Type 2 Diabetes Remission vs Cure

[DCB 2]

Guys,

I think that we all agree that presently there is not a cure for type 2 diabetes and the best that one can expect is to be in remission The definition of what I use for remission is to have an A1C below 48.6 for two consecutive 3 month readings. I am across the pond and the number might be slightly off due to conversion errors. The point of my question ius that see a great deal of stuff on the web purporting diet and exercise as a cure for diabetes. I would agree that they are important to manage diabetes, but is not a cure. Some even state that people who are type 1 can follow some plan and no longer need insulin.

There is one website in particular, Qoura, which is a question and answer website were this is prevalent. I have even brought this up to the site administrators and have no received a response back from them. Some people think the difference between being cured or in remission is just a question of semantics. I vehemently disagree with this because once you are in remission you still have to make the effort to watch your diet and continue doing the things that got you there in the first place.

I will be honest, I was in remission once before and thought I was cured and went off the wagon and created a real mess and had to take a cocktail of meds to get my blood sugar under control again. My point is that someone might just read these things and think they are cured and create a real mess for themselves. Even in remission I will for the rest of my life will always have to careful about my diet and exercise and thinking you are cured is counter productive.

I hope I am not out of line on this.

Dave

 

[ianf0ster]

I agree that remission is not cure! Though I have seen a couple of members of this forum claim they are cured of T2D and can now eat as much carby junk food as they like. But personally I wouldn't eat that **** even if it didn't spike my BG.

Certainly most of us can get into remission with a Way Of Eating (WOE) alone - I did, along with thousands of others using LCHF no additional exercise and no diabetes medications (not even Metformin).

An HbA1C of below 48 but of 42 or above is termed 'pre-diabetes' here. There are several different definitions of remission from different studies and most allow for metformin use with HbA1C of less than 48. Though some will accept just a single reading where others require 2 readings 3,6 or even 12 month apart.

 

[DCB 2]

Sorry about the conversion error you are correct, I should have typed my post only AFTER having my morning coffee, the number should have been 39. Everyone is different, but with me exercise became of my routine when I was transitioning off glipizide when when I took it I always went hypo and still needed a way to manage my blood sugars, I guess it has just became a habit. I do have my occasional dietary rebellions, but the exercise helps compensate for them and they are planned and the situation has to be correct. Generally I do it after swimming where my numbers average around 4.6 and my system can handle it.
These rebellions just give me a feeling of control, but I remember the saying don't do the crime if you do not want tp spend the time.

Thanks for your response

Dave

 

[Mrs T 123]

I have been "in remission" for over 3 years now but if I occasionally happen to try and forget I have diabetes and eat something very carby (last thing was a fish supper about 2 months ago on a day out at the beach), I am reminded by my blood sugars spiking to over 10 that I am diabetic - so I would probably describe my diabetes as something I will always have but I am at the moment very lucky that I am able to control it through diet and exercise (albeit at times difficult) and I don't consider I am cured or ever will be.

 

[DCB 2]

I have been "in remission" for over 3 years now but if I occasionally happen to try and forget I have diabetes and eat something very carby (last thing was a fish supper about 2 months ago on a day out at the beach), I am reminded by my blood sugars spiking to over 10 that I am diabetic - so I would probably describe my diabetes as something I will always have but I am at the moment very lucky that I am able to control it through diet and exercise (albeit at times difficult) and I don't consider I am cured or ever will be.

I have all of the respect of someone who is an alcoholic, but I look at being in remission like being an alcoholic in this one way, an alcoholic can not have that one drink, a diabetic can not have that one candy bar. It is something that has to be monitored and controled.

 

[ziggy_w]

My take on this is a little bit different -- even though I also have my problem with the word "cure" (and I agree with the @DCB 2 as to the reasons) as this implies, we can go back to our old way of eating without having to worry. Even if blood sugars are truly normal, we are not on any medication and might even be able to indulge in carby food once in a while without penalty, the genetic predisposition remains.

Personally, after five years of truly normal blood sugar levels and the last four years without any medication, I no longer consider myself diabetic, but as genetically carb-intolerant (to remind me that I shouldn't change my way of eating). The reason is that at this point, I no longer believe that I am any more likely to suffer from any of the complications of diabetes than a metabolically healthy person. However, a diagnosis of diabetes would imply this. The problem with not changing the diagnosis of active diabetes is that everytime my GP refers me to a specialist, he puts on the referral form "diabetic with an HbA1c of 11.3% (or 100 mmol)." Of course, this causes the specialist to immediately zero in on diabetes as an explanation for any health-related problem rather than exploring other possible causes. I have also talked with my GP about this and he agrees that this is likely to evoke a wrong impression. Unfortunately, neither carb-intolerance or diabetes in remission is a possible diagnosis in Germany -- so there is nothing that can be done about this.

