Doing the Newcastle

ringi said:

One option (and I can't decide if it is a good option) would be to restart the metformin if you can do so without getting the side effects - confirm your GP is happy for you to do so first. I am assuming you are having solid/vag along with the shakes once a day.

Metformin is known to help with weight lose, and is likely to lower FBG a bit, however, it has not been tested to see if it affects the rate of fat loss from the pancreas. (Clearly, it does not stop fat loss from the liver and may even speed it up.)

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Great minds... I was wondering about that as well but I'd like to get off all medications and until I've seen how it works with none, I'm not too keen to reintroduce anything. At the end of the day I might have to have some medication but I want to give it a good shot first. I think with no insulin injections, I'll have a much better chance of weight loss. The FBG this morning is, I think, a good indication of how little the insulin is now doing for BG. It'll be interesting to see what happens over the next couple of weeks. But the metformin is certainly something to consider. Thanks.

Minor update: since my numbers today are all slightly below yesterday's I'll move onto zero insulin tomorrow to see what happens. That'll be the first day with no medication at all in over thirteen years. I never imagined it would ever be possible for me so I'm rather pleased about that.

Week 4 Day 27 Saturday 6th January. FBG 7.3 Weight 100.7kg

Blood is reasonable so this is the first day off meds in thirteen years which feels rather strange. I'm a little apprehensive though I know in my mind there won't be any massive spikes. The three drivers of the vicious cycles according to Taylor are positive energy balance combined with high FBG and high fat in the liver and pancreas. The first four weeks will have greatly reduced the liver fat and has certainly created a negative energy balance, and the FBG number is pretty reasonable so I hope the cycle is starting to be broken. The liver has certainly shown decreased insulin resistance or I could never have reduced it. Now I have to stick solidly to the diet and see if my pancreas can show some signs of recovery over the coming weeks. Now the emphasis has to be on substantial weight loss without any loss of BG control. Any improvement I see now will be down to liver and pancreas recovery because of restored lipid metabolism and it will no longer be slowed by the presence of insulin. This is quite a new step for me so it'll be interesting to see the results.

Update: I've had a couple of 10s today so the last of the insulin was doing something. Nevertheless, I'll stick with it and see if the numbers come down over the next week or so to a sensible level. I have to give it a chance to work.

Week 4 Day 28 Sunday 7th January. FBG 8.8 Weight 99.7kg

This is day 2 of no meds so no surprise the BG is a little up but I've seen numbers like that when I was on the full dose of insulin. I have an odd sensation of actually being in complete control for the first time with better results to look forward to. It's a good feeling after all this time. And at long last, my weight is coming down. I feel as though it's turning a corner so very positive again today. It should be easier losing the kilos without the insulin.

Update: I've had some higher numbers today, 11 and 12, but as it's on no meds I think I just need to stay calm about it. I recall @Peerless67 had numbers up to 17 when he started after stopping all the meds, but it came down very quickly. I hope the same thing happens here. We get quite paranoid at times about high numbers and perhaps lose sight a bit of the underlying biochemistry. If Taylor is right, I have little or nothing to worry about so it's a question of do I trust his and other people's results. Yes, I do. Sit tight and carry on Bob!

Week 5 Day 29 Monday 8th January. FBG 10.0 Weight 98.5kg

As expected, the blood has gone up because there's now no additional insulin so I just have to keep my nerve and wait a few days to see what happens. It all depends on how much my pancreas can do at present. I'd like to be positive about that but after thirteen years on meds, who knows. Now is definitely not the time for second thoughts. It's the time to calmly think about the data and the response others have had. It may take a while for the pancreas to recover and restarting the meds will impair the process. So I just stick to the plan.

On the very positive side, the weight is coming down nicely. I've lost 7.5kg in four weeks. Time to sit tight and watch the numbers come down.

Update: I checked the numbers regularly this morning and it peaked at 13.4 but then quickly came down to under 10 again. That's likely to have been a response from the pancreas so that's pretty positive. When you see the numbers going up there's a temptation to reach for the meds but I'm glad I waited to see them come down again. I watched an excellent Jason Fung video explaining the evidence for Taylor's Twin Cycle hypothesis and illustrating it with a patient example which exactly matched my numbers.

Week 5 Day 30 Tuesday 9th January. FBG 9.7 Weight 99.5kg

Not much change today so it's a case of just waiting. Intake was well under 800 kcals yesterday. I really want to see those numbers coming down now. I hope today's peak will be lower than yesterday. Let's get that liver and pancreas working!

Update: Numbers are up today. Since this morning they've been over 12 and haven't come down in the last five hours. No meds, no shakes, just broccoli soup so far. Looks like a liver dump. Not looking good but being patient. I don't want to see many days like this but I'll sit it out and wait for some positive change.

ringi said:

If you are mixing your shakes with milk, it may be better to use water (maybe with a little cream) until your FG numbers start to come down.

It's moving away from the ND, but I would consider a bulletproof coffee, with the amount of cream, butter and coconut oil to give about 200 calories, as a replacement for the breakfast shake until you are happy with your BG levels. (Move back to the shakes when you can, so as to get enough protein.)

