Type 2 Still Under Control

[Grateful]

Greetings,

I haven't posted here in a long time. Things have been quite stable although my HbA1c did creep up during the various lockdowns, while still at acceptable levels: 42 according to my annual check earlier this week.

More than five years after my Type 2 diagnosis, I feel fortunate to continue to be able to manage the condition entirely with a low-carb diet and exercise.

In an ideal world I would try to knock the A1c down by a few units in order to create a bit more of a "safety cushion": a couple of years ago it was in the mid-30s. But overall, I can't complain.

 

[Goonergal]

Excellent news and good to see you around again!

 

[Rachox]

Welcome back! Good to see you are keeping things under control, well done!

 

[NicoleC1971]

Just wondering what you envisage stopping, starting and continuing to take you into the normal range?

 

[Grateful]

Just wondering what you envisage stopping, starting and continuing to take you into the normal range?

My experience is that it is 99% to do with diet. I have been pushing it a bit during the past two years by drinking some beer, which of course is basically carbs in liquid form. I am almost certain that cutting back moderately on the beer will bring the A1c back below 40. The rest of my diet is very low-carb apart from a small bowl of muesli at breakfast time (I could cut that out too, if necessary).

I also do half an hour of strenuous exercise every morning: climbing the steep hill that overlooks our village in Kent! Plus a lot of other walking in the countryside. But I do that mainly because it's fun and exercise is good for its own sake; it is unlikely to be making much difference to the A1c.

What I have been trying to do, after the initial panic of the diagnosis 5 years ago, is to seek a "middle way" that is realistically sustainable for the rest of my life. If the numbers climb into the danger range in the future, I know what to do: in the first few months after the diagnosis I was essentially eating keto, less than 30g of carbs per day, and that got me way down to an A1c in the low 30s in a few months.

The other thing I know from experience is that in my case, losing weight (on its own) seems to be effective in sharply reducing A1c. The last time I lost a lot of weight was by deliberately reducing portion size; not just by cutting out carbs. I have since gained all of that weight back, so controlling weight would be "low hanging fruit" if I had to do it. (I am a "thin diabetic" and have never been medically overweight, but in my opinion my "best" weight is considerably lower than my current weight. See the statistics in my signature below.)

My message for anyone facing this for the first time is: you are in it for the long haul. So try to adjust your lifestyle in a way that will be sustainable for the rest of your life. If you are in the fortunate position of being able to achieve A1c control with diet only, you may find (as I have) that you hardly even think about being "a diabetic" any more except when you are food shopping for dinner! (The only monitoring I do is the annual NHS Type 2 checkup, plus occasionally stepping on the weighing scales.)

Thank you for the best wishes and welcomes, they are much appreciated!

 

[MrsA2]

My experience is that it is 99% to do with diet. I have been pushing it a bit during the past two years by drinking some beer, which of course is basically carbs in liquid form. I am almost certain that cutting back moderately on the beer will bring the A1c back below 40. The rest of my diet is very low-carb apart from a small bowl of muesli at breakfast time (I could cut that out too, if necessary).

I also do half an hour of strenuous exercise every morning: climbing the steep hill that overlooks our village in Kent! Plus a lot of other walking in the countryside. But I do that mainly because it's fun and exercise is good for its own sake; it is unlikely to be making much difference to the A1c.

What I have been trying to do, after the initial panic of the diagnosis 5 years ago, is to seek a "middle way" that is realistically sustainable for the rest of my life. If the numbers climb into the danger range in the future, I know what to do: in the first few months after the diagnosis I was essentially eating keto, less than 30g of carbs per day, and that got me way down to an A1c in the low 30s in a few months.

The other thing I know from experience is that in my case, losing weight (on its own) seems to be effective in sharply reducing A1c. The last time I lost a lot of weight was by deliberately reducing portion size; not just by cutting out carbs. I have since gained all of that weight back, so controlling weight would be "low hanging fruit" if I had to do it. (I am a "thin diabetic" and have never been medically overweight, but in my opinion my "best" weight is considerably lower than my current weight. See the statistics in my signature below.)

My message for anyone facing this for the first time is: you are in it for the long haul. So try to adjust your lifestyle in a way that will be sustainable for the rest of your life. If you are in the fortunate position of being able to achieve A1c control with diet only, you may find (as I have) that you hardly even think about being "a diabetic" any more except when you are food shopping for dinner! (The only monitoring I do is the annual NHS Type 2 checkup, plus occasionally stepping on the weighing scales.)

Thank you for the best wishes and welcomes, they are much appreciated!

@FatBadger this answers your question on another thread...and saves me typing it!

