Discouraged

[Neohdiver]

It is the first Newcastle study - but I got the duration wrong (it was up to 4 years post-diagnosis, not 1).

Both Newcastle studies collected substantially more data than A1c - the first more thorough than the second. In the first, addition to the markers that merely indicate good control (A1c and BG), the participants were measured for: fasting insulin secretion, arginine induced insulin secretion (first phase), and pancreatic and liver fat content - and were followed up 12 weeks later with an OGTT. (At 12 weeks after the end of the study, 3 of the participants had a recurrence of diabetes. No case-by-case information about whether diabetes recurring was associated with returning to prior (full-calorie) eating habits.)

You are correct about the remission rate in the second study (with patients with longer duration of disease and, if I recall correctly, far less dense data collection) - that reversal rate was less than 50%, and generally split along the lines of duration of disease and age. Younger participants, with shorter disease duration achieved remission; older participants with longer disease remission didn't. I got one of the two going for me!

Remission in the second study was determined based on the "gold standare" inslin secretion test (not A1c or even by the more reliable OGTT). Responders returned to a normal insulin secretory response (and remained there for the 6-month follow-up); non-responders did not. They also collected longer post-intervention data - which showed that reversal in those who achieved it was sustained with weight maintenance on a diet that was not intentionally carb-restricted.

It was actually the rigor of the Newcastle studies, the care with which they distinguished between control (e.g. A1c, finger pricks) and remission (e.g. insulin secretion response - particularly 1st phase, change in fat composition of pancreas {previously linked to expression of diabetes} and the OGTT) that convinced me that it was worth a try. The studies are way too small to give any indication how many people can achieve remission, or what characteristics - other than the blunt duration and age seem to matter. But what they did prove, becuase they used criteria associated with a normal glucose metabolism, v. mimicking a normal response by tight control (and becuase after 6 months of eating a diet restricted by calories but not by carbohydrates, at least on one of those criteria the glucose metabolism was still normal), that prove to me it is possible for some people. Since the risks of trying are extremely low, it is worth it to me to try. (In contrast - I would not make the same decision, based on the same data, to try a drug unless the side effects were already well-known and very minimal. My decision to try any new medical approach is always based on there being some well-controlled and documented success + minimal to no risk to the new approach + no requirement that I forfeit a known beneficial approach in order to try it.).

I do think Taylor has now gone off the rails. His first study (and all subsequent studies) have been based on a 600-800 calorie diet, on the premise that, "Little attention has been paid to the potential role of a sudden negative energy balance on glucose metabolism after bariatric surgery," so he set out to study that role. He now touts a personal fat threshold, based on nothing beyond volunteered anecdotes & theorizing. That, to me, sounds like the same-old, same-old mostly failed theory that if you lose 10% (or 15%, etc.) of your body weight you can reverse diabetes. Just don't name a specific amount, so you can't be blamed when they fail. (My mother lost more than 15%; I have lost 35% of mine. No dent in either of our glucose metabolisms (the improvement in mine came in connectiton with the BSD). My grandfather - from whom we (and everyone else my age or older who descended from him inherited it) didn't have 10% to spare when he was diagnosed.)

 

[Neohdiver]

If your fasting level is your greatest concern, . . .

My concern is remission v. control. The food-related BG levels tell me that I have good control - the non-food related BG levels tell me that I'm not there yet as to remission.

The dawn phenomenon is a reality for everyone - it just bumps people with diabetes up higher because the bump comes on top of a level that is not normal. So when I see morning readings in the range of .5 or higher, it tells me that I didn't drop to a non-diabetic range overnight. Same thing with the non-food related readings - for people without diabetes (going from memory here) that range is 4.4 - 5.0. So when it's been 3 hours since I ate anything - and my BG is 5.6, it tells me that my system is still broken.

I think I'll be able to sort it out, without continuous monitoring, since it isn't an objective concer about what my BG is doing at a particular time of day. I'm just using two categories of numbers it as a tool to gauge remission.

