“Reversing” prediabetes

[Doireallyneedanams]

I don’t understand this at all.

Doctors will say you can “reverse” prediabetes, but not T2.

Once prediabetic, doesn’t that mean your body has reached a point where it simply does not function in the way it did before, and that will be the case forever - however it can be managed with diet.

If a prediabetic “reversed” their prediabetes to normal levels with diet but then started eating their previous diet, wouldn’t they end up prediabetic again in a short space of time? Or is it possible to cure or “heal” your body at this stage? I’m a little confused as I know with full blown T2 it’s fairly common to reduce your glucose to non diabetic levels but that doesn’t mean you’re no longer insulin resistant.

Why the different language? Can a prediabetic cure themselves of insulin resistance / prediabetes and then go on to eat whatever they like?

 

[Antje77]

I'm pretty sure this is a language issue, not a medical one.

 

[Andydragon]

I don’t understand this at all.

Doctors will say you can “reverse” prediabetes, but not T2.

Once prediabetic, doesn’t that mean your body has reached a point where it simply does not function in the way it did before, and that will be the case forever - however it can be managed with diet.

If a prediabetic “reversed” their prediabetes to normal levels with diet but then started eating their previous diet, wouldn’t they end up prediabetic again in a short space of time? Or is it possible to cure or “heal” your body at this stage? I’m a little confused as I know with full blown T2 it’s fairly common to reduce your glucose to non diabetic levels but that doesn’t mean you’re no longer insulin resistant.

Why the different language? Can a prediabetic cure themselves of insulin resistance / prediabetes and then go on to eat whatever they like?

There seems still debate as to whether pre-diabetes should be considered a condition or not.

But that aside, knowing that the body has an impairment that is causing higher than normal blood levels but not quite ticked over into the diagnosis range for diabetes offers a way to be aware that there is a heightened risk and that taking a change in your life would be a good idea

As for the latter point, it’s interesting, if T2 can be put into remission and controlled but tends to get back out of control if the dietary and lifestyle changes are reversed which increases blood levels back to a measure that is used for diabetes diagnosis then it would follow on that “pre-diabetes” would reverse in the same way. After all, the levels are just a level at which diagnosis is made.

 

[Mbaker]

There are only a small percentage of people who can eat whatever they like throughout a life time, with no ill effects, apparently 12% of Americans are in that group that do not have one of the metabolic syndrome symptoms.

We know that cultures that eat a small range of whole foods do not get non-communicable diseases of modern civilisation (they have historically died from transmitted diseases or infant mortality prematurely). They have low blood pressure for life, no diabetes and so on. When "they" eat "our" foods they get similar health outcomes to "us".

In my view there is a cognitive dissonance on a mass scale, which affects every culture. "We" have all been susceptible to the lure of hyperpalatable new foods, even some of the modern Hadza tribes are incorporating the foods that have got "us" to where we are.

HOMA-IR is a cheap way of testing insulin resistance. We can test half of the equation with glucose rises on suspect foods, but cannot conveniently know how much insulin is required to be in range. A choice needs to be made as to if certain foods are worth it.

 

[bulkbiker]

Can a prediabetic cure themselves of insulin resistance / prediabetes and then go on to eat whatever they like?

No. In short.

But if what they have been eating created the problem then why would anyone want to go back to what they were eating before?
It's completely illogical.

If an alcoholic was sober for 5 years can they then start drinking in moderation again?

 

[Seacrow]

But if what they have been eating created the problem then why would anyone want to go back to what they were eating before?
It's completely illogical.

If an alcoholic was sober for 5 years can they then start drinking in moderation again?

Ummm, because they preferred the taste of the food they used to eat? Some people don't have the will-power to eat what's good for them rather than what they want.

On the alcoholic question. I know it's highly disrecommended, but it may be possible. My dad was drunk every night when I was a kid, so much so I think he was probably still over the limit the next morning.
One Saturday he shattered his knee. Where there were three bits of bone he now had eight. He drove to the hospital, where they decided since he'd had 20 pints and half a bottle of whisky, they'd wait to operate. He ended up staying alcohol-free in the hospital for two weeks, and quit drinking. 20 odd years of no alcohol. 4 or 5 years ago he started drinking a glass of wine with dinner. Still drinks only one small glass.

