Dr Jason Fung on T2 Diabetes and Drugs

[ickihun]

I do have a different opinion on this, as LCHF is not limiting, for me it is liberating. Yesterday my daughter made a super creamy panacotta using Xylitol, it was far too sweet for me after a small mouthful, this would be the case for mainstream varb

Now that I have educated myself about the food groups, mentally I cannot face regular off the shelf carbs, such as biscuits and bread. As I am trying to get a 6 pack again I know I would have to work even harder. Finally for me I am comfortably achieving 1 meal a day at least 3 times a

I was furious, my eGFR count went down on Metformin and immediately back up without it; for something that could be "end-of-life" full disclosure I think is vital. All I was told was that Metformin does not induce a Hypo.

All drugs can do that to the kidneys and liver @Mbaker . i know that is why you are dead against meds which is the right decision for you. But we arent all the same, unfortunately.

 

[ickihun]

I think the name “Type2” does not help and the NHS should start to measure insulin levels at health checks and treat the condition of “Insulin Resistance” as we all know it is a big risk factor for strokes, high BG, heart issues, dementia etc.

If someone is overweight with the fat on the middle it is very likely the issue is “Insulin Resistance” and a low carb diet is the best option, but yet my GP says “low fat”! I tend to think that Metformin should be offered to everyone with Insulin Resistance even if their BG is normal.

I expect some people who are labels Type 2 are closer to being “half a Type1”, e.g they are producing a level of insulin that is lower than a “normal person”, for some reason other than fat clogging up the system.

Maybe DNA testing will let us be classified into more useful groups allow GPs to give the same meds to everyone in a grouping….

Research is going on in leptin resistance which opens up research for more insulin resistance. Some leptin deficiencies are genetical and as I've posted on a thread recently 3000 known genes are related to diabetes.

 

[ickihun]

I so agree. Why use Gliclazide to stimulate the pancreas to produce more insulin without knowing how much the pancreas is already producing? People are drowning in insulin and gaining weight if they continue to eat to their medication, which is what the NHS seems to want us to do. No wonder it is seen as progressive.

I am losing weight on insulin injections because am treating the IR not assuming everyone on insulin is eating the wrong things so they can cover it with insulin like they presume type1s can.

 

[ringi]

I think you are both right. With what I know now, I would immediately do the Newcastle Diet (using real food, no satchets), I would then maintain on LCHF with exercise. I think it depends where you are in your journey; as I had never dieted a low cal diet would most likely have got me to where I needed to be initially, killing myself with over exercising I think was a harder root.

What you know now, would have taken more then the 7 minutes a GP has to explain it to you! I expect that using some of the "Doctor in the House" TV footage etc a DVD could be created that could be given out to everyone with a "bad" test result, getting a lot of people onto mild LCHF very quickly. Then the diabetes education can be offered and options needing more commitment considered.

 

[ringi]

Is insulin a better option than Gliclazide because at least it gives the pancreas a bit of a rest, and unlike Gliclazide, people on insulin seem to be empowered to reduce their dose when they start to get BG under control?

 

[ickihun]

Not convinced as too many people go back to their old ways…… Hence I think controlled carbs (say under 100g) should be the first angle of attract getting people eating in a way they will be happy with for the rest of their life’s. Then and only then use intermittent fasting or Newcashle Diet.

Asking people to do something that lots of people fail at is a bad option, but even if people fail to get down to low carb levels they are very likely to have learned to avoid the worse foods.

This is where I feel I'm going to get the best of both worlds. Bariatric surgery for supported 600cals (unless crazy and stupid enough to blend marsbars and the likes) and low carb lifestyle.
I'm doing half already and have done 600cals in the past for 8-9mths losing 7stones. Oh and of course the IR/diabetes I wasn't aware of.
I won't be cocky enough to say I-'ll do it but I will have a very good shot at it!

 

[ickihun]

Is insulin a better option than Gliclazide because at least it gives the pancreas a bit of a rest, and unlike Gliclazide, people on insulin seem to be empowered to reduce their dose when they start to get BG under control?

Dr Bernstein seemed to think so. Oh and my specialist who looks after the north of england.

 

[ickihun]

As soon as SGLT2 inhibitors (Farxiga) have been in use for long enough for any long term side effect to be know, I think they should replace Gliclazide on the NICE flow chart, maybe even alongside Metformin without waiting to see if the Metformin works on its own.