 

[Brunneria]

It is the first Newcastle study - but I got the duration wrong (it was up to 4 years post-diagnosis, not 1).

Thanks for the clarification.
You mentioned a reversal/remission rate of 100%. Presumably you were referring to the 1st Newcastle Study?
If so, the study literature (available here) states this:

A total of 87% of the short-duration group and 50% of the long-duration group achieved nondiabetic fasting plasma glucose levels at week 8. Clinically significant improvements in blood pressure and lipid profile were seen regardless of diabetes duration.​

Now, to my mind, a non-diabetic fasting plasma glucose result immediately after 8 weeks of an 800 calorie diet is a good sign, but it is definitely not evidence of reversal/remission. Maybe Professor Taylor disagrees, but I would want to see those people eating normal amounts of calories, preferable 'normal' amounts of carbs, for some time, with ongoing testing and follow up, before I started banging the Reversal/Remission drum. I would certainly expect to see significant improvements in blood pressure and lipid profile in people who had only had 800 calories a day for the past 8 weeks! Bearing in mind that this was a small study of only 29 people, all of whom fit Taylor's criteria. The, literature found on the same page lists a number of subgroups of diabetics who will not benefit from the 800cal weight loss regime - including some type 2s.

The 2nd study is doing more detailed followup work, over a decent length of time, and am following that with interest.

I am sorry if I seem to be picking at your posts. Please understand that I am only doing so in the interests of accuracy.

We have had a number of posts and threads here over the last few years that have made some astonishingly unrealistic claims about the success rates and amazing achievements of the Newcastle Diet - to the point where we have had people claiming that it is The Only One True Way to reverse T2, that it Works for Everyone, and that Anyone Can Do It If They Work Hard Enough.

I see those kind of claims and statements as nothing more than ill-informed and misleading, so I tend to pipe up (like a stuck record) when I see anything like them being repeated.

 

[Neohdiver]

Thanks for the clarification.
You mentioned a reversal/remission rate of 100%. Presumably you were referring to the 1st Newcastle Study?
If so, the study literature (available here) states this:

A total of 87% of the short-duration group and 50% of the long-duration group achieved nondiabetic fasting plasma glucose levels at week 8. Clinically significant improvements in blood pressure and lipid profile were seen regardless of diabetes duration.
​

​

That's the second study, not the first. There were no long duration members in the first study - everyone in the first study (by the definition Taylor uses) was short duration, and achieved remission.

Now, to my mind, a non-diabetic fasting plasma glucose result immediately after 8 weeks of an 800 calorie diet is a good sign, but it is definitely not evidence of reversal/remission. Maybe Professor Taylor disagrees, but I would want to see those people eating normal amounts of calories, preferable 'normal' amounts of carbs, for some time, with ongoing testing and follow up, before I started banging the Reversal/Remission drum. I would certainly expect to see significant improvements in blood pressure and lipid profile in people who had only had 800 calories a day for the past 8 weeks!

That is exactly what Taylor did, in the post-intervention followups (included in both of the studies that I linked to). In the first, there were no study-imposed restrictions on consumption. In the second the restriction was on eating behaviors (not content), in order to maintain the weight loss.

The first:

In the first study, follow-up was at 12 weeks and (as I noted above) in three diabetes returned. (The follow-up was not planned, but - like you - Dr. Taylor felt it was needed and obtained approval of it as an add-on. Because it was added on, and not part of the original plan, the data post-intervention is not as complete - but they were told to return todiet was not monitored - but they were instructed to return to normal eating. Among other measures, OGTT was used to confirm remission. (Personally, I'm more impressed with the data on insulin secretion - but OGTT is much more indicative of remission v. control than the A1c.)

At the end of the 8 week intervention participants returned to normal eating but were provided with information about portion size and healthy eating.

