management v cure how to tell the difference?

[staying positive]

I am recently diagnosed and dont understand this so please be patient with me if you read this.Thanks....
Some people ive read about including one very knowledgeable writer have said that their GP has pronounced them cured after being satisfied with a Glucose Tolerance Test.
It appears that with weight loss their health has dramatically improved and the pancreas is again working efficiently.
These people have made the GTT the arbiter of this decision as indeed has their GP.
BUT WHAT IS IT ABOUT THIS SPECIFIC TEST in that it somehow differs from the HBAIC test ( does it?-help please) which allows this specific affirmation and HOW CAN IT BE PROPERLY DISTINGUISHED from a continuing condition which is being well-managed by diet and moderate exercise,say an hours walking a day?

Does anyone have an answer in laymans language plz

thanks Bill

 

[phoenix]

Another name for the OGTT is a glucose challenge test. It tests to see if the body responds within norms ,to the challenge of a large amount of glucose (very fast 'sugar'), To 'pass' you would also have to have a normal fasting glucose level.
( To put that in perspective, I have little or no insulin of my own, mere 3-6g of glucose can be enough to raise my levels from 3mmol/ to 5mmol/l ; imagine what the 75 g from this test would do!)

Someone may have good glycemic control in terms of an HbA1c but still have a relatively high fasting level. They could also still have high levels after a normal mixed meal including carbohydrates. . They are controlling their condition but if they are still hyperglycaemic after eating carbohydrates then they are by definition diabetic.

Even if you 'pass' a glucose tolerance test, you would still be at high risk for higher glucose levels returning in the future . Before diagnosis, you may have lost a considerable number of beta cells . If since then you lost weight, this would have reduced your insulin resistance so you need less insulin ,you might have enough beta cells left to cope normally with the lighter you. If you regained the weight then you might also regain diabetes symptoms.

 

[staying positive]

Another name for the OGTT is a glucose challenge test. It tests to see if the body responds within norms ,to the challenge of a large amount of glucose (very fast 'sugar'), To 'pass' you would also have to have a normal fasting glucose level.
( To put that in perspective, I have little or no insulin of my own, mere 3-6g of glucose can be enough to raise my levels from 3mmol/ to 5mmol/l ; imagine what the 75 g from this test would do!)

Someone may have good glycemic control in terms of an HbA1c but still have a relatively high fasting level. They could also still have high levels after a normal mixed meal including carbohydrates. . They are controlling their condition but if they are still hyperglycaemic after eating carbohydrates then they are by definition diabetic.

Even if you 'pass' a glucose tolerance test, you would still be at high risk for higher glucose levels returning in the future . Before diagnosis, you may have lost a considerable number of beta cells . If since then you lost weight, this would have reduced your insulin resistance so you need less insulin ,you might have enough beta cells left to cope normally with the lighter you. If you regained the weight then you might also regain diabetes symptoms.

Another name for the OGTT is a glucose challenge test. It tests to see if the body responds within norms ,to the challenge of a large amount of glucose (very fast 'sugar'), To 'pass' you would also have to have a normal fasting glucose level.
( To put that in perspective, I have little or no insulin of my own, mere 3-6g of glucose can be enough to raise my levels from 3mmol/ to 5mmol/l ; imagine what the 75 g from this test would do!)

Someone may have good glycemic control in terms of an HbA1c but still have a relatively high fasting level. They could also still have high levels after a normal mixed meal including carbohydrates. . They are controlling their condition but if they are still hyperglycaemic after eating carbohydrates then they are by definition diabetic.

Even if you 'pass' a glucose tolerance test, you would still be at high risk for higher glucose levels returning in the future . Before diagnosis, you may have lost a considerable number of beta cells . If since then you lost weight, this would have reduced your insulin resistance so you need less insulin ,you might have enough beta cells left to cope normally with the lighter you. If you regained the weight then you might also regain diabetes symptoms.

oh right thanks i get the difference now and that was very clear; maybe you are a doctor?// i realise that if you have lost weight which has brought down the numbers( sorry im still learning about this stuff) and the HSAIC tests are ok ( between 4/5?) theres a clear danger that putting weight back on will make the numbers climb again as medication may have been changed or reduced whether "cured" or managed.......this is why i am following as GP advised a low carb low cal diet with low animal fats with more exercise but in wintertime this will present a whole new set of challenges it seems to me as salads arent a lotta fun for Christmas lunch.It also seems that food preparation and shopping are also very important.

