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How Important is OGTT?

BloodThirsty

BloodThirsty

Well-Known Member
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157
I take my hat off to this forum... one would be hard pushed to find another with such collective knowledge and intelligent discussion (and such nice people to boot).

Enough plaudits, and on to my question.

There are a considerable number of T2D's here who have achieved normal HbA1c levels and no longer on any medication whatsoever (@bulkbiker being a prime example).

In my own case, my sub 41 readings are controlled via LCHF and my BMI is 21.8.

Assuming that I continue the downward trajectory from 38 and sustain an HbA1c around 30, is it considered possible that given time my B cells might regenerate?

Secondly, how important is a normal OGTT response (currently untested) and would this be an important factor in considering myself in remission?

All opinions gratefully appreciated.
 
Type twos start off with an overproduction of insulin rather than lack of it - so for the lucky ones, just taking the strain off by eating low carb is enough to start a recovery - at least, that is what I think (hope) is my situation.
I can definitely eat more carbs than before and my BG level doesn't shoot up to the same extent, but I would not put it to the test by overdoing the carbs for even three days - or whatever the rules are for the OGTT. If I did eat over 50 gm of carbs a day - my longtime CCLL in Atkins speak - I would see my weight increase, so not going to happen.
The labeling of remission is somewhat problematic for me - I would not drive my car in a race or across country to see if it could do it, and in the same way I would not test my body on diets I would not wish to eat due to the damage it might do.
It is simply unnecessary.
 
BloodThirsty said:
I take my hat off to this forum... one would be hard pushed to find another with such collective knowledge and intelligent discussion (and such nice people to boot).

Enough plaudits, and on to my question.

There are a considerable number of T2D's here who have achieved normal HbA1c levels and no longer on any medication whatsoever (@bulkbiker being a prime example).

In my own case, my sub 41 readings are controlled via LCHF and my BMI is 21.8.

Assuming that I continue the downward trajectory from 38 and sustain an HbA1c around 30, is it considered possible that given time my B cells might regenerate?

Secondly, how important is a normal OGTT response (currently untested) and would this be an important factor in considering myself in remission?

All opinions gratefully appreciated.
Click to expand...

To be honest I'm unconvinced that we necessarily have lost our beta cells just that our liver and pancreas became less effective so the cells we had were impaired rather than dead. So far as I know there is no way of measuring how many we have or what they are doing until we're dead so I'm hoping to keep that particular piece of self experimentation on the back burner for a while.
I reckon that Prof Taylor (of Newcastle Diet fame) could be right when he says that NAFLD contributes greatly to the impairment of our insulin response so loosing visceral fat is key. Once that has gone our little Islets of Langerhans can get on with their day job quite happily.
I think that once that's been done most of our responses can "normalise" it just takes time. I guess I should do another non carbed OGTT to see what happens again but I may wait until the new year and see if I can get to my new desired weight target first then have another go. I was watching a young PhD student who works with Prof Noakes today who was saying that the OGTT really does show how much our T2 has been put into remission and that its not done often enough simply down to the time it takes at the surgery.. So I'm guessing if those guys think its important then it may well be.
 
Resurgam said:
Type twos start off with an overproduction of insulin rather than lack of it - so for the lucky ones, just taking the strain off by eating low carb is enough to start a recovery - at least, that is what I think (hope) is my situation.
I can definitely eat more carbs than before and my BG level doesn't shoot up to the same extent, but I would not put it to the test by overdoing the carbs for even three days - or whatever the rules are for the OGTT. If I did eat over 50 gm of carbs a day - my longtime CCLL in Atkins speak - I would see my weight increase, so not going to happen.
The labeling of remission is somewhat problematic for me - I would not drive my car in a race or across country to see if it could do it, and in the same way I would not test my body on diets I would not wish to eat due to the damage it might do.
It is simply unnecessary.
Click to expand...
Some very good points and I certainly understand why you would not wish to muck up a successful dieting regimen just to complete an OGTT.

I also take heart in the fact that your carb tolerance is improving which kind of supports my notion (and hope) that things might improve over time.

Back to the test itself... I understand that one can purchase a small sachet of glucose (or whatever) from the chemist which maybe causes just a short-term spike. I'm possibly wrong though as others have mentioned the need for some form of preliminary carbing (???).