. . .​

The striking results seen at 8 weeks demanded experimental follow-up, and additional ethics permission was obtained to repeat the MRI studies and carry out OGTTs 12 weeks after completing the dietary intervention.

. . .

At follow-up 12 weeks after completion of the dietary intervention, mean weight gain was 3.1 ± 1.0 kg. Hepatic triacylglycerol remained low and unchanged (2.9 ± 0.2 vs 3.0 ± 0.3%;p = 0.80), and pancreatic triacylglycerol decreased further to a small extent (6.2 ± 1.1 vs 5.7 ± 1.1%; p = 0.005). HbA1c was unchanged (6.0 ± 0.2 vs 6.2 ± 0.1% [42 ± 2 vs 44 ± 1 mmol/mol]; p = 0.10) and fasting plasma glucose increased modestly (5.7 ± 0.5 vs 6.1 ± 0.2 mmol/l; p < 0.01), with a 2 h OGTT plasma glucose of 10.3 ± 1.0 mmol/l. Three participants had recurrence of diabetes as judged by a 2 h post-load plasma glucose >11.1 mmol/l.
​

The Second

In the second study, followup was at 6 months and carbohydrates were not restricted post intervention.

The study was designed to define the durability over 6 months of the clinical and pathophysiologic changes after VLCD and return to isocaloric eating and did not include a control group maintained on usual therapy.
. . .

During the 6 month weight maintenance phase, participants were supported by a structured individualized program based on goal setting, action planning and barrier identification with monthly reviews [14]. The primary goal of this phase was to prevent weight regain by individualized dietary advice guided by weight trajectory. Physical activity was encouraged but food behaviors were the priority. If fasting plasma glucose exceeded 10mmol/l on 2 occasions, hypoglycemic agents were recommenced.

. . ,

After return to isocaloric eating, 40% (12/30) achieved a fasting glucose of <7.0mmol/l (responders). After 6 months of weight loss maintenance, 43% (13/30) had a fasting plasma glucose <7 mmol/l off all oral hypoglycemic agents or insulin.

. . .

The major improvement in blood pressure, triglyceride and non-HDL cholesterol following the VLCD in both responders and non-responders was maintained over the 6 month weight maintenance period.​

The 2nd study is doing more detailed followup work, over a decent length of time, and am following that with interest.

That is the third study. (I can't access the protocol at the moment, but I believe the focus on that is testing the protocol outside of a clinical setting, perhaps with food other than the replacement meals.) I'm interested in that, as well, since it will provide additional information - but given that one thing identified in the first two studies that seems to make a difference, (and I was nearly at my weight goal when I found the first Newcastle study) I'm not willing to wait to give it a try - since my weight would alread be too low - or the disease duration long enough that it would be unlikely to work.

I am sorry if I seem to be picking at your posts. Please understand that I am only doing so in the interests of accuracy.

Unfortunately, your response introduced a significant amount of inaccuracy.

I don't have a problem with correcting inaccuracies in things I say (like the fact that short duration was <4 years, rather than <1 year as I originally said. I remembered that incorrectly, and I acknowledged that immediately.) It does trouble me a bit that after I provided links to both studies that you inaccurately described the second study as the first, you implied that Taylor did not do the the follow-up (that you say is needed) - follow-up that is included in both studies.

We have had a number of posts and threads here over the last few years that have made some astonishingly unrealistic claims about the success rates and amazing achievements of the Newcastle Diet - to the point where we have had people claiming that it is The Only One True Way to reverse T2, that it Works for Everyone, and that Anyone Can Do It If They Work Hard Enough.

I believe if you read my posts carefully (any of them, not just those in this thread), you will see that that is not even close to what I am doing. I am accurately reporting the results of a small study (aside from underestimating how quickly after diagnosis you needed to act to meet the criteria of those who achieved remission). In most posts I even go out of my way to explain how I, personally, make the choice as to when intriguing research that lacks one or more of the cirteria typically neccessarily to be scientifically rigorous, is worth the risk of trying for me. See the last paragraph in my previous post. I often provide links to the studies. I have never claimed that it is the only, or a certain, way to achieve diabetes remission. I do that precisely so that I am providing enough information for each individual person to make their own decision.

