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Type 2 Diabetic or not?

M

moey90moey90

Member
hello guys
i have a few questions but at the beginning id like to tell you guys a few things about me.
im 28 years old and im a doctor
ive alway played sports when i was a teenager but then i started weightlifting for almost 10 years and made me eat a lot and gain a lot of muscle weight. Then i got a cough that lead to an occult hernia which made me stop weightlifting for almost 5 months. Before this hernia issue i weight at about 95kg and my weight stayed constant for almost 8 years (im 174cm). When i stopped training because of this hernia thing i gained almost 15 kg in about 3 months and stopped at about 110ish kg. i went for a checkup and my Hb1AC was 6.8 %. i then dieted (low carb diet) for 3 months lost about 25kg and didnt take any medications....had a recheck up and my Hb1AC was at 5.4%, my OGTT with 75g sugar was at 4.5mmol ( 81mg) and my fasting was 4.3mmol (77mg).
so im just hoping id find an explanation for these results in here because my doctor didnt have one. ( Hes a family doctor not a diabtologist )
and 1 more thing...no one in my family suffers from diabetes.
 
moey90moey90 said:
what do you mean by arrànge blood work?
Click to expand...
My GP arranges blood work for me by filling in a blood test request form with my pathology shop of choice.

This is all you need to do as a doctor, you are a medical doctor and not a doctor of divinity?
 
So your question is why did your latest results look so good? Because you cut the carbs out and lost 25kg. You reduced the demand on your insulin by not raising blood glucose levels and reduced the resistance your body has to said insulin so it now responds better to carbs.

Type 2 doesn’t just happen to fat, lazy people btw; genetics has a role and the side effect of the glucose disregulation and excessive insulin levels is weight gain as a symptom not just a cause . Am I really explaining the basics of type 2 to a medical doctor or have I misunderstood your question?
 
Hello, your doctor can order a blood test to determine whether you are a diabetic. However your low carb diet did help to lower your hba1c which could explain your lower result.If you hadn't, I'm sure it'll be a different story. If you keep it up, I'm sure there's nothing to worry about. Your family doesn't have to have diabetes in order for you to be a diabetic, my family doesn't have a history of diabetes either but here I am.
 
Without wishing to insult the op, if dr’s training doesn’t cover this fundamental understanding of diabetes then I think I understand why we get such random and frequently shoddy advice from our own gp’s and why in turn so many people with diabetes struggle to understand and control it. Perhaps like our information, the training is very variable and it depends which institution did their training how much is really taught.
 

Agreed, you could probably add that once taught the basics (How are outdated are they and inaccurate?) there seems to be little updating taking place by doctors. Perhaps that explains some of the dinosaur and just plain detrimental advice being handed out still. To be fair, doctors are extremely busy people trying to work with a broken system and patients in long waiting lines. They just don't have the time to research like some of us do. Unfortunately it's the people affected by diabetes that are caught in the middle.

To the OP. I do hope you can get the tests wanted completed in good time. Good luck.
 
Guys im a gp
I do know what diabetes is and how its diagnosed but i was just confused about tge results. Im just a gp and no endocrinologist so whatever i studied about diabetes during college was not in depth as what an endocrinologist studied.
What i also know is that there is something called obesity related diabetes and thats not only because youre overweight...normal BMI people can even have it. Its because the internal organs that regulated glucose metabolism ( liver and pancreas ) are covered with a thick layer of fat and that causes them to function in a less than optimum manner. Ive had a fatty liver ( not alcoholic fatty liver ) for years and maybe thats the reason but ive always got regular blood check ups and everything was good. So thats why i was wondering if is was a phase or something is actually wrobg with my pancreas( but i think not brcause my OGTT was normal )or my tissue insulin receptors. And i wanted to know now if i stay at about 85 kg now but start eating more carbs but try not to gain a massive amount of food..will this keep my glucose levels normal or not?
And another question.. if i start taking metformin just to keep my weight at about 85kg and normal blood sugars but without qctually dieting...has anyone tried this before ? And did it work?
Sorry for the long post guys and thanks a lot for replying .
 
