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"Complete diabetic remission!"

Ceres said:
Yikes, apologies, guys! I've been away on holiday and have been neglecting this forum!

Thank you to everyone for their kind words and encouragement. It is pretty much solely because of all of you that I've managed to get to this point. This forum was a lifesaver for me when I was first diagnosed and in a pretty bad place emotionally. Honestly, I cannot thank you enough.

To answer a couple of questions:



Initially, I went super low-carb (<20g of carbs per day, predominantly from vegetables) and dropped some weight. Unfortunately, a couple of months of being in ketosis seemed to exacerbate some sensitive bladder issues!, so I began to reintroduce some lower GI carbs, such as pasta and wholemeal bread--up to 100g per day. To my surprise, I found that I could tolerate them quite well. This tolerance keeps improving as I lose more weight (e.g. I ate an 80g serving of pasta last night and the highest number I saw was 5.6, and I was back to 4.5 after 3 hours). Since diagnosis, I have lost about 30kg. From my highest weight, I have lost 46kg in total. I also exercise regularly, though I wasn't exercising at all when I was low-carbing. My current regime is a 30-40 minute moderately-paced walk, a couple of aerobics classes, and a few gym sessions per week. I should reiterate, though, that my numbers were already quite good when I started exercising, so whilst exercise is a fantastic tool in the diabetic toolbox, diet (in my case, low carb) is the sledgehammer!

I think I was lucky in some ways, because if you look at my numbers at diagnosis, I had essentially just tipped over the line between prediabetes and diabetes. Add in the fact that I had so much weight to lose (I still have about 15kg to go to be at the top end of my 'ideal' weight range), and possibly my age (30s), I was in a fairly good position to 'reverse' the diabetes.



Lose the rest of the weight! At least 15kg, to get to a healthy BMI. Continue with regular exercise. And, probably most importantly, not slip back into my previous eating habits (I was a terrible emotional/binge eater). I plan to be on a lower-carb diet for life, sticking to lower GI carbs as much as possible.

And, uh, for those of you who may be questioning my initial diagnosis, I first received a 7.8 fasting BG during a regular 'check-up' blood test. That alerted my GP to the potential diabetes diagnosis. I was then referred to take the OGTT, for which I received the below results (including a fasting BG of 7.6). I had not been low carbing in the week leading up to the test, nor do I suffer from any medical conditions, or take any medication that may adversely affect BG. I was fasting for the appropriate time prior to the test and I am not a smoker. I was obese at diagnosis, and I have a very strong family history of diabetes type 2. I hope that helps clarify things. :)
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Many folks find they can tolerate carbs a bit better as their body normalises and repairs itself, usually after a period of trimming the carbs and their waistline.

I completely and totally agree with you about diet being utterly paramount in fighting T2. My take, at the outset was if I could modify my diet, into ideally non-diabetic ranges, but remained diabetic, then that was my given lot. If I focused wholly on weight loss, as I see some newbies do, expecting their bloods to follow their weight on a downward trend, then I'd be absolutely shattered if I lost a shed load of weight, but my bloods were still unsatisfactory, so I focused wholly on diet for bloods.

Just one point about your "sensitive bladder issues"; without asking too much detail, that sort of chimes with me. I too sometimes get a sensitive bladder (of course could be completely different in nature to yours) whereby I have increased frequency, but very modest output, and discomfort whilst achieving the output. My solution has been to use these symptoms/feelings to signal I am not drinking enough and to jack up fluids, rather than any eating modifications. That works for me every time.

I must and it, I am a bit of a maniac for making my self-diagnostic questioning begin with a simple, "are you drinking enough", as so, so, so many issues relate to dehydration - especially when low carbing and in ketosis.

That may not be relevant to you, but many folks have commented on how much better they feel if they up their fluids. I don't know whether you had this issue rear or re-rear it's head in your winter or summer season, but here, in the Tropics (for now), I have to be far more mindful of fluid intake than in the UK.

Nice to hear a good success story, and good luck with your onward journey.
 
