Carbs-independent remission

[oldgreymare]

How they can class "severe insulin deficiency " as T2 is completely beyond me..

Do they not use simple logic any more?

When I was originally diagnosed as a diabetic (symptoms and an OGTT), the endocrinologist immediately put me on insulin, but waited two months before ordering c-peptide and GADAb test. His explanation was that he suspected that I had burnt out my beta cells through hyperinsulinemia and the exogenous insulin might give my pancreas a chance to recover. I was a classic metabolic syndrome patient at the time so Type 2 seemed the likely diagnosis...but my GADAb test was strongly positive, so definitely the autoimmune version.

 

[chrisjohnh]

it would help so much if every diabetic was tested annually for insulin production.

Absolutely right, it really vexes me that, given the seriousness, prevalence and cost of this disease, so little testing is done routinely to inform us of our true metabolic situation.

 

[bulkbiker]

When I was originally diagnosed as a diabetic (symptoms and an OGTT), the endocrinologist immediately put me on insulin, but waited two months before ordering c-peptide and GADAb test. His explanation was that he suspected that I had burnt out my beta cells through hyperinsulinemia and the exogenous insulin might give my pancreas a chance to recover. I was a classic metabolic syndrome patient at the time so Type 2 seemed the likely diagnosis...but my GADAb test was strongly positive, so definitely the autoimmune version.

So if they'd tested c-peptide at the start you would have been correctly diagnosed as insulin deficient from day one?

 

[pixie1]

I started this thread from curiosity as to whether low carb eating remained necessary after getting oneself into “remission”. At the time I reached that latter state I had been on about 65g daily, but over the past couple of years have increased that to 100g, then 130g and then 150g with no change in A1c (currently 38) or in fasting glucose or in after-meal elevations. I said I would next experiment with three months at 180g and I have now started that a few days ago. Gastronomically I am happy at 150g but I just want to see how flexible I can be. Will report how I get on.

I think you are very lucky, if you can introduce carbs with no ill effect.
For me, to stay in remission, I have to carry on low carbing, I do find it difficult, the last few years to keep the carbs down. My weight and glucose levels rise if I don't. I put on between 6 to 8lb in weight over Christmas. I have lost that weight gain, by keeping my carbs low.
I'm not doing too badly though, as my last A1c was 44, I expected it to be a lot higher. being active is helping me, to achieve that goal.

 

[chrisjohnh]

I think you are very lucky, if you can introduce carbs with no ill effect.

It is of course a very big “if”. I don’t know whether it is true for myself at present, nor if it were true whether it would remain so long term. The most I know at present is that 150g daily appears for me to be tolerable. 250g could be an entirely different story. I think that if one’s diabetes has not simmered away for years before diagnosis and one then does lose a load of fat, and if that fat loss does include clearing excess from the pancreas, then it gives those beta cells a fighting chance of recovery to restore some semblance of normal metabolism and thence ability to process carbs without difficulty. But whether enough of those cells will recover and to what extent is down to the individual. Some people have five times as many beta cells in infancy than others, so they will be a bit more robust when confronting T2D in later life. So yes, a good deal of “luck” behind that big “if”.

 

[pixie1]

It is of course a very big “if”. I don’t know whether it is true for myself at present, nor if it were true whether it would remain so long term. The most I know at present is that 150g daily appears for me to be tolerable. 250g could be an entirely different story. I think that if one’s diabetes has not simmered away for years before diagnosis and one then does lose a load of fat, and if that fat loss does include clearing excess from the pancreas, then it gives those beta cells a fighting chance of recovery to restore some semblance of normal metabolism and thence ability to process carbs without difficulty. But whether enough of those cells will recover and to what extent is down to the individual. Some people have five times as many beta cells in infancy than others, so they will be a bit more robust when confronting T2D in later life. So yes, a good deal of “luck” behind that big “if”.