Ooh, we get to advise a GP! (Sorry, that is making me gleeful). You have an impaired metabolism, and carbs will always be a problem. You can still have carbs and reduce portion size, but in all likelyhood that will mean you will progress to full fledged T2. While going hungry in the meantime. You already were borderline diabetic with the HbA1c of 6.8. Just barely still in the prediabetic stage. You missed a T2 diagnosis by a hair. Remember, the weight came on because of your impaired ability to process carbs: When you're insensitive to your own insulin, rather than help you burn off the blood sugars, it just stores the glucose in available fat cells instead. You don't get diabetes because you're obese (or TOFI: Thin Outside, Fat Inside), you get bigger because you are becoming a diabetic. It's when the cells can no longer cater to the storage demand, that the glucose spills out into the rest of your body, because it's got nowhere else to go. Blood, organs, saliva, tears. Voila, T2. In any case... Going for medication means you're opting for progression, unless you either combine it with a low carb diet, or just go diet-only. If you can keep up the low carb deal, all the better. No progression, no complications, no medication. And as a GP, you get to help your patients the same way you're helping yourself. Anyway, whether you do that with or without metformin, well.. That's up to you, really, but the possible side effects are.... Unpleasant. (I ended up weak, dehydrated, and bleeding from ends I never ever wanted to bleed from. Living in the loo is not for everyone.)

As for the NAFLD, my liver was so fatty the endo thought it was one big tumorous mass, and I was mere weeks from dying. Took an additional MRI and CT to find out it was an "abnormal stacking of fat", and I was told there was nothing I could do about it. And to come back when the pain worsened and cirrhosis set in! Gee, that's helpful! Well... On low carb the fat melted off of my liver. Liver function is back to normal, and the only way to see I ever had NAFLD is to do an ultrasound, because it sure isn't showing in my bloodwork anymore. https://www.drberg.com/blog/how-to-reverse-a-fatty-liver#how might help a litte too, Dr. Berg explains it better than I can. (Ignore the pop-ups, he knows a lot so it's worth it to click through.).

This is my own little quick-start guide, https://www.diabetes.co.uk/forum/blog-entry/the-nutritional-thingy.2330/ which might help a little in picking your way forwards. But the absolute best things you can do? Read Dr. Jason Fung's The Diabetes Code and visit www.dietdoctor.com. This forum's website (diabetes.co.uk , NOT .org!!!), has a load of information too. And maybe watch some of Dr. Eric Berg's youtube video's. He once was where you now are, after all.

And yeah... My own GP doesn't know much about T2 either. You guys have so much to keep up with it's practically undoable. But she agreed to see where things'd go on this diet, will let me test anything I ask for, and I am her guinea pig. I'm the only one in the practice to go from full fledged T2/metabolic syndrome to normalising everything: The T2, fatty liver, cholesterol, weight.... My bloodpressure already was low, but.... If this can help you help yourself, and the many patients you'll have in your career... I have a feeling you'll have a very successful practice in the coming decades.
Jo
 
Hi and welcome @moey90moey90

If you have had a fatty liver, and lost weight (some of it from the fat on your liver), and gone low carb, then your HbA1c improvement is consistent with that - and providing you don't re-fat your liver, and you don't overload with carbs, you should keep those good HbA1cs for a good long time.

Well done!

In order to understand the process in more depth, you may find the work by Virta (in the States) very interesting. They have set up an institution where T2s get personalised diet education and regular monitoring, along with MD supervised med reduction, and have produced some really impressive stats on the health improvements of their patients.

Likewise, Professor Taylor of Newcastle University has been conducting studies for the last 5? 7? years on the effect of weight loss on fatty livers, and the improved liver and pancreatic function that can (in some T2s) lead to a reduction in HbA1c. He calls this 'reversal' but his criteria are rather lax, IMHO Taylor's studies are available, as well as his protocol, and he has given a number of presentations on the subject which are on youtube.

