Is T1 diabetes preventable?

[Ian DP]

You have my sympathies, but there is a reason scientists bother with large studies - because one case study is completely irrelevant.

That is incorrect - if beta cells were holding static, you'd be lying in hospital in same state you were first diagnosed in. For you to have better BG than when you were diagnosed, you're beta cells would have to a have improved.

Which is of course exactly what you'd expect from a t1 diabetic going through honeymoon, but don't let that stop you from sending this case study to Stockholm - I'm sure you'll have your Nobel price in medicine by Christmas.

If you are still insulin-free in 5years, then we might have something to to talk about.

I don't think I am unique, Dr Bernstein has many, maybe hundreds or thousands of patients like myself. Some forecasters believe that around 10% of T2s are LADA, this means there could be more LADA's than T1s.

I don't understand. I am not saying you are wrong, just don't understand. I am sure I have fewer insulin making beta cells now than 4 months after diagnosis. 4 months after diagnosis (no insulin or meds) I was still eating bread, pasta and rice (in line with NHS guidelines) and my pre breakfast BG levels were around 6.0. No way could I still eat bread, rice and pasta now, I would be in double figures for sure, probably back in hospital!. Only through gradually reducing carbohydrates have I been able to keep my BG levels stable, this therefore makes me think during that time my beta cells were still decaying. Only in the last 5 months, since being on Dr Bernstein's diet, has my carbohydrate intake been constant, and with it my BG levels. This as forecast by Dr Bernstein in his book. Dr Bernstein says that with 'normal' BG levels he has experienced patients that have stayed in the 'honeymoon' period for ever, preserving all remaining beta cells for ever, and he has even seen some patients beta cells regrow. I do not think my beta cells have improved over the last 5 months, just stayed the same.

I doubt that I will be insulin free in 5 years time. I have already seen my BG levels rise considerably when I had the noro virus a few months back. Something almost for sure will increase my BG levels, and for sure I will be taking insulin as soon as they rise above 7.0 in the morning.

Maybe LADA's are different to T1s, but I see that most T1s diagnosed in later life seem to go through the LADA stage.

..... And I still believe that had I been on a LCHF diet before diagnosis I would not be diabetic now, simply because the LCHF diet would have kept my BG levels down. Nobody's fault, not anyone to blame, I was before diagnosis on a very healthy low fat diet, lots of fruit, very little fatty meat... Unknowingly lots of carbs, I didn't even know what carbs were!!!

 

[Ian DP]

Ian, I see you are down as Type 1 ( LADA ) since Dec 2013, so that, surely is not the same as a 'type 1'
[/SIZE]

Mr consultant said I was LADA (through a GAD test) in dec 2013. My nurse, reading through my hospital notes a few months back said I was T1 in the honeymoon period, no mention of LADA on my medical record at all!!! NHS / Drs in the UK seem to have two categories only T1 and T2. But I agree completely, LADA is not the same as T1, probably an early progression towards T1.

 

[Ian DP]

When you are diagnosed you have already lost a great deal of your beta cell function.(see diagram below)
How much depends on where in the process that you are diagnosed. They know that there is a pre diabetes period even in children. The autoimmune response causes the bodies own immune system to kill off the beta cells as if they are invaders. Glucose levels rise and there is a period, longer or shorter (depending on how quickly the destructive process ) during which there is too much glucose in the blood This results in glucotoxicity which may itself kill off cells or at least stop them functioning properly.....

Sadly, once killed, even if we do regenerate a few cells and the juries out on if that is even possible after the age of about 30, it is very few.

I can relate to this completely. And thanks for the very informative info and chart.

My point being, in my very short experience, once BG levels are low (normal) beta cells do not seem to degenerate any further. Thus if one had low (normal) BG levels, beta cells would not degenerate, and it is a pretty much accepted fact that low carb intake keeps BG levels low, or at least lower than a high carb intake, even with people that are non diabetic. Thus at the point in time that the autoimmune kicks in and attacks beta cells, had we been at lower sugar levels it would not have happened, thus we could have delayed the onset.

Since diagnosis (over a year ago) I have seen my beta cells slowly degenerate (ever decreasing carbs to keep BG levels constant). But since being on Dr Bernstein's 'normal' BG levels (for the last 5 months), my BG levels have stayed the same and my carb intake and weight are the same. I can only conclude, in this very short period of time, that my beta cells have not deteriorated over this 5 months. This non destruction of beta cells at normal BG levels is pretty much an accepted fact in Dr Bernstein's book.