I also think it may be worth offering Metformin and Farxiga to anyone that commits to “low carb training” without first waiting to see if diet and exercise works. Offer a small reward to anyone that controls their BG well enough for come off them, rather than wasting 3 months before they are started.

I think self monitoring of BG can be such a big motivator that it should be standard, but how do we stop people just writing down the number, without thinking about it and taking action when needed? Just having the Low Carb Training being led by people who have proved it works would be a great ideal.

I think most people with Type2 could turn it round, provided it is not left for many years to damage their organs.

Are you refering to the mix currently with metformin and victoza?

 

[ickihun]

But it is only reversed until someone goes back to their old ways of eating..... Even on basic LCHF most people can go back to having carbs often, just not all the time. The problem is when people eat to their meters so never burn off enough fat by being "just enough low carb to get a good reading".

PS, does anyone want to buy our old bread maker, the bread it makes is so nice that you will get Type2........

Of course your right bgs being good isn't a sign of IR reversal.
Maybe we need a new kind of meter?

 

[Oldvatr]

[QUOTE="Daibell, post: 1503326, member: 21149"......... It's obvious from many posts on the forum that GPs often just guess what medication e.g. if Metformin doesn't work then add Gliclazide and then insulin regardless of the patient in front of them, their weight, their diet and whether they have high or low natural insulin.[/QUOTE]
Don't blame the GP's. What you describe here is exactly what the diagnosis guidelines laid down by NICE say, and follows their treatment Flow Chart exactly. By following this recipe exactly the GP is protected from any malpractice litigation,

Edit to add: See Post #6 of this thread to see a copy of the relevant guidelines.

 

[AloeSvea]

[QUOTE="Daibell, post: 1503326, member: 21149"
Don't blame the GP's. What you describe here is exactly what the diagnosis guidelines laid down by NICE say, and follows their treatment Flow Chart exactly. By following this recipe exactly the GP is protected from any malpractice litigation,

If not litigation, then at least - following those conventional guidelines (not called NICE in other countries! Remember the www is global!) is what the doctor's performance is measured on. What they measure their own performance on.

And, of course, they really do want us to get well! I hope! .

I personally don't use medication, as by just monitoring how my body is responding not to medication but to diet and exercise I can truly see how my cells and organs are functioning, if IR is improving, what food and activity works, what doesn't. Medication usage does not provide for that.

But I completely understand others choosing to use medications. Different strokes for different folks etc etc etc.

 

[ickihun]

The key point is that Type 2 is caused by too much insulin in the body, so taking drugs to increase insulin or by injecting insulin you are making things worse, not better. Since 90% of type 2 diabetics are either overweight or obese, any increase in insulin which causes further weight gain can result in a higher risk of long term complications and shorter life expectancy.

But the point is that some have to use insulin treatment to stop high bgs damaging the body until the patient can be strong enough to fight back to improve their care. Most people who end up on insulin due to IR only are very ill/filled with circulating glucose which their own insulin isn't converting. That is why you get reviews on insulin therapy too. Things get worse and better.

 

[ringi]

Are you refering to the mix currently with metformin and victoza?

No firstly I don't like mixed drugs, they cost the NHS more then the separate drugs and give less control over how much someone takes.

Victoza stimulates insulin secretion and is therefore likely to increase insulin resistance but at least in the trails it did result in weight lose. It also seems to never reduce BG to too low a level even if someone eat no carbs on a given day. (It has to be injected every day.) In 10 years time we will know more about its long term risks/benefits.

 

[ringi]

Of course your right bgs being good isn't a sign of IR reversal.
Maybe we need a new kind of meter?

Yes we need a meter that measures insulin levels as well as BG levels, ideally automatically every 15 minutes and is cheap enough for the NHS to give to all of us. (We also need runways for all the pink pigs....)

 

[Chook]

Reducing and then coming off of

This is where I feel I'm going to get the best of both worlds. Bariatric surgery for supported 600cals (unless crazy and stupid enough to blend marsbars and the likes) and low carb lifestyle.
I'm doing half already and have done 600cals in the past for 8-9mths losing 7stones. Oh and of course the IR/diabetes I wasn't aware of.
I won't be cocky enough to say I-'ll do it but I will have a very good shot at it!