You may also want to look up the work of our very own @Southport GP aka Dr David Unwin.
He has created a LC education model for NHS GPs and has transformed the lives of many of his patients by simply encouraging low carb, with a truly impressive reduction in medication costs to his practice.

You may get a bit of stick for being a GP asking about D on here. I hope you will take it in the spirit of mild hazing and gleeful delight that a doc is here, asking questions, and listening to the answers. The mere fact that you are here and interested in the process, makes you worth your weight in gold as a GP. So many members just experience an attitude of 'T2 is progressive, have a prescription and lose weight by low calorie (even though the stats show you are doomed to failure)'. For you to be here shows that you recognise there is a lot more to the T2 experience that that! And for you to offer an understanding of the benefits of LC to your T2 patients could well transform their lives and reduce their burden on the NHS for decades to come.
 
Despite my earlier comments I too am very glad to see a gp seeking more knowledge and wholeheartedly agree with @JoKalsbeek and @Brunneria in welcoming you.

Losing the fat around your organs will have improved your insulin response for sure and reducing the demand for it will have lowered the circulating insulin which as t2 will most likely have been very high previously. But you have to remember how you got those organs covered in fat and gained the weight first off - your metabolic inability to correctly process the carbs. Previously you may have somewhat mitigated this with the exercise but the problem was still there.


Taking the metformin and resuming carbs is pretty much the route many are advised to take and that’s what makes the disease progressive. You continue to tax a flawed system, you continue to bathe your cells in insulin, you continue to demand high levels of insulin from your pancreas. The metformin will help a little sure but it can’t fight the battle alone. Gradually over time the insulin resistance gets worse and worse, the meds get ever stronger til you end up on insulin forever trying to pump in more and more to overcome the resistance. Maybe in time your pancreas gives up”worn out” so to speak.

I understand metformin is designed to work with a suitable diet not in place of it. Most here find it’s effects are minimal without the diet. Most here find that keeping the carbs down (even if not seeking to lose weight ie not dieting in the traditional sense) is far more effective and beneficial and a great deal of those either never, no longer take metformin. Some do find it is beneficial in addition to the way of eating. Because it is a way of eating, not a weight loss diet, for good. The underlying issue is still there and will come back if you return to old ways of eating and weight gain as a result.
 
Just new here, and this is one of the first posts I’ve read. Is the person claiming to be a GP a typical poster? All GPs had medical training, work alongside medical professionals and deal with diabetic patients multiple times each day. If this poster is genuine, then what does this say about our health system? GPs must always keep up to date with new medical advances, advice and practices. Most people I know have friends from their work, you’d imagine a GP would simply ask a colleague? Btw not picking on the OP, just seems very hard to find a good place for advice.
 
Hi @moey90moey90

Sorry to hear you've joined our merry band.

but if you were going to be T2 anywhere on line, then here is DEFFO the place to do it.

No one here can diagnose or prescribe, as you well know, all we can do is advice based on our won experiences and the links and post sent to us, that we have found useful.

In that spirit, as you mentioned weightlifting
i found this interesting.

the idea of how Metformin works i liked,
the idea that walking was ultra effective fits well with what most think on here.

it DOES sounds like met should be dropped, But for me,....MY intention was for it to show how WELL it works, and i guess in tandem with exercise works better.
(if you can tolerate the side effects, i was lucky had very few, and still take now.)



and am i right guessing your not uk>

if so as mentioned our Dr Unwin is a star.

I was sent a link earlier and made a few simple notes to save watching all (though it is a wonderfully informative piece, and well worth the full viewing)

https://www.diabetes.co.uk/in-depth/david-unwin-low-carb-not-just-diabetes/

Loving the "Long silent scream from the liver" that predicts T2 among others
10 years before it appears
and 20% of people seem to have it.

That tsunami of T2, could get even worse then predicted if we don't take note of NFLD

And i took comfort in the case study where the Full fat made the HDL increase (good) AND the trigs go down (also Good )

and funny to boot...28:30..

and a good bit about insulin and how it worked AND what it helps 34:04



And i couldnt let @Brunneria wonderful post pass without agreeing FULLY with her summation:

"You may get a bit of stick for being a GP asking about D on here.