***************** said:
Forgive my sceptism, but an Hba1c of 39 is not diabetes.

"Diagnosed T2 Sept 2015

[Sep. 2015] HbA1c 39 (5.7%) || FBG 7.6 || GTT: 1hr 10.5; 2hrs 11.6 || BMI 38
[Jan. 2016] HbA1c 27 (4.6%) || FBG 4.4 || BMI 32"

You may have had a high FBG but, I don't think tthat you were a proper diabetic. Prediabetes is diagnosed at 42 and above and diabetes at 48 and above.
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Is`nt 3.5-5.5 considered normal then if her fasting blood glucos reads 7.6 it is way to high ?
 
@AndBreathe thank you for your post, I could have made an almost identical post myself - apart from the tropics bit, for tropics read "frozen north" I was a little concerned about feeling the need to frequently urinate with little result - feel reassured now! Thanks
 
Ceres said:
I just got back from my first appointment with an endocrinologist, and, subsequent to my latest test results, he says that he considers me to be in "complete diabetic remission"!

My latest fasting glucose was 4.4 mmol/L and my HbA1c was 27 (4.6%). Essentially, I was told it's likely that if I maintain my current weight, or (preferably) continue losing weight, as well as maintain my current diet (lowish carb/lower GI), I can ward off the diabetes for many years, though I am obviously more at risk of it returning than someone who has never been diagnosed with diabetes.

Anyway, I just wanted to share my good news! Needless to say, I'm thrilled! :)
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Fantastic. congratulations.
 
***************** said:
Check this site and Google for the HbA1c indictators and range.

The term HbA1c refers to glycated haemoglobin. It develops when haemoglobin, a protein within red blood cells that carries oxygen throughout your body, joins with glucose in the blood, becoming 'glycated'.

By measuring glycated haemoglobin (HbA1c), clinicians are able to get an overall picture of what our average blood sugar levels have been over a period of weeks/months.

For people with diabetes this is important as the higher the HbA1c, the greater the risk of developing diabetes-related complications.
HbA1c mmol/mol %
Normal Below 42 mmol/mol Below 6.0%
Prediabetes 42 to 47 mmol/mol 6.0% to 6.4%
Diabetes 48 mmol/mol or over 6.5% or over

I rest my case.
Click to expand...
Quote from www.gp-update.co.uk
"An HbA1c of <6.5%/48mmol/mol does not exclude type 2 diabetes. The HbA1c test
is less sensitive than fasting glucose measurements"

People with high red cell turnover e.g due to anaemia or pregnancy, or who have an unusual variant of haemoglobin can have a lower HbA1c than would be expected for their blood glucose levels.
 
Firstly congratulations on your excellent HbA1c result :) .

As have been pointed out. HbA1c measures only the glucose aspect of diabetes. In reality our condition is one of insulin insensitvity (impaired glucose tolerance) and beta cell dysfunction (incorrect or inadequate insulin response) that eventually results in chronically elevated glucose level.

Hence a good, enviable HbA1c, even < 5% is unable to provide a confirmation of that the underlying impairment has been fully corrected and healed. However the risks of diabetic complications resulting from elevated glucose is definitely greatly diminished.

It would be therefore have been very interesting to see the results of another OGTT with full insulin measurement at HbA1c 4.6%. But I suppose that would not be practical.
 
Well done to you. I know how hard it is as I was diagnosed 4 years ago after I went to local chemist for a blood sugar test. The reading was 13 and this was a fasting reading. I then went to doctor who confirmed diagnosis and was given 3 months to see if I could reduce it on my on which I did. I have just had my latest test and the HBA1C was down to only 32. Nurse says I don't need to go back for year. I am late 40s and was obese at start but now under 10 stone and 5ft still a bit to go but getting there. Go to gym 5 times a week and walk 30 min 5 days a week along with low carb food. Never felt healthier and people have started to notice change.
 
