My remission story so far - with regular updates

[Lupf]

I've realised that I posted my results in random threads so far,
thus I've decided to collect these posts here. I will give the latest update in the next post.

My first post is from Dec 2019, when I joined the forum. I copy the first few paragraphs here as this gives my back story.
"I am a 59 year old male and was diagnosed with T2 diabetes in Sept 2014 (with an HbA1c > 100). I was put on Metformin and HbA1c went down to 62 to 65, but not further. After diagnosis I was eating a healthy diet, no more fizzy drinks, lots of fruit and veg, few sweets, but I like pasta, potatoes and bread. Weight was stable at about 10 kg overweight. Early in 2019 Doctor asked me to take more medicine (Gliclazide), but I decided to lose weight and to start exercise instead.
Since April 2019 I have been doing 5+2 diet (Michael Mosley) with 600 calories on fast days (200 breakfast/ 400 dinner, water for lunch). I travel a lot for work, but found ways to fast while travelling, On fast days, I basically don't eat carbs. Surprisingly I don't feel hungry as you can eat lots of soup and vegetables. I also drink lots of water during the day. For exercise, I have am cycling regularly, even use hotel gyms. In addition, I started judo, but I had to stop due to shoulder pain for which I am doing physiotherapy now.
Since starting 5+2 diet I have lost 10 kg most of it in the first 4 months. I now weigh 80 kg, which is the same as when I was 19 years old. My waist reduced from 105 to 90 cm. My HbA1c dropped from 65 to 52 (in July 2019) to 42 mmol/mol (end of November 2019) and my blood sugar measurements (in the morning before eating) now average just below 6 mmol/litre. I also noticed that my resting pulse decreased from 68 to 58 per minute.
Last week I went to see the doctor and we agreed to stop Metformin. I am not on any medication anymore. Wow!"
For the link to the full post, see: https://www.diabetes.co.uk/forum/threads/t2-reversed.170844/

At that moment my questions was - can I sustain this?
My next test three months later was a bit of a shock and I titled the thread "How reliable are HbA1c tests?
see https://www.diabetes.co.uk/forum/threads/how-reliable-are-hba1c-tests.172402/
18 Feb 2020 - 81.1 kg HbA1c 55 mmol/mol

Corona took over our lives shortly after that.
I also learned a lot on this forum and I made sure that my two fast days are essentially no carbs.
At the time i tested how I reacted to different food, but once this was done,
I was pretty much able to predict my blood sugar values, usually around 6.0 mmol/l,
so I went back to testing twice weekly, then weekly, always in the morning.
My next test results were in summer 2020, and my HbA1c was back in the 40s,
see https://www.diabetes.co.uk/forum/threads/latest-hb1ac-results-are-in.175917/
22 Jul 2020 - 78.3 kg HbA1c 45 mmol/mol

I then didn't get tested again for almost two years, I was working abroad for 9 months,
but I was very active, kept cycling a lot, and I kept testing my blood sugar once a week.
After my return in April 2022 my result was (see same thread)
12 Apr 2022 - 81.4 kg HbA1c 47 mmol/mol

As my birthday is early in the year, I now get called up once a year,
just after new year, which keeps me honest, i.e. any cheating at Christmas will be noticed.
I also got a rather bad case of covid (2 weeks flat, lost my voice, ...) at the end of Nov 2022.
As result my blood sugar test in Dec 2022 were actually lower and around 5 mmol/l.
My HbA1c test at the end of January came back as
31 Jan 2023 - 80.4 kg HbA1c 45 mmol/mol
So far so good.

A side story is that my cholesterol was also high when diagnosed and at least twice I was asked to take statins, which I declined.
With my weight loss and lowering of HbA1c, this has come down to around 5.0, so I am not asked anymore.
Thanks to the forum I now also get HDL, LDL and Trigs measured.
What is interesting is that HDL, LDL and Trigs kept improving after end of 2019.
HDL was 1.2 in 2019 and has been going up to 1.6.
LDL was 3.4 in 2020 and was coming down to 2.9/2.8.
TRIGs were 3.9 in 2014, next measurement was 2.1 in 2020, and has been going down to 1.0.
These values are all (almost) in the green range.

 

[Lupf]

It is now a bit over 4 years that I lowered by HbA1c into the 40s,
and I have been off medication since Dec 2019.
Since then I have been continuing with intermittent fasting (IF) (5+2) with no almost carbs on fast days,
i.e. lots of vegetables, soups, salads, an egg, a bit of fish or chicken, so I don't feel hungry.
While I don't check the calories anymore, but it is usually around 600 to 800 kcals.
From this point of view this works very well, i.e. I can keep my weight down.
it is usually a bit lower in the summer when I cycle a lot.