It's all down to willpower. Alas, I don't have as much as my dad.


I've always figured the boundary between insulin impaired and full diabetes should be whether your blood glucose eventually gets back to normal levels or not. I can see this wouldn't work for doctors trying to diagnose though.

 

[Mr_Pot]

I don't think there is a switch that occurs in the body at 48mmol/mol. As far as I know that level was set to correspond with the onset of complications in the long term. Without complications diabetes wouldn't be a disease just a benign condition. Reversing pre-diabetes is the same as reversing diabetes, just from a different starting point. In both cases if it was brought on by diet it will happen again with the same diet.

 

[DanW13]

I don't think there is a switch that occurs in the body at 48mmol/mol. As far as I know that level was set to correspond with the onset of complications in the long term. Without complications diabetes wouldn't be a disease just a benign condition. Reversing pre-diabetes is the same as reversing diabetes, just from a different starting point. In both cases if it was brought on by diet it will happen again with the same diet.

Agree with this although did read somewhere a while back that the pancreas in people with Pre or T2D tends to look somewhat deformed when viewed, but has been shown to return to a more normal looking state after an extended period of LCHF, so I guess repair of the pancreas structure could lead to improved function & possible tolerance of carbs? I’d expect though as others have said that if you reverted back to old habits you’d likely undo the good work pretty quickly and end up back at square one.

 

[Ronancastled]

Agree with this although did read somewhere a while back that the pancreas in people with Pre or T2D tends to look somewhat deformed when viewed, but has been shown to return to a more normal looking state after an extended period of LCHF.

I believe this is the study you reference
https://diabetes.diabetesjournals.org/content/69/Supplement_1/1781-P

Was part of the 2 year Direct Study follow up by Prof Roy Taylor.

 

[Ronancastled]

I don't think there is a switch that occurs in the body at 48mmol/mol. As far as I know that level was set to correspond with the onset of complications in the long term. Without complications diabetes wouldn't be a disease just a benign condition. Reversing pre-diabetes is the same as reversing diabetes, just from a different starting point. In both cases if it was brought on by diet it will happen again with the same diet.

Correct, it's a awful slight on newly diagnosed diabetics who read that 47 has a way back yet 48 is a chronic progressive disease.
Pre 1997 the diagnostic threashold was a FBG of 7.8 which was then dropped to 7.0.
I believe the criteria for pre-diabetic being 5.7 - 6.9 was created then too.
HbA1c has not been around that long in reltive terms & the cutoff threshold of 48(6.5) was based on the noticed increased instances in retinopathy.
So the diagnostic value for the disease diabetes is actually based on the higher risk occurance of the complications.

 

[HSSS]

I agree with others that’s there is no magic switch at a certain level. It’s a scale that progressively causes more (or less) damage and complications and the longer you spend at the wrong need the more and the longer lasting that damage is likely to be. And I’m not sure where you get the idea prediabetes can be reversed but not full blown t2. Are you talking cure not reversal/remission?
It also ignores the fact that prediabetes probably have noticeably raised insulin levels, even if the bgl isn’t showing it so badly, and thus do still have some insulin resistance.

 

[Doireallyneedanams]

I agree with others that’s there is no magic switch at a certain level. It’s a scale that progressively causes more (or less) damage and complications and the longer you spend at the wrong need the more and the longer lasting that damage is likely to be. And I’m not sure where you get the idea prediabetes can be reversed but not full blown t2. Are you talking cure not reversal/remission?
It also ignores the fact that prediabetes probably have noticeably raised insulin levels, even if the bgl isn’t showing it so badly, and thus do still have some insulin resistance.

because I see people saying their Hba1c is now in the prediabetic range but it’s “ok because it’s not full blown T2 and is reversible” - I don’t really see any difference between the two anymore.

The confusion for me is that I’ve read (and I can’t remember where) that by following a low carb diet, a prediabetic can somewhat cure their insulin resistance which suggests that T2 is “beyond repair.” I also find it strange that someone in the prediabetic range could continue eating the exact same way and never progress to T2. Is there a better test of a prediabetic diagnosis is received, which could help determine if someone was likely heading to higher levels?

