Definition of Diabetes

[Bellx15]

I've been given to understand that diabetes involves two factors, one of which is insulin under-production and the other insulin resistance.

On the first one, the pancreas can be overwhelmed temporarily by excessive carb intake, and just referring to a temporarily high BG level doesn't establish that there has been permanent loss of beta cells. So on that point I think it is a bit premature to infer that my pancreas has suffered permanent damage, or that it is irreparable. I need to wait and see.

On the second point, body fat is known to impede insulin uptake by the body, which again might be a temporary and remediable condition. So again, I am trying to remain optimistic that the condition can be rectified.

I bear in mind that my BG was pretty normal up to about five years ago, and also that I have abused it pretty badly since then, so there is at least some reason for hope that although I have overloaded my system I have not done any permanent damage.

 

[xyzzy]

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?

Good question but largely not relevant nowadays in my opinion. If you take the ADA then they recommend an RDA of 130g / day for T2's. On a 2000 calorie a day regime that's a 26% carb intake. When I do my new member posts I say "half starchy carbs" as that will roughly equate to that 130g level IF the person has been following the standard UK dietary guidelines. If it's deemed ok by the ADA then I think I am ok in assuming it is safe. In reality if you read the ADA logic they simply pick 130g because you can guarantee that someone who consumes at that level will not be in ketosis i.e. they will remain sugar burners for energy rather than fat burners. No one has yet recommended ketogenic regimes long term for T2's although the Swedes come pretty close by not discouraging T2's who go on one. They just say to closely monitor the subject. The obvious issues are things like increasing protein to compensate for the lack of carbs so you should monitor kidney function etc. They do not say a full ketogenic (sub 50g / day) is dangerous and in recent T1 & T2 studies they have been publishing interesting and positive results for regimes in the 70 to 90g / day area. In reality in other areas sub 50g / day regimes are recommended for epileptics as they help to control seizures. So there is one example of long term ultra low carb diets in action. Some T2's on the forum have been doing sub 50g / day for a number of years and I think in all cases have said it has stopped the progression of the condition but someone will correct me if I'm wrong on that point.

Myself, I do around 60g / day so a semi ketogenic regime. Even though my BMI is 24 and I count myself as relatively active (I walk around 3 to 5km a day) and have lost some insulin resistance there is no way I can do more than around 80g / day without my BG's beginning to rise or spike dangerously. As I don't want to take any stronger meds then I'll stick at that level and have my GP's who is supposed to be a diabetic specialist GP's blessing to do so. He is very impressed with my 60g / day. I showed him my food diary which details meal by meal what I eat, how many carbs and how many calories along with all my BG records and his comment was "keep it up you have put your diabetes into remission". I now have a sub 5% hBA1c and have done that from having an 11.3% hBa1c at diagnosis just 6 months ago. As I really do very little structured exercise (just walk the dogs) I put 95% of my improvement down to "low carb" 4% down to Metformin and herbs and 1% on walking.

 

[Bellx15]

Excellent stuff - well done!

Only 1% on walking? Do you have a chihuahua? :mrgreen:

So I think I should try to get a clearer idea of my own carb intake. It's pretty low, as I have completely given up beer, and have eggs and tomato for breakfast, sprout and cheese surprise for lunch, and then it is all downhill from there. I imagine I am on the right lines, though.

 

[xyzzy]

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.

I accept your point entirely Daibell. I should have made it clear I was talking about bog standard T2's. In the case of LADA then yes the condition will unfortunately progress. Given I was never obese at the point of diagnosis I also wonder if I maybe slow LADA as there is a history of T1 and LADA in my family. Like you the doc wont pay for the test. It was the one thing he told me to prepare for namely I may be in remission now but at some point I should expect my levels to begin to rise. If I have slow LADA then yes I agree with him but if I am just T2 then keeping my levels at those of a non diabetic should, in my opinion, stop the progression or at least slow it down so much that something else will get me first.

 

[xyzzy]

Only 1% on walking? Do you have a chihuahua? :mrgreen:

Anything but! I have two dogs. One is a 90kg Spanish Pyranean and the other a 65kg Leonburger. If you look at the Pet thread I uploaded some pics of them. Basically when they decide it's time for a walk you don't get a lot of choice. :lol:

 

[Anonymous]

This is not synthetic indignation.

My perspective is that my pancreas is not overwhelmed temporarily by excessive carb intake since I have been low carbing for some time. Neither am I typical of someone who has insulin resistance - I was barely overweight when diagnosed and am rather skinny now.

If you want to invent a diagnosis of temporary-diabetic for yourself, then go right ahead. But to suggest to others that this is a common distinction or a ray of hope for the newly diagnosed is not borne out by the evidence, namely that a lack of pancreatic function is the root cause of the diagnosis.