 

[phoenix]

Many people with LADA avoid insulin for a period of time (indeed the present definition normally includes not needing insulin for at least 6 months after diagnosis). The median time in a London centre from diabetes diagnosis diagnosis to first insulin use in people eventually found to be GADA positive was 47 months (range 29.5-64.8) The London centre had the longest period of diagnosis to insulin. At the time of the study, they did not test for GADA anitbodies at the initial diagnosis of atypical older people. Countries that tested at diagnosis tended to have people starting to use insulin at an earlier stage. http://care.diabetesjournals.org/content/31/3/439.full.pdf

I don't think anyone really knows whether the autoimmune reaction causes a steady loss or a more 'spiky one. They may find out in the future after studying children with the genetic susceptibility. Anecdotally, I do think that it seems that people with LADA have a relatively 'spiky' loss and my own definitely seemed that way . . I imagine it may depend on the trigger and how big a reaction it causes at any one time . There are a number of candidates for triggers and there are probably more than one. (my favourite is the coxsackie B virus but that's because it fits in with my profile . There;s no way for me that other candidates like having cows milk early fit the bill (I was breastfed and it seems unlikely that it would take 50 years to cause a reaction in any case)
Coxsackie B was a virus that I would have encountered often as a teacher Maybe lots of low grade reactions to it eventually causing a threshold to be tipped. But, it's just my own bit of speculation.

 

[Ian DP]

Many people with LADA avoid insulin for a period of time..........Countries that tested at diagnosis tended to have people starting to use insulin at an earlier stage. http://care.diabetesjournals.org/content/31/3/439.full.pdf

Thanks Phoenix, An interesting report, but it also raises more 'time process' questions, which I guess can only be answered with more trials. Eg
1). What were the patients BG levels when they went on insulin as this would effect the time process?... I guess this could be anything between 7 and 20, depending on patient and Dr.
2). What diets were patients on and did these have any effect in the time process?
3). What effect does the GAD reading have on the time process?. Mine was very high (over 2000).

If I had not requested a GAD test I would probably still be down as T2!. Interesting that around 10% of T2s tested were GAD positive.

 

[Emmotha]

I'm type 1 in honeymoon. I don't need bolus insulin when I low carb. You said yourself that ur levels go up if u increase ur carbs so how could you possibly know u're beta cells are not being destroyed?

I don't really know about LADA, it is type 1 it just means it was identified before too many cells are killed off, but u have the antibodies that will continue to destroy the beta cells until u don't have enough cells to manage without medicine.

Lots of T1s in their honeymoon suddenly think they're cured, but sadly no. It's the antibodies which break the pancreas down.

You couldn't have prevented the antibodies but u can manage on low carb without medication for as long as poss.

 

[Lesleywo]

If you have GAD antibodies, will they increase or decrease? I had a blood test for GAD antibodies 3 years ago and reading was 516. Just wondered if this is likely to change. I am getting tested again before next visit to endo, as well as C-peptide, but this was at my request. Any thoughts, anyone?

 

[Ian DP]

.......You said yourself that ur levels go up if u increase ur carbs so how could you possibly know u're beta cells are not being destroyed?
.

Over the last 5 months with very little carb intake and weight change my BG levels have been very much constant (my average pre breakfast BG readings have been under 5 and my average 2hr after meal testings have been under 6).

Since diagnosis a year ago, and until the last 5 months, I was constantly reducing carbs (from probably around 200g to 36g) in order to keep BG constant (at around 6.0 fasting and 7.0 2hr after eating)

This makes me conclude that I have as many beta cells now as 5 months ago, but fewer than when I was first diagnosed. Thus at this moment in time, my bet a cells are no longer being destroyed, which I can put down to the fact that my BG levels are constantly low.

And thus, were I on my present diet, with low BG levels, before diagnosis I would not be diabetic...... Simply because I had, for sure, more beta cells then, than now.

 

[Ian DP]

If you have GAD antibodies, will they increase or decrease? I had a blood test for GAD antibodies 3 years ago and reading was 516. Just wondered if this is likely to change. I am getting tested again before next visit to endo, as well as C-peptide, but this was at my request. Any thoughts, anyone?