My latest HbA1c is now in:
07 Feb 2024 - 82.5 kg HbA1c 49 mmol/mol
So technically I am not in remission anymore (the threshold is 48).
To be honest I am not totally surprised, I've been less active this winter
and Christmas has its carby dangers.
All my cholesterol values went slightly in the wrong direction as well.
I take this as a warning sign that I cannot take the eye off the ball.

I'll see the new nurse in a two weeks, which is different and better,
before my feet checkup was done, when giving a blood.
Since the start of the pandemic I wasn't able to discuss the results
neither with the nurse nor have I seen the GP.
This time they also asked me to bring a food diary, which will be interesting

I realise that many here manage to get their Hb1Ac into the 30s by going very low carb,
probably below 50g a day. Given that he NHS calls below 48 in remission,
and that I am feeling ok, I am wondering if I should aim lower.
This would be a significant change to my lifestyle, and I am not sure I could sustain this.
Until now my partner, who does not have T2, and I basically eat the same meals.
She joined me originally when I lost weight and this makes it very easy.
Less than 50 g of carbs would make our meals diverge and I am not sure I would succeed.

 

[AndBreathe]

It is now a bit over 4 years that I lowered by HbA1c into the 40s,
and I have been off medication since Dec 2019.
Since then I have been continuing with intermittent fasting (IF) (5+2) with no almost carbs on fast days,
i.e. lots of vegetables, soups, salads, an egg, a bit of fish or chicken, so I don't feel hungry.
While I don't check the calories anymore, but it is usually around 600 to 800 kcals.
From this point of view this works very well, i.e. I can keep my weight down.
it is usually a bit lower in the summer when I cycle a lot.

My latest HbA1c is now in
07 Feb 2024 - 82.5 kg HbA1c 49 mmol/mol
So technically I am not in remission anymore (the threshold is 48).
To be honest I am not totally surprised, I've been less active this winter
and Christmas has its carby dangers.
All my cholesterol values went slightly in the wrong direction as well.
I take this as a warning sign that I cannot take the eye off the ball.

I'll see the new nurse in a two weeks, which is different and better,
before my feet checkup was done, when giving a blood.
Since the start of the pandemic I wasn't able to discuss the results
neither with the nurse nor have I seen the GP.
This time they also asked me to bring a food diary, which will be interesting

I realise that many here manage to get their Hb1Ac into the 30s by going very low carb,
probably below 50g a day. Given that he NHS calls below 48 in remission,
and that I am feeling ok, I am wondering if I should aim lower.
This would be a significant change to my lifestyle, and I am not sure I could sustain this.
Until now my non-diabetic partner and I basically eat the same meals.
She joined me originally when I lost weight and this makes it very easy.
Less than 50 g of carbs would make our meals diverge and I am not sure I would succeed.

How you manage your life and condition is completely up to you.

I am one of the fortunate ones who seem to coast along with an A1c of 31<>33, whilst consuming more than 50gr carbohydrate a day, on average. I am overseas a the moment and guestimate I am pretty well into thee keto ranges. My A1c, if I have it measured here always begins with a 2.

My OH is now 77 and seems to have a great metabolic system, meaning he can much carbs to his heart's content, and still return A1cs akin to my own. That said, he has a very healthy "Off" button, and when he has eaten enough, he will stop, irrespective of what might be remaining on his plate.

We seem to manage pretty well on our slightly divergent eating styles. Breakfast for me is usually Greek yoghurt and some berries, or a small portion of other fruit, but here, it tends to be salad based (Yes, I know, a bit odd) with eggs.

Lunch, at home I have a large salad. He has a sandwich. Here we don't bother with lunch, but eat earlier in thee evening.

Dinner at home we have the same meal, with him adding in whatever carbs he wants. The meat and veg elements will be the same. He may or may not (more often not) have dessert.

Here, as we eat out every evening, we choose whatever we want, independently, unless we fancy the same thing. He will have rice or rarely noodles, but I'll stick with thee main event.

Perhaps, before deciding whether you will further tweak your lifestyle, have a chat with your partner and see how she feels about it. It is doable, and I can state categorically that at home our main, evening meals are virtually always (95%) the same +/- the carbs. Sometimes it's a bit of a mindset thing.

 

[lovinglife]

I realise that many here manage to get their Hb1Ac into the 30s by going very low carb,
probably below 50g a day.

