Healthy BMI - Recently Diagnosed Type 2 at 34 years old - (Help Required!)

[SlimType2]

Hello!

In Jan 2024 I was given a HBA1C of 116 mmol/mol.
Startled and alarmed, the doctors said that i needed to be on 4 tablets of Metformin a day but that would need to be titrated up with time.

I was told that because my height and weight do not resemble a Type 2 Diabetic (Male - 172cm - intially weighed 62kg) there was no chance of me gaining remission.

I began taking one tablet a day and did NOT titrate upwards - instead tried increasing my activity level and made significant dietary changes (120g of carbs a day max) - I now weigh 57.5kg - I did a HBA1C at the middle of February and it had gone down to 79 mmol/mol.

So I decided to carry on with only one tablet a day and not change anything more as my C-peptide levels are very good as well.

My questions:

1. Is it possible for me to achieve remission?
2. I'm wearing a CGM (Freestyle Libre 2) and my numbers are so varied - some days I'm in the mid-low ranges and on others I reach 13.2mmol/L before it comes down again. These numbers are triggering my anxiety as I hate to reach those numbers when I'm eating the same meal!
3. Have there been instances where people have initially achieved control through medication and then come off them?

Please help!

 

[EllieM]

Hi @SlimType2 and welcome to the forums.

Just a few questions, What do you mean by

as my C-peptide levels are very good as well.

Though there are plenty of TOFI (thin outside fat inside) T2s out there, there are also other types of diabetes to be considered when you are a slightly unusual presentation (young and thin in your case). Do you know if you have been tested for any? (The obvious one is T1 but there are many types out there, you might need a referral to an endocrinologist to diagnose).

Plenty of T2 forum members have been able to come off or reduce meds by lowering the carbs in their diets. Whether this counts as remission or not is a question of semantics, as they usually need to maintain the low carb in order to maintain the normal blood sugars. But I would argue that being thin just means that you aren't going to be able to use weight loss to achieve the results you want, not that you can't use diet to do it.

Tagging @ianf0ster who is TOFI

 

[mouseee]

Thats brilliant. Being diagnosed is scary but you've taken the bull by the horns.
I think I'd be asking the question as to could you be T1 as well, although if you have a family history of T2 then perhaps you were always destined for it! Important to take note that it can be a big part of why you are diabetic and you didn't do this to yourself.
If you're reducing your hba1c with that level of carbs, keep going. If you find you need to cut more then it's possible to do.
Personally I am happy with taking more meds to help my body use the insulin I produce better but that completely personal choice. I don't want to add more to my current prescription so I'm being careful with carbs again.
As to remission, many people who are T2 on here prefer terms like 'well managed'. Feom my point of view, I nearly got out of diabetic numbers and was in prediabetic numbers. However, as soon as I slipped on carbs again my numbers have increased. So well managed works best for me. Remission to me says its pretty much gone...... it hasn't.....

 

[SlimType2]

Hi @SlimType2 and welcome to the forums.

Just a few questions, What do you mean by

Though there are plenty of TOFI (thin outside fat inside) T2s out there, there are also other types of diabetes to be considered when you are a slightly unusual presentation (young and thin in your case). Do you know if you have been tested for any? (The obvious one is T1 but there are many types out there, you might need a referral to an endocrinologist to diagnose).

Plenty of T2 forum members have been able to come off or reduce meds by lowering the carbs in their diets. Whether this counts as remission or not is a question of semantics, as they usually need to maintain the low carb in order to maintain the normal blood sugars. But I would argue that being thin just means that you aren't going to be able to use weight loss to achieve the results you want, not that you can't use diet to do it.

Tagging @ianf0ster who is TOFI

Hello and thank you very much for responding!

No true genetic connection - my mother has just been diagnosed as a T2 but at the age of 58. I've seen an endocrinologist and been tested for T1 - tested negative. Recently had a pancreas CT scan (Waiting for results).

My currently estimated hba1c (according to my CGM) is 6.3% (45 mmol/mol) which is in the Pre-diabetic range.

 

[SlimType2]

Thats brilliant. Being diagnosed is scary but you've taken the bull by the horns.
I think I'd be asking the question as to could you be T1 as well, although if you have a family history of T2 then perhaps you were always destined for it! Important to take note that it can be a big part of why you are diabetic and you didn't do this to yourself.
If you're reducing your hba1c with that level of carbs, keep going. If you find you need to cut more then it's possible to do.
Personally I am happy with taking more meds to help my body use the insulin I produce better but that completely personal choice. I don't want to add more to my current prescription so I'm being careful with carbs again.
As to remission, many people who are T2 on here prefer terms like 'well managed'. Feom my point of view, I nearly got out of diabetic numbers and was in prediabetic numbers. However, as soon as I slipped on carbs again my numbers have increased. So well managed works best for me. Remission to me says its pretty much gone...... it hasn't.....