 

[kesun]

Some people ive read about including one very knowledgeable writer have said that their GP has pronounced them cured after being satisfied with a Glucose Tolerance Test.

I can't put it better than @phoenix did, but here are some additional thoughts.
As far as I understand it, the typical progression for T2 is that first your initial response insulin fails, then the secondary response, then finally your basal overnight trickle. So an OGTT can give some idea of how far your condition has progressed by testing fasting, one-hour and two-hour.
For T1, the insulin failure is pretty much total and very fast, so this doesn't apply.
For my weird mitochondrial diabetes, my overnight insulin supply failed first, and the last thing to go is my initial insulin response: so for many years my fasting was at diabetic level but my one- and two-hour OGTT levels were normal. This helped the doctors to realise I don't fit either the T1 or the T2 pattern and to do further tests.
So in a way it's fair to say that if your fasting, one-hour and two-hour results are normal, you're not diabetic, especially if you've followed instructions and eaten lots of "healthy carbs" for three days before the test. Until recently as long as I stuck to LCHF and took my Q10 my fasting, post-prandial and HbA1c levels were all normal: but if I carbed for three days then did a GTT I was well into diabetic range. So I'm treated rather than cured.
One thing to beware of is that as soon as you get the dread db diagnosis the goalposts are moved: as far as I remember, a fasting level over 5.6 is worrying for a non-diabetic, but for a diagnosed diabetic up to 7.8 is considered OK.

Kate

 

[gfmoore]

As I understand it peeps without diabetes can go out and drink five pints of beer, have a fish, chips and mushy peas supper, then have a twix or three and their body just deals with it. Sure they get fat, but don't get their legs amputated and go blind.

Don't think I'll be able to do that just yet, I.e. be "cured". Wry

 

[Yorksman]

Cure is an odd word because diabetes is diagnosed on the basis of blood sugar levels, whether that is fasting levels in the blood plasma or the now more favoured HBA1c. An oral glucose tolerance test is a specific type of plasma test. You never really get to know the exact reason why that happened.

Diabetes is a metabolic disorder which results in your having too much glucose in your blood. The things that cause that to happen are mostly not measured at all. Type 2s generally have three metabolic processes which are not wholly effective, speed of insulin response, quality and quantity of insulin produced and the effective processing of that insulin.

It is known that the insulin that you do produce can be made more effective by exercise and it is now thought that your insulin response, the speed at which which your pancreas reacts, and the quality and quantity of insulin produced can be improved by losing weight. However, what is never known is how much damage there is to the beta cell mass in the pancreas which produces it. You can stop the deterioration and some of the damaged cells can recover but there will always be some that are permanently lost - and we never know how much. So, beware of words like 'Cured'. If your BG levels improve, continue to take things steady and try for more improvement. Don't think everythng is OK and you can go back to the way things were before. Why would you want to? That's why you got diabetes in the first place.

 

[staying positive]

r

Cure is an odd word because diabetes is diagnosed on the basis of blood sugar levels, whether that is fasting levels in the blood plasma or the now more favoured HBA1c. An oral glucose tolerance test is a specific type of plasma test. You never really get to know the exact reason why that happened.

Diabetes is a metabolic disorder which results in your having too much glucose in your blood. The things that cause that to happen are mostly not measured at all. Type 2s generally have three metabolic processes which are not wholly effective, speed of insulin response, quality and quantity of insulin produced and the effective processing of that insulin.

It is known that the insulin that you do produce can be made more effective by exercise and it is now thought that your insulin response, the speed at which which your pancreas reacts, and the quality and quantity of insulin produced can be improved by losing weight. However, what is never known is how much damage there is to the beta cell mass in the pancreas which produces it. You can stop the deterioration and some of the damaged cells can recover but there will always be some that are permanently lost - and we never know how much. So, beware of words like 'Cured'. If your BG levels improve, continue to take things steady and try for more improvement. Don't think everythng is OK and you can go back to the way things were before. Why would you want to? That's why you got diabetes in the first place.

Right thanks-good advice im sure!! Looking ahead my problem has always been weight gain in Winter and i had a long-term problem with eating way too much wholemeal bread as i believed it was good for us as per BBC Diet Book and a sandwich or toast easier than cooking a meal. I am wondering how people cope when salads and fish arent so easy to come bye as in summer and simply dont seem as satisfying and of course Christmas and New Year everyone seems to put on weight.
Yes of course to go back would be crazy after changing lifestyle habits and losing weight and in fact did overcome weight problem until had surgery in arm and could not physically cook for about 4 months...
HOW TO MANAGE WEIGHT IN WINTER MONTHS???????

