Could I go into remission?

[Swiggy]

I'm not asking for medical advice.

The practice nurse at my surgery was going to refer me to the Pathway to Remission programme but then realised that I was diagnosed in 2015 so I'm not eligible. The information she signposted me to explained that things get more challenging the longer one has diabetes because beta cells in the pancreas are depleted and produce less insulin. My latest C-peptide result is below.

Plasma insulin C-peptide level
25 March 2026

Your result
2015 pmol/L

The reference range is between 190 and 990 pmol/L.

I'm still producing far to much insulin and my blood sugar levels are very high (fasting usually 11mmol + and they go up when I eat). 130g of cottage cheese and a pint of water takes me up to 19 mmol after 2 hours.

The practice nurse prescribed Gliclazide 5 weeks ago but my levels have only gone down a bit. I also take Metformin.

If I replicated the Newcastle protocol using shakes from the supermarket would it be possible to go into remission?

I have been following a lchf diet since 2018 but I have not lost weight and I have gained weight since starting to take Gliclazide.

 

[Pipp]

Hi @Swiggy,

You say you have been following LCHF since 2018, but not lost weight, and have gained weight since starting to take Gliclazide 5 weeks ago.

It seems regimes you have been using are not working for you.

With the introduction of Gliclazide, I would be cautious about embarking on a strict calorie restrictive diet, due to the possibility of hypos with this medication. As the nurse has suggested a very low calorie diet, but you are not eligible for the NHS funded programme, if you are determined to self fund the meal replacements, could you ask your surgery if there is a nurse or other HCP who would monitor you if you did this? Most surgeries now seem to outsource the Pathway to Remission programme, and the support seems to be online, rather than face to face. Some pharmacies do offer the support if you purchase meal replacement products from them. The pharmacists are medical professionals, but recently many seem overwhelmed with demands placed on them by GPs redirecting patients to pharmacies for things like coughs and minor ailments, so some are allowing counter assistants, not HCPs to provide the weight loss management and support.

As for your question about achieving remission.. The definition of remission for the Pathway to Remission, is very loose. It is defined as having two HbA1c readings under 48 over a period of three months, and not being on medication.

https://www.thelancet.com/journals/landia/article/PIIS2213-8587(24)00194-3/fulltext

It seems you haven’t yet found a way of controlling your T2 and weight, so I am wondering if your GP surgery would be willing to refer you to weight management services? There are specialist services available, which maybe will be able to provide the support you require.

It would also help members here be able to provide some advice if you update your profile info to include medications. Also post about what you eat on your LCHF diet and your most recent HbA1c.

 

[Pipp]

I would add that in the early days of research into T2 and very low calorie diets, 2011- 2012, I was not able to get into any of the research programmes, because I had already had T2 for more than five years. I did, with support of GPnurse, use products and the supported programme for a total food replacement diet, from a pharmacy. This was self funded. I had weekly monitoring of weight and BP, at pharmacy, monthly meetings with GP nurse for weight, HbA1c, and general wellbeing checks. I was provided with ample supplies of test strips and a free meter. Also observed by specialist weight management NHS clinic, who had been cynical about me being able to complete the twelve weeks, and / or achieve the remission or weight loss. My BG had returned to normal levels within a week of starting. Overall I lost 26 kg in twelve weeks. I repeated the programme for weight loss after a short break and lost a further 23 kg. My HbA1c settled at just under 40 for a couple of years. It started to increase as some weight was gained, when I was ill with other conditions when I needed steroid meds, and was immobile awaiting surgery to my abdomen and spinal problems.

I have for several years managed T2 eating the low carb way. Apart from one high HbA1c three years ago, when I was quite seriously ill, I have maintained levels below that HbA1c threshold of 48. (Which is a contentious measure, as it indicates pre-diabetes rather than non-diabetes). Most recently HbA1c was 37, and I am not on diabetes medicines now. This is despite having to increase consumption of some carbs and dairy on advice of endocrinologist due to having developed osteopenia / osteoporosis. I still have too much weight, too, but feel fairly well. Having been diagnosed T2 for 21 years, and having pre-diabetes for at least five years prior, I am content that I have none of the predicted at diagnosis complications. No neuropathy, or retinopathy, etc.