I do not think there has been any real research on diabetes. Yes there has been theories, people are trying to fit their research into the theories. The text books do not seem to fit the reality of diabetes, those without diabetes seem to have no ideas on the condition itself. Going by people own experience dealing with the medical profession, including myself. If I had listened to my diabetic nurse those years ago, no doubt, I would be on insulin, instead of diet controlled. I think Dr Aitken is right, when he mentioned that people have their tolerance levels of carbs. before they start putting weight on. For me it co insides with the change of diet recommendation of healthy eating, being carb loaded.
in my opinion and looking at the facts, We were mainly meat eaters, because of harsh environment. No way anyone could survive on carbs and veg alone in those long harsh winter conditions. Fats and protein were necessary to survive, they gave us the energy and warm, as well as maintain muscle and growth that is how we evolved. This trend has continued in other countries.

 

[chrisjohnh]

I do not think there has been any real research on diabetes. Yes there has been theories, people are trying to fit their research into the theories. The text books do not seem to fit the reality of diabetes, those without diabetes seem to have any ideas on the condition itself. Going by people own experience dealing with the medical profession, including myself. If I had listened to my diabetic nurse those years ago, no doubt, I would be on insulin, instead of diet controlled. I think Dr Aitken is right, when he mentioned that people have their tolerance levels of carbs. before they start putting weight on. For me it co insides with the change of diet recommendation of healthy eating, being carb loaded.
in my opinion and looking at the facts, We were mainly meat eaters, because of harsh environment. No way anyone could survive on carbs and veg alone in those long harsh winter conditions. Fats and protein were necessary to survive, they gave us the energy and warm, as well as maintain muscle and growth that is how we evolved. This trend has continued in other countries.

Somewhat related to this I am interested in the evolutionary history of the first-phase insulin response. Why is it there, and why is it such a hugely rapid and efficient device for dealing effectively with a tsunami of serum glucose following a high carb meal? Would it have evolved merely to deal with high carbs on rare occasions, or to deal with a regular diet involving plenty of carbs?

 

[oldgreymare]

So if they'd tested c-peptide at the start you would have been correctly diagnosed as insulin deficient from day one?

Correct. But it would not have made any difference to my actual treatment - I was put on insulin immediately and since being diagnosed with the autoimmune version, have never attempted to stop using it. That said I had low but some c-peptide activity at my first test (so probably LADA), c-peptide reading was undetectable 9 years later when repeated.

Personally I prefer the conventional definition of T1 being an autoimmune condition, as I am much more vigilant monitoring other possible autoimmune conditions that T1s can be prone to. It certainly seems that the T2 definition could be subdivided in more detail depending on characteristics.

 

[bulkbiker]

It certainly seems that the T2 definition could be subdivided in more detail depending on characteristics.

I can't agree I'm afraid.. T2's are insulin overproducers so sticking even more in them would seem to me to be madness.

If they really are insulin deficient then they are heading for T1 or one of the LADA, MODY variants and will almost certainly end up using insulin in the future.

Early correct diagnosis of the correct over or under producing seems to me to be key to putting T2 into remission and including insulin deficient people in with T2's simply muddies the waters.

 

[pixie1]

Somewhat related to this I am interested in the evolutionary history of the first-phase insulin response. Why is it there, and why is it such a hugely rapid and efficient device for dealing effectively with a tsunami of serum glucose following a high carb meal? Would it have evolved merely to deal with high carbs on rare occasions, or to deal with a regular diet involving plenty of carbs?

It is interesting. In reality carbohydrates is relatively new, in evolutionary terms. Any carbs there was, it was very basic and seasonal and an inability to store over winter. People where active, to kill for meat and to fish. In modern terms now. The hunting is done in shops, highly processed food, carb loaded, activity levels is far lower, because of changes through the ages, to modern day farming and majority of the work done these day is more sedentary, of course not those in construction. The combination factors coming together, possibly having an impact , as well as being told to eat more carbs, based on possibly faulty, flawed research.
We know the impact of processed foods has on people, such as American indigenous people living on Reservations and the Inuit people on there health, there is a higher increase rate of Diabetes. Also globally the question is why amongst those who live in Countries which diets are rice based, it could be the increase of high processed foods available maybe.
Food for thought and pun intended

 

[chrisjohnh]

Early correct diagnosis of the correct over or under producing seems to me to be key to putting T2 into remission and including insulin deficient people in with T2's simply muddies the waters.