As to an official diagnosis of remission, I believe most would define it as an HbA1c below 48 mmol on at least two different consecutive tests while on no diabetes-related medication other than metformin (this is at least the definition that the Virta Health and the Newcastle diet uses). Personally, though, I would probably choose a tighter definition myself.

Edited to add the word consecutive in the text.

 

[Mr_Pot]

I have been "in remission" for over 3 years now but if I occasionally happen to try and forget I have diabetes and eat something very carby (last thing was a fish supper about 2 months ago on a day out at the beach), I am reminded by my blood sugars spiking to over 10 that I am diabetic - so I would probably describe my diabetes as something I will always have but I am at the moment very lucky that I am able to control it through diet and exercise (albeit at times difficult) and I don't consider I am cured or ever will be.

I am in the same situation as you, except that for the very occasional carby meal, I don't bother to test my BG. Partly because it might spoil the treat but also I suspect that the high reading would be because my body is conditioned to expect low carbs.
Fish and chips is of course essential when near the sea, luckily my wife eats most of the chips.

 

[DCB 2]

I am in the same situation as you, except that for the very occasional carby meal, I don't bother to test my BG. Partly because it might spoil the treat but also I suspect that the high reading would be because my body is conditioned to expect low carbs.
Fish and chips is of course essential when near the sea, luckily my wife eats most of the chips.

Fish and Chips? You can not deny your yourself food from one of the basic food groups!!!! Occasional dietary rebellions are fine as long as you are smart about it and sounds like you doing just that.

 

[DCB 2]

My take on this is a little bit different -- even though I also have my problem with the word "cure" (and I agree with the @DCB 2 as to the reasons) as this implies, we can go back to our old way of eating without having to worry. Even if blood sugars are truly normal, we are not on any medication and might even be able to indulge in carby food once in a while without penalty, the genetic predisposition remains.

Personally, after five years of truly normal blood sugar levels and the last four years without any medication, I no longer consider myself diabetic, but as genetically carb-intolerant (to remind me that I shouldn't change my way of eating). The reason is that at this point, I no longer believe that I am any more likely to suffer from any of the complications of diabetes than a metabolically healthy person. However, a diagnosis of diabetes would imply this. The problem with not changing the diagnosis of active diabetes is that everytime my GP refers me to a specialist, he puts on the referral form "diabetic with an HbA1c of 11.3% (or 100 mmol)." Of course, this causes the specialist to immediately zero in on diabetes as an explanation for any health-related problem rather than exploring other possible causes. I have also talked with my GP about this and he agrees that this is likely to evoke a wrong impression. Unfortunately, neither carb-intolerance or diabetes in remission is a possible diagnosis in Germany -- so there is nothing that can be done about this.

As to an official diagnosis of remission, I believe most would define it as an HbA1c below 48 mmol on at least two different consecutive tests while on no diabetes-related medication other than metformin (this is at least the definition that the Virta Health and the Newcastle diet uses). Personally, though, I would probably choose a tighter definition myself.

Edited to add the word consecutive in the text.

Here in the States once you diagnosed as a diabetic you will be considered one regardless if you are in remission. The only way you can have it removed from your record is be in remission for 5 years without any meds and without any medical treatment. This includes any 6 month check ups with your doctor.

 

[Richard'63]

Guys,

I think that we all agree that presently there is not a cure for type 2 diabetes and the best that one can expect is to be in remission The definition of what I use for remission is to have an A1C below 48.6 for two consecutive 3 month readings. I am across the pond and the number might be slightly off due to conversion errors. The point of my question ius that see a great deal of stuff on the web purporting diet and exercise as a cure for diabetes. I would agree that they are important to manage diabetes, but is not a cure. Some even state that people who are type 1 can follow some plan and no longer need insulin.

There is one website in particular, Qoura, which is a question and answer website were this is prevalent. I have even brought this up to the site administrators and have no received a response back from them. Some people think the difference between being cured or in remission is just a question of semantics. I vehemently disagree with this because once you are in remission you still have to make the effort to watch your diet and continue doing the things that got you there in the first place.

I will be honest, I was in remission once before and thought I was cured and went off the wagon and created a real mess and had to take a cocktail of meds to get my blood sugar under control again. My point is that someone might just read these things and think they are cured and create a real mess for themselves. Even in remission I will for the rest of my life will always have to careful about my diet and exercise and thinking you are cured is counter productive.

I hope I am not out of line on this.

Dave

From this website, today.
https://www.diabetes.co.uk/news/202...-type-2-diabetes-prevention-and-reversal.html

 

[bulkbiker]

From this website, today.
https://www.diabetes.co.uk/news/202...-type-2-diabetes-prevention-and-reversal.html

Unpublished paper and looking at the sponsors I'm not sure it would be necessarily accurate.. let wait until we can "study the study" so to speak.

