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Am I In Remission?

Eurobuff

Well-Known Member
Messages
358
Type of diabetes
Treatment type
Diet only
For the last 3 years my hba1C have been “normal” the highest being 42. I’ve had 38, 37, 35, 37, 34, 36, 42, and the latest 40. When checking on my notes to get the results of my latest test, there is a note on my record saying based in results diabetes in remission, discuss at review, still monitor for now. Inform patient that she does not need to check her blood sugar.

I have lows of 4.2, 4.3, and have had highs of 8, 8.1, 9.5. i feel dizzy when I have the lows. I don’t have them all the time the lows about once every 3 or 4 weeks and the highs once every couple of weeks.

I follow a low carb diet and don’t eat chocolate or sweets.

Is this classed as being in remission? I thought remission is that if you ate a bar of chocolate you wouldn’t get a high reading, but in my case I would.
 
There is no single definition. Most consider it as “normal” hb1ac without meds for a given period of time eg 1 or 2 yrs.

This sometimes extends to non diabetic numbers ie pre diabetic, metformin allowed, just one or two tests in a row.

I think the no hyper reaction to carbs you mention is more like a cure than remission and as far as I know highly unlikely.

and 4.2 isn’t considered a low. In fact it’s a pretty normal number for non diabetics. I’m surprised you feel hypo with such a reasonable hb1ac and generally good numbers. Even non diabetics get the occasional higher number, depending on food and test timing.
 
Eurobuff said:
For the last 3 years my hba1C have been “normal” the highest being 42. I’ve had 38, 37, 35, 37, 34, 36, 42, and the latest 40.
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I do not use the word remission but well controlled, your hba1c readings show you are in well control.
Eurobuff said:
Is this classed as being in remission? I thought remission is that if you ate a bar of chocolate you wouldn’t get a high reading, but in my case I would.
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As I am in control of my T2, but if I start eating carby foods again I will loose control and run of the rails back into T2 territory.

It's like a alcoholic who has been in recovery for a couple of years then starts drinking again, back where they started.
 

Agree. Is it theoretically possible for someone ot undo the metabolic damage of (maybe) decades so completely that their system can deal with a bar of chocolate in the way they would have aged 20? I don't know, but I've never heard of it happening. It is surely miracle enough to stop in its tracks a supposedly chronc and progressive endocrine disorder through diet and lifestle alone. That is lttle short of a miracle, and to this day most GPs have never seen it happen and barely believe that it can. IF you have achieved that, it is an amazing and wonderful achievement, and well done.
 
I have had a non-diabetic hba1c for approx 7 years which I consider to be in remission but my DN classes as being well controlled.
 
andromache said:
That is lttle short of a miracle, and to this day most GPs have never seen it happen and barely believe that it can. IF you have achieved that, it is an amazing and wonderful achievement, and well done.
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@andromache I do not know about miracles but LCHF food and Metformin started me on the road to recovery and controlling it.

The speed bump is when I started taking Metformin in this pix, which I have since been off of for the past year and half. The pix in my sig is metformin free and up to date at the beginning of March.


 
Each GP surgery has its own ideas of what remission is. My own surgery believes it to be consecutive HbA1cs under 48 without medication for a couple of years. (maybe 4 tests over that time). There is no official guidance as far as I know. This is something I found from https://www.diabetesremission.org/our-task/

“Definition of Diabetes Remission”
Following international standards [1,2] a person goes into diabetes remission when the following conditions are fulfilled:

  1. Had a diagnosis of diabetes
  2. Fasting Serum Glucose (FSG) is less than 100 mg/ml (5.6mmol/l)
  3. HbA1c is less than 6.0% (42mmol/dL)
  4. There is no active hypoglycemic therapy (either pharmacological or surgical)

We define three levels of remission:

  • Initial. When the conditions are fulfilled for three months
  • Complete. When the conditions are fulfilled for one year
  • Operational cure. When the conditions are fulfilled for five years or mor
References:
1. Buse JB, Caprio S, Cefalu WT, Ceriello A, Del Prato S, Inzucchi SE, et al. How do we define cure of diabetes? Diabetes Care. 2009 Nov;32(11):2133–5.
2. World Health Organization (WHO). Global Report on Diabetes 2016 [Internet]. Geneva: World Health Organization; 2016. Available from: http://www.who.int/diabetes/global-report/en/
 
I think the term “remission” is confusing. Remission to me means “gone, at least for now”. A cancer patient is in remission because there is no trace of the cancer in their system. In my case I would say it’s well controlled because I’m eating 50grams of carbs a day. It’s not in remission because if I was to eat a bar of chocolate I would have a high blood sugar result. Probably if I was to eat a bar of chocolate a day, my hba1c would then be a diabetic reading. So I would then be classed as a diabetic. Is an alcoholic that’s stopped drinking still an alcoholic?
 
Eurobuff said:
Is an alcoholic that’s stopped drinking still an alcoholic?
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Are you addicted to metabolic syndrome and high blood glucose? Not really analogous

My view is that glucose intolerance is not the same thing as diabetes any more than having fair skin means you've got sunburn just because you might have if you lay in the sun too long. Normal glucose and normal insulin equals no diabetes, irrespective of what may happen tomorrow or the day after.