I hope you will take it in the spirit of mild hazing and gleeful delight that a doc is here, asking questions, and listening to the answers.

The mere fact that you are here and interested in the process, makes you worth your weight in gold as a GP.

So many members just experience an attitude of 'T2 is progressive, have a prescription and lose weight by low calorie (even though the stats show you are doomed to failure)'.

For you to be here shows that you recognise there is a lot more to the T2 experience that that!
And for you to offer an understanding of the benefits of LC to your T2 patients could well transform their lives and reduce their burden on the NHS for decades to come. "

So while we may seemed humoured at your asking for advice... i LOVE it.

as said you docs have SO much to keep tabs on, that it just about becomes an impossible task
BUT i do consider that others on the team SHOULD be looking at whats is MOST cost effective treatments and BEST for the Patients..to whit, modern dietary regime, and non invasive NOT highly medicated treatments in the first instance.

And for you ..you now have a personal interest in better treatments..so a win / win for the T2 team..whoop whoop.

Good luck finding the advise and help you need.
 
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A GP has to know about every single thing that can go wrong in a person... That's a lot. Seriously. Ever seen a medical textbook? You could bash someone's head in with those. Considering a doc has just a few minutes per patient, has to do paperwork, be on call... There's no way they can keep up with developments as they happen and still find time to have a life. (Besides, magazines like the Lancet are often specialism specific.) That my endo dropped the ball, that irks me no end, as it's her specialism. But a GP.... They're overtaxed as it is, so yeah... I think the OP is a genuine GP, and being on the other side of the doc's desk, is going to be a learning experience that'll help their own health and that of many, many patients in the future.
 
Regarding Metformin...I was on it for 7 months between January and August of this year. I have just taken myself off it as I lost 3 stone and look skeletal. (I was prediabetic last Dec 45% a1c which is why my dr put me on it) If you need to lose weight it's the perfect medication but if not exercise and right food may be better. That's what I'm doing now and hope to put some weight back on. I hope you can get it sorted out.
 
Theres a subspecialty for diabetes here in germany for endocrinologists and theyre called DIABETOLOGIST. A GP has general knowledge about diabetes but nothing in detail...all the epigenetics and this stuff is not what i studied so instead of prejudging people thinl before you type
 
HI. I have a simple reaction to your post. You were eating too many carbs and the revised diet enabled any insulin resistance to fade hence the improved HBa1C? This is very common experience with T2s who follow a LCHF diet after diagnosis
 

Hello @moey90moey90,

Welcome to the forum. Glad to see another compatriot here. Congrats on getting your blood sugars back into the normal range.

I agree with the others, it is most likely losing weight combined with eating low carb that helped you get your HbA1c back in the non-diabetic range.

As to being considered diabetic with an HbA1c of 6.8% followed by an HbA1c of 5.4% and a normal OGTT, we can't diagnose as others have said. However maybe this can help. Based on the posts on this forum, some have reported that their GPs have taken them off the diabetic register, some were coded as in diabetes in remission or diabetes resolved (either after some years or two consecutive non-diabetic HbA1c) and some have stayed on the diabetic register because their GPs believed that diabetes is a chronic progressive disease. There are many new studies coming out on the remission of T2 and it doesn't seem to be as rare (due mainly to low carb) as once believed in the past, so it seems the field is in a state of flux right now.

In the end, it probably doesn't matter much. Having had diabetic blood sugar levels once, I believe that we are always prone to becoming diabetic again if we return to our old lifestyle. Personally, I look at myself as carbohydrate-intolerant.
 
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I am sorry you feel aggrieved by the reaction of some forum members - but many people go to their GP and are given very bad, but most emphatic advice on how to manage their diet - I had decades of insults and sneering accusations of gluttony, of being delusional about the amount I was eating and handed yet another diet sheet of low calorie low fat foods which - if I followed it - would make me better. Yeah - right.
 
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