Interesting question.... No idea of the answer. Mine were 2000+ on testing. Anything over around 70 indicates T1. I would love to know what they are now, but know the NHS will not fund a second, and paying out around £400 for the test is too much.

 

[Emmotha]

Over the last 5 months with very little carb intake and weight change my BG levels have been very much constant (my average pre breakfast BG readings have been under 5 and my average 2hr after meal testings have been under 6).

Since diagnosis a year ago, and until the last 5 months, I was constantly reducing carbs (from probably around 200g to 36g) in order to keep BG constant (at around 6.0 fasting and 7.0 2hr after eating)

This makes me conclude that I have as many beta cells now as 5 months ago, but fewer than when I was first diagnosed. Thus at this moment in time, my bet a cells are no longer being destroyed, which I can put down to the fact that my BG levels are constantly low.

And thus, were I on my present diet, with low BG levels, before diagnosis I would not be diabetic...... Simply because I had, for sure, more beta cells then, than now.

I don't think that's true. You wouldn't know if u're cells are being destroyed above the carb threshold that u have. You obv dropped below a point that ur beta cells can still maintain. It will only be when u don't have enough cells left for what u currently eat that u will know.

Ur diet would never have stopped the antibodies killing ur beta cells. On the diet u r on now u just wouldn't know yet because u still have enough beta cells to maintain that.

 

[phoenix]

@Ian DP
I'm sure that in many cases time to insulin will depend on the doctor. They do have another tool though in Cpeptide testing. In one prospective study, those with two or three different types of antibodies had a faster deterioration with minimal C peptide at 5 years. those with only GAD or ICAs took longer. There are some interesting comparisons with people who had been diagnosed as T1 at onset. They don't say anything about the large the antibody titres are.
All the studies I've found before say that the larger the amount the quicker the deterioration but until recently the studies mostly use arbitrary units ( and definitions of LADA) so you really don't know what you are comparing .http://diabetes.diabetesjournals.org/content/54/suppl_2/S68.full.pdf html

GAD anti bodies persist but fluctuate for up to 12 years with LADA http://paperity.org/p/21808155/gad-...-persist-after-diagnosis-in-latent-autoimmune

I've just found an excellent doctoral thesis.. The actual research is very specific but the initial literature review section helps to show what is and isn't known about antibodies and T1 and LADA so is worth reading .(section 2.3 is about GADA
https://helda.helsinki.fi/bitstream/handle/10138/37943/type1fam.pdf?sequence=1

 

[Ian DP]

Thanks again Phoenix? Very interesting studies. I have picked out a few points I found interesting below, but I note of most interest the absence of a mention to low BG levels in patients. Lots and lots of variables within patients studied, but not BG level variances.... I wonder why, could it be because the pharmesutical industry know the best way of lowering BG levels is a low carb diet, and there is no financial gain for them in this method!

I wish I had put this thread in the LADA section. It is obviously more LADA orientated than general.

* LADA is not a latent disease. We suggest autoimmune diabetes in adults with slowly progressive beta cell failure (ADASP).

* LADA, although an autoimmune disease, differs from Type 1 diabetes, and has a genetic profile that includes genes also found in people who develop Type 2 diabetes

* No association of GADA levels with disease progression or insulin requirement was observed.

* A one-time screening in the general childhood population in Finland identified 43 to 50% of the individuals who will develop Type 1 diabetes in the next 27 years

 

[Ian DP]

I don't think that's true. You wouldn't know if u're cells are being destroyed above the carb threshold that u have.

But surely I would know, if my carb intake and weight are both stable (which they are) and my BG levels are stable (which they are) my beta cell ability to make insulin must be stable, if they were degenerating my BG levels would rise or I would be loosing weight.

 

[Emmotha]

But surely I would know, if my carb intake and weight are both stable (which they are) and my BG levels are stable (which they are) my beta cell ability to make insulin must be stable, if they were degenerating my BG levels would rise or I would be loosing weight.

They may well start rising at some point. But as I've dramatically reduced ur carbs u have no way of knowing if they're being destroyed or how quickly. They could have been slowly being destroyed ur whole life. To say type 1 can be prevented by diet is not plausible. Ur diet would never ever stop the antibodies killing off beta cells. Whether diet can slow it down, maybe, but they would still be destroying them

 

[phoenix]

Sorry Ian, I don't buy into the pharma conspiracy. If anything pharma has looked for ways of stopping the autoimmune reaction or at least delaying it . Though that was not 'big' pharma but very small pharma. Most studies into LADA originate from academic research centres

.Why do you think a low carb diet would be the answer now when it wasn't 100 years ago?