All only in my opinion. Others choose to see it though a different lens. As is their prerogative
 
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Well controlled I think is a much easier term to understand and correlates with the results you are showing in your HBA1C's. These debates on remission and well controlled have been going on for a long time however.

Keep doing what you are doing, it is working well for you. I think that's what is important. I personally would ignore the advice that may come to no longer check blood glucose. That is some of the weakest poor advice you can get in my view. It's cost cutting advice with little regard for a persons health, you didn't get to where you are now by ignoring glucose levels.
 
Just keep your priorities right - keep on as you have been and don't get tangled up in terminology.

I believe the only time you may need to be concerned about the definition of "remission" is if it has an impact on the regular tests and check ups you may need as a diabetic - well controlled or otherwise.
 
I appreciate you’ve had this conversation many times but a thought just occurred to me. I know you have zero wish to up your carb intake and as such it is irrelevant for you personally but I’m still curious about the concept. Your position on this always makes me question mine.

If a persons natural mechanism for controlling carb intake is still impaired then surely the disease still exists even if it currently causes no symptoms of hyperglycaemia and hyperinsulemia due to the lack of “poking the bear”. Isn’t that what a metabolically healthy person can do should they wish to?

Is diabetes defined by these two symptoms or does it go beyond that I guess is my question? Is it about response to glucose not exposure to it? Is anything else happening in diabetes beyond these two symptoms we don’t focus on currently?

It is if that mechanism works or not that surely defines diabetes rather than if you choose to quantifiably exercise that mechanism by eating carbs. Perhaps in that sense a glucose tolerance test is more appropriate for testing a hypothesis of “no diabetes currently detectable”. Is that the same as not there? If disease symptoms are likely to return - given reasonable circumstances- what is that labelled? I thought it was remission.

The non alcoholic alcoholic anology isn’t about addiction. It’s about testing under one set of circumstances only and declaring the disease gone as a result rather than controlled.

Just my, rambling, thoughts.
 

By that rationale, I was born with type 2? My body was never going to be able to withstand a lifetime of carbohydrates and seed oils. If I’d always eaten the way I do now, I would never have become diabetic, and no one would accuse someone of being diabetic simply because they don’t consume carbs.

Will I forever be metabolically scarred? Probably. But as I intend to eat this way for life, it’s moot. My body was never able to cope with the SAD diet. If it were, I wouldn’t be here. Whether or not I can cope now is entirely irrelevant to me, because I never could.

All that said, I appreciate it’s a matter of perspective. Whatever gets us through the day eh?
 
My thoughts were never meant as an accusation - to you or anyone in general. I’m sure you realise this. You are not alone in your perspective. I find it an interesting but probably open theoretical discussion and though I’d made that clear. Indeed whatever works as there’s no single answer.

No one has said a person is diabetic purely on the basis they don’t eat carbs, more putting forward the opinion that ceasing to eat carbs doesn’t make a previous diabetic no longer one. Quite possible if a person only ever ate low carb they would not become or know they were diabetic (unable to cope long term with above a certain level of carbs - once more down to definitions). Not being able to sustain a lifelong appropriately named SAD diet is very different from maintaining a reasonable real food, moderate carb diet more typical in generations past. Perhaps we are indeed born with (the predisposition towards) type 2 that the high carb modern way of eating makes apparent. Genetics is certainly part of it. None of which is the point I attempted to make.

My point was more what is T2 diabetes? Is it purely hyperglycaemia and hyperinsulemia or is it other damaged mechanisms and these are merely symptoms of the damage which may or may not be on display given a particular lifestyle once awareness of the condition has arisen. If the former then your assertion that you no longer have diabetes holds true.
 
HSSS said:
No one has said a person is diabetic purely on the basis they don’t eat carbs, more putting forward the opinion that ceasing to eat carbs doesn’t make a previous diabetic no longer one
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I agree with this in many ways. I've always felt that individuals ARE born with certain propensities many of which never come to the fore for a variety of reasons (ie, eat no carbs and your body won't have to go into action...and fail) so you'd probably never know. On the other side of the coin, what allows a non diabetic to consume hundreds/thousands of carbs without becoming diabetic? It has to be a flaw somewhere in the body I reckon, ie DNA. Of course there is plenty that can be done to help the body out. x
 

The problem is that I don’t think I have normal insulin levels, I know that if I ate the NHS “healthy” diet of 130 grams of carbs per day, my hba1c would be at a diabetic level.
 

That is what I’m worried about, that the tests will stop. Especially as it says needs monitoring “for now” until you have a word with the patient. That sounds like I will get crossed off their books
 

My thoughts are that if I were to take a glucose tolerance test I would fail. If that were the case would I still be “in remission”? I would say not. I think only the people that would pass a glucose tolerance test (ie non diabetic level) should be classed as in remission.
 

Sure thing. Totally understood. My only point is that glucose intolerance is not diabetes. Diabetes is the result of not managing it properly.
 
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