Diabetes Resolved - What Does This Mean?

[Eurobuff]

Hi

I’m hoping you can help me. I was diagnosed with diabetes type 2 in 2014, my hba1c at the time was 7.9%. I had a further hba1c a couple of weeks later which was7.8%. I immediately started on a low carb diet (50grams per day), and my next hba1c after 3 months was 6.3%. After that my hba1c was hovering at 36mmol, 37 mmol (they changed to the new figures). I wasn’t overweight at diagnosis (8 1/2 stone). I did eat fruit, veg and bread, before diagnosis, which I now don’t eat at all. I am controlling my diabetes by diet only.

In the last 18 months, my low carb options have been disappearing so I have substituted them with items that are still low carb, but not as low, so now I am eating around 60 grams of carbs per day. My hba1c is now hovering at 40mmol, I did have one result at 42mmol (my most recent two being 40mmol).

I do suffer lows 3.2, 3.8, 3.9. Also I have had 11, 12’s etc.

I had a telephone review with my doctor today. He told me that I only needed to test occasionally for lows and that I don’t need to test for highs as my hba1c was fine. He said my hba1c results are “normal / non diabetic”. I explained that I am having highs and lows, and told him the figures. I said it’s that is probably why it’s averaging out as a “normal” hba1c. He just said “hmmm” and told me that he was taking my strips off repeat prescription and that I could have one tub every 6 months if I wanted as in his opinion that’s all that I need.

I have access to the doctors notes at my surgery, and when I’ve looked, he’s put “diagnosis: diabetes resolved” (not remission). Just as a test tonight I had a cod (no batter), 2 potato scallops (very thin sliced potato with batter), 50ml of gin with diet lemonade. I tested my blood sugar after 2 hours of eating it and it was 10.6, after three hours it was 8.2. I know I can’t say this to the doctor as he will say that I am only supposed to be testing for lows. In my opinion my diabetes isn’t “resolved”.

What I wanted to ask is, what does “diabetes resolved” actually mean to me? Will I now stop getting the eye screening and other checks that I was getting (hba1c, cholesterol, kidney function etc)? If so is there anything I can do about it as this worries me as I think I am still diabetic?

The doctor I spoke to is the doctor that assigned to deal with the diabetic patients.

 

[EllieM]

In the last 18 months, my low carb options have been disappearing so I have substituted them with items that are still low carb, but not as low, so now I am eating around 60 grams of carbs per day. My hba1c is now hovering at 40mmol, I did have one result at 42mmol (my most recent two being 40mmol).

Eating 60g a day means your hba1c goes to prediabetic levels. Not a serious suggestion, because it would damage your body, but if you went to normal levels of carbs (eg 150g a day) as recommended by the NHS eatwell plate, you'd manage a diabetic hba1c in no time.

So the answer is that eating sufficiently low carb puts your diabetes in remission, not that it's resolved. Any chance you could see a different doctor?

As regards the lows, how confident are you that the 3.1 wasn't just a meter error? High 3s are normal for non diabetics and not a concern because they don't go lower.

Buy your own strips and keep testing.

Good luck. (And well done on achieving remission.)

 

[bulkbiker]

What I wanted to ask is, what does “diabetes resolved” actually mean to me? Will I now stop getting the eye screening and other checks that I was getting (hba1c, cholesterol, kidney function etc)? If so is there anything I can do about it as this worries me as I think I am still diabetic?

The doctor I spoke to is the doctor that assigned to deal with the diabetic patients.

Your doctor is very wrong. Can you try and see another?
I found that the "Diabetes Care Doctor" at our surgery knew very little about T2 and just signed the prescriptions written by the Diabetes Nurse (who to be honest didn't know much more either).

https://www.berkshirewestccg.nhs.uk/media/1507/diabetes-201cin-remission201d-coding.pdf

 

[Eurobuff]

Eating 60g a day means your hba1c goes to prediabetic levels. Not a serious suggestion, because it would damage your body, but if you went to normal levels of carbs (eg 150g a day) as recommended by the NHS eatwell plate, you'd manage a diabetic hba1c in no time.

So the answer is that eating sufficiently low carb puts your diabetes in remission, not that it's resolved. Any chance you could see a different doctor?

As regards the lows, how confident are you that the 3.1 wasn't just a meter error? High 3s are normal for non diabetics and not a concern because they don't go lower.

Buy your own strips and keep testing.

Good luck. (And well done on achieving remission.)

Regarding the lows. When I test if I do get a low like 3.1 etc, I always wash my hands again and test again. When I’ve done this I have got the same result, or maybe 3.0, or 3.2. Also when I have these numbers I do feel shaky, dizzy etc.