Just a thought.... I'm getting better results at the end of week 1 of Zero Carb than I did from the Blood Sugar Diet (600 cals/day) - which is basically eat as much as you like from meat, cheese, fish, water - but no plant based foods.

 

[Oldvatr]

The key point is that Type 2 is caused by too much insulin in the body, so taking drugs to increase insulin or by injecting insulin you are making things worse, not better. Since 90% of type 2 diabetics are either overweight or obese, any increase in insulin which causes further weight gain can result in a higher risk of long term complications and shorter life expectancy.

Actually in the early days of T2D, the insulin resistance stops glucose being burnt off in the muscle tissues, and it congregates in the bloodstream, leading to possible DKA. The insulin resistance ALSO puts up barriers to the glucose being stored in the same cells (for future use) so actually one symptom of T2D is weight loss, not gain. So yes, one way of treating T2D is to flood the body with insulin to force glucose past the IR barriers so it becomes usable and storable again. Whilst this is a bad policy long term, it does prevent the deadly DKA, so saves lives. Ultimately the pancreas goes into burnout, and then insulin becomes totally necessary. The weight that glucose 'puts on' due to storage is a mixture of glucogen + water, and so when we cut carbs and glucose by diet then we lose weight due mainly to water loss. This plateaus out but is not the real cause of metabolic syndrome, which is actually caused by storing lipids in the liver and adipose cells.

This lipid fat storage is often forgotten in the rush to reduce glucose levels, but the process also needs insulin for storage to occur, Thus T2D using meds to increase insulin to lower bgl are also promoting weight gain, especially around the midriff (a typical T2D profile), This increase fat around the liver and midriff in turn seems to make the IR worse, giving the NHS mantra that T2D is irreversible and progressive.
But people like Jason Fung are showing that LC diets and fasting are a valid means to reducing the IR, and lowering bgl without meds. Not everyone is able to come off meds completely, but many find they can significantly reduce their meds portfolio, which can lead to a sort of resolution. I am resolved, but cannot give up all my meds.

 

[grante]

An interesting article.
So, Fung agrees with my decision that staying on Metformin is actually beneficial, and rushing to be med free may not actually be the diabetic's holy grail?

But if you maintain healthy blood levels why take them ? I've recent seen my hda1c come down to 59 from 102 in 8weeks. I have stopped my Metformin and seen my bg level drop again.

Should I consider my self lucky that I have been prescribed metformin ?

 

[Hotpepper20000]

But if you maintain healthy blood levels why take them ? I've recent seen my hda1c come down to 59 from 102 in 8weeks. I have stopped my Metformin and seen my bg level drop again.

Should I consider my self lucky that I have been pescribed metformin ?

Metformin has other benefits it doesn't really reduce BG by much. My A1C has been 40 for the last year. And I will continue to take it.
For me it has been key in reducing PCOS symptoms.

 

[Art Of Flowers]

Metformin does seem to be beneficial for those with high blood sugar, however it does seem to have some serious side effects which make it advisable to not take it such as vitamin B12 deficiency causing memory loss and neuropathy. I was surprised that I was getting pins and needle sensations in my hand after my HbA1C had dropped from 99 to 59. I also started to get brain fog and memory problems. I reduced Metformin from twice a day to once a day and took B12 and Alpha Lipoic Acid which helped with the neuropathy and brain fog. I now have stopped taking Metformin and the pins and needles and brain fog have gone. See http://www.medscape.com/viewarticle/811546

Another problem I had with Metformin is that it caused me to get up in the middle of the height to pee. Before taking Metformin and after stopping taking it I was able to sleep right through. The fractured sleep pattern from Metformin made me more tired during the day. Having reduced my blood sugars through a LCHF diet and fasting, I think Metformin is no longer necessary for me.

 

[Brunneria]

Metformin has other benefits it doesn't really reduce BG by much. My A1C has been 40 for the last year. And I will continue to take it.
For me it has been key in reducing PCOS symptoms.

Absolutely. I've been trying to get prescribed Metformin for years - for the benefit is has on PCOS insulin resistance.
But my CCG (regional Clinical Commissioning Group) doesn't approve it for ppl with my HbA1c.