time with raised BG levels and may have developed complications. And may have insulin looming earlier, as a result.

Is the assumption that even slim type 2s need to lower their bmi, to get rid of organ fat? Or are type 2s who are already slim diabetic for different reasons and skinnifying will never get the result? Maybe some slim type2s will chip in with their experiences.

I'm not aiming these questions at you @LittleGreyCat , it is just that your post prompted me to ask the question I've been wondering for a while...

Must admit that slim T2s often don't get diagnosed because of the entrenched current belief that its an 'overweight' disease. My BMI has been between 17-19 most of my life, and yes, was and still am very active, never ever ate '****' food, etc. etc. so don't fit the type. When I first started getting symptoms, e.g. almost collapsing after eating a normal meal, with a few carbs but not loads of carbs, blurred vision, excessive thirst, palpatations, feeling sick, high cholesterol etc. never once did my doctor think to test for diabetes. Problem - fasting BGs absolutely normal, although beginning to rise into the 5s. Got sent to heart specialists, gastro specialists, even an endo who dismissed the problem!. Nevertheless was experiencing raised post-prandial spikes. The spikes were consistant with a diagnosis of diabetes e.g. frequently over 11mmol/l. I now control them by having a LCHF diet as would many diabetics, but still classed as normal. But the interesting thing is that where many of you on here have experienced a huge fall in a1cs on LCHF, its taken 2.5yrs for mine to get below 6.0 from 6.3. So, may be there is something else going on, maybe its just an age thing and the pancreas is on the blink - although if I ingest pure glucose (OGTT 75g) I don't go above 6.3 at any time(?) its makes you wonder if there is something that is blocking the secretion of insulin after a meal but not after glucose. If ignored the ever increasing post-prandial numbers would ultimately lead to insulin resistance and eventually pancreatic failure - cells start to get damaged with levels above 10mmol/l for any length of time.

 

[jack412]

https://www.diabetesaustralia.com.au/Documents/DA/NDW 2012/NDW 2012 Media Report.pdf
Let's get rid of the myth
Of all the people who develop type 2 diabetes, about 50per cent come from the high-risk population and the remaining 50 per cent come from the general (low-to-intermediate-risk population) – so if we want to prevent type 2 diabetes, we need to have a high-risk prevention program operating in conjunction with community wide, all of population initiatives

 

[Harpar]

I notice from that report it recommended that no more than 30% of energy should come from fat, so if we go low carb, where are we supposed to get the rest of our energy intake from?
So for those on around 50g carb a day that equates to 200 cals.
If you are on 1200 cals a day, you can get 30% from fat that equals 40g fat / 360 cals.
That leaves 640 cals short fall, or you would have to eat a huge quantity of protein to make it up, 160g of protein - far, far, too much.
or are they recommending a much higher intake of carbs? - don't work for me.

 

[LittleGreyCat]

I notice from that report it recommended that no more than 30% of energy should come from fat, so if we go low carb, where are we supposed to get the rest of our energy intake from?
So for those on around 50g carb a day that equates to 200 cals.
If you are on 1200 cals a day, you can get 30% from fat that equals 40g fat / 360 cals.
That leaves 640 cals short fall, or you would have to eat a huge quantity of protein to make it up, 160g of protein - far, far, too much.
or are they recommending a much higher intake of carbs? - don't work for me.

Depends how much you weigh.
One guideline is to not eat more than 1 gram of protein per pound of body weight.
So someone weighing 11 stone 6 lbs should be fine on 160 gm of protein a day.

If you follow LCHF, of course, you need a lot more fat

 

[LittleGreyCat]

I am already skin and bone at BMI of 23. I have a big frame, large bones and naturally broad shoulders. However, I could try losing enough to get me to 22 but no less. Thanks for the response LGC.

If you fall outside the 'average' body shape then BMI can be misleading.
A very good guide then is that your waist measurement should not be more than half your height - if possible it should be less.
So someone 6 foot (72 inches) tall should have a waist measurement of no more than 36".
[Note that is your properly measured waist - not the size waistband on your trousers ]
I have only just got my waist measurement down to half my height, so there is room for improvement.

Cheers

LGC

 

[Harpar]

Depends how much you weigh.
One guideline is to not eat more than 1 gram of protein per pound of body weight.
So someone weighing 11 stone 6 lbs should be fine on 160 gm of protein a day.

If you follow LCHF, of course, you need a lot more fat

I think you might have got your pounds and grams mixed

http://authoritynutrition.com/how-much-protein-per-day/

I think you will find 11st 6lb is about 72 kg, at 0.8 gm per kg = about 58 gm protein a day.
Unless you are going in for body building. - Women usually have less than 0.8gm per kilo.

 

[jack412]

Depends how much you weigh.
One guideline is to not eat more than 1 gram of protein per pound of body weight.
So someone weighing 11 stone 6 lbs should be fine on 160 gm of protein a day.

If you follow LCHF, of course, you need a lot more fat

That is a common myth on bodybuilding forums and is 30% more than an extreme person needs ..75g per lb or 1.7 per kg maximum
It is also of LEAN body mass = bmi minus - fat%
http://www.ausport.gov.au/ais/nutrition/factsheets/basics/protein_-_how_much


A normal active person needs 0.8-1g per kg or 0.35-.45g per lb of lean body mass, that's your bmi minus the fat%

 

[jack412]

http://www.medicinenet.com/script/main/mobileart.asp?articlekey=50900&page=2

The recommended amount of protein consumption is about 10%-35% of your daily calories. Adult women need, on average, 46 grams of protein a day, while adult men need about 56 grams

 

[paulins]

My GP told me that many T2s never go onto insulin, and indeed many of his patients never take drugs, but control it with diet and exercise. He has supported me on the Newcastle diet, prescribed the meter and test strips and lancets, and has done an HbA1c every month for the past 6 months (currently 4.8) to see how I have been doing. Fasting reading was 4.2 this morning. I believe my body has allowed the beta cells to regenerate, or renew, as these seem such good readings to me (and to the doctor who is amazed!). I think the fat has now gone from my organs as they seem to be behaving much better! I think we are genetically disposed towards diabetes - I have some very slender friends who have recently been diagnosed as T2 - but I also think I am part of the majority who were overweight and because of this triggered the diabetes because of the fat that had been deposited in my liver and pancreas. But, it is really important for me to remember that I have a predisposition to diabetes and never to let myself get fat again, or eat all the wrong things, and to make sure I keep up the exercise. Hmm ... a big ask then!