 

[peacetrain]

Vegetable stir fries.
You can eat them with chicken or oily fish. Add chillies if you want to spice things up.
If you want some carbs but want to steer clear of bread, rice, pasta and potatoes, try falafel. I can eat one or two of those.
There's a lot you can have in winter and Christmas turkey is carb free!

You have plenty of time to experiment between now and Christmas if you're worried about festive food. Perhaps there's something on the food and nutrition threads.
If you read about almond flour, think ground almonds.
Don't worry, you'll have plenty of choice at Christmas. Actually, I lost weight last Christmas ;-)

If you can't get out to exercise during the winter months why not invest in an exercise bike? You can exercise on the stairs.


Sent from the Diabetes Forum App

 

[staying positive]

Vegetable stir fries.
You can eat them with chicken or oily fish. Add chillies if you want to spice things up.
If you want some carbs but want to steer clear of bread, rice, pasta and potatoes, try falafel. I can eat one or two of those.
There's a lot you can have in winter and Christmas turkey is carb free!

You have plenty of time to experiment between now and Christmas if you're worried about festive food. Perhaps there's something on the food and nutrition threads.
If you read about almond flour, think ground almonds.
Don't worry, you'll have plenty of choice at Christmas. Actually, I lost weight last Christmas ;-)

If you can't get out to exercise during the winter months why not invest in an exercise bike? You can exercise on the stairs.


Sent from the Diabetes Forum App

thanks peacetrain have looked into falafel which i had never heard of and will give baked a try....the veg stir fry is also a great idea as indeed is the exercise bike.

 

[RosieLKH]

r

Right thanks-good advice im sure!! Looking ahead my problem has always been weight gain in Winter and i had a long-term problem with eating way too much wholemeal bread as i believed it was good for us as per BBC Diet Book and a sandwich or toast easier than cooking a meal. I am wondering how people cope when salads and fish arent so easy to come bye as in summer and simply dont seem as satisfying and of course Christmas and New Year everyone seems to put on weight.
Yes of course to go back would be crazy after changing lifestyle habits and losing weight and in fact did overcome weight problem until had surgery in arm and could not physically cook for about 4 months...
HOW TO MANAGE WEIGHT IN WINTER MONTHS???????

I've been thinking about how I can continue avoiding bread in particular, but also potatoes, pasta and rice, through the winter. Nothing like planning ahead - lol.
I think I will be in a position, as the weather cools, (ie; having lost some weight) to try introducing a few more carbs, but I will have to experiment and see what changes occur in my BS levels.
Out of interest, this weekend I made tabouleh for a family gathering. It's a salad made largely from bulghur (same stuff in falafel). My BS this morning was 6.1 and after a very carby meal it can be much, much higher than that the next day, so it seems that bulghur might be a good alternative to rice or pasta. It's nothing like rice or pasta, being a less refined version of cous cous, but it's something I can have cold in salad, or warm with a sauce. That will make a great winter meal.

 

[staying positive]

One of the realities of the last few years especially which must effect the diabetes epidemic is increasing food prices so for me i am considering becoming a vegetarian which demands for me a huge!! imagination stretch for menus so thanks for another idea....of course not all veg is low carb is it for example parsnips and most of it seems mid-range apart from leafy veg. Sweet potatoes seem to get a better press but am not sure why( theres just so much to learn about this) but ordinary potatoes even jacket pots i believe now use with caution,like wholemeal bread and wholegrain rice.... Variety seems essential as of course taste and low hassle preparation.Or maybe feeling satisfied might be a better description? Weight and exercise seem important as they improve the way the body produces insulin but the reason for my original question was to seek to ascertain how results can be quantified because without regaining weight if we can eat things without the danger of spikes then great but how can we be sure our bodies can cope without measurement afterwards which no one has mentioned to me or without the GTT (as opposed to HBAIC )which measures insulin effectiveness as i understand things.... do i need a meter or strips as GP hasnt mentioned this at all????

 

[RosieLKH]

I had a discussion with my diabetic nurse about wanting to test to keep a check on such things. She was against it, saying since I don't adjust my medication according how I test it didn't make sense to rely on self-testing and I should go by whatever the hbaic shows, but suddenly sighed and said it was because it was so expensive to prescribe endless test strips. She did prescribe me a box of 50 and then said this for while I was learning how to get control of my BS and what foods work for me. she said she considered this money well spent.