 

[AloeSvea]

Thank you for sharing this @Grateful. So many of us found the intense covid years to have very real impacts on us with the diabetes. (Stress, comfort eating and drinking - even with it being low-carb, social isolation, oh - and did I mention stress?) You have really clearly highlighted what monitoring is about, in terms of your body and diet, and physical exercise at least, in relation to your HBA1c.

 

[Pipp]

Welcome back, @Grateful .
I like your philosophical way of dealing with your T2.
Hope you will stick around, and keep us updated on progress.

 

[Grateful]

Today, I had the follow-up NHS consultation one week after the diabetes tests.

There was only one non-normal test result and that was for serum cholesterol:

• Serum cholesterol 5.5 (NHS target is no higher than 5.0 and possibly lower for diabetics)
• Serum HDL cholesterol 1.8
• Serum cholestorol/HDL ratio 3.1
• Calculated LDL 3.25 (fractionally above NHS target)
• Serum non HDL cholesterol level 3.7

On the basis of this they are suggesting taking statins. My response:

• The "abnormal" result is only slightly above the target of "not more than 5.0".
• The HDL is good
• The ratio is excellent
• If I really want to lower my cholesterol, there are non-drug avenues available (diet, and losing some of that belly fat that I have)

They get quite insistent about taking statins on the grounds that diabetes is a "risk factor". My counter-argument is that my diabetes has been completely under control for the past five years, using diet only. Furthermore, my serum cholesterol varies from year to year: there have been years when it is a bit below 5.0 and years when it is a bit above 5.0.

So I am minded to continue to decline their entreaties that I should take statins. Thoughts?

(Edited to add: there is heart disease in the family. My mother had cardiac arrhythmia. She died of a heart attack last year ... at the age of 96!).

 

[Goonergal]

Do you have your trigs number too? The trigs/HDL ratio is an important one.

You could try putting your numbers into these two calculators to provide further evidence: https://cholesterolcode.com/new-report-tool-launched/

https://www.hughcalc.org/chol-si.php

 

[BravoKilo]

FYI, the Qrisk3 calculator can be found here QRISK3 which you can play around with.

I think NICE guidelines place the cut-off for risk at 10%, which once you pass 60 is easy to exceed on this calculator. even for non-diabetics.

 

[Grateful]

Do you have your trigs number too? The trigs/HDL ratio is an important one.

My triglyceride number is 1.0. So the trig/HDL ratio is 0.555.

According to the sources you linked to, that number is "IDEAL".

FYI, the Qrisk3 calculator can be found here QRISK3 which you can play around with.

I think NICE guidelines place the cut-off for risk at 10%, which once you pass 60 is easy to exceed on this calculator. even for non-diabetics.

Funny you should say that. A year ago, the nurse calculated my QRISK3 as being 12.0% but today she came out with a scary figure of 22.4% based on very similar test results to last year's!

Using the QRISK3 calculator that you linked to, I get 18.9%. So I do think the nurse may have made a mistake somewhere, or perhaps her calculator is more sophisticated.

But the BIGGIE is if I change my "diabetes" status to "none" -- this yields a QRISK3 of 11.6%. This is almost exactly what would be expected for a healthy person of my age, once you discount diabetes.

So there's the rub, heh? If I have my T2 diabetes 100% under control and my A1c has been the "normal" range for five years running, and if I can maintain this indefinitely into the future, then which QRISK3 number should I believe?

 

[BravoKilo]

My triglyceride number is 1.0. So the trig/HDL ratio is 0.555.

According to the sources you linked to, that number is "IDEAL".



Funny you should say that. A year ago, the nurse calculated my QRISK3 as being 12.0% but today she came out with a scary figure of 22.4% based on very similar test results to last year's!

Using the QRISK3 calculator that you linked to, I get 18.9%. So I do think the nurse may have made a mistake somewhere, or perhaps her calculator is more sophisticated.

But the BIGGIE is if I change my "diabetes" status to "none" -- this yields a QRISK3 of 11.6%. This is almost exactly what would be expected for a healthy person of my age, once you discount diabetes.

So there's the rub, heh? If I have my T2 diabetes 100% under control and my A1c has been the "normal" range for five years running, and if I can maintain this indefinitely into the future, then which QRISK3 number should I believe?

Yes, diabetes almost doubles the risk in this tool.

The QRISK3 number just has a binary variable for T2 (yes, or no). So the T2 risk factor covers all the T2s who have medication, insulin and T2 derived health issues (retinopathy etc), those whose blood sugars are out of control, as well as the "borderline" T2s and those in remission / carefully controlling their blood sugars. The data for this research is also a few years old, when
the control of diabetes was poorer.