I'm a bit surprised that you let your knee jerk reaction keep you from (re)reading the studies I linked to, and reading what I actually wrote especially since you've read enough of my posts to know how methodical I am about health care.

 

[Brunneria]

So, not a 100% reversal/remission rate then by whatever criteria is applied.

And no, I am not getting at you. I am simply confirming the original reason I commented.

 

[Glink]

I appreciate this detailed discussion about the very low cal studies, because I have trouble interpreting them myself (and I have quite a bit of scientific training). The pilot studies are small and the populations are quite different from me (substantially older and heavier, and with higher blood sugars at intake), and I think it's quite difficult to advance a reasonable hypothesis regarding whether it would be useful for me to adopt such an extreme diet (especially since with my food allergies I would have to do it differently; no premade shakes for me). If I lost as much weight as those study participants did, for example, I would be underweight and I think would possibly be losing muscle mass. I understand that as a minority in the prediabetes/diabetes camp I am obviously not a member of a priority group for research--of course the more common profiles (e.g., people who are older, more sedentary, higher BMI) will be addressed first, as advances for them will go farther toward population health. It's just sort of frustrating and discouraging on an individual level.

Ultimately, it seems very difficult, given the current state of scientific evidence, to assess what is an extreme fad diet and what is an actual successful treatment. And I say that fully aware that my current low-carb meat-and-nut-heavy diet seems quite extreme compared to the mostly plant-based, whole-grain-heavy diet I ate until my diagnosis in 2015.

To try to answer a few previous questions: yes, I have terrible trouble w dawn phenomenon/fasting #'s, but my cortisol has been tested and is normal. My personal cutoff for postprandial #s being "too high" is 7, although I often feel bad at lower levels.

I threw up my hands last night and had TWO pieces of my low-carb wholemeal toast, plus a (freaking delicious!) prune as a treat. Passed out afterwards and this morning tested with a 7.2 FBG. So, I guess in a way I have answered my own question, with your help. As AndBreathe and Brunneria have kindly pointed out, a lot of the incredible success stories here can be very discouraging for those of us who do not experience such results. I may not be able to achieve improvement no matter what I do, and that is incredibly frustrating. However, based on available evidence, I believe the austerity of my current diet is at least slowing down my deterioration. I should probably step back from reading and researching in attempts to optimize my results (If I read one more article claiming that these X# of things that I already do will reverse my prediabetes I will scream!), and accept the inevitability of full-blown diabetes in my future in one form or another, just aiming to stave it off as long as possible but trying not to beat myself up about my prediabetic numbers.

 

[Neohdiver]

So, not a 100% reversal/remission rate then by whatever criteria is applied.

And no, I am not getting at you. I am simply confirming the original reason I commented.

That is not correct.

As I noted: the FIRST study had a 100% remission rate, not the 87%, or 50%, you attributed to it based on the SECOND study. Remission rate was measured by the return of the damaged insulin response pattern to normal and a non-diabetic response on an OGTT. It was not measured, as you suggested, by transient BG or A1c (which, I agree, only indicates well-controlled diabetes). Even though my BG and A1c are absolutely normal, I don't consider myself in remission - because eating a higher carb meal would spike my BG. The individuals in this study who achieved remission were able to eat normally, with a normal BG response (including a normal insulin secretion and response on an OGTT).

The follow-up at 12 weeks showed that 3 of the participants who initially achieved remission were no longer in remission. Failure to maintain remission is a different question than achieving it. Both need to be mastered, and none of the Newcastle studies published to date give much guidance as to maintaining remission. But the fact that 3 participants came out of remission (no longer had normal insulin secretion, and tested as diabetic on an OGTT) doesn't alter the fact that they were able to achieve remission by 8 weeks of dietary intervention.