 

[Daphne917]

Here in the States once you diagnosed as a diabetic you will be considered one regardless if you are in remission. The only way you can have it removed from your record is be in remission for 5 years without any meds and without any medical treatment. This includes any 6 month check ups with your doctor.

It seems to depend on how it’s interpreted by your GP practice. I have had a non diabetic Hba1c for approx 7 years and am diet controlled, so, whilst I consider myself to be in remission, my diabetic nurse just tells me that I am a well controlled T2 diabetic. Others on the forum have been taken off the diabetic register, such as @Bluetit1802, after only a few non diabetic Hba1cs. I can tolerate more carbs than many on this forum - after going out to lunch and eating chilli and rice yesterday I decided to test and my BS was 5.7 after 2 hours. I do eat bread and potatoes, albeit small portions, but I am not complacent and try not to exceed 130g carbs per day which is still classed as low carb. However I do tend to have low carb breakfasts and, when at home, lunches.

 

[DCUKMod]

Here in the States once you diagnosed as a diabetic you will be considered one regardless if you are in remission. The only way you can have it removed from your record is be in remission for 5 years without any meds and without any medical treatment. This includes any 6 month check ups with your doctor.

@DCB 2 - It could be worth a little while consulting Dr Google on this. I'm just about to get on the move this morning, to do errands and jobs for the day, but if you Google "Type 2 Diabetes Operational Cure", hopefully some useful information will be returned.

From memory (and don't heold me to the detail please, there is a US group who consider 5 consecutive years in non-diabetic ranges (can't recall their cut-off point) amounted to an Operational Cure. They had natty labels for the steps in between too, if I recall.

Personally, I don't easily subscribe to labels, whether is is well-controlled, remission, resolved, cured, or anything else. For me, I strive to do what I can, given the package life is asking me to deal with at the time. That said, I am fortunate to have had decent outcomes over the years (diagnosed 7 years ago next month, with normal HbA1c results and OGTT blood glucose readings since 4 months later).

Who knows how long I can continue to keep that up, but I'll give it a shot. If life throws me the odd curved ball along the way, I'll just have to crack on and deal with it.

My one piece of denial in all of this is blocking out my Endo's throwaway remark of "Keep an eye out for LADA. It has a habit of creeping up on folks". Great. I'll keep an eye open, but it won't stop me living a good life to the full.

 

[Resurgam]

I have always been very sensitive to carbs and there are whole swathes of things I have never tasted - Oreos, peanut butter, and ketchup for instance.
When I got my Hba1c down to 41 I thought it might go lower, but it has been 42 in subsequent, even though I dropped down to 40 gm of carbs a day from 50gm. Something is broken, I suspect.
These days I can eat something higher in carbs than the 40 gm, and next morning I see my weight is higher, so I know exactly where it has gone. My blood glucose doesn't spike hugely, the carbs are just stashed away by the insulin.
I tend to say that I am cured of diabetes, as a lab test would not detect it as such - but I have always been, and forever will be unable to deal with carbs in the 'normal' way. I reduce carbs and slowly the weight reduces back down again - but it isn't really worth eating carbs. We have Friday evening dinner from the fish and chip shop, and I just have a fish and peel off the batter.

 

[Bluetit1802]

It seems to depend on how it’s interpreted by your GP practice. I have had a non diabetic Hba1c for approx 7 years and am diet controlled, so, whilst I consider myself to be in remission, my diabetic nurse just tells me that I am a well controlled T2 diabetic. Others on the forum have been taken off the diabetic register, such as @Bluetit1802, after only a few non diabetic Hba1cs. I can tolerate more carbs than many on this forum - after going out to lunch and eating chilli and rice yesterday I decided to test and my BS was 5.7 after 2 hours. I do eat bread and potatoes, albeit small portions, but I am not complacent and try not to exceed 130g carbs per day which is still classed as low carb. However I do tend to have low carb breakfasts and, when at home, lunches.

Yes, I have been taken off the register, but only after 4 years of non-diabetic HbA1c's. (Probably after about 8 or 9). What the GP did was to backdate the coding to my first HbA1c under 48 in 2014, but he only did this in 2018. I should also point out that some of these HbA1c's were in the low pre-diabetic range. I still get 2 tests a year, an annual review with the nurse, and my retinal screening. All I have lost is the foot check with the nurse, but she will do one if I ask.

 

[Mr_Pot]

I got a text from the surgery to say I could book a flu jab. When I phoned I asked if it was on the basis of age and was my wife also entitled to a jab. They said, not in the first round we are dealing with the vulnerable first. So although I have had non-diabetic numbers for over 4 years on diet only and I am classed as "well controlled" they still count my diabetes as a vulnerability.