Anyhow, thank you for your encouraging reply.
 
bulkbiker said:
To be honest I'm unconvinced that we necessarily have lost our beta cells just that our liver and pancreas became less effective so the cells we had were impaired rather than dead. So far as I know there is no way of measuring how many we have or what they are doing until we're dead so I'm hoping to keep that particular piece of self experimentation on the back burner for a while.
I reckon that Prof Taylor (of Newcastle Diet fame) could be right when he says that NAFLD contributes greatly to the impairment of our insulin response so loosing visceral fat is key. Once that has gone our little Islets of Langerhans can get on with their day job quite happily.
I think that once that's been done most of our responses can "normalise" it just takes time. I guess I should do another non carbed OGTT to see what happens again but I may wait until the new year and see if I can get to my new desired weight target first then have another go. I was watching a young PhD student who works with Prof Noakes today who was saying that the OGTT really does show how much our T2 has been put into remission and that its not done often enough simply down to the time it takes at the surgery.. So I'm guessing if those guys think its important then it may well be.
Click to expand...

Hi bulkbiker - Was the presentation you watched this morning on YouTube? If so, do you have the link to title please?

As you may recall, I did a non carbed-up OGTT a year or so ago, just out of curiosity really, so I'd like to listen to what's being said out there.
 
While I agree with what has been said above, I am somewhat pessimistic (I prefer to think of it as realistic).

Let’s say that a T2 loses weight and drops their HbA1c to perfectly normal levels.
This is fantastic. A truly wonderful achievement.
They may even be able to return to ‘normal’ carb levels and maintain their weight and blood glucose levels.
That is even more wonderful.

But... for how long? (my natural scepticism kicks in here)
Losing weight, regularising bg and taking an OGTT are so short term, aren’t they?

Here we have a person whose body has already shown a tendency to fail in bg control. They have a few decades still to live (hopefully), their beta cells have already been under strain, and may have made a recovery, a partial recovery.

The older they get, the more their beta cells... um... mature... the more susceptable they will be to future damage/overstrain/natural die off. Heck, maybe they just think ‘I am due an early retirement, after all that abuse!’

I guess I am saying that even if they return to adequate function, they still need to be treated with care. Tucked up warm with an electric blanket, and not asked to run marathons.

I hope you get what I am saying?

It makes me flinch when I read of people who ‘reverse’ their T2 and skip off merrily to eat ‘normally’. I just anticipate them using the revolving door back into T2 as their battered-but-hanging-on beta cells can only take so much and (in a month, a yeat, a decade) just give up the ghost.

Far better to treat them like pampered pwincesses, and ask them to do as little as possible. They will last much longer that way.
 
Brunneria said:
I guess I am saying that even if they return to adequate function, they still need to be treated with care. Tucked up warm with an electric blanket, and not asked to run marathons.
Click to expand...
I absolutely agree with this. Although I am now 'in remission ' my beta cells are very happy to be tucked up warm and not asked to run marathons. To stay in remission I have to stick to keto - maybe forever. If I up my carbs even a little they immediately protest and 'down tools and walk out '.

I was very lucky that I had some beta cell function left when I started low carb - but even if I had found low carb 10 or 15 years ago I don't think I would have maintained remission if I had gone back to my 'normal ' way of eating '. Sometimes l feel a little bit sad that I didn't find low carb and intermittent fasting all those years ago and do have to remind myself that I am lucky to have found it when I did, before my beta cells had reached the point of no return.
 
I think how people react to their remission/reversal or OGTT test is their own business, as only they will live with the consequences.

Personally, I had a very decent result from the OGTT - particularly bearing in mind I did it un-carbed, but I'm not fussed about altering my way of eating too much. I do eat more carbs than when I was in serious number reduction mode, but pasta? No thanks (although that's no change from before diabetes days). Bread? No thanks - can't have gluten now anyway. Potatoes? I have the odd chip, but don't feel inclined to go mad on them. Puddings? I just tend not to bother. It's over 5 years since I had a biscuit, and no plans to change that in the foreseable future.

That's my choice, but others choose differently.

Like Brunneria, I refer to the forum as having a revolving door. I don't mean that as an insult or negatively, but more that for those who choose to leave, for whatever reason, the revolving door allows them back any time they choose, for whatever reason.