So,as I said a few posts ago 100% of the participants in the initial study did achieved remission at the end of the 8-week intervention, by the "gold standard" criteria used to determine whether someone is diabetic - rather than just well-controlled (insulin secretion pattern and/or OGTT).

That doesn't mean it everyone will achieve remission (as the second study demonstrated). I never claimed it did. That doesn't mean everyone who achieves remission will be able to maintain remission (both studies demonstrated that). I never made that claim either.

 

[Glink]

Neohdiver (sorry - not sure how to tag you), I've been a little confused trying to follow which studies folks on this thread are referring to. Can you post a link to the pubmed or similar citation to the studies you're referring to as first, second, etc., for my future reference? Thanks!

 

[frenchlady]

It's been over a year now, and I've dramatically changed my diet, continued exercising daily, and started medication, and I still cannot bring my numbers into the "normal" range, especially the fasting ones. It's just discouraging. I am thin and fit, and eat low carb now, but my blood sugars swing too much, and it really feels like it's just out of my control. Does anyone else grapple with this? How do you manage to feel better about not making progress on the metre. My check-in blood tests are next week and I'm worried the #s will be worse than last time. And then I just feel like giving up and eating regular food again, even though I know that will make me feel worse. Who's in this boat with me? Want to give me a pep talk?

Why don't you wait until next week and discuss it with your diabetes nurse/doctor? Things change over a period of time and your meds might need changing too. It may be that you just need to up your medication slightly. If you are doing everything else right then, this would seem the obvious thing to do. Every one is different, so what might work for you may not work for someone else.

 

[Neohdiver]

I appreciate this detailed discussion about the very low cal studies, because I have trouble interpreting them myself (and I have quite a bit of scientific training). The pilot studies are small and the populations are quite different from me (substantially older and heavier, and with higher blood sugars at intake), and I think it's quite difficult to advance a reasonable hypothesis regarding whether it would be useful for me to adopt such an extreme diet (especially since with my food allergies I would have to do it differently; no premade shakes for me). If I lost as much weight as those study participants did, for example, I would be underweight and I think would possibly be losing muscle mass. I understand that as a minority in the prediabetes/diabetes camp I am obviously not a member of a priority group for research--of course the more common profiles (e.g., people who are older, more sedentary, higher BMI) will be addressed first, as advances for them will go farther toward population health. It's just sort of frustrating and discouraging on an individual level.

Ultimately, it seems very difficult, given the current state of scientific evidence, to assess what is an extreme fad diet and what is an actual successful treatment. And I say that fully aware that my current low-carb meat-and-nut-heavy diet seems quite extreme compared to the mostly plant-based, whole-grain-heavy diet I ate until my diagnosis in 2015.

To try to answer a few previous questions: yes, I have terrible trouble w dawn phenomenon/fasting #'s, but my cortisol has been tested and is normal. My personal cutoff for postprandial #s being "too high" is 7, although I often feel bad at lower levels.

As to the first two paragraphs - yup. I'm juggling some of the same questions (and the same response to "just" the low carb diet I ate from October through May). The way many people are practicing the Newcastle diet, it is a fad. I've encountered way too many people who are on it purely to lose weight - and far too many who have decided to stay on it indefinitely (I know of at least one person who's been on it for more than 32 weeks). The former is not the best way to lose and maintain, and the latter is not sustainable - the diet ws designed to mimic the sudden calorie drop associated with bariatric surgery, over the 8-week time period that had the most evidence for diabetic remission in that context.

Although I started as obese when diagnosed, by the time I discovered the Newcastle research I was overweight (but not by much) - and would have overshot my weight goal if I lost as much as many of the participants. The difference between what I had been eating (1200 calories) and the diet (800) was not very significant - so I wouldn't get the sudden calorie deficit the study was testing. That's why I added intermittent fasting (16:8), to have a sudden drop in calories for a portion of each days.