This isn’t always the case, not everyone gets those what are considered “magic” numbers & it can be disheartening for some that they don’t get them and can fee like they are failing. I eat keto on less than 20g carb a day and have done for a good few years but have never had a Hb1Ac below 46 (I think) my current one is 49. It’s good enough for me and I’m happy with that but I sometimes think that it’s good to remind people that not all of us no matter how low carb we go can get into remission. It’s not my goal, my goal is to be the best I can be and most of the time I achieve that.

 

[Lupf]

How you manage your life and condition is completely up to you.

I am one of the fortunate ones who seem to coast along with an A1c of 31<>33, whilst consuming more than 50gr carbohydrate a day, on average. I am overseas a the moment and guestimate I am pretty well into thee keto ranges. My A1c, if I have it measured here always begins with a 2.

My OH is now 77 and seems to have a great metabolic system, meaning he can much carbs to his heart's content, and still return A1cs akin to my own. That said, he has a very healthy "Off" button, and when he has eaten enough, he will stop, irrespective of what might be remaining on his plate.

We seem to manage pretty well on our slightly divergent eating styles. Breakfast for me is usually Greek yoghurt and some berries, or a small portion of other fruit, but here, it tends to be salad based (Yes, I know, a bit odd) with eggs.

Lunch, at home I have a large salad. He has a sandwich. Here we don't bother with lunch, but eat earlier in thee evening.

Dinner at home we have the same meal, with him adding in whatever carbs he wants. The meat and veg elements will be the same. He may or may not (more often not) have dessert.

Here, as we eat out every evening, we choose whatever we want, independently, unless we fancy the same thing. He will have rice or rarely noodles, but I'll stick with thee main event.

Perhaps, before deciding whether you will further tweak your lifestyle, have a chat with your partner and see how she feels about it. It is doable, and I can state categorically that at home our main, evening meals are virtually always (95%) the same +/- the carbs. Sometimes it's a bit of a mindset thing.

Hi @AndBreathe, thanks for kind words and letting me know your experience. It's good to hear that eating differently can actually work. I am of course discussing this with my partner. To be clear, she is great and would support me, we are discussing this regulalry. It is me who would like to find out if going as is for the next 20 years will work or if I will develop serious problems.
On the other hand there is also the question of does long term low carbs have a higher mortality rate, which is the current doctrine by medics. There were a few posts on this topic, including one from me in a recent thread https://www.diabetes.co.uk/forum/threads/confirmation-bias.201793/post-2672408.

 

[Lupf]

This isn’t always the case, not everyone gets those what are considered “magic” numbers & it can be disheartening for some that they don’t get them and can fee like they are failing. I eat keto on less than 20g carb a day and have done for a good few years but have never had a Hb1Ac below 46 (I think) my current one is 49. It’s good enough for me and I’m happy with that but I sometimes think that it’s good to remind people that not all of us no matter how low carb we go can get into remission. It’s not my goal, my goal is to be the best I can be and most of the time I achieve that.Hi

@lovinglife thanks for saying this. I agree with you. It is so important to say this. If you are diagnosed with diabetes and are actively trying to improve your health, you are never failing, you are already winning. I would not use the word "magic", an HbA1c in the 30s is simply an Hb1Ac in the non-diabetic range.
My questions on long-term effects remain.
1) how is your life expectancy affected by being in the prediabetic range (42 < HbA1c < 48), which called in remission, for decades.
2) What are the long term effects of LCHF diet? Note this might be different for the diabetic and healthy population, also between T2, T1, LADA, ...

 

[Lupf]

I went so see the nurse for my annual review today and was rather pleasantly surprised. Someone at the surgery must have seen the light. The nurse gave me a five page guide called "Aiming for Remission in Type 2 Diabetes - Information Sheet. If I understood correctly, the document was written by one of their GPs. It is not a glossy leaflet, but 3 pages with actual content and 2 more pages containing illustrations with carbs in vegetables and fruits.
A few extracts:
A) There are lots of ways in which you can change your diet to potentially lower your blood sugar and insulin levels ...
- Low carbohydrate diets
- Very low calorie diets (<800 calories per day)
- Mediterranean diet
- Intermittent fasting
B) What practical changes can I make?
... rather than being "on a diet" we're looking to encourage you to make changes that you think you cna maintain in the long-run as the "new normal"
1) Start looking at the total carbohydrate of foods and aim for less than 20g per meal....
2) At least initially, weigh your food ...
3) Your insulin resistance ... is at its worst in the morning. Aim to have a savoury breakfast that is low in carbohydrate. Eggs are a great option.
4) It is OK to have the occasional treat. Aim for good food choices 90% of the time.
5) In order to stay full and avoid snacking, you will need to increase the amount of fat, protein and fibre in your diet. ...
6) Try to eat regular meals and not to snack between meals. Having gaps between meals allows your blood and insulin levels to fall and gives your pancreas a rest from producing insulin.
7) if you are going to have something sweet, ... have it with a meal ....
C) Where can I get more information on what foods are good and bad?
- David Unwin's low carb diet sheet, attached
- For more in-depth information, read "The Diabetes Code by Jason Fung
I really liked the next paragraph:
D) Wait, did you just tell me to eat more fat and eggs?!
- Yes, despite previous information there is little evidence to link dietary fat with blood cholesterol and risk of stroke and heart disease. As good quality fats ... including eggs have little or no carbohydrates, they are really good choices for a diet to put diabetes in remission.

