5 different types of diabetes identified now

Daibell said:

I agree. LADAs like myself (diagnosed at age 60) don't fit into any category. How did this Swedish team with 15K people sampled miss the large number of mid-age, thin, insulin deficient diabetics like ourselves. My c-peptide showed my diabetes wasn't 'mild' whatever that means.

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Likewise thin and positive GAD. Being treated as type2 on metformin and low carbing, but rising HbA1c. Might be MARD as 52 but certainly not coping on diet alone. Still confused.

Fleegle said:

I am not sure that everyone with T2 still produces too much insulin though? but almost certainly got to where they are by doing so. Some will have damaged or clogged their beta cells that it is hard to manage without additional insulin not less.

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I think that's where better diagnostics could help. So currently we get the HbA1c test, which looks at glycated haemoglobin as a proxy for pancreatic function. Get a high score and win some metformin and a T2 label. Quick and easy for a GP. Kraft's study and others looked more closely at insulin levels and glucose response to refine diagnostics, but those are more expensive tests and need more skill to interpret the results.. Which is where this paper's a step in the right direction.

Alexandra100 said:

According to Jenny Ruhl, going low carb causes a big weight loss due to loss of fluid not fat, and adding carbs back into your diet entails a sudden weight gain which is additional fluid not fat. Hope that helps!

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I'm not convinced. According to my super-scales, my body water percentage increased as I switched to low carb.. Or that could just have been due to fat loss, ie absolute water content stayed roughly the same, but as a percentage of my reduced weight it showed an increase. Or maybe I should brush the snow off.. Curious what mechanism Ruhl thinks could cause water retention/loss though.

first14808 said:

I'm not convinced. According to my super-scales, my body water percentage increased as I switched to low carb.. Or that could just have been due to fat loss, ie absolute water content stayed roughly the same, but as a percentage of my reduced weight it showed an increase. Or maybe I should brush the snow off.. Curious what mechanism Ruhl thinks could cause water retention/loss though.

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I am also curious about water loss, where is it lost from? If you have a drink wouldn't it be retained to restore any loss?

You can read what Jenny Ruhl has to say about water loss and gain here: http://www.phlaunt.com/diabetes/43067073.php

Alexandra100 said:

You can read what Jenny Ruhl has to say about water loss and gain here: http://www.phlaunt.com/diabetes/43067073.php

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That is a good summary of what I understood that the body stores much more water with its fuel store.

Quick reaction (I have read the entire thread but need to digest it better).

I hate the word "mild" in any description of diabetes (of any type).

I do clearly fit into their "mild" description because I am an entirely diet-controlled T2, not taking any drugs, and was never overweight or obese.

However I do find it shocking to describe *any* form of diabetes as a "mild" disease. The diet change I made were dramatic and most non-diabetic people would consider them almost impossible, although now that more than a year has passed since my diagnosis, I realize it is not quite as hard as you might think. The lifestyle changes (stepped-up exercise, and much greater attention to regular checkups for eyes, feet, general condition) were -- for me -- anything but "mild."

Edited to add: Considering the complications of uncontrolled diabetes, how can it ever be described as a "mild" condition?

Alexandra100 said:

You can read what Jenny Ruhl has to say about water loss and gain here: http://www.phlaunt.com/diabetes/43067073.php

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Ah, so..

Whether you are low carbing or not, you must burn off 3,500 more calories than you take in to lose a pound of fat and you must eat 3,500 calories more than you need to gain a pound.

A rather gross oversimplification. Not all calories are created equal, and we don't process them the same way.

If the body can't get glucose from the diet it has two choices: use stored carbohydrate--our friend glycogen again, or convert dietary or muscle protein into carbohydrate using a lengthy process called "gluconeogenesis" which takes place in the liver.

..and elsewhere. Like kidneys, via lactates and the Cori cycle, which is why metformin's contraindicated for people with impaired kidney function as it can lead to lactic acidosis. But unless we're starving, the body doesn't want to cannibalise itself and burn muscles. So glucose levels drop, pancreas secretes glucagon to signal fat cells to give up triglycerides, and then gluconeogenesis can convert that into glucose. This is the bit that's impaired in us, and why LCHF/Ketogenesis works.. Burn fat, not carbs!