I started the second round (only because the first was interrupted by cancer), in an even more tenuous position - since I'm now within the normal weight range for my height and (as of the start date) 5 lbs above my target weight. I haven't committed to the full 8 weeks - I'm tentatively targeting 4 - and then I'll re-evaulate.

(I haven't been using the shakes - I considered it, reviewed the research, and the shakes were used for convenience and uniform control of calorie intake.)

I'm used to making medical decisions based on insufficient data - my daughter has a very rare chronic disease. There aren't enough bodies available for studies to generate solid scientific proof. Since her disease moves inexorably toward a liver transplant (or multiple liver transplants), there isn't time to wait for enough information to be dead certain. So I've figured out how to live with uncertainty, and to evaluate what data there is available (how methodically was it gathered, were they testing remission v. control, does she fit within the characteristics of the small studies that are available, how safe is the treatment - v. - what - with proven benefits - would she have to give up to pursue the treatment). Diabetes isn't quite in the same boat, but it is similar in that it is considered as a chronic, progressive disease - and the data available that suggests it doesn't always have to be - is not yet up to normal scientific standards.

As to your PP# - assuming a 7 is your peak, not where you end up at 2 hours, that's pretty low. Even though 7.2, as a fasting BG level, is within the prediagetic range, your 7 PP is within the normal response. I start feeling the effects of elevated BG at around 7.2 (even though that is technically normal, as well). By most of the information I've found, the normal response to food consumption is as high as 7.8 - but back under 6.7 in 2 hours.

 

[Brunneria]

That is not correct.

As I noted: the FIRST study had a 100% remission rate, not the 87%, or 50%, you attributed to it based on the SECOND study. Remission rate was measured by the return of the damaged insulin response pattern to normal and a non-diabetic response on an OGTT. It was not measured, as you suggested, by transient BG or A1c (which, I agree, only indicates well-controlled diabetes). Even though my BG and A1c are absolutely normal, I don't consider myself in remission - because eating a higher carb meal would spike my BG. The individuals in this study who achieved remission were able to eat normally, with a normal BG response (including a normal insulin secretion and response on an OGTT).

The follow-up at 12 weeks showed that 3 of the participants who initially achieved remission were no longer in remission. Failure to maintain remission is a different question than achieving it. Both need to be mastered, and none of the Newcastle studies published to date give much guidance as to maintaining remission. But the fact that 3 participants came out of remission (no longer had normal insulin secretion, and tested as diabetic on an OGTT) doesn't alter the fact that they were able to achieve remission by 8 weeks of dietary intervention.

So,as I said a few posts ago 100% of the participants in the initial study did achieved remission at the end of the 8-week intervention, by the "gold standard" criteria used to determine whether someone is diabetic - rather than just well-controlled (insulin secretion pattern and/or OGTT).

That doesn't mean it everyone will achieve remission (as the second study demonstrated). I never claimed it did. That doesn't mean everyone who achieves remission will be able to maintain remission (both studies demonstrated that). I never made that claim either.

Yup. As i said, the Newcastle Diet regime does not offer 100% remission/reversal.

Anyway, my central point remains: claiming 100% remission/reversal for the Newcastle Diet leads to unreasonable expectations and sets people up for disappintment.

We get some fantastic success stories for all sorts of diets and ways of eating - and one of them is the Newcastle Diet - but claiming a 100% success rate for any diet, based on relatively small samples is misleading and leads to false hope.

This is my last post in this dicussion, because I am getting tired of repeating myself.

 

[Neohdiver]

Neohdiver (sorry - not sure how to tag you), I've been a little confused trying to follow which studies folks on this thread are referring to. Can you post a link to the pubmed or similar citation to the studies you're referring to as first, second, etc., for my future reference? Thanks!