 

[HSSS]

because I see people saying their Hba1c is now in the prediabetic range but it’s “ok because it’s not full blown T2 and is reversible” - I don’t really see any difference between the two anymore.

The confusion for me is that I’ve read (and I can’t remember where) that by following a low carb diet, a prediabetic can somewhat cure their insulin resistance which suggests that T2 is “beyond repair.” I also find it strange that someone in the prediabetic range could continue eating the exact same way and never progress to T2. Is there a better test of a prediabetic diagnosis is received, which could help determine if someone was likely heading to higher levels?

That is not how I read it at all and I do t see people saying that either. Some with “full blown” get totally normal readings with a change of diet. Others reduce readings a great deal but get stuck at prediabetic levels. This limitation for a few of us stuck at prediabetic levels does not support the assertion full blown is not reversible as others as quite successful. I’d go so far as to say in here, with low carb maintained at the right level, the majority do get to normal levels. Both type 2 and prediabetic can reverse their insulin resistance in theory. I think you are reading further assumptions into statements that simply aren’t there.
Sadly I know of no tests other than hb1ac and OGTT (diabetes, impaired glucose tolerance and impaired fasting glucose measured). No one knows for sure which will remain static and which will progress without active measures. But it’s much more likely to progress if you do nothing.

 

[Doireallyneedanams]

That is not how I read it at all and I do t see people saying that either. Some with “full blown” get totally normal readings with a change of diet. Others reduce readings a great deal but get stuck at prediabetic levels. This limitation for a few of us stuck at prediabetic levels does not support the assertion full blown is not reversible as others as quite successful. I’d go so far as to say in here, with low carb maintained at the right level, the majority do get to normal levels. Both type 2 and prediabetic can reverse their insulin resistance in theory. I think you are reading further assumptions into statements that simply aren’t there.
Sadly I know of no tests other than hb1ac and OGTT (diabetes, impaired glucose tolerance and impaired fasting glucose measured). No one knows for sure which will remain static and which will progress without active measures. But it’s much more likely to progress if you do nothing.

Surely there must be a more accurate test.

hba1c is easily manipulated / influenced by diet or medical conditions, and an OGTT can be passed by diabetics or failed by non diabetics on a low carb diet.

Do you know of any tests to measure actual insulin resistance? Surely a specialist could determine the chances of prediabetes progression based on a result like that.

 

[bulkbiker]

Do you know of any tests to measure actual insulin resistance?

Kind of .... you can get HOMA IR test - fasting insulin and fasting glucose - which then calculates your level of IR.

You likely won't ever get it through the NHS though.

I've had 2 official and one unofficial (took my own fasting glucose).

 

[HSSS]

Surely there must be a more accurate test.

hba1c is easily manipulated / influenced by diet or medical conditions, and an OGTT can be passed by diabetics or failed by non diabetics on a low carb diet.

Do you know of any tests to measure actual insulin resistance? Surely a specialist could determine the chances of prediabetes progression based on a result like that.

Sorry you asked about tests predicting which prediabetic people would progress to full blown rather than IR tests. They are different things. Some people maintain the level of insulin resistance they have and remain at prediabetic levels. Some increase their IR and progress. So in that sense monitoring insulin resistance would be observing progression or reversal in real time, therefore likely outcomes but it’s not exactly prediction, particularly not from a single test.

No test is perfect and they all have relevance if you understand the limitations and strength of each one. OGTT for example needs a carbing up period before taking the test to avoid physiological IR effecting the results negatively. Anemia can influence hb1ac. etc etc.

Lowering your blood glucose and also insulin resistance by low carbing is not manipulation. It’s treatment, just not a drug treatment.

 

[Tannith]

I don’t understand this at all.

Doctors will say you can “reverse” prediabetes, but not T2.

Once prediabetic, doesn’t that mean your body has reached a point where it simply does not function in the way it did before, and that will be the case forever - however it can be managed with diet.