My GP practice has designated doctors for certain health conditions. I would imagine if I managed to get past the receptionist to make an appointment with another doctor that they would then say I had to speak to the diabetic doctor? Would it backfire and close ranks on me, trying to go over his head?

 

[Eurobuff]

Your doctor is very wrong. Can you try and see another?
I found that the "Diabetes Care Doctor" at our surgery knew very little about T2 and just signed the prescriptions written by the Diabetes Nurse (who to be honest didn't know much more either).

https://www.berkshirewestccg.nhs.uk/media/1507/diabetes-201cin-remission201d-coding.pdf

View attachment 46908

Judging by the way this is worded, that looks like I wouldn’t get any further checks?

I don’t think my doctor is any more clued up either to be honest. The diabetic nurse has just retired and has been replaced with someone that seems to have less knowledge than the doctor.

As the doctor that I spoke to is the designated diabetes doctor, the normal protocol is that you speak to that doctor If it’s in connection with your diabetes. If I could get to speak to another doctor, they would probably refer me back to him. I don’t know if this would make matters worse.

 

[KK123]

Judging by the way this is worded, that looks like I wouldn’t get any further checks?

I don’t think my doctor is any more clued up either to be honest. The diabetic nurse has just retired and has been replaced with someone that seems to have less knowledge than the doctor.

As the doctor that I spoke to is the designated diabetes doctor, the normal protocol is that you speak to that doctor If it’s in connection with your diabetes. If I could get to speak to another doctor, they would probably refer me back to him. I don’t know if this would make matters worse.

Hi there, all I would say is please don't be intimidated by your Doctor, I know that's easy to say but it's YOUR health, not his. I would make another appointment with him and stress your concerns, give him all your numbers and explain your low carb diet. Then say things like 'I'm getting very depressed over this', (which is true), or 'I'm worried about going out the house because of the lows', or 'Please can I have that in writing' (so it's recorded). If that doesn't work then make an official complaint after reading the NICE guidelines which is their bible, so as to speak. Buy yourself a months supply of strips and test, test, test, NOBODY can tell you what to do, YOUR choice. I know this sounds a bit bolshy but it can all be done whilst remaining calm and polite, a months worth of numbers would be evidence that cannot be ignored. x

 

[Ronancastled]

It's your health, sounds like your Doc is just snowed under or has far worse diabetics to deal with.
Buy your own strips & test, test, test.

I've posted before that you need to become your own practitioner here.

 

[Eurobuff]

The problem is that I’ve told him my results. I went to A&E for something unconnected and they tested my blood sugar has I hadn’t eaten for 5 hours and it was 12. I told him this too. He said I shouldn’t be testing for highs and that my hba1c is coming out as a non diabetic reading. I said that it is probably averaging out my highs and lows to show as normal and he just said “hmm”.

 

[bulkbiker]

Judging by the way this is worded, that looks like I wouldn’t get any further checks?

That's what the classification should indeed mean which it's why its highly likely to be wrong in your case.

 

[HSSS]

The problem is that I’ve told him my results. I went to A&E for something unconnected and they tested my blood sugar has I hadn’t eaten for 5 hours and it was 12. I told him this too. He said I shouldn’t be testing for highs and that my hba1c is coming out as a non diabetic reading. I said that it is probably averaging out my highs and lows to show as normal and he just said “hmm”.

Quite simply you need a new dr.

 

[Mrs T 123]

Yes you need a new dr. You should still get all the check-ups -I do - although I sometimes have to fight for them *sigh*

 

[Eurobuff]

Yes you need a new dr. You should still get all the check-ups -I do - although I sometimes have to fight for them *sigh*

That’s what’s worrying me. Part of me (and I know this is stupid) thinks is it worth following the NHS Eat Well Plate for 3 months, which would give me a diabetic HBA1C. I don’t want to risk my health, but if I’m going to stop getting the checks, isn’t that worse, than 3 months of “normal” carbs. Can I ask if you are coded as Resolved or In Remission?

 

[HSSS]

That’s what’s worrying me. Part of me (and I know this is stupid) thinks is it worth following the NHS Eat Well Plate for 3 months, which would give me a diabetic HBA1C. I don’t want to risk my health, but if I’m going to stop getting the checks, isn’t that worse, than 3 months of “normal” carbs. Can I ask if you are coded as Resolved or In Remission?

Please don’t. You’ll still have a dinosaur dr and worse health. Challenge the one you have or even better change.

