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Definition of Diabetes

Seems to be a theme here developing. I have 3 friends , all with different GP's, but in the same county, that have been told that they are no longer Diabetic.
What's happened they normalised thier bm's for two consecutive hba1c tests i.e 12 months and as a result thier gp no longer considers them Diabetic. Which is a surprise as I believed the nhs stance was that once diabetic always diabetic. similarly we have tried a glucose tolerence test ourselves and they are all still very glucose intolerent

what is very worrying, is that they no longer get the full diabetic support, and testing that we are entitled to. I am reluctant to suggest but is this yet another cost cutting exercise. I sincerely hope not.

Anybody else had any similar experiences
 
RoyG - thanks for that. I think this guy is the best reference source I've found to date. He makes a lot of sense. Just on one point at the beginning of your post, though, I think fats have to be the right sort of fats.

paragliderpete - it seems to me that there are two sides to this. On the one hand, obviously the move over to pronouncing people no longer diabetic could be seen as a cost-cutter [although if they hadn't done it we would probably be accusing the NHS of being in bed with the drug companies!] , but on the other hand I think it at least constitutes a recognition of people's success in getting things under control. I tend to focus on the positive aspect, as I strongly resent being labelled as ill for life.
 
6 years ago I walked in to my doctors surgery because of stomach cramps. He did a quick blood test and it read 18.1 . The rest, as they say, is history.
If I walked in today, no previous history, it would read between 4.3 and 6.5 perhaps. If he decided on an HBA1C then at the last count he'd get 6.4% - pre-diabetic?

I have the same condition (or worse) now than I had then. It's silly to use blood test results alone to determine how advanced (or present) our diabetes is - it depends what we eat.
 
The flip-side of this, of course, is that people who have been maintaining a healthy diet for a while might have no idea whether they are diabetic.

What i am trying to say is that for me there seems to be a very important point to be made - and that the medical profession has not been making it. That is, there is a very significant distinction to be made between people who can control their glucose levels perfectly well with just diet and exercise, and those that can't. If I am in the former category, then i don't think I have a functional disorder.

If the drug companies and medical profession insist that I do have a functional disorder, I think they are doing so without my interest in mind.
 
A lot of it comes down to how much the GP knows about the condition. If it's never dawned on them a diabetic (simplistically a person who can't process carbohydrates adequately) can still get normal blood levels then they are likely to shout "miracle you're cured!" Alternatively we've had posters who have stated that their GP's or DSN's have said "obviously the initial diagnosis was wrong, you have never been diabetic"
 
Isn't the source of this problem that diabetes is diagnosed on BG levels alone, or with Hba1c levels?

This is where I came in. They diagnose on the basis of BG levels, and then the question is how are you going to decide whether someone gets better? There has to be an underlying physiological dysfunction, in which case the BG diagnoses are not adequate.
 
Hi. I agree with Swimmer2 that once some of your beta cells have gone then you are effectively diabetic for life, however if only a small % are damaged then with a good diet, exercise etc you could consider yourself 'almost' normal. This assumes also that any insulin resistance is overcome by the right diet and exercise. Of course anyone suffering diabetes due to auto-immune destruction such as T1, T1 LADA etc will remain a diabetic and get worse. There was a report referred to this week on the Forum which showed that diagnosis by Glucose Fasting Test (GFT) only was not a good predictor or diagnostic method for diabetes (presumably due to the ovenight liver-dump scenario?). The Glucose Tolerance Test (GTT) is a better predictor as it measures the typical behaviour of the pancreas due to eating. As you have discovered there are many tablets of stone within HCPs regarding diabetes and many of them are suspect or guesswork.
 
I think I should try to summarise my position here, as I am confusing myself!

Several categories:

1. 'healthy' - person who can eat junk food and still keep BG within healthy limits.

2. 'Naturally controlled' diabetic - person who can keep BG within healthy limits using diet and exercise alone.

3. 'Assisted controlled' diabetic - person who needs chemical assistance to keep BG within healthy limits.

Category 2 do not have an active functional disorder, as category 3 people do. So in that respect they are living normal, healthy lives without drugs. That is a significant achievement and takes them off the 'sick' list. Even so, they do have an unactivated functional disorder, or weakness, which would come into play if they were to eat too much carbohydrate. So in that respect they are not 'better'.