I agree that the determination of insulin levels at diagnosis would be extremely useful, it seems absurd to me that it should not be standard procedure, in order to guide the way ahead for the patient and for the doctor. If the diabetes has come on quite recently then they are very likely to be overproducing insulin in the desperate attempt to force glucose into resistant cells. But if the diagnosis has been delayed for years then by that time the patient is more likely to be under producing insulin with a knackered pancreas and presenting somewhat more like a T1. So the timing is key here. T2D is really the Cinderella in the diagnosis game compared to, e.g. cancer.

 

[bulkbiker]

T2D is really the Cinderella in the diagnosis game

I think that's largely down to doctors not doing the correct tests from the start. I think we can agree on that.

 

[chrisjohnh]

I think that's largely down to doctors not doing the correct tests from the start. I think we can agree on that.

And I guess that in the NHS they would not have the scope under the guidelines even if they wished?

 

[bulkbiker]

And I guess that in the NHS they would not have the scope under the guidelines even if they wished?

"Individualisd care" would get round the guidelines.. but most docs have never even thought of fasting insulin as an indicator or even c-peptide. Worse luck for us the poor patients.

 

[HSSS]

"Individualisd care" would get round the guidelines.. but most docs have never even thought of fasting insulin as an indicator or even c-peptide. Worse luck for us the poor patients.

Not every dr is willing (or in the current climate has the capacity) to “get round the guidelines“. They are taught according to and within a belief system. I understand it’s hard to step outside that but oh boy is it needed

 

[pixie1]

"Individualisd care" would get round the guidelines.. but most docs have never even thought of fasting insulin as an indicator or even c-peptide. Worse luck for us the poor patients.

And I guess that in the NHS they would not have the scope under the guidelines even if they wished?

Working in the care sector, having done training, going on courses, the main thought process is all about person centre care. that each individual should be encourage to have their input on treatment and care, going through the process. In reality in some areas its a different story. As we all know and experience. Everyone has the right to request. My own care practice does not follow the principles of care. On reflection there are too many patients to, too few Drs, there is no continuity of care for this reason. Drs and nurses have there own opinion, that is what I think when they all give different answers.

 

[bulkbiker]

Drs and nurses have there own opinion, that is what I think when they all give different answers.

Plus of course most GP practices are independent contractors so in effect can do whatever they want.
There are "guidelines" but they aren't really enforced in any meaningful way that I can tell.

 

[chrisjohnh]

Plus of course most GP practices are independent contractors so in effect can do whatever they want.
There are "guidelines" but they aren't really enforced in any meaningful way that I can tell.

In some ways we should be thankful that the guidelines are not enforced, given the flakey basis of some of them.

 

[pixie1]

In some ways we should be thankful that the guidelines are not enforced, given the flakey basis of some of them.

Guidelines are just that Guidelines. these do not need to be followed as they are not set in stone. Most care settings do follow guidelines

 

[Ricmel]

When diagnosed my HbA1c was 93 and I weighed 117kgs. I lost 30kgs 3 years ago and have kept it off. Changed my diet to relatively low carb (I log all my food) and my average daily carb intake over last 3 years is 105 gms.

My 3 HbA1c readings since have been 41, 39 and 37. My daily readings range between 5.5 and 6.5 very occasionally 7+. I have never been on meds.

So I guess by definition I am in remission and the occasional high carb meal does not seem to move the dial too much. BUT - I do a lot of exercise, I strictly control my portion sizes and my carb intake is mostly whole carbs. I know if I eased off my BS would very quickly head in the wrong direction and I accept that if I want to keep my BS under some control I have to maintain this discipline for as long as possible.