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I think this is most likely a liver dump, the BG dropping below the trigger level and gluconeogenesis kicking in, probably just before I got up and then there being low insulin to deal with it. I cut out the shakes today but I don't see them as the problem particularly. I haven't had breakfast for many years and the first shake has normally been around 1-ish. This rise is quite new and I haven't seen it since going on the ND. It occurred before I would have had the shake so I think the liver has to be responsible. I haven't come across any other account of this happening but I guess it must have, or perhaps wasn't noticed. I think that with continued low energy intake this should just sort itself out so I'll wait a few days and see. Broccoli soup was a pretty safe substitute for today so I'll stay steady and see what happens tomorrow morning. If the BG is still raised during the day after a few more days, I might have to consider something else, maybe getting up earlier and eating something, but I'm postponing that for now. Staying hopeful for now.

ringi said:

Most people who do the ND don't monitor their own BG.

Don't stop the shakes for long, as your body needs the protein they contain. Remember that Jason Fung talks about fasting being safe for "well fed" people, you are not well fed, as you are doing the ND.

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No chance of me getting protein deficient. I only dropped the shakes today to get complete control over the carb intake. Fung also said that even going without food for a couple of days is no big deal. As he jokingly put it "No-one dies!" I'll keep an eye on the nutrients. Thanks for the advice.

Biggles2 said:

Congrats on your success thus far @AlcalaBob! You might be interested in this Prof. Taylor & Allison Barnes journal article in the February 2018 issue of Diabetologia as you contemplate your long term management plans:

Translating aetiological insight into sustainable management of type 2 diabetes

“Taylor and Barnes summarise studies testing the hypothesis in individuals with a short duration of type 2 diabetes using a low-energy diet and maintenance of reduced body weight. The beta cell defect can now be understood as de-differentiation, caused by cellular metabolic stress and reversible loss of specialised function. Longer-term management highlights the need for effective approaches to dietary advice. It is clear that one diet cannot suit all, therefore, a range of soundly based approaches, tailored to individual preferences, is described.”​

Link to the full article: https://link.springer.com/content/pdf/10.1007/s00125-017-4504-z.pdf

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That's brilliant. Thanks very much for posting the link. The de-differentiation explains completely why long-standing T2 patients have a lower success rate. We've lost a lot of the cells. Our recovery would then depend on the growth of new alpha cells which can then differentiate. But that's a lot weaker than rebooting the existing dormant beta cells. Thanks for this paper. Much appreciated.

Week 5 Day 31 Wednesday 10th January FBG 10.3 Weight 99.5kg

Another day starting with raised BG so not that good. My blood stayed over 10 all day yesterday clearly because there's nothing to clear it out of my system. I don't want it to be reconverted to triglycerides so I'm off for a brisk hilly walk in a little while to see if that can bring it down. Heavy rain prevented my walk yesterday. Then I need to think about taking a metformin because if it's liver-dumping as it looks like, the liver will just top up the level again. I obviously don't want insulin nor anything that stimulates insulin production and as metformin instead acts by reducing gluconeogenesis and increasing insulin sensitivity, it's the drug of choice for this situation. I realise I could just sit it out but the high triglycerides will also impede weight loss. Some pondering to be done today.

Update: forty minutes of a very hilly walk, which typically brings the numbers down three points resulted in a rise of 0.2 which means it would have gone up by much more in the time without the walk. That's pretty clear evidence of liver-dumping so until my liver readjusts some more, I'd be foolish not to take a metformin to keep it in check. I'm glad to have established what's going on as I can now do something about it. The conventional treatment response to liver-dumping once on insulin is... more insulin... so I'm glad I'm out of that cycle. And metformin has no effect on weight loss so that's another positive.

I've decided to take an Icandra tablet once a day. It's 50mg vildagliptin and 850mg metformin. The metformin will counter the liver dumping and increase insulin sensitivity, and the vildagliptin acts to inhibit DPP4 which in turn increases pancreatic beta-cell response to glucose. It basically gives the beta-cells a prod to produce a bit of insulin, which I need to get rid of the excess glucose. Vildagliptin, according to the research, has a negligible effect on weight, but a very consistent effect on FBG and postprandial levels. I'll try this for a few days to assess the impact. I see this as only a very slight adjustment and no change of the diet. Before the start of the diet, I was taking this as well as all the insulin so I'm still well ahead in treatment terms.

Week 5 Day 32 Thursday 11th January. FBG 9.8 Weight 99.8kg

Another high FBG so I took 25 units of insulin this morning. After five days, I needed to take some action about it. There's an argument that says carrying on with no insulin and being patient will bring the numbers down but that rests on the idea of the pancreas recovering relatively quickly. Given that there's clearly some pancreatic response, that at least sounds plausible. But at the same time, the response so far is too weak even with the help of some vildagliptin. The other side of the argument is that as a long-standing diabetic, that recovery might be slow, weak, and in the end inadequate. Only sticking with the ND over a longer period will provide the data to decide.

In the meantime, it's clear that metformin and vildagliptin were not enough to bring the levels down so I still need some meds to control the BG. I was too quick to reduce the meds and certainly in eliminating all the insulin so I need to get the levels back under control, get the BG stabilised again and then assess what's happening. It's a minor set-back but only psychologically because I was too optimistic over too short a period of time. In a word, impatient. The liver is still recovering, there's some pancreatic function, and the weight has come down reasonably so, at the middle of week 5, it's showing some good progress. Now I just hang in there and once the BG level comes down, think about the meds again. So no change to the diet. Sticking to the plan. Still very positive.