 

[MrsA2]

That’s what’s worrying me. Part of me (and I know this is stupid) thinks is it worth following the NHS Eat Well Plate for 3 months, which would give me a diabetic HBA1C. I don’t want to risk my health, but if I’m going to stop getting the checks, isn’t that worse, than 3 months of “normal” carbs. Can I ask if you are coded as Resolved or In Remission?

Better to buy your own strips, test 7 times a day and keep records for a few weeks.
He is more likely to believe data than believe you (sad but true)

 

[EllieM]

I'm concerned about the lows. I'll ask @Lamont D who is very knowledgeable about reactive hypoglycemia to comment (not saying you've got this but there are a number of insulin irregularities that get tested for on the way to a RH diagnosis). 3.1 not's low enough to make you unconscious but you probably wouldn't be safe to drive.

A good endo (guess you're not going to see one till after lockdown) would be able to do the right tests and work out what is going on with your body. I'd ask for a referral.

Good luck. I'm sorry your doctor is being such a <insert favourite derogatory term here>.

 

[Eurobuff]

I'm concerned about the lows. I'll ask @Lamont D who is very knowledgeable about reactive hypoglycemia to comment (not saying you've got this but there are a number of insulin irregularities that get tested for on the way to a RH diagnosis). 3.1 not's low enough to make you unconscious but you probably wouldn't be safe to drive.

A good endo (guess you're not going to see one till after lockdown) would be able to do the right tests and work out what is going on with your body. I'd ask for a referral.

Good luck. I'm sorry your doctor is being such a <insert favourite derogatory term here>.

When I googled “diabetes resolved” to try and find out what that meant in terms of ongoing monitoring, one of the pages mentioned about a low carb diet can result in hypos. I clicked on that many pages I don’t know where it was now! Also I take a tablet called Nortriptyline which can cause hypos. So maybe a mixture of the two might be to blame?

 

[Dark Horse]

This is the information from Public Health England:-

Diabetes in remission’ and ‘Diabetes resolved’ codes

• patients should be screened annually for life if there has ever been a definite diagnosis of diabetes, excluding gestational diabetes
• patients in remission – for example due to an intervention such as bariatric surgery – should be classified ‘Diabetes in remission’, not ‘Diabetes resolved’. This ensures they will still be invited for screening
• patients will not be invited for screening if they have a read code of ‘Diabetes resolved’. This code should not be used for patients whose diabetes is in remission due to an intervention
• GPs should review all patients with a ‘Diabetes resolved’ read code and amend to ‘Diabetes in remission’ as appropriate

https://assets.publishing.service.g...87/DES_07_GP_information_sheet_March_2016.pdf

There is someone on this forum who had 'diabetes resolved' written in their notes but still gets the correct diabetic checks - presumably they were coded correctly despite the 'diabetes resolved' term. It would be a good idea to go back to your GP and ask them what the significance of 'diabetes resolved' is in your notes . You could take a print-out of the information from PHE that I linked to above and explain your concerns.

 

[EllieM]

So maybe a mixture of the two might be to blame?

The only mention I can find of low carb diets causing hypos is in the first few weeks of one, when the body is converting from a high fat diet. The best treatment for reactive hypoglcemia appears to be to eat low carb (RHers over produce insulin in response to carbs so get hypo a few hours after eating them). Is there an alternative drug you can use other than nortryptiline?

 

[Eurobuff]

The only mention I can find of low carb diets causing hypos is in the first few weeks of one, when the body is converting from a high fat diet. The best treatment for reactive hypoglcemia appears to be to eat low carb (RHers over produce insulin in response to carbs so get hypo a few hours after eating them). Is there an alternative drug you can use other than nortryptiline?

I was Amitriptyline originally after being on that for 3 years I was diabetic, there has been a study that says that if you take Amitriptyline for one year the chances of you getting type 2 diabetes is 84% if you aren’t monitored. I wasn’t monitored, I didn’t know till after the event. My doctor then tried various other tablets which at best didn’t work or made me vomit or have hallucinations. Nortriptyline was recommended by the specialist. I think I’ve tried them all

 

[HSSS]

When I googled “diabetes resolved” to try and find out what that meant in terms of ongoing monitoring, one of the pages mentioned about a low carb diet can result in hypos. I clicked on that many pages I don’t know where it was now! Also I take a tablet called Nortriptyline which can cause hypos. So maybe a mixture of the two might be to blame?

Hypos on low carb are almost always only because of medications also taken. If you are low carb without medication hypos are extremely unlikely. Effectively it is because the medication is now stronger in the blood glucose lowering effects than your new diet needs it to be. You might however experience false hypos where you feel horribly low even though you’re not, a product of becoming accustomed to high levels and being shocked by more normal ones all of a sudden.