https://www.dietdoctor.com/most-amazing-type-2-diabetes-reversal-ever
Maybe not everyone will get such stunning results but it has to be worth a try..
Maybe not everyone will get such stunning results but it has to be worth a try..
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For the newbies out there
- Thread starter bulkbiker
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douglas99
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Hope there was no retinopathy when they went down that fast.
Impressive, but not always the wisest thing to do.
Maybe it's time they stopped trying to outdo each other with unsuspecting patients, as it seems to be a bit of a game from what he's saying?
Impressive, but not always the wisest thing to do.
Maybe it's time they stopped trying to outdo each other with unsuspecting patients, as it seems to be a bit of a game from what he's saying?
Says the man who did an 800 calories a day diet?
douglas99
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Only after I'd done the research, slowly got my hba1c down by a classic low fat NHS diet, lost some weight, then I did the Newcastle diet to actually properly reverse the diabetes.
Overall, a much slower process to bring down my BG for me.
It seems to be a bit of a race for some, which isn't good generally.
Newbies need to be aware of that.
Overall, a much slower process to bring down my BG for me.
It seems to be a bit of a race for some, which isn't good generally.
Newbies need to be aware of that.
If (as you claim) reducing HbA1c rapidly causes retinopathy, then please produce evidence to support your argument.
Otherwise you just look as if you are trying to derail a positive, upbeat thread with unsubstantiated warnings of doom.
The idea that rapid reductions in bg sends people blind is one that is occasionally mentioned, but I have not yet seen anyone bring out reputable studies that show the (slightly increased) risk of developing retinopathy (within a specific and relatively short timescale) outweighs the (highly increased) risk of developing any and all diabetic complications for the duration of the raised blood glucose, and for years afterwards.
Please douglass99, produce those studies, and let us discuss them.
(@bulkbiker hope you don't mind the derailment? Only this is obviously something that bothers douglas99, and it seems only right that his concerns are laid to rest. We could make it another thread, if you liked, to save derailing this one further?)
Not at please carry on
Well I would have thought that the two DOCTORS who had these patients in their care had also done their research?
douglas99
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As you rightly say, it is a subject that does come up time and again when rapid decrease of hba1c is mentioned.
I would think it far better that you provide absolute proof for reassurance of newbies de-bunking the 'scaremongering' to put their minds at ease?
Otherwise it seems slightly petty to put them in even the slightest possibly of harms way?
Or let's leave it out there, and let newbies make up their own minds?
I'm sure they are intelligent enough.
So you don't have any evidence for your claim?
douglas99
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As I guess you want to use newbies as guinea pigs, I'll throw you a bone, so you can disprove it with your evidence.
Alternatively, maybe you'll prefer to help them keep their sight if you can't?
http://www.diabeticretinopathy.org.uk/retinopathyprogression.htm
Site maintained by David Kinshuck (Good Hope Hospital Eye Department)
He would be very interested in any proof you have he is wrong.
david.kinshuck @ heartofengland.nhs.uk
Last edited:
@douglas99
I think you have misunderstood. There is no need for me to trot out evidence of anything. You are the one that made unsubstantiated claims, and the one who has, so far, only produced one link intended to support your claim.
The link you have produced is to a website and an article that I have already seen, and I don't think you can have read it thoroughly, or you would not be using it.
These are exact quotes taken from that webpage:
Once background retinopathy develops, unless diabetic control is improved as below, the retinopathy will deteriorate, laser will be needed, and even with laser sight may be affected.
Please note that the first thing on the list is high blood glucose. Then high blood pressure, then high cholesterol. These risks are listed above sudden improvement of blood glucose control.
Further down the page, another quote (my bold):
Good diabetic control is essential in the long term, but unfortunately in the short term may cause a rapid deterioration in retinopathy. A lot of laser may be needed, and usually stabilises the condition.
So, the writer is mentioning rapid, extreme blood glucose improvements as the 6th least likely cause for a rapid deterioration in pre-existing retinopathy, but which may need treatment, and which responds well to that treatment.
Then, further down the page (using pregnancy as an example):
A 3% drop in HbA1c may increase the progression rate for 1-3 years. But after 3-4 years of good control, progression rates drop significantly (lilac line). In the long term, good control causes much less progression.
(a 3% drop in HbA1c is approximately equivalent to lowering from 100 to 65 mmol/l as used in the UK)
Then again:
A sudden improvement of control, perhaps with a 3% HbA1c drops, causes an increase in retinopathy progression for 1-3 years.
After 3-4 years of very good control retinopathy usually stops progressing completely and most patients will never need laser again (our patients are discharged back to the retinopathy screening service).
And (using blood pressure as the example):
If blood pressure rises, as may happen if renal failure starts or a patient stops their blood pressure medication, the retinopathy starts to progress more quickly.
So, the examples he uses are blood pressure and pregnancy, and he states that most patients are stabilised and discharged after treatment. A good result then, over time.
Interestingly, if the retinopathy is worsening as a result of improved control (whether by stopping smoking, blood pressure, cholesterol or HbA1c), his suggestion is for them to get their eyes checked every 3-4 months, to see if laser is needed. He certainly doesn't suggest people stop improving their control.
