Carbs-independent remission

[chrisjohnh]

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.

This mirrors very closely my own experience. For two years I have been very rigorous with daily exercise and calorie restriction, all in the context of keeping carbs at a moderate level, keeping weight and waistline at strict low values and thereby keeping A1c at or below 42 (now 38). The only variation I have allowed is the carbs level, experimenting in a systematic manner to assess its impact on my situation.

 

[AloeSvea]

@chrisjohnh, what a fabulous thread. And I look forward to reading more of your experiment as it progresses.

 

[AloeSvea]

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

Do they not use simple logic any more?

I am a big fan of Lund Uni's sub-groups (MODs, MARDs, SIRDs, SIDDs and SAIDs) - had hoped that they would take off but have come to accept - they haven't. . (And Swedes are nothing if not supremely logical! Imho.)

In the sub-grouping there is a clear distinction of those who were diagnosed (correctly one assumes! At least for Lund Uni's argument) between SAID - Severe Auto Immune Diabetes, which of course is the auto-immune form, including LADA, and SIDD, which is caused by pancreatic burn-out or environmental/pharmaceutical/surgical damage to the pancreas and therefore one's own insulin production., that you mention above.

The genetic component mentioned in a post above (what an interesting read it all is indeed), is accounted for in these sub-groupings, as the Swedes found these five types of diabetes to be genetically distinctive. This makes sense to me, as I often boil down 'genes' to what we can see in body types and ancestral differences which mean one's metabolism and/or tendencies play out in different ways, including of course - to evolutionary recent food sources (like wheat and dairy). I've read Jenny Ruhl again recently, and she talks about the multiple factors contributing to blood glucose system breakdown in a very accessible logical way. And her citations are brilliant.

The Lund Uni researchers also associated certain complications with certain sub-groups - of particular interest to me as a SIRD Kiwi, as kidney problems are hugely associated with SIRD - which I like to point out to medical professionals and associates when I fight for subsidised care, as kidney dialysis is very expensive for our healthcare systems. (A losing battle in Kiwiland, sadly, although a highly logical argument - I am seen as an outsider in the system rather than a flag bearer, but you know - many of us are and we are hoping for bigtime change.)

Retinopathy is associated with SIDD, for those interested in their findings.

I do have a wee rave about how this links up with remission-pathways, but I am trying to keep this post digestible ...

 

[chrisjohnh]

@chrisjohnh, what a fabulous thread. And I look forward to reading more of your experiment as it progresses.

Thank you! I shall do fine-grained tests on post-prandial elevations for all my meal types, weekly weigh-ins and fortnightly fasting bg tests, and should have my next A1c on about April 15th. My expectation is that my A1c will drift from its 38 up to maybe 44 or so, but who knows? I’ll report in detail the results. If the conclusion is that 180g daily carbs is beyond my tolerance then I’ll revert to 150g which I know I can process unproblematically.&

 

[CatieLee]

What I was told during discussion with the principal investigator is that after the crash-diet phase the remitters resumed eating that was reduced somewhat (so not literally free) but with unrestricted and freely chosen macronutrient composition, and that the remitters maintained their position for the rest of the two-year period - and that not a single one of them went on low carbs. Well, I don’t know what to make of it all, but I’m minded to up my carbs from 125 to 180 for 3 months and see what happens. I suspect my A1c will rise but who knows? Just curious to see if remission life is possible without constant fear of catching sight of a bread crumb or half a banana!

I bought Taylors book, unfortunately I don't like Mediterranean food. So realising I need to lose a couple of stones I just started to read nutritional information on the back of tins and packaging. And choosing the lower sugar content or half portions. I did blot my copybook during lockdown and went up to pre-diabetic. I eat bread everyday and bananas even chocolate under 75%. I just now make sure that if I have a carbon rich day I also have more exercise, even if that means I wave my arms around and lift my feet off the ground while watching TV.
In other words eat what you like but in small doses and exercise according to your intake. I can eat custard, ice-cream, sweets, cakes etc but in moderation with extra exercise.

 

[HSSS]

I can eat custard, ice-cream, sweets, cakes etc but in moderation with extra exercise.

For now. Are you actually checking your response with a meter or cgm? Or just relying on an annual/six month hba1c?

But what you are likely doing is increasing your insulin resistance in the background by demanding extra insulin to cover these high carb items. At some point you could easily max out on how much insulin you can produce to counteract the carbs and it’ll then show up in the blood glucose readings.

Consider too what will happen if you are otherwise sick/injured/unable to exercise.

And finally please remember whilst this moderation is a choice you might be ok making for a lot of people it simply doesn’t work as it just leads to a slippery slope of cravings and increasing amounts or a painful mental battle easier faced by not having such temptation in the first place

 

[HSSS]

choosing the lower sugar content

All carbs, except fibre, turn to glucose in the blood not just sugar which is a single type of carb. It’s usually advisable for a type 2 to ignore the “of which sugars” bit and focus on the carbs part of a label. That is the true glucose dose you’ll be getting

 

[hooha]

I have wondered whether any of our members with T2D has achieved remission through deliberate weight loss and then maintained it for at least a year whilst regaining no weight and, subject to that strict proviso, consuming as many carbs as they fancied. The investigators in the DiRECT trial take the view that this is what remission really means, i.e. being able to eat freely provided no weight gain. Literally all their participants who remained in remission after 2 years did not adopt a low carb to do it, so I am told.

I got remission from type 2 db in 6 weeks using Prof Roy Taylor's weight loss method, then gradually put some of the weight back on. However by this time I was low carbing most of the time. I then found I was very sensitive to carbs. [ Physiological Insulin Resistance ] I am happy to stay low carb and otherwise eat freely, in the comforting knowledge that my blood sugars are being kept low .

 

[Ronancastled]

My expectation is that my A1c will drift from its 38 up to maybe 44 or so, but who knows? I’ll report in detail the results.

You may find the opposite conversely, although you may spike higher then an elevated 2nd phase insulin response may crash you longer than the spike elevated you.
I do like the description of the low carb diet being a low insulin diet, I'm about 150gs of carbs per day which is easily done with 2 meals per day.
Sandwich with crisps for lunch, 50gs of carbs, pasta/potatoes/rice for dinner,100gs of carbs, walk the dog so no spike.

This where a CGM is worth it's weight in gold.

 

[HSSS]

Sandwich with crisps for lunch, 50gs of carbs, pasta/potatoes/rice for dinner,100gs of carbs, walk the dog so no spike.

Wow. Sounds a veritable carb fest for me. Long may you have this flexibility and metabolic resilience.

 

[Ronancastled]

Wow. Sounds a veritable carb fest for me. Long may you have this flexibility and metabolic resilience.

Still only 150gs of carbs per day in a world where the average non-diabetic eats 300-350g.
I ran my pre-diagnosis diet through MyFitnessPal once & I was close to 500gs of carbs per day back when I was 19.5st.
I wonder how I got so fat

 

[HSSS]

Still only 150gs of carbs per day in a world where the average non-diabetic eats 300-350g.
I ran my pre-diagnosis diet through MyFitnessPal once & I was close to 500gs of carbs per day back when I was 19.5st.
I wonder how I got so fat

Oh I’m well aware lots of people eat loads more. I guess I was just highlighting the very different responses we all have to the “same” disease and treatment, probably with a little envy. I was probably only on 150g before diagnosis at 55mmol although overweight but not obese. Even 40’s hbA1c was only achieved on about 40g a day and nearly 20kg weight loss well into normal bmi range. Kind of why I’m convinced there are different types of type 2.