So the bottom line for me is that when the HCPs tell you diabetes cannot be reversed they can only be taken seriously if they mean category 2s cannot get back to being category 1s. To label people as sick even though they succeed in going from 3 to 2 seems perverse to me. I would think it far more appropriate and useful to reserve the label 'diabetic' for category 3s, since it is only they who actually need medical intervention.
 
Yes agree with what you saying on Category 1 but not necessarily on 2 & 3. Many of us who can control by diet still take medications such as Metformin and Ramipril for protective rather than diabetic reasons. Metformin was initially developed as a heart disease preventative and likewise Ramipril while it is a blood pressure reducing drug also protects kidney function which is important if you are in your category 2 and have upped your protein intake because you have reduced your carbs.

You could suggest that Category 3 should start at diabetics who take insulin stimulating drugs but even then I would have difficulty categorising say paragliderpete in 3 rather than 2 from what he has posted in previous threads. I think the 2 & 3 distinction is more down to the individuals attitude rather than a specific medication regime.

I also take "herbs" like Bitter Melon and Gymnema as they also aid spike control without being insulin stimulating. Again a grey area I would suggest. I would certainly count myself as Category 2 in your setup.
 
I'm open to grey areas, certainly, but is it really true that a low-carb diet carries its own health risks? How low are we talking here, and how high are the risks?
 

I don't quite see the distinction between your category 2 and 3. If I am, say, wheat intolerant but I don't eat wheat - I still have the disorder. If I have to watch what I eat to maintain my BG levels then I have diabetes. If I have to watch what I eat and take medication, then I still have diabetes - perhaps I have worse diabetes - but the condition is the same. If you insist on trying to categorise between the two scenarios then I would suggest that there are lots and lots of categories between 2 and 3, depending on the types of medication that are effective, the amount of insulin resistance, the types of diets adopted etc.

Can I ask - is this helpful? I understand the argument from a intellectual standpoint and I think there is much to criticise in the way that diagnosis happens, but there are also many newly diagnosed diabetics that are hoping that it's not a diagnosis for life, which I would contend it is and suggesting that a 'category 2' diabetic is somehow like a 'non-diabetic' doesn't seem right.
 
Hi. Having monitored this forum for well over a year now it is obvious that diabetes is a continuous spectrum of types and degree and I don't agree with xyzzy with regard to medication. If I take myself, I low-carb, have never been over-weight, go to the gym etc yet my meds have had to go to a 3rd level. Therefore in my case the meds are there to actively control not just protect. One day I will be on insulin but that is just a progression. I may well be a 'slow' LADA but the NHS doesn't often test for this due to cost and ignorance. This is just another example of the spectrum of types and whether progression is likely or not and whether it appears rapidly or not. I suspect many of the 20% of T2s who are not overweight etc have variants of late onset T1 due to a range of causes. As the spectrum is continuous it doesn't really make sense to categorise types.
 
It would be my conclusion regarding the youtube videos and the transcription I posted that Ken Hampshire, cannot cure Diabetes and he is not saying he can, but bring BG to normal, which a lot of us do using similar diets that he himself is promoting. He even says, give up for life all the the sugars and refined flours, soda and such, If you are Pre-Diabetic/Type 2 and your pancreas is still producing a moderate amount of Insulin, that in itself will give you good control and lower BG. It wont cure you, the minute you eat a bag of toffees you will start the Upward spiral to high BG again. I think the best you can do is aim for damage limitation, if you can keep good control then you will be less likely (possibly stop) to suffer the onslaught of complications later on in life. I don't know were your trying to get with the categorised diabetes Bellx15, as has been said if your beta cells have gone west you ain't getting them back. By all means get you BG to normal levels and call yourself cured if it helps, just remember to keep a close eye on your levels and stick to your diet.
 
On the point about categories, spectra, etc.:

There is a substantive difference between someone who can remain perfectly healthy for life just by choosing an appropriate diet and lifestyle, and someone who needs medical intervention to do so. That applies to obesity and also to blood glucose management. I don't want to regard myself as ill just because I get fat if I eat too much, and similarly I don't want to regard myself as ill just because I need to do something very similar to keep my BGs healthy.