If a prediabetic “reversed” their prediabetes to normal levels with diet but then started eating their previous diet, wouldn’t they end up prediabetic again in a short space of time? Or is it possible to cure or “heal” your body at this stage? I’m a little confused as I know with full blown T2 it’s fairly common to reduce your glucose to non diabetic levels but that doesn’t mean you’re no longer insulin resistant.

Why the different language? Can a prediabetic cure themselves of insulin resistance / prediabetes and then go on to eat whatever they like?

https://www.everydayhealth.com/type-2-diabetes/treatment/can-type-2-diabetes-reversed-through-weight-loss/#:~:text=It's well established that losing,weight is the magic range.
Hear all about from Professor Roy Taylor the 5 minute summary. https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation

• Type 2 diabetes is a potentially reversible condition
• If a person has type 2 diabetes, they have become too heavy for their own body (nothing to do with the arbitrary concept of obesity)
• Weight loss of around 15kg is necessary for most people
• This can be achieved using a simple 3-step method: the 1, 2, 3 of diabetes reversal
• Type 2 diabetes is most easily reversed to normal in the early years after diagnosis
• How and why type 2 diabetes happens can now be understood

 

[DanW13]

because I see people saying their Hba1c is now in the prediabetic range but it’s “ok because it’s not full blown T2 and is reversible” - I don’t really see any difference between the two anymore.

There’s a greater urgency if full blown T2 as 48+ on Hba1c is apparently where damaging complications due to the condition start to really take off according to the stats.

However really isn’t everybody else pre diabetic pretty much? Looking at the numbers here in the west that are apparently already PD, even if they’re not aware of the fact, and the fact most of the rest have the potential to become T2 if they don’t watch their lifestyle. Virtually none of us have a green pass to eat whatever we want, when we want for our whole life, there are constraints on all of us.

 

[bulkbiker]

https://www.everydayhealth.com/type-2-diabetes/treatment/can-type-2-diabetes-reversed-through-weight-loss/#:~:text=It's well established that losing,weight is the magic range.
Hear all about from Professor Roy Taylor the 5 minute summary. https://www.ncl.ac.uk/magres/research/diabetes/reversal/#publicinformation

• Type 2 diabetes is a potentially reversible condition
• If a person has type 2 diabetes, they have become too heavy for their own body (nothing to do with the arbitrary concept of obesity)
• Weight loss of around 15kg is necessary for most people
• This can be achieved using a simple 3-step method: the 1, 2, 3 of diabetes reversal
• Type 2 diabetes is most easily reversed to normal in the early years after diagnosis
• How and why type 2 diabetes happens can now be understood

and what about people who achieve remission without weight loss?
or who get there before the "15 %" that Taylor seems to think is the magic figure?

 

[Mbaker]

There’s a greater urgency if full blown T2 as 48+ on Hba1c is apparently where damaging complications due to the condition start to really take off according to the stats.

However really isn’t everybody else pre diabetic pretty much? Looking at the numbers here in the west that are apparently already PD, even if they’re not aware of the fact, and the fact most of the rest have the potential to become T2 if they don’t watch their lifestyle. Virtually none of us have a green pass to eat whatever we want, when we want for our whole life, there are constraints on all of us.

There’s a greater urgency if full blown T2 as 48+ on Hba1c is apparently where damaging complications due to the condition start to really take off according to the stats.

However really isn’t everybody else pre diabetic pretty much? Looking at the numbers here in the west that are apparently already PD, even if they’re not aware of the fact, and the fact most of the rest have the potential to become T2 if they don’t watch their lifestyle. Virtually none of us have a green pass to eat whatever we want, when we want for our whole life, there are constraints on all of us.

Absolutely right, it is the elephant in the room. It drives me to distraction when I hear the terms "fit and healthy" - what? Prove it before saying so, yet there is an assumption of both. Just physically look at the average person now, compared to last century, clearly there is excess energy as the norm now - this is what happened to me, only now can I say I was over fat, even though in my networking groups etc I was relatively small and "normal" looking.

Whilst it is not just about fat, the nuclear bomb of metabolic illness within a generation clearly is not evolution; although I think that Mum's and Dad's are making less carb tolerant children.