So this is an interesting one, thank you for your comment! This forum provides so much support and I'm grateful for it

I've recently seen a diabetes-specialist dietician who looked at my numbers and said that I should explore introducing more low GI carbs into my diet, as I have an overall goal of increasing my muscle mass. To fuel my workouts, I need carbs!

I guess that I will need to experiment over time to see what my body likes and doesn't like.

I find that my BG goes up when I've had a shower which is very annoying and then stabilises at a higher level than I'd like (in the 6s normally) whereas I'd prefer the 5s.

 

[In Response]

I find that my BG goes up when I've had a shower which is very annoying and then stabilises at a higher level than I'd like (in the 6s normally) whereas I'd prefer the 5s.

Do you shower first thing in the morning?
I ask because the rise could be due to Dawn Phenomenon/Foot on the Floor and it could also be the affect of the hot water on your sensor.
That said, there is no problem with stabilising in the 6s.

 

[HSSS]

I've seen an endocrinologist and been tested for T1 - tested negative

Can I check what this entailed?

Some only check GAD antibodies. And whilst a positive is near definite, a negative doesn’t rule it out entirely. The antibodies can not show up after they’ve done their thing, other type of antibodies can be responsible too. Was c -peptide/insulin checked?

Since Covid there seem to have cases of Covid induced type 1 (not sure where antibodies sit with that onset) and occasionally “temporary“ type 1-like diabetes where the infection creates a similar situation but can be temporary

And there are types other than 1 & 2. It does seem unusual for someone your age, weight and fitness to have type 2. That said 120g a day is too many for me as a type 2 to achieve anything like normal levels.

 

[Antje77]

To fuel my workouts, I need carbs!

You might like to read up on working out on low carb, many people do this without issue.

Carbohydrate is used to fuel metabolic activity in the cells, fats provide hormonal foundation for cells and proteins rebuild and repair cells.

Carbohydrate is used to fuel metabolic activity in the cells, fats provide hormonal foundation for cells and proteins rebuild and repair cells.

www.diabetes.co.uk

 

[Antje77]

Since Covid there seem to have cases of Covid induced type 1 (not sure where antibodies sit with that onset) and occasionally “temporary“ type 1-like diabetes where the infection creates a similar situation but can be temporary

Do you happen to have a link to a decent article on this?
I've read about it in different places but I'd like to have a good article bookmarked.

 

[SlimType2]

Can I check what this entailed?

Some only check GAD antibodies. And whilst a positive is near definite, a negative doesn’t rule it out entirely. The antibodies can not show up after they’ve done their thing, other type of antibodies can be responsible too. Was c -peptide/insulin checked?

Since Covid there seem to have cases of Covid induced type 1 (not sure where antibodies sit with that onset) and occasionally “temporary“ type 1-like diabetes where the infection creates a similar situation but can be temporary

And there are types other than 1 & 2. It does seem unusual for someone your age, weight and fitness to have type 2. That said 120g a day is too many for me as a type 2 to achieve anything like normal levels.

Hi!

So my c-peptide was checked and came up as adequate.

Thank you for the information about Covid-induced T1, I will take that away and read about it.

As a vegetarian, lowering carbs has been very tough. However, I seemed to have achieved a result with it (HBA1c down to 79 from 116 in under two months).

Where I worry is that the progress that I am making in lowering these levels will stagnate and my hba1c won’t continue to lower to the early 40s (my goal at the moment).

The endocrine seems to be convinced that I am a T2, although I do wish to have further testing done. Can anyone help to recommend the right tests that I should be asking the doctors to do?

 

[SlimType2]

You might like to read up on working out on low carb, many people do this without issue.

Carbohydrate is used to fuel metabolic activity in the cells, fats provide hormonal foundation for cells and proteins rebuild and repair cells.

Carbohydrate is used to fuel metabolic activity in the cells, fats provide hormonal foundation for cells and proteins rebuild and repair cells.

www.diabetes.co.uk

Thank you for this!

My experience with muscle building so far (as my muscle mass is very low) is that the carbs do help in being able to lift heavier (and thus increase muscle mass).

But I completely agree when we talk about cardiovascular exercise (Low Intensity Steady State in particular) where no fuelling is wholly required

 

[Melgar]

I am going through something similar as are a number of people here. There are also vegetarians on the forum too with their experiences with high blood sugars. Worth a read on the various forums here. You are a lot younger than I am though. There is a difference there for sure.
I have a BMI of 19, I weigh about 120lbs. I'm very fit, i do weights, mountain hiking, aerobic exercises. So my calorie burn off is significant. Low trigs, no insulin resistance. Bottom line for me is I do not produce enough insulin. I do get a DP rise in the AM reaching around 7.5mmol/Ls by late afternoon my liver struggles to dump glucogen when my blood sugars fall. I too have very unstable blood sugars. My baseline blood sugars can be 7 for days with the corresponding rises, then drops to around 4 mmol/Ls. Then I risk nightime hypos. Yes, I get nightime hypos. I have got familiar with my own blood sugar patterns and how the foods I eat impact my blood sugars. Root veggies are carby, greens are not. It definitely pays to understand how food impacts your blood sugars as we are all different.