He also states (my bold):
It is probably safer to lower the HbA1c gradually, over a year if necessary, as below. There is no hard evidence that this will help, but logical argument.
and
Prof Harding recommends (2011, Manchester) dropping the HbA1c gradually at the rate of 1% a year. But this seems too gradual to me. We know from the DCCT study that good control helps in the long term, so why delay good control so long? However, by dropping the HbA1c quicker than this does result in progress on of retinopathy, and some patients do develop severe macular problems and sight is not so clear. Nevertheless I think it is preferable to accept this rather than delaying good control several more years.
So, it is pretty clear that there is a somewhat increased risk that pre-existing retinopathy may worsen as a result of rapid reduction of HbA1c. That was never in doubt, and is fairly well documented.
However, it is equally clear that this writer thinks the best option to deal with the problem is to monitor the situation and laser the eyes, if necessary, and that the benefits of improved control outweigh the negatives of not improving the control. He encourages good control throughout the article, and suggests that careful monitoring is better than not achieving good control, and that gaining good control should not be slowed down too much, because of the risks involved in bad control.
- which is exactly what I said in my first post in this thread.
So thank you for producing a link that supports my point of view
I think you have misunderstood. There is no need for me to trot out evidence of anything. You are the one that made unsubstantiated claims, and the one who has, so far, only produced one link intended to support your claim.
The link you have produced is to a website and an article that I have already seen, and I don't think you can have read it thoroughly, or you would not be using it.
These are exact quotes taken from that webpage:
Once background retinopathy develops, unless diabetic control is improved as below, the retinopathy will deteriorate, laser will be needed, and even with laser sight may be affected.
- glucose level/HbA1c, linear relationship with retinopathy progression
- blood pressure, linear relationship
- lipid level, probably a near linear relationship
- smoking, probable linear relationship (some work suggests 20 cigarettes a day triples/quadruples retinopathy, others less so)
- pregnancy may cause a rapid deterioration
- sudden improvement (lowering to normal) of glucose levels in a person whose diabetes has been poorly controlled for sometime see and here .
Please note that the first thing on the list is high blood glucose. Then high blood pressure, then high cholesterol. These risks are listed above sudden improvement of blood glucose control.
Further down the page, another quote (my bold):
Good diabetic control is essential in the long term, but unfortunately in the short term may cause a rapid deterioration in retinopathy. A lot of laser may be needed, and usually stabilises the condition.
So, the writer is mentioning rapid, extreme blood glucose improvements as the 6th least likely cause for a rapid deterioration in pre-existing retinopathy, but which may need treatment, and which responds well to that treatment.
Then, further down the page (using pregnancy as an example):
A 3% drop in HbA1c may increase the progression rate for 1-3 years. But after 3-4 years of good control, progression rates drop significantly (lilac line). In the long term, good control causes much less progression.
(a 3% drop in HbA1c is approximately equivalent to lowering from 100 to 65 mmol/l as used in the UK)
Then again:
A sudden improvement of control, perhaps with a 3% HbA1c drops, causes an increase in retinopathy progression for 1-3 years.
After 3-4 years of very good control retinopathy usually stops progressing completely and most patients will never need laser again (our patients are discharged back to the retinopathy screening service).
And (using blood pressure as the example):
If blood pressure rises, as may happen if renal failure starts or a patient stops their blood pressure medication, the retinopathy starts to progress more quickly.
So, the examples he uses are blood pressure and pregnancy, and he states that most patients are stabilised and discharged after treatment. A good result then, over time.
Interestingly, if the retinopathy is worsening as a result of improved control (whether by stopping smoking, blood pressure, cholesterol or HbA1c), his suggestion is for them to get their eyes checked every 3-4 months, to see if laser is needed. He certainly doesn't suggest people stop improving their control.
He also states (my bold):
It is probably safer to lower the HbA1c gradually, over a year if necessary, as below. There is no hard evidence that this will help, but logical argument.
and
Prof Harding recommends (2011, Manchester) dropping the HbA1c gradually at the rate of 1% a year. But this seems too gradual to me. We know from the DCCT study that good control helps in the long term, so why delay good control so long? However, by dropping the HbA1c quicker than this does result in progress on of retinopathy, and some patients do develop severe macular problems and sight is not so clear. Nevertheless I think it is preferable to accept this rather than delaying good control several more years.
So, it is pretty clear that there is a somewhat increased risk that pre-existing retinopathy may worsen as a result of rapid reduction of HbA1c. That was never in doubt, and is fairly well documented.
However, it is equally clear that this writer thinks the best option to deal with the problem is to monitor the situation and laser the eyes, if necessary, and that the benefits of improved control outweigh the negatives of not improving the control. He encourages good control throughout the article, and suggests that careful monitoring is better than not achieving good control, and that gaining good control should not be slowed down too much, because of the risks involved in bad control.
- which is exactly what I said in my first post in this thread.