You might be interested in this account of a 29 year old man diagnosed in 1909 who treated his diabetes with diet because there was nothing else. He was successful surviving for 14 years on a series of various very restrictive diets He doesn't appear though to have had a very good quality of life and he became skeletal
He became one of the first British people to receive insulin. The writers, his great grandchild and grandchild suggest that this might have been a case of LADA
His first diet was indeed low carb and high fat but with his health 'slowly deteriorating' he went on to the Allen starvation diet and then other versions of very low calorie diets.
After going onto insulin he survived another 45 years dying 88 with no complications
http://link.springer.com/article/10.1007/s00125-007-0641-0

 

[tim2000s]

I don't buy in to the idea that t1 is preventable either. I suspect that in the case of 1.5 there are multiple things going on and that while it might be possible to reduce loss of beta cells attributable to high glucose levels, antibodies WILL win eventually.

As there are no studies it is hard to determine which mechanism is the most influential in the onset of LADA or early onset t1, and given when early onset t1 is diagnosed it is too late, you'd need a population study to find out.

 

[Ian DP]

Why do you think a low carb diet would be the answer now when it wasn't 100 years ago?

/

There is a lot of statistics that say it was successful 100 years ago. We know that the number of people that were diabetic 100 years ago was much less than now, and far more people 100 years ago were on low carb high fat diets, probably most people..... But I think more importantly than low carb is low blood sugar levels..... It just so happens that most of us find low carb reduces our BG levels. The real key being low (normal) blood sugar levels.

Getting back to my original question, if we had had 'normal' blood sugar levels prior to diagnosis, could we have deferred diagnosis..... None of us will know, because we don't know our BG levels prior to diagnosis.

LADA onset does seem to be different to T1 onset, so maybe LADA onset could be deferred with low blood sugar levels, but T1 can't. I can only relate to my own short term experience, where, after having kept my BG levels at 'normal' levels for 5 months I can see no degeneration of my beta cells, whereas I could before when my BG levels were higher..... And that is what still make me think that had I had 'normal' blood sugar levels (achievable through low carb) prior to diagnosis I would not have been diagnosed..... Thus it is could have been deferrable.

Don't you think that if the world population were to go back to having lower BG levels (through lower carb eating) diabetes onset would be reduced?

 

[Ian DP]

http://download.springer.com/static/pdf/762/art%3A10.1007%2Fs00125-007-0641-0.pdf?auth66=1417889105_4892b3a68e31ade3decb1a82e895bf19&ext=.pdf

Sounds interesting, but I can't open the link

 

[Ian DP]

I don't buy in to the idea that t1 is preventable either. I suspect that in the case of 1.5 there are multiple things going on and that while it might be possible to reduce loss of beta cells attributable to high glucose levels, antibodies WILL win eventually.

As there are no studies it is hard to determine which mechanism is the most influential in the onset of LADA or early onset t1, and given when early onset t1 is diagnosed it is too late, you'd need a population study to find out.

I think you may well be right, as Phoenix has pointed out, LADA onset is different to T1 onset.... I have no experience with T1 only LADA (although my hospital notes don't mention LADA, just that I am T1 in the honeymoon period!!).

I agree completely, antibodies will win eventually.

 

[Ian DP]

They may well start rising at some point. But as I've dramatically reduced ur carbs u have no way of knowing if they're being destroyed or how quickly. They could have been slowly being destroyed ur whole life. To say type 1 can be prevented by diet is not plausible. Ur diet would never ever stop the antibodies killing off beta cells. Whether diet can slow it down, maybe, but they would still be destroying them

You are right, I am sure they will start rising at some point. They could indeed have been slowly destroyed my whole life, indeed I think that is highly likely.... Which also strengthens my argument that had I been able to have kept my BG at a lower level prior to diagnosis, my diagnosis would have been deferred.

Phoenix has pointed out that LADA onset is different to T1 onset. You are probably right, T1 onset can not be prevented, but I still think mine (LADA) could. Since LADA is early T1, I had mistakenly thought the two on sets were the same.