This is a long haul, and I can never say never, because I just don't know what my future holds, and what I might have to contend with in the future.
 
Brunneria said:
While I agree with what has been said above, I am somewhat pessimistic (I prefer to think of it as realistic).

Let’s say that a T2 loses weight and drops their HbA1c to perfectly normal levels.
This is fantastic. A truly wonderful achievement.
They may even be able to return to ‘normal’ carb levels and maintain their weight and blood glucose levels.
That is even more wonderful.

But... for how long? (my natural scepticism kicks in here)
Losing weight, regularising bg and taking an OGTT are so short term, aren’t they?

Here we have a person whose body has already shown a tendency to fail in bg control. They have a few decades still to live (hopefully), their beta cells have already been under strain, and may have made a recovery, a partial recovery.

The older they get, the more their beta cells... um... mature... the more susceptable they will be to future damage/overstrain/natural die off. Heck, maybe they just think ‘I am due an early retirement, after all that abuse!’

I guess I am saying that even if they return to adequate function, they still need to be treated with care. Tucked up warm with an electric blanket, and not asked to run marathons.

I hope you get what I am saying?

It makes me flinch when I read of people who ‘reverse’ their T2 and skip off merrily to eat ‘normally’. I just anticipate them using the revolving door back into T2 as their battered-but-hanging-on beta cells can only take so much and (in a month, a yeat, a decade) just give up the ghost.

Far better to treat them like pampered pwincesses, and ask them to do as little as possible. They will last much longer that way.
Click to expand...
But doesn't this support the idea that excess carbs past a certain level may eventually lead to T2D in the population at large (witness the so-called diabetes epidemic)?

To revert to normal HbA1c levels without medication is certainly a challenging task and I would think that persons who achieve this would not readily return to the carb intake that got them to T2D in the first place.
 
BloodThirsty said:
But doesn't this support the idea that excess carbs past a certain level may eventually lead to T2D in the population at large (witness the so-called diabetes epidemic)?

To revert to normal HbA1c levels without medication is certainly a challenging task and I would think that persons who achieve this would not readily return to the carb intake that got them to T2D in the first place.
Click to expand...

If you are saying that the gen pop eats more carbs than their bodies can cope with, then yes. Been happening progressively for decades (poss since sugar became widely available in late 1700s, and then the widespread use of potato, and sugar beet, and changing dietary recommendations post WWII...
https://www.diabetes.co.uk/forum/threads/sugar-intake-increase-over-the-years.157076/

But IMO what is key is the understanding that we all have different tolerances (pancreas, beta cells, family genetics, insulin resistance, personal health histories, muscle mass, activity levels...) plus, once having been pre-D or D, we are at hugely increased risk of getting back there, esp with ageing ticking away in the background.

Weight regain is a hugely common experience after dieting. Often ending up heavier than before the diet.
https://www.psychologytoday.com/us/blog/smart-people-don-t-diet/201501/5-lies-the-diet-industry
I have seen significant numbers of forum members (I don’t want to name them) who have done the Newcastle Diet with the express intention of returning to a lifestyle of significant carb intake. Some have done yoyo dieting, eating carbs, regaining weight, then using ND shakes to slim down prior to Christmas Feasting, or cruise holidays, or similar. Not ideal, I think you will agree.
 
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Brunneria said:
If you are saying that the gen pop eats more carbs than their bodies can cope with, then yes. Been happening progressively for decades (poss since sugar became widely available in late 1700s, and then the widespread use of potato, and sugar beet, and changing dietary recommendations post WWII...
https://www.diabetes.co.uk/forum/threads/sugar-intake-increase-over-the-years.157076/

But IMO what is key is the understanding that we all have different tolerances (pancreas, beta cells, family genetics, insulin resistance, personal health histories, muscle mass, activity levels...) plus, once having been pre-D or D, we are at hugely increased risk of getting back there, esp with ageing ticking away in the background.