 

[DCB 2]

@DCB 2 - It could be worth a little while consulting Dr Google on this. I'm just about to get on the move this morning, to do errands and jobs for the day, but if you Google "Type 2 Diabetes Operational Cure", hopefully some useful information will be returned.

From memory (and don't heold me to the detail please, there is a US group who consider 5 consecutive years in non-diabetic ranges (can't recall their cut-off point) amounted to an Operational Cure. They had natty labels for the steps in between too, if I recall.

Personally, I don't easily subscribe to labels, whether is is well-controlled, remission, resolved, cured, or anything else. For me, I strive to do what I can, given the package life is asking me to deal with at the time. That said, I am fortunate to have had decent outcomes over the years (diagnosed 7 years ago next month, with normal HbA1c results and OGTT blood glucose readings since 4 months later).

Who knows how long I can continue to keep that up, but I'll give it a shot. If life throws me the odd curved ball along the way, I'll just have to crack on and deal with it.

My one piece of denial in all of this is blocking out my Endo's throwaway remark of "Keep an eye out for LADA. It has a habit of creeping up on folks". Great. I'll keep an eye open, but it won't stop me living a good life to the full.

Just came back from consulting Dr Google. the only thing mentioned as gastric bypass surgery as a cure. This is just my opinion but that approach is addressing a symptom not root causing the problem of insulin resistance. It may or may not be appropriate, but that has to be handled on a case by case basis and needs to be decided between the person and their doctor. Any surgery has risks and that has to be taken into consideration.

@DCUKMod if you would like to have a detailed discussion about this I would be glad to have it off line. I also do not believe in labels and and after reading more than my fair share of snake oil on the web about cures for diabetes. https://en.wikipedia.org/wiki/Snake_oil, I thought it would be a good idea to raise the question. I really hope that some day they find a cure for type 2 diabetes, but there are things we now can do to mitigate the problem. Using the term cure just gets into the way, my humble opinion and that is why I raised the question.

My personal definitions:

• Well Controlled Diabetes, having blood sugar and A1C within target ranges with medicine
• Remission Diabetes, having blood sugar and A1C within normal ranges without medication, with 2 consecutive A1C reading 3 months apart.

Dave

 

[DCUKMod]

Just came back from consulting Dr Google. the only thing mentioned as gastric bypass surgery as a cure. This is just my opinion but that approach is addressing a symptom not root causing the problem of insulin resistance. It may or may not be appropriate, but that has to be handled on a case by case basis and needs to be decided between the person and their doctor. Any surgery has risks and that has to be taken into consideration.

@DCUKMod if you would like to have a detailed discussion about this I would be glad to have it off line. I also do not believe in labels and and after reading more than my fair share of snake oil on the web about cures for diabetes. https://en.wikipedia.org/wiki/Snake_oil, I thought it would be a good idea to raise the question. I really hope that some day they find a cure for type 2 diabetes, but there are things we now can do to mitigate the problem. Using the term cure just gets into the way, my humble opinion and that is why I raised the question.

My personal definitions:

• Well Controlled Diabetes, having blood sugar and A1C within target ranges with medicine
• Remission Diabetes, having blood sugar and A1C within normal ranges without medication, with 2 consecutive A1C reading 3 months apart.

Dave

Dave - Reading your response, I had a bit of a lightbulb moment, relating t who had posted about it. It was @sally and james (Thanks, Sally and James).

https://www.diabetesremission.org/our-task/

The thread it was posted on is here: https://www.diabetes.co.uk/forum/th...-for-attaining-remission.155691/#post-1866647

 

[DCB 2]

If a a person gets to be "Operationally Cured" they still need to be careful about the carbs. They should have more flexibility with things but the still need to be careful about the carbs. I am not saying not to treat yourself time to time, but be smart about. it. I was in remission once before and went off the wagon and ate a lot of junk and the diabetes came back and I learned my lesson.
I guess that is the reason why I distinguish cure and remission separately.

Thanks for the paper getting to complete and operational levels will provide me the motivation to keep it up. I do not want to relapse and start this thing all over again. Having being Operationally Cured means that you are without symptoms for 5 years which make the habits that got you there as second nature

Dave

 

[BigNorsk]

I kind of refuse to get into the diagnosis word games.

when the system says someone who has normal blood sugar, normal insulin, good liver and kidney function and so on is diabetic.

At the same time saying someone with high blood pressure, fatty liver sticking out a foot, can’t get an erection without a pill, and can’t feel it when he does, and triglycerides through the roof along with elevated insulin if they ever looked, doesn’t have diabetes.

I just think it isn’t useful to argue with nonsense.

if the doctors ever learn something about diabetes, then we can argue cure vs. remission.
I believe full out cure is possible, if cure is eating a decent diet that includes a reasonable amount of carbs and not needing meds to control sugar. Maybe not possible for all but certainly for some.