We sometimes get blamed for our diabetes - either because of a lack of willpower or for being fat. I don't need a whole new category of Type2-on-medication that is somehow less virtuous than someone who can manage it in "diet and exercise" alone.

I wish I wasn't diabetic. I also wish I was taller. I manage on very few meds and quite a bit of exercise and when I mention my levels, my diet ad my meds I hope I do it to encourage those who are struggling with the condition. I don't act as if I've just wandered in to the wrong room by mistake and then telling other people that they can get better.

 

[lucylocket61]

swimmer2 said:

I don't need a whole new category of Type2-on-medication that is somehow less virtuous than someone who can manage it in "diet and exercise" alone

I truly dont think that the vast majority of people on here would ever consider your statement to be true in their eyes. Sometimes people just need time to become informed, or to get over their initial denial. You sound hurt and I hope it is appropriate to send hug.

we are all in this together, regardless of how much or how little medication and help we need.

 

[Bellx15]

Agreed, except that I don't think I am in denial. At this stage I don't have enough information about my condition. All I do know is that I have recently experienced poor BG management. I am just keeping an open mind about it and remaining optimistic.

Swimmer2 has taken me wrongly, so I hope he will realise that no offence was intended.

 

[xyzzy]

I've been given to understand that diabetes involves two factors, one of which is insulin under-production and the other insulin resistance.

On the first one, the pancreas can be overwhelmed temporarily by excessive carb intake, and just referring to a temporarily high BG level doesn't establish that there has been permanent loss of beta cells. So on that point I think it is a bit premature to infer that my pancreas has suffered permanent damage, or that it is irreparable. I need to wait and see.

On the second point, body fat is known to impede insulin uptake by the body, which again might be a temporary and remediable condition. So again, I am trying to remain optimistic that the condition can be rectified.

I bear in mind that my BG was pretty normal up to about five years ago, and also that I have abused it pretty badly since then, so there is at least some reason for hope that although I have overloaded my system I have not done any permanent damage.

Afraid this is where I have to agree with the other posters. The problem is you can have been eating a "healthy" diet for years and do permanent and lasting damage. That is what happened to me. My family was classic 5 a day, all fresh food, very little puddings, very little chocolate or cakes, all low fat, no Big Macs etc. Over the last 10 years I gradually got somewhat overweight but like I said never obese. Result Dec 2010 diagnosed pre diabetic and given the NHS healthy eating rubbish which I followed to the letter, why wouldn't I there was no way I wanted diabetes my family is full of it so I know exactly what it means. Result Dec 2011 HbA1c 11.3% and PERMANENT damage done to my pancreas. It transpired that in March 2011 an hBA1c had shown my levels had risen to 8.3% so properly diabetic within 3 months of adopting the NHS diet. That letter for whatever reason never got sent out and I spent the next 9 months blissfully unaware that I was killing my pancreas day by day. It wasn't until Dec 2011 that it suddenly dawned on me I had all the symptoms and returned to my GP. So you see on a perfectly healthy diet things can have spiralled out of control and I would say you will be very luck to get away without suffering some damage. Hopefully I am wrong but to be honest you need to psychologically prepare yourself for that outcome.

On the insulin resistance side I agree with you entirely.

 

[Bellx15]

Point taken.

There are differences, though; there's no known diabetes in my family, and I am also encouraged by the way my recent changes have resulted in a plunging BG level.

I'll have to see what transpires, but I'll take it on the chin whatever it is.

 

[xyzzy]

swimmer2 said:

I don't need a whole new category of Type2-on-medication that is somehow less virtuous than someone who can manage it in "diet and exercise" alone

I truly dont think that the vast majority of people on here would ever consider your statement to be true in their eyes. Sometimes people just need time to become informed, or to get over their initial denial. You sound hurt and I hope it is appropriate to send hug.

we are all in this together, regardless of how much or how little medication and help we need.

Yes this it what I meant by saying that if you had to accept there where categories then the distinction between the proposed 2 and 3 is more an attitude thing than a medication thing. A far more logical divide is those diabetics who control their condition and those who do not. Even that has real problems as the vast majority who do not do so because they have not received the dietary advice on how to effectively control regardless of what part of the T2 medication spectrum they sit in.

 

[Bellx15]

Could someone kindly explain the carbs issue? Why does the NHS say you should continue to take in 50% carbs? Is it to avoid using body fat instead of carbs for glucose? What is the latest wisdom on the best percentage carbs to take in?

xyzzy - I appreciate that you have already offered some information on this, but I am not clear on the NHS philosophy.