Strange that Ruhl overlooks preferential fat burning to muscle given ample evidence from fasting experiments, voluntary or enforced. And from an evolutionary point of view, it makes zero sense to suggest we would consume muscle in preference to stored fat.

If you eat a significant amount of carbs, your liver and muscles grab glucose from your bloodstream to replenish that emergency stock. As they do this, four grams of water join each gram of glycogen and, as fast as you can say, "Omigawd, I cheated!"

I think someone has.. cheated. That only happens if liver and muscle glycogen stores are depleted. As muscles don't like giving it up, that means exercise, and as glycogenesis requires energy, well, that's another benefit. But the water isn't gained or lost, just redistributed.. Otherwise athletes would keel over from hypovolemia as their muscles dehydrate glycogen. The metabolism really doesn't work that way.

Grateful said:

I do clearly fit into their "mild" description because I am an entirely diet-controlled T2, not taking any drugs

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I think they looked at test results before any action was taken, therefore you need to look at yourself as you were before you did a low carb diet to see what cluster they would have put you in.

ringi said:

I think they looked at test results before any action was taken, therefore you need to look at yourself as you were before you did a low carb diet to see what cluster they would have put you in.

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Agreed. It also mentions modest metabolic derangement. This includes blood pressure and cholesterol/lipid levels as well as insulin resistance, and I suspect a fairly low diagnostic HbA1c and FBG level although it doesn't specifically mention these.

Cluster 5 (39.1) named "Mild Age-Related Diabetes" (MARD) was associated with older age and only modest metabolic derangement.

On diagnosis I was 66 with an HbA1c of 53 and a FBG of 7. My cholesterol/lipids were good. My blood pressure was ideal. My liver markers for fatty liver were exceptionally good (ALT and Gamma GT). The only downfall was my BMI of 31 but that had increased to that level only during the previous year. So only modest metabolic derangement?? It would be good to get some definitions.

Bluetit1802 said:

It would be good to get some definitions.

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They had a computer AI based stats system try to group people so that the markers were very close between people in each group, and very different between groups. And then gave names to the groups that the AI system found

Hence there are no definitions, but at least the research has shown the insulin resistance should be used as one of the "markers".

Maybe it will lead to some useful definitions in a few years time......

Alexandra100 said:

You can read what Jenny Ruhl has to say about water loss and gain here: http://www.phlaunt.com/diabetes/43067073.php

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This is my take away...we need some time to get into full ketosis mode...that is when the fat loss kicks in...otherwise it is mainly water loss.

Do you lose any REAL fat weight on a Low Carb Diet?
Probably not in the first three days--unless you cut 1200 calories out of your usual diet, too. But once you have gotten through the first week or two another benefit of low carbing kicks in that does make it much easier for most people to cut out the calories they need to cut to lose real fat.

That's because when you cut out your carbs you eliminate the blood sugar swings that cause hunger in most people. The cravings you used to get when dieting may fade out in as little as two weeks. When you stop eating in response to those nasty hunger cravings, you will find it much easier to eat a whole lot less than you used to. It is the drop in calorie intake that follows this drop in hunger that that results in the very real and often dramatic weight loss so many long-term low carbers report.

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I welcome the new category of SIRD. Maybe now people will be more understanding of those who simply don't lose weight on a low cal diet.

Grateful said:

Quick reaction (I have read the entire thread but need to digest it better).
I hate the word "mild" in any description of diabetes (of any type).
I do clearly fit into their "mild" description because I am an entirely diet-controlled T2, not taking any drugs, and was never overweight or obese.
Edited to add: Considering the complications of uncontrolled diabetes, how can it ever be described as a "mild" condition?

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I suppose because there are far worse conditions. I am disappointed to have diabetes and having to struggle with diet choices that make difficult for me to enjoy to go to the restaurant with friends, or scooping an ice cream cone. But not having to inject me with insulin everyday is a nice thing, still having my driver license is also a good thing.

lucylocket61 said:

can you point me to this please?

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It's in the link at the start of this thread. It's also mentioned in post no. 3 on this thread.