NoCrbs4Me said:
HbA1c is not an exact science. An HbA1c result depends on how long your red blood cells are around before they die/get replaced. The shorter the cells live, the lower the HbA1c for a particular level of average blood glucose. So an HbA1c value is not an exact correlation to a person's average blood glucose level. In other words, a person could have a supposedly non-diabetic HbA1c, yet have diabetes, and vice versa. The OGGT is a much better indication of whether a person has type 2 diabetes or not.

To give some perspective on the HbA1c test, here's a graph showing average blood glucose versus HbA1c:

View attachment 17432

It's not particularly helpful to tell someone who failed an OGTT that they were not diabetic. Clearly they were.
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NoCrbs4Me said:
Your GP surgery is partially right. Type 2 can be diagnosed from an HbA1c, but a normal HbA1c does not rule out diabetes. Similar with a fasting blood glucose. An OGTT is pretty much the gold standard for diagnosis. Using only HbA1c is kind of lazy, but it does save money. Unfortunately it will result in some false positives and negatives (see graph above). If you have some kind of evidence that smoking or not fasting would result in failing an OGTT, that would be interesting. A prolonged very low carb diet can result in failing an OGTT, but I don't think this is the case here.
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No test has 100% sensitivity or specificity. A1C has a n error rate of +/- 0.5% or 5mmol/Mol. OGTT are also very variable and much more dependant on subject and operator adhering to the protocol. 3 days of adequate CHO intake, correct fasting period and correct timing of venesection. Even when carried out correctly it, has significant variability. Another rather bizarre aspect of GTTs is that we give the same (huge) dose of glucose to a 55kg woman as we would to a 110kg male.This test is an anachronism. I very rarely order n OGTT for patients other than for gestational diabetes, for very specific reasons.
Dysglycemia is part of a continuum. Lower glucose is desirable, and attempts to achieve lower BGLs are to be encouraged , as long as the risk benefit equation falls on the right side.
It's easy to get fixated on the numbers. They are a very important and useful barometers that help track progress and quantify risk, but it's easy to be distracted by the minutiae.
 
Ceres said:
I just got back from my first appointment with an endocrinologist, and, subsequent to my latest test results, he says that he considers me to be in "complete diabetic remission"!

My latest fasting glucose was 4.4 mmol/L and my HbA1c was 27 (4.6%). Essentially, I was told it's likely that if I maintain my current weight, or (preferably) continue losing weight, as well as maintain my current diet (lowish carb/lower GI), I can ward off the diabetes for many years, though I am obviously more at risk of it returning than someone who has never been diagnosed with diabetes.

Anyway, I just wanted to share my good news! Needless to say, I'm thrilled! :)
Click to expand...

Well done you.
 
Thanks, everyone!

Sorry, I've not been on the board in awhile! I wanted to update you all, as I see there's been some interest about the way my body currently responds to carbohydrates. These days, it's rare for me to see any number higher than a 6 or 7, and that would only be in response to a carb-loaded meal. Even when I hit those numbers, my blood sugar very quickly drops back down into the 4s or low 5s (typically within two or three hours post-meal). I still try to eat less than 100g of carbs per day (because I genuinely believe a lower-carb diet is the best option for my health generally), but when I eat substantially more than that (say in excess of 200 or 300g of carbs, my blood sugar is still fine (i.e. might rise to 7, but will quickly drop back down to the 4s or low 5s again). My fasting blood sugar tends to be between 4.1 and 4.5 most days, and the bedtime measurement is about the same. I am a frequent blood sugar tester, and have been since diagnosis, and I saw my blood sugar improve as I lost weight. I believe that losing weight has significantly reduced my insulin resistance. I don't know about my beta cells, but they seem to be working okay! I have no issue (occasionally) eating large amounts of carbs these days, so I would actually like to take another OGTT and see what transpires. I will report back after I see my endocrinologist in a few weeks.