 

[xyzzy]

Could someone kindly explain the carbs issue? Why does the NHS say you should continue to take in 50% carbs?

I really don't know. I wish someone would tell me too. It can't be the ketosis thing as even at half that amount you wouldn't be in ketosis. What is particularly stupid is the latest UK diabetes position statement references the ADA position statement all over the place and as I mentioned earlier that ADA doc does says state a specific RDA of 26% or 130g / day. The UK document even goes as far as stating how important carbohydrate intake is to blood glucose levels in nigh on identical language as the ADA but nowhere does it give the clear concise grams / day RDA. It is a document of weasel words written by the best bureaucrats our taxes can buy and in my opinion best used as emergency backup in the loo.

 

[Bellx15]

So in your experience is 26% a good level to aim for?

 

[borofergie]

Could someone kindly explain the carbs issue? Why does the NHS say you should continue to take in 50% carbs? Is it to avoid using body fat instead of carbs for glucose? What is the latest wisdom on the best percentage carbs to take in?

Because they've been collectively pushing the "fat is bad for you" message for so long, that they can't back out of it, even though science has been definitively unable to demonstrate a link between dietary fat and cardiovascular mortality.

Since low carb is necessarily high-fat, they can't afford the collective loss-of-face, by doing a u-turn (and admitting that their advice is at the heart of the obesity epidemic).

Of course, they'll hide behind the "not enough evidence about the long-term safety of low-carb diets", but this argument is obviously "a load of old ****". We didn't evolve to eat a 50% carbohydrate diet, it is therefore ridiculous to suggest that stuffing your face with "healthy wholegrains" is optimal for your health.

 

[Bellx15]

Of course, they'll hide behind the "not enough evidence about the long-term safety of low-carb diets", but this argument is obviously "a load of old ****". We didn't evolve to eat a 50% carbohydrate diet, it is therefore ridiculous to suggest that stuffing your face with "healthy wholegrains" is optimal for your health.

Quite!

 

[RoyG]

Point taken.

There are differences, though; there's no known diabetes in my family, and I am also encouraged by the way my recent changes have resulted in a plunging BG level.

I'll have to see what transpires, but I'll take it on the chin whatever it is.

Excellent at least you will have plenty of time to get your head round the Idea. I know it is not easy to take on board the fact that you have Diabetes, and it really is a game changer in your life, because it's something you cannot see or feel to any great extent early on, but it does not leave you alone, it is there in your mind all the time. Sometimes you just feel like lashing out, but there is nothing to lash out at, sometimes feel like screaming at the moon, well I do. Only tonight, a simple little thing, I got myself all wound up because one of the lads (I have four lads all under 17) was having Cheery pie with Devon custard, one of my all time favourites, and I felt so so P***D off I just went off in a sulk haha, man that's how it messes with your head sometimes. So enjoy your Honey moon and I do hope your right.

 

[Bellx15]

Thanks - and sorry to hear about the pie! I'll appreciate my situation better when I have more information.

 

[Mileana]

If we assume that a pancreas is temporarily overloaded and we then give it a break by low carbing, then in say 6 months we decide that now it needs to return from holiday and put it back to work at processing carbs, let's say without the overtime, and make the new percentage of carb 80 percent of what we used to do, then a healthy and recovered pancreas should be able to process this just fine, right?

Personally, my beta-cells are currently being eaten by anti-bodies which is not nice of them. However, also in Type 2s there seems to be a decline in beta-cell function that comes from too high blood sugars over time and from age and other things. It may be entirely possible that this can be controlled still by diet but not to anywhere near the level that it was before. If a pancreas doesn't do the job (anymore) that it used to be able to then the pancreas is not functioning (enough). We can turn the discussion around for all I care and say that the non-diabetic population have over-functional super-pancreae, fine. But there is a difference between diabetics and non-diabetics either way we look at it.

I have been on insulin now for a while for what was first believed to be Type 2. I was very happy about that and don't consider myself less successful than the person who does it by diet. My success criteria is a normal blood glucose and a normal hba1c level. Or as close as I can get it by the means available to me. Then finding out I was really LADA, I had a few aha moments why pills were not working etc. But some people just have more sensitive systems, some people have higher insulin resistances and making a big divide btwn people who control with diet compared to those who don't, serves little purpose as the goal of the matter is to have normal levels and I don't think that your pancreas would like you eating 250g of carbohydrate a day anymore than mine would like me not taking my insulin - afraid I don't think it would it 6 months either.

 

[SouthernGeneral6512]

What is the historical perspective on diabetes? I mean surely there must have been periods in the past when our ancestors lived on plentyful wheat when meat was too expensive was there a lot of diabetes around then?