I was diagnosed as T2, but now they think I may have autoimmune diabetes. They say my blood sugars are 'brittle'. I feel frustrated without an definite diagnosis, but I it will reveal itself given time, but I am impatient I guess. I am one of those types who always reads the end of books first so I can relax when reading. My Ac1's are still in check as I do the low carb thing, but are edging back up even though I am on a drug that forces my pancreas to secrete more insulin. Your carbs are at 120g per day, although classed as low carb they are still too high for a significant AC1 reduction, if T2. Folks here go very low carb, low enough to induce nutritional ketosis. For T2's and early Lada's that is 'manner from heaven. T2's can achieve remiision, Ladas it can delay those out of control blood sugar rises for a time.

 

[SlimType2]

I am going through something similar as are a number of people here. There are also vegetarians on the forum too with their experiences with high blood sugars. Worth a read on the various forums here. You are a lot younger than I am though. There is a difference there for sure.
I have a BMI of 19, I weigh about 120lbs. I'm very fit, i do weights, mountain hiking, aerobic exercises. So my calorie burn off is significant. Low trigs, no insulin resistance. Bottom line for me is I do not produce enough insulin. I do get a DP rise in the AM reaching around 7.5mmol/Ls by late afternoon my liver struggles to dump glucogen when my blood sugars fall. I too have very unstable blood sugars. My baseline blood sugars can be 7 for days with the corresponding rises, then drops to around 4 mmol/Ls. Then I risk nightime hypos. Yes, I get nightime hypos. I have got familiar with my own blood sugar patterns and how the foods I eat impact my blood sugars. Root veggies are carby, greens are not. It definitely pays to understand how food impacts your blood sugars as we are all different.

I was diagnosed as T2, but now they think I may have autoimmune diabetes. They say my blood sugars are 'brittle'. I feel frustrated without an definite diagnosis, but I it will reveal itself given time, but I am impatient I guess. I am one of those types who always reads the end of books first so I can relax when reading. My Ac1's are still in check as I do the low carb thing, but are edging back up even though I am on a drug that forces my pancreas to secrete more insulin. Your carbs are at 120g per day, although classed as low carb they are still too high for a significant AC1 reduction, if T2. Folks here go very low carb, low enough to induce nutritional ketosis. For T2's and early Lada's that is 'manner from heaven. T2's can achieve remiision, Ladas it can delay those out of control blood sugar rises for a time.

Thank you for this!
In that case, as I have seen a significant A1C reduction already I'm not sure if what I have is T2 (despite the doctors telling me that I do).

Considering what you've mentioned below, I can say the below from my perspective:

1. My insulin levels (through a c-peptide blood test) were assessed as adequate (almost close to the top-end!)
2. I'm also fairly fit - do about 15k steps a day, weight training 3x a week.
3. By going low carb and keeping my calories in good check, my body reacts and I end up loosing weight. My weight came down to about 57.5kg and I just don't have any more to lose.

But I will take a look at the Vegetarians Forum - thank you!

 

[HSSS]

Do you happen to have a link to a decent article on this?
I've read about it in different places but I'd like to have a good article bookmarked.

Sorry having searched I find I’ve not saved them. Like you I’ve read it in various places

 

[HSSS]

Thank you for this!
In that case, as I have seen a significant A1C reduction already I'm not sure if what I have is T2 (despite the doctors telling me that I do).

Considering what you've mentioned below, I can say the below from my perspective:

1. My insulin levels (through a c-peptide blood test) were assessed as adequate (almost close to the top-end!)
2. I'm also fairly fit - do about 15k steps a day, weight training 3x a week.
3. By going low carb and keeping my calories in good check, my body reacts and I end up loosing weight. My weight came down to about 57.5kg and I just don't have any more to lose.

But I will take a look at the Vegetarians Forum - thank you!

So cpeptide being highish is a sign of type 2 - what was the corresponding blood glucose at the same time though? With high glucose you’d expect higher insulin. If glucose is low there’s no real demand for insulin therefore you’d expect lower.

If you have no weight to lose why are you restricting calories? Low carb replaces calories from carbs with extra proteins and fats rather than restricts them. And at 120g a day you have considerable scope to lower them further if after the next hba1c the results aren’t what you want. Admittedly as a vegetarian you have stacked the deck against doing so as easily as an omnivore could. But people can and do manage it. The sub forum is a good place to start. Is vegetarianism negotiable for you? If it’s for “health” then maybe it’s not the optimal choice for you as a type 2. If it’s for other reasons then perhaps a tougher decision.