As to whether I had actual 'diabetes' in the first place... there is so much contention as to what actually constitutes the disease, but by current diagnostic criteria, I did. And I believe that if I was to gain weight, my insulin resistance, and hence my diabetes, would return. I have now lost over 52kg from my highest weight last year, and have about 10 more to go until I attain a healthy BMI. I run, and go to the gym regularly. I feel amazing. I never thought I'd say this, but a diabetes diagnosis changed my life for the better. (Now I feel like I'm in an ad for diabetes!)
 
Ceres said:
Thanks, everyone!

Sorry, I've not been on the board in awhile! I wanted to update you all, as I see there's been some interest about the way my body currently responds to carbohydrates. These days, it's rare for me to see any number higher than a 6 or 7, and that would only be in response to a carb-loaded meal. Even when I hit those numbers, my blood sugar very quickly drops back down into the 4s or low 5s (typically within two or three hours post-meal). I still try to eat less than 100g of carbs per day (because I genuinely believe a lower-carb diet is the best option for my health generally), but when I eat substantially more than that (say in excess of 200 or 300g of carbs, my blood sugar is still fine (i.e. might rise to 7, but will quickly drop back down to the 4s or low 5s again). My fasting blood sugar tends to be between 4.1 and 4.5 most days, and the bedtime measurement is about the same. I am a frequent blood sugar tester, and have been since diagnosis, and I saw my blood sugar improve as I lost weight. I believe that losing weight has significantly reduced my insulin resistance. I don't know about my beta cells, but they seem to be working okay! I have no issue (occasionally) eating large amounts of carbs these days, so I would actually like to take another OGTT and see what transpires. I will report back after I see my endocrinologist in a few weeks.

As to whether I had actual 'diabetes' in the first place... there is so much contention as to what actually constitutes the disease, but by current diagnostic criteria, I did. And I believe that if I was to gain weight, my insulin resistance, and hence my diabetes, would return. I have now lost over 52kg from my highest weight last year, and have about 10 more to go until I attain a healthy BMI. I run, and go to the gym regularly. I feel amazing. I never thought I'd say this, but a diabetes diagnosis changed my life for the better. (Now I feel like I'm in an ad for diabetes!)
Click to expand...

Pleased to see you are continuing to do really well, I hope you can lose the remainder of the weight you would like to lose. It's great to hear of people who have worked hard and got really good results and continue to get good results. Well done.
 
Saw my endocrinologist today. It's a no-go on the OGTT because he says he doesn't consider me diabetic anymore in any capacity. My latest HbA1c was 27 (again), and my fasting glucose was 4.3. These numbers are despite the fact that in the last few weeks I've been eating far more carbs than I have since diagnosis (naughty, I know! I'm back on the low-carb train now, I swear!). My good cholesterol is up (ratio 3.2), my triglycerides are down slightly (1.0). C-peptide normal, insulin normal.

Just a brief update for those who are still curious! :)
 
Ceres said:
Saw my endocrinologist today. It's a no-go on the OGTT because he says he doesn't consider me diabetic anymore in any capacity. My latest HbA1c was 27 (again), and my fasting glucose was 4.3. These numbers are despite the fact that in the last few weeks I've been eating far more carbs than I have since diagnosis (naughty, I know! I'm back on the low-carb train now, I swear!). My good cholesterol is up (ratio 3.2), my triglycerides are down slightly (1.0). C-peptide normal, insulin normal.

Just a brief update for those who are still curious! :)
Click to expand...
You could always do you own test?
 
Ceres said:
Saw my endocrinologist today. It's a no-go on the OGTT because he says he doesn't consider me diabetic anymore in any capacity. My latest HbA1c was 27 (again), and my fasting glucose was 4.3. These numbers are despite the fact that in the last few weeks I've been eating far more carbs than I have since diagnosis (naughty, I know! I'm back on the low-carb train now, I swear!). My good cholesterol is up (ratio 3.2), my triglycerides are down slightly (1.0). C-peptide normal, insulin normal.

Just a brief update for those who are still curious! :)
Click to expand...

Thanks for posting @Ceres
It's great to hear a continued success story. Well done.
 
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