I embedded the links a few posts ago - maybe it's the updated server, but scrolling back, they aren't as obvious as most embedded links.

Here they are again:

The first Newcastle study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3168743/

The second Newcastle study: http://www.ncl.ac.uk/magres/research/diabetes/documents/VerylowcaloriedietS.Stevenetal.pdf

 

[Neohdiver]

Yup. As i said, the Newcastle Diet regime does not offer 100% remission/reversal.

Anyway, my central point remains: claiming 100% remission/reversal for the Newcastle Diet leads to unreasonable expectations and sets people up for disappintment.

We get some fantastic success stories for all sorts of diets and ways of eating - and one of them is the Newcastle Diet - but claiming a 100% success rate for any diet, based on relatively small samples is misleading and leads to false hope.

This is my last post in this dicussion, because I am getting tired of repeating myself.

I have not ever, on this thread, this forum, or anywhere else, made the general statement general statement "the Newcastle Diet regime {offers} 100% remission/reversal."

What I accurately stated is 100% remission in the first Newcastle study.

As someone who is fairly widely respected on this forum, I am disappointed that you seem unable or unwilling to acknowledge that you are condeming my accurate, because they are limited, statmemts based on the sins of others who may not have been so careful about not speaking beyond what there is evidence to support.

 

[ckneppel]

I appreciate this detailed discussion about the very low cal studies, because I have trouble interpreting them myself (and I have quite a bit of scientific training). The pilot studies are small and the populations are quite different from me (substantially older and heavier, and with higher blood sugars at intake), and I think it's quite difficult to advance a reasonable hypothesis regarding whether it would be useful for me to adopt such an extreme diet (especially since with my food allergies I would have to do it differently; no premade shakes for me). If I lost as much weight as those study participants did, for example, I would be underweight and I think would possibly be losing muscle mass. I understand that as a minority in the prediabetes/diabetes camp I am obviously not a member of a priority group for research--of course the more common profiles (e.g., people who are older, more sedentary, higher BMI) will be addressed first, as advances for them will go farther toward population health. It's just sort of frustrating and discouraging on an individual level.

Ultimately, it seems very difficult, given the current state of scientific evidence, to assess what is an extreme fad diet and what is an actual successful treatment. And I say that fully aware that my current low-carb meat-and-nut-heavy diet seems quite extreme compared to the mostly plant-based, whole-grain-heavy diet I ate until my diagnosis in 2015.

To try to answer a few previous questions: yes, I have terrible trouble w dawn phenomenon/fasting #'s, but my cortisol has been tested and is normal. My personal cutoff for postprandial #s being "too high" is 7, although I often feel bad at lower levels.

I threw up my hands last night and had TWO pieces of my low-carb wholemeal toast, plus a (freaking delicious!) prune as a treat. Passed out afterwards and this morning tested with a 7.2 FBG. So, I guess in a way I have answered my own question, with your help. As AndBreathe and Brunneria have kindly pointed out, a lot of the incredible success stories here can be very discouraging for those of us who do not experience such results. I may not be able to achieve improvement no matter what I do, and that is incredibly frustrating. However, based on available evidence, I believe the austerity of my current diet is at least slowing down my deterioration. I should probably step back from reading and researching in attempts to optimize my results (If I read one more article claiming that these X# of things that I already do will reverse my prediabetes I will scream!), and accept the inevitability of full-blown diabetes in my future in one form or another, just aiming to stave it off as long as possible but trying not to beat myself up about my prediabetic numbers.

I'm sorry that you are having such a hard time. As my doc reminded me when my A1c didn't budge, she said that without my diet and exercise changes and metformin they would be worse given my family history/genetic predisposition, and that I should be glad that my numbers didn't get worse. We do what we can given the genes we are dealt. With any luck they'll figure out how to fix our faulty DNA via gene splicing with CRISPR ;-) Unfortunately, probably not in my lifetime.