There is a natural tendency to believe what we want, but in this case, do you think you have the same risk as a T2 who is eating anything they want, and has blood sugar levels spiralling out of control, on medication etc?? Personally ....

(Deliberately not commenting on whether the explanatory variables, such as Cholesterol / HDL ratio are appropriate).

 

[Goonergal]

So there's the rub, heh? If I have my T2 diabetes 100% under control and my A1c has been the "normal" range for five years running, and if I can maintain this indefinitely into the future, then which QRISK3 number should I believe?

You might also want to try changing your postcode - there’s an inbuilt bias based on assumptions about health in particular areas. Seems I’m at risk just by living where I live!!

 

[Grateful]

There is a natural tendency to believe what we want, but in this case, do you think you have the same risk as a T2 who is eating anything they want, and has blood sugar levels spiralling out of control, on medication etc?? Personally ....

That's the trouble. I ask the nurses this question almost annually: "Why is my risk so high simply because there was a time, more than five years ago, when I had uncontrolled T2 diabetes?"

As you rightly suggest, this is a big problem with "binary" factors such as this one. I don't have the medical or scientific education to know whether, as someone with completely "reversed" T2, my risks are as high as someone who is less fortunate in their experience with T2.

The nurses certainly treat it as a totally binary issue, and they're the ones who should know!

Or perhaps there is an inbuilt assumption, among the medics, that many T2 patients will eventually deteriorate even if their numbers are currently under control. Therefore, "better safe than sorry", and give out the prescriptions. I can see why that reasoning might make sense on a population-wide basis, but not necessarily for each individual!

 

[Pipp]

HCPs have been using various versions of QRISK to predict my probable demise, for at least 30 years.
Still here, proving them wrong.

 

[Outlier]

Part of this is a back-covering exercise so nobody can accuse the medics of not prescribing enough treatment. Prescribing too much or the wrong sort doesn't seem to carry the same stigma.

Part of this involves financial incentives and strong pressure from those with financial interests.

Part of this involves a genuine belief that we must all fit into a particular set of figures, despite modern research indicating otherwise. A risk/benefit analysis can be revealing.

We also need to remember that science moves on. Today's "scientific fact" becomes tomorrow's "we used to think".

 

[Koalajane]

I have been in remission for 5 years. Last hba1c was 37 and having my review in a couple of days. I hope it is still as good

 

[Lupf]

Hi @Grateful I like your attitude and agree that diabetes T2 is a marathon, not a sprint; we are in it for the duration. A diet controlled approach only works, if it is sustainable, so it is very good to see that you have managed to keep your HbA1c level down for five years. I am of a similar age and can see myself in these numbers. Just like you I lost weight, during 2019, and I succeeded to lower my HbA1c to the 40s. Unlike you, I never managed to go below 42 for the HbA1c. In addition to coming off medication (Metformin) I really like not having this spare tyre around my belly when going cycling (or hiking). You gaining weight back confirms that I should not take this weight loss for granted. So far so good, I still do intermittent fasting to keep my weight, this has now worked for me for three years. I do 5+2, i.e. on two days a week I only eat 600 calories, with very few carbs, Greek yoghurt or eggs for breakfast, liquid lunch (water) and soup, vegetable (curries), maybe a bit of chicken or seafood and salad for dinner. I don't feel hungry this way and it must be good for my blood sugar levels. I've concluded that intermittent fasting works, because it has been tested by evolution. We evolved to burn fat reserves when hunting (mammoth) failed. On the other days, like you I like my muesli for breakfast, I tolerate berries of half an apple, but I am curious what you are typically eating and drinking for lunch and dinner.

Regarding statins, there is a long thread, "Cholesterol and statins" on this forum, I have put my two cents worth into this post https://www.diabetes.co.uk/forum/threads/cholesterol-and-statins.156985/page-25#post-2553796. I was asked to start statins in 2015 after my T2 diagnosis, based on my overall cholesterol being 6.5, but I politely declined for the reasons outlined in above post. Since losing weight my numbers have come down. My overall cholesterol is around 5, my last HDL is 1.5 and LDL is 2.8 and the topic has not come up again. That said, I have not had a face2face with my GP since covid, they seem to be happy with me being able to stop medication. You need to decide for yourself if you want to take statins. Unless you have a history or genetic disposition for coronary heart disease (heart attacks and/or strokes), the case of taking statins, from the numbers you show, is simply "everyone with diabetes should take it", regardless of our actual blood sugar levels. The QRisk scores are indiscriminately adding around 6% for diabetes without taking into account if we are on insulin or in remission, so a very crude indicator. The benefits of statins are clearly exaggerated and the side effects could be significant.