The undeniable fact that there are infinite spectral nuances and variations doesn't cancel out the basic fact that there is a meaningful, and I find helpful, distinction to be drawn. One is under the doctor (possibly for the rest of his life), and the other is not. I just happen to find that a significant distinction to recognise.

OK - I'll use myself as an example case:

Up until just a few years ago I was getting pretty normal BG readings on the very few occasions they were checked. After drinking myself stupid for a few years and doing almost no exercise I found that I had readings in the mid-teens. Five or six weeks down the line from that, having given up drinking and started on a low carb but normal, sustainable diet, and a regular exercise regime, I now have pre-lunch readings of 5.2 or so. I don't know how my HBa1c level is going to pan out, but obviously it is going to be a lot better.

So think of me as another Ken Hampshire. I just refuse to be told that I am sick for life. From the evidence I have already, it is probably not true. I reacted badly to self-abuse and now I am reacting well to stopping it.
 

Bellx15 firstly I doubt your A1c will come back favourably if you had stopped abusing your body in the last six weeks! as it reads levels going back over 3 months if I am correct, and I seriously hope it does. I am in the same boat as you and would love to believe that I could get rid of this. I consider my diagnosis was more pre-diabetic than full type 2, in fact I was asked did I want to use just diet only, but chose the medication route, because the DSN said I could cheat somewhat, by that I assume she meant I could have the odd cake and Pizza, I was just diagnosed and new nothing, cheating seemed good to me? My levels never go above 6.8 and on average read about 5.5mmol, so by your definition I have not got Diabetes. But personally I don't want to take the chance, and after reading on here and researching on Internet I can see how and why people are getting Diabetes, as the good doctor says you start on the path from and early age if you are so predisposed and without intervention you end up here, or at the train wreck site. It's up to you to decide which route to take. I know where my trains going ! Low carb Junction and i'm staying on thank you.
 

No, I am starting to disagree entirely. I don't like the distinction you're drawing. If you are type 2 (and if I am too) then we share a condition and it's the degree of damage that's already been done and our insulin resistance that makes us different (plus weight and some other factors).
You are suggest I am "sick" because I take medication and you are "well" because you do not. Furthermore, if you have a diagnosis of diabetes then you are also "under a doctor" though that's not a phrase I like - it suggests that my doctor controls my condition rather than me. I have chosen my medication and I have chosen the dosage.

I am not sick - I have a damaged internal organ that restricts what I am able to eat - and I find it offensive for you to parade some idea that your ability to control the same condition with diet alone makes you more pro-active than me.
 
It has nothing to do with levels of proactivity, so you are taking offence at a straw man. Don't be offended.

What I am saying is that if you know you have internal damage that is irreversible, and that you need medication to manage it, then that is one thing, but if you don't yet have that condition and therefore don't need medication to manage it that is another. Why should we lump both together? Draw finer distinctions if you like, but why draw none at all? At this stage I am hopeful that my problem is that I regularly overloaded my system with booze and behaved like a slug, and my body couldn't handle it, but also that the situation is reversible. My situation is different from yours in many respects, so why should we accept the same label?

It seems to me that the prevailing approach is to draw a very clear and rigid distinction between diabetics and non-diabetics, so that anyone who questions their label is 'in denial', but at the same time allow no finer distinctions within the diabetic category.
 
RoyG - I think you are right to err on the careful side, and I certainly wouldn't want to influence your chosen approach. Good luck with that.

My Hba1c is going to be measured in September, so by then it should give a useful indication.
 

Bellex15: if this is what helps you to cope with your condition, then that is fine.

The trouble is, there is no distinction to be drawn. Your pancreatic function is failing. For whatever reason. You may be able to keep it stable for a long time. You may not. But the damage done so far will not be reversed. By that I do not mean to suggest that any damage is your fault, I mean the damage of dyeing beta cells for whatever reason. As things are so far with medical science, we have no way of regenerating these beta cells. So some sort of invention, whether by dietary changes alone, or combined with medication, will be required.

And, according to all received wisdom so far from the medical profession, this is progressive.

A diagnosis of Diabetes is a recognition that your pancreas is no longer functioning properly. It really is as black and white as that. The only distinction is the degree of pancreatic failure at any given time.
 
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