 

[Melgar]

Thank you for this!
In that case, as I have seen a significant A1C reduction already I'm not sure if what I have is T2 (despite the doctors telling me that I do).

Considering what you've mentioned below, I can say the below from my perspective:

1. My insulin levels (through a c-peptide blood test) were assessed as adequate (almost close to the top-end!)
2. I'm also fairly fit - do about 15k steps a day, weight training 3x a week.
3. By going low carb and keeping my calories in good check, my body reacts and I end up loosing weight. My weight came down to about 57.5kg and I just don't have any more to lose.

But I will take a look at the Vegetarians Forum - thank you!

I hear ya. I can lose weight very easily. Frustrating for those who can't but losing weight easily has it's downside too. There are many on here who can advise you on diet. They are very knowledgeable around great meal choices and low carbing, Ac1 reductions, the whole thing. Forget what you hear about low fat diets. The tide is definitely turning on that one.

 

[ianf0ster]

My being a TOFI T2 diabetic was the reason I chose the Low Carb rather than Very Low Calorie route to remission.
Basically, I ate to my meter (aiming to never go over 8.5 mmol at the 2hrs post prandial mark and always keeping the rise from just before to 2hrs after a meal at or below 2.0 mmol). It took up to 3 months before I realised that I was fully fat adapted (no longer felt hungry at meal times), so at that time I cut out 'breakfast' and even going to one meal a day (OMAD) at weekends, eating between 15:30 and 16:30 unless its inconvenient.

As has already been said, for a slim T2 Blood glucose control is about eating fewer carbs, not cutting calories. I have never measured my calories, but when I wanted to gain weight, I just added more protein and more fat to my meals. While you certainly need calories to exercise, they don't need to be in the form of carbohydrates. Type 1 diabetics tell me that this is also the case for them.
I'm very sceptical about there being something magical about carbs for exercise (either aerobic or anaerobic), to me they just convert to fuel (glucose) and actually have disadvantage in other areas compared with ketones. These days there are plenty of athletes who train or compete in nutritional ketosis.

There is no one size fits all with diabetes, each of us (especially Type 2, RH etc.) is different and even have different tolerances to individual and total carbohydrates. So I can't advise how many or which types of carbs somebody else should eat. We each have to find what works best for us.

 

[Impy]

Hi @SlimType2,

I too am a thin Type 2. Indeed it was my weight loss and family concern which led to me getting tested and diagnosed as Type 2 in the first place.

Whilst I'm not vegetarian, the low carb (ketogenic) approach worked for me in reducing my Hba1c from a diagnosis level of 123 to where it is now at 36. You might find that your metabolic rate has increased with the adoption of a low carb approach to eating, which means you will need to eat more to maintain your current weight. I'm currently operating on about 3000 kcal a day which seems to work for me for maintenance (I'm about 10 stone).

You'll probably have to experiment a bit to see where your intake needs to be to maintain your current weight, especially with you being as active as you are

 

[Antje77]

In that case, as I have seen a significant A1C reduction already I'm not sure if what I have is T2 (despite the doctors telling me that I do).

Considering what you've mentioned below, I can say the below from my perspective:

1. My insulin levels (through a c-peptide blood test) were assessed as adequate (almost close to the top-end!)

Early LADA can be very hard to differentiate from T2, even with all the blood tests thrown in.
If you test positive for any of the antibodies, it's a T1 diagnosis (although something may be going on with those post covid diabetics there).
Negative antibodies isn't conclusive.

With C peptide there are various possibilities, and it's very useful to have a glucose test at the same time as the blood draw for C peptide.

Very high C peptide = almost certainly T2.
Very low C peptide + high BG = almost certainly T1 (or T3C).
Lowish C peptide + healthy BG = unknown. If you eat low carb you need less insulin, no matter your type. Despite the low C-peptide, the BG proves you produced the correct amount of insulin at the moment of the blood draw.

In the normalish range, things aren't as clear cut.
Early T1's can still produce a significant amount of insulin, so normalish range + high BG = unknown, although early T2's tend to overproduce.
Normalish range + healthy BG = unknown. It merely shows your body can deal with the foods you chose to eat.

The endocrine seems to be convinced that I am a T2, although I do wish to have further testing done. Can anyone help to recommend the right tests that I should be asking the doctors to do?

So it may be it simply needs a bit more time before a diagnosis is even possible.

I would also make sure you have access to your actual test results in numbers (and units used). 'Adequate' or 'a bit high' doesn't really tell you anything, and can be subject to the interpretation of the person who tells you.