Weight regain is a hugely common experience after dieting. Often ending up heavier than before the diet.
https://www.psychologytoday.com/us/blog/smart-people-don-t-diet/201501/5-lies-the-diet-industry
I have seen significant numbers of forum members (I don’t want to name them) who have done the Newcastle Diet with the express intention of returning to a lifestyle of significant carb intake. Some have done yoyo dieting, eating carbs, regaining weight, then using ND shakes to slim down prior to Christmas Feasting, or cruise holidays, or similar. Not ideal, I think you will agree.
Click to expand...
You are so right!

It probably all boils down to degrees of carb intolerance and we may be all some way along the carb intolerance spectrum.

Remember, you heard it here first.
 
BloodThirsty said:
You are so right!

It probably all boils down to degrees of carb intolerance and we may be all some way along the carb intolerance spectrum.

Remember, you heard it here first.
Click to expand...

Sorry, I've been diagnosed as carb intolerant over four years ago!
But it is still not recognised as a condition itself!
And it's not only carb intolerance but insulin response and hormones!
And, it's never as straightforward as everyone is completely different to how their metabolism works because of the millions of bacteria in your gut.
And the more you learn, you realise, the less you know!

Happy thoughts!
 
Lamont D said:
Sorry, I've been diagnosed as carb intolerant over four years ago!
But it is still not recognised as a condition itself!
And it's not only carb intolerance but insulin response and hormones!
And, it's never as straightforward as everyone is completely different to how their metabolism works because of the millions of bacteria in your gut.
And the more you learn, you realise, the less you know!

Happy thoughts!
Click to expand...
I take your point but I was being flippant.
In my clumsy way I was trying to say that carbs are the source of all evil - nah, maybe not.
 
BloodThirsty said:
You are so right!

It probably all boils down to degrees of carb intolerance and we may be all some way along the carb intolerance spectrum.

Remember, you heard it here first.
Click to expand...

So a bit more flippancy.

People taking heroin develop a tolerance, so take higher doses. It's a hard habit to break and there may be many temptations to relapse.

Or once someone's kicked the habit, they stay quit and have a healthier life.

For me, it's easy to replace heroin with carbohydrates. Getting diagnosed T2 was a wake-up call that I had a carb addiction and needed to kick that habit. For me, it would also seem sensible to stay clean and keep to a reduced carb intake, especially given all the temptations surrounding me to start chasing the carbs again.

Luckily my willpower has been holding up, partly I think due to having a monthly 'cheat' day, or treat day where I'll treat myself to some nice fresh bread, or egg & chips.. Which on the plus side means my treats are also cheap. But given the potential for self-harm, I don't want to get hooked on carbs again.
 
first14808 said:
So a bit more flippancy.

People taking heroin develop a tolerance, so take higher doses. It's a hard habit to break and there may be many temptations to relapse.

Or once someone's kicked the habit, they stay quit and have a healthier life.

For me, it's easy to replace heroin with carbohydrates. Getting diagnosed T2 was a wake-up call that I had a carb addiction and needed to kick that habit. For me, it would also seem sensible to stay clean and keep to a reduced carb intake, especially given all the temptations surrounding me to start chasing the carbs again.

Luckily my willpower has been holding up, partly I think due to having a monthly 'cheat' day, or treat day where I'll treat myself to some nice fresh bread, or egg & chips.. Which on the plus side means my treats are also cheap. But given the potential for self-harm, I don't want to get hooked on carbs again.
Click to expand...
I am fortunate inasfar as I am an all or nothing bloke. I can't spell moderashun so I don't do it.

For instance, I cannot have just a glass or two of wine. If I open a bottle I will finish it (and possibly another if at hand) so I would rather go without than feel deprived with half measures.

When I was first diagnosed pre-diabetic my GP took all my vital statistics and then asked me how much I drank. At that time I drank for Devon and admitted to 74 units per week, but advised her not to double it (imbibers inevitably wildly underestimate) as I was being totally honest.

She reflected for a moment and then informed me that I was on the verge of type 2 diabetes and it was due to one thing.

I prepared myself for "It's the demon drink" but instead she said "You're three stone overweight".
A choir of angels appeared behind her singing the Hallelujah Chorus.
Somewhat pushing it I asked "What about the drinking then?"
I wished I hadn't asked. "If you expect to lose three stone drinking the amount you do you're jolly well mistaken!"

I retell the story merely to illustrate my character and explain why it is easier for me to stick rigidly to an LCHF diet than attempt moderashun.
 
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