So thank you for producing a link that supports my point of view
douglas99
Well-Known Member
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- Type of diabetes
- I reversed my Type 2
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I don't feel the need to compete, but I'm glad you're happy if you feel you have scored points somehow.
Anything to help others feel good about themselves!
As for the information, it's out there for the newbies, knowledge where it belongs, troubling though it may be to some.
(You missed a bit of bold by the way. I don't feel I need to edit the original author personally, so I'll leave it as he wrote it.
'However, by dropping the HbA1c quicker than this does result in progress on of retinopathy, and some patients do develop severe macular problems and sight is not so clear.' )
Anything to help others feel good about themselves!
As for the information, it's out there for the newbies, knowledge where it belongs, troubling though it may be to some.
(You missed a bit of bold by the way. I don't feel I need to edit the original author personally, so I'll leave it as he wrote it.
'However, by dropping the HbA1c quicker than this does result in progress on of retinopathy, and some patients do develop severe macular problems and sight is not so clear.' )
Hiitsme
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- Diet only
http://www.diabetes.co.uk/diabetes-complications/diabetic-retinopathy.html
People with diabetes should, however, be aware that a rapid improvement in blood glucose levels can lead to a worsening of retinopathy. A rapid improvement in blood glucose levels in this case is defined as a drop in HbA1c of 30 mmol/mol or 3%.
I have background retinopathy but I only read this after I knew. I was only given 3 months by GP to get control so tried to work too quickly as I didn't know any better.
I found a shorter explanation at the same site:-
http://www.diabeticretinopathy.org.uk/prevention/hba1c_and_retinopathy.htm#sudden
Sudden improvement in your control
If you suddenly improve control and your HbA1C drops the retinopathy may need laser treatment. The benefits of an HbA1C drop, say from 53-75mmol/l (9 to 7%), are long term. The retinopathy may actually deteriorate in the short term, and so require laser. If this is difficult to understand, ask your ophthalmologist to explain.
After two-three years however, assuming you have any laser that may be necessary, you will be better off and the retinopathy will be less active than it would otherwise have been.
A friend on this forum gave me this link a while back when I was worried about the risks of dropping BGs too quickly. He reassured me that lowering the BG was the most important thing even if there was exisitng retinopathy that wasn't known about. The longterm benefits of lowering the HbA1c by far outweigh the short term risks.
http://www.diabeticretinopathy.org.uk/prevention/hba1c_and_retinopathy.htm#sudden
Sudden improvement in your control
If you suddenly improve control and your HbA1C drops the retinopathy may need laser treatment. The benefits of an HbA1C drop, say from 53-75mmol/l (9 to 7%), are long term. The retinopathy may actually deteriorate in the short term, and so require laser. If this is difficult to understand, ask your ophthalmologist to explain.
After two-three years however, assuming you have any laser that may be necessary, you will be better off and the retinopathy will be less active than it would otherwise have been.
A friend on this forum gave me this link a while back when I was worried about the risks of dropping BGs too quickly. He reassured me that lowering the BG was the most important thing even if there was exisitng retinopathy that wasn't known about. The longterm benefits of lowering the HbA1c by far outweigh the short term risks.
Indy51
Expert
I'm assuming that doctors test their patients for retinopathy as part of their initial diagnosis, but maybe I'm wrong? Isn't it part of the standard testing?
Bluetit1802
Legend
We are put on an annual retinal screening check when diagnosed. It is hit and miss when the first of these happens, but then it is every 12 months after that.
Yes,
the key things seem to be that rapid improvement in bg control may worsen existing retinopathy. Therefore monitoring and treatment (if necessary) should be offered.
However, if there is no pre-existing retinopathy, then improving control won't worsen what isn't there.
And if retinopathy does worsen, over the long term, with appropriate treatment and continued bg control, the patient is better off in the long run than if that control had not been achieved.
How are your eyes now?
Dark Horse
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The National Standards say that the first screening should be within 3 months of diagnosis. If this hasn't happened, people should contact their GP to ask why.
Dark Horse
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There is a discussion about effect of rapid HbA1c reduction on retinopathy in the DCCT trial here:- http://www.medscape.com/viewarticle/452955
It says:
"Early worsening of retinopathy occurred in 13.1% of 711 patients assigned to intensive treatment and in 7.6% of 728 patients assigned to conventional treatment. Nevertheless, after 18 months this early worsening in retinopathy reversed, and patients in the intensive-treatment group fared better than those on conventional therapy. Risk factors for early worsening were higher hemoglobin A1c level at baseline and reduction of this level during the first 6 months following randomization. There was no evidence that a gradual reduction in A1c levels reduced the risk of early worsening."
It says:
"Early worsening of retinopathy occurred in 13.1% of 711 patients assigned to intensive treatment and in 7.6% of 728 patients assigned to conventional treatment. Nevertheless, after 18 months this early worsening in retinopathy reversed, and patients in the intensive-treatment group fared better than those on conventional therapy. Risk factors for early worsening were higher hemoglobin A1c level at baseline and reduction of this level during the first 6 months following randomization. There was no evidence that a gradual reduction in A1c levels reduced the risk of early worsening."