I can see her point in not testing all the time. I am lucky to have a monitor and ten strips a month prescribed free (all diabetic prescriptions are free), but while I'l learning so much about this I feel I need to test more frequently, which is why she ok'd the box of 50 in addition to the 10 a month. I can't change my meds much as such, although even this isn't true as I've dropped one Gliclazide tablet in the evening due to BS going too low over night. I wouldn't have known I'd had my first hypo if I hadn't tested and seen BS at 3.5. I'd have assumed the palpitations, sweating and feeling ill were menopausal or blood pressure or just being ill.

I can already see the benefits in my BS of a change in diet. As I learn more I will be more confident that my BS is under control with just a light touch on the self-testing and regular hbaic tests to confirm good control. As I lose weight (fingers crossed) and exercise more i will see that my average BS is in better ranges. If you are T2, as I understand it, your body could, with the right care (diet, exercise) get back to dealing with spikes without them being so dangerous to you - like everyone else's body does if they're not diabetic (and assuming not too much damage has already been done to pancreatic cells).

I think that being able to self test will show me how well I cope after different foods, which will reassure me that my body deals ok with occasional spikes, so I guess I'm saying it might be good for you to get a meter if your GP won't provide one - and folks on here have done that, so I'm sure they can advise on most economical types.

 

[staying positive]

Hi Rosie,
Between messages here i have in fact bought a BS monitor from Amazon not that i intend to experiment with foods i enjoy like say fish and chips until i am much further along the weight loss journey with lower BS levels which for me is so much easier in warmer months so looking ahead seems sensible as being prepared with ideas for menus may help us feel more relaxed about things? So if things have improved and if the GP says ok your weight is ok now i may consider looking at the moderate consumption of foods now frowned upon if i test afterwards . Anyhow it wasnt too expensive and i can stuff it in a drawer... BUT ALSO AS YOU SAY IT MAY HELP IN DIAGNOSING HYPOS AS I SURE I HAVE HAD SEVERAL THO LIKE YOU SAY ITS HARD TO KNOW FOR SURE WITHOUT TAKING THE BS test..
It would of course also be good to have some butter and some cheese not used for 9 weeks now though which many diabetics apparently use in following the LFHC diet as i have found out-my GP expressly banned butter.How did she know?? LOL There is apparently ANOTHER debate about this diet which is equally confusing and i have made an appointment to see my GP to ask her about this.....
I feel overall we should keep looking at what we have achieved and not look back unless to learn from our mistakes

 

[RosieLKH]

I will only use butter and olive oil. Eating zero bread has really lowered my butter consumption, but the GP has never mentioned any problem with my cholesterol. I'm not bothered by any butter debate and eat cheese (we spend a fortune on cheese!), though on a low carb low cal diet, I'm using it as a small treat.

I'm very concerned not to eat processed food and have been for years, but the weight has piled on due to lack of portion control and loving home made bread too much (not making it these days, though husband makes himself a rye loaf every Sunday). We eat a lot of veggie stuff, but are not veggies - we love meat far too much. We are foodies, I guess, but I have found once I get on a carb binge I can't stop and then I would buy any old rubbish - pies, ready made Chinese stuff, even doughnuts. On this low carb diet I really do not seem to get daily cravings. I can't say there are no cravings, but I haven't been hungry. I am also trying to work on 'mindful eating', and have a much better control of how and what I eat than say ten years ago.

 

[staying positive]

i tend now to eat porridge oats am as this makes me less likely to want to snack i have found but remain unsure if oats are ok as some people arent but Joyce Bauer and others say they are a diabetics superfood as low GI... learning all the time. I also bought a steamer and the third one actually works! 2 returned to Amazon and this allows easier veg cooking and can do superb fish with maybe a salad then thats it WITH LITTLE KITCHEN TIME- the odd beer....before when eating eggs or mushrooms for breakfast i did eat a small lunch- it wasnt cholesterol that caused GP to say no butter as no test done which surprised us both but the high cals- anyway its working as have lost between 2-3 1/2 lbs every week and can wear some old clothes again but never as fast as i want LOL - we are impatient human beings...and would hope to be within sight of target weight over next 6 weeks or so and have tests again next month/presumably this is what the nurse does tho nothing said about fasting....you have to fast before a HSAIC test right?

 

[RosieLKH]

have tests again next month/presumably this is what the nurse does tho nothing said about fasting....you have to fast before a HSAIC test right?

I haven't always had to fast for this. Sometimes told definitely to, but for pre-op hospital they didn't want my fasting levels. Best check with the surgery.

 

[Yorksman]

i had a long-term problem with eating way too much wholemeal bread as i believed it was good for us as per BBC Diet Book and a sandwich or toast easier than cooking a meal.

Most supermarket bought wholemeal bread is not 100% wholemeal. The Waitrose loaf for example is only 6% wholemeal and 53% refined white, leaving 41% of 'other stuff'. See A Wholegrain of Truth

Even artisan bakers cannot be wholly relied on with their descriptions but at least they do tend to tell you what is in them.. I use 3 different bakers and although they sell several types of loaf, only the 100% rye loaves are any good for me. I still buy them but have found it cheaper to bake my own. To find a real bread baker near you, use this page: Real Bread Finder,

but ask. The baker I used today has a sourdough rye loaf which is 100% rye and a light rye loaf, which is a rye/white wheat mix and not so good. They also do a wholemeal spelt loaf which is also good for me. You can basically tell by feel. If it is light and springy, it's probably no good. Wholegrain rye or spelt is heavy and solid and you probaby could smash a window with it.

I eat lots of stir fries but use Blue Dragon Wholewheat Noodles. That works for me and others have reported low blood glucose levels too. It seems fairly reliable. Pearl barley, buckwheat groats and pinhead oats are all good, but all are for cooked meals. One pot meals or slow cookers though are useful because you can throw all the right ingredients in, switch it on and just leave it.

For snacks, I find Peters Yard Artisan Rye Crispbread, Dr Kargs and Finncrisp all very very good. You need good teeth though! A little butter and sardine paste, perhaps a thin slice of sharp cheddar and some pickled onion or tomato or some low fat cream cheese and small slice of smoked salmon or smoked mackerel. They will all satisfy your hunger and are all healthy and OK for most diabetics.

 

[Yorksman]

I've been thinking about how I can continue avoiding bread in particular, but also potatoes, pasta and rice, through the winter. Nothing like planning ahead - lol.
I think I will be in a position, as the weather cools, (ie; having lost some weight) to try introducing a few more carbs, but I will have to experiment and see what changes occur in my BS levels.

I found my local chinese store very good. They have over 50 types of noodle including brown rice noodles. Morrisons brown rice is a low carb and low calorie converted rice. An 80g serving only has about 15g carbs and 100 cals, that's about a third of normal rice. It's a bit chewier, but good in curries or with a chinese style meal. Pearl Barley is very good for dibetics and can be used as a rice substitute. I've had a go with things like couscous, pinhead oats and quinoa and today tried buckwheat groats. There's lots of things to try.

 

[staying positive]

I found my local chinese store very good. They have over 50 types of noodle including brown rice noodles. Morrisons brown rice is a low carb and low calorie converted rice. An 80g serving only has about 15g carbs and 100 cals, that's about a third of normal rice. It's a bit chewier, but good in curries or with a chinese style meal. Pearl Barley is very good for dibetics and can be used as a rice substitute. I've had a go with things like couscous, pinhead oats and quinoa and today tried buckwheat groats. There's lots of things to try.

the findings re the constituents of our daily bread are staggering by implication and the abandonment of their scrutinising responsibilities by the agencies approached to investigate this which is their role anyway and what they should be doing equally galling-it truly is a scandal and indicates how people may unknowingly and in good faith be actually worsening their health in the belief they are being healthy with other serious implications re the diabetes epidemic. Furthermore many of the supermarkets are stonewalling Sustain with obviously stuff to hide ......im going to look at this in more detail with a view to seeking to move things forward SOMEHOW.Waitroses behaviour and the others remain silent at 6% is an outrage

 

[Yorksman]

Furthermore many of the supermarkets are stonewalling Sustain with obviously stuff to hide ......im going to look at this in more detail with a view to seeking to move things forward SOMEHOW.Waitroses behaviour and the others remain silent at 6% is an outrage

If you register, you can download the Sustain report. They ask for a donation but I downloaded it and read it to see if it was any good before I made a donation.

The supermarkets say that the recipes are confidential and that they are under no obigation to make them public. The term 'secret ingredient' is a double sided coin.