While we might not agree with everything written in this guide, this is pretty close to what I would have written. I've read by a few people on this forum recently that they are getting encouraged to do LCHF, and am very happy that my own surgery (in Scotland) is doing is as well.

My own review went
- ah but you are doing this already.
- you've gained some weight, try to lose it and your HbA1c will go down again.
- no change on my feet.
The nurse also suggested that I try out the Freestyle Libre on a free trial.

 

[Outlier]

What an astonishingly impressive document!! Gold cup to your health providers.

Great results from your own efforts as well. Another gold cup!

 

[Lupf]

What an astonishingly impressive document!! Gold cup to your health providers.

Great results from your own efforts as well. Another gold cup!

I will let the surgery know

 

[KELI]

I went so see the nurse for my annual review today and was rather pleasantly surprised. Someone at the surgery must have seen the light. The nurse gave me a five page guide called "Aiming for Remission in Type 2 Diabetes - Information Sheet. If I understood correctly, the document was written by one of their GPs. It is not a glossy leaflet, but 3 pages with actual content and 2 more pages containing illustrations with carbs in vegetables and fruits.
A few extracts:
A) There are lots of ways in which you can change your diet to potentially lower your blood sugar and insulin levels ...
- Low carbohydrate diets
- Very low calorie diets (<800 calories per day)
- Mediterranean diet
- Intermittent fasting
B) What practical changes can I make?
... rather than being "on a diet" we're looking to encourage you to make changes that you think you cna maintain in the long-run as the "new normal"
1) Start looking at the total carbohydrate of foods and aim for less than 20g per meal....
2) At least initially, weigh your food ...
3) Your insulin resistance ... is at its worst in the morning. Aim to have a savoury breakfast that is low in carbohydrate. Eggs are a great option.
4) It is OK to have the occasional treat. Aim for good food choices 90% of the time.
5) In order to stay full and avoid snacking, you will need to increase the amount of fat, protein and fibre in your diet. ...
6) Try to eat regular meals and not to snack between meals. Having gaps between meals allows your blood and insulin levels to fall and gives your pancreas a rest from producing insulin.
7) if you are going to have something sweet, ... have it with a meal ....
C) Where can I get more information on what foods are good and bad?
- David Unwin's low carb diet sheet, attached
- For more in-depth information, read "The Diabetes Code by Jason Fung
I really liked the next paragraph:
D) Wait, did you just tell me to eat more fat and eggs?!
- Yes, despite previous information there is little evidence to link dietary fat with blood cholesterol and risk of stroke and heart disease. As good quality fats ... including eggs have little or no carbohydrates, they are really good choices for a diet to put diabetes in remission.

While we might not agree with everything written in this guide, this is pretty close to what I would have written. I've read by a few people on this forum recently that they are getting encouraged to do LCHF, and am very happy that my own surgery (in Scotland) is doing is as well.

My own review went
- ah but you are doing this already.
- you've gained some weight, try to lose it and your HbA1c will go down again.
- no change on my feet.
The nurse also suggested that I try out the Freestyle Libre on a free trial.

Wow, it's great that your GP surgery are being this forward thinking! Wish all surgeries were this informative. As for the Libre sensor free trial - I did this and now buy my own whenever I feel the need. They are helpful. They do sometimes read quite differently from the blood glucose meter but that's why they always say if you don't feel like the sensor reading, double check with a blood glucose meter. The sensors have helped me this time around to get my hba1c down from 52 to 48.

 

[Outlier]

What marvellous advice! It's great to see that some surgeries are giving out such good information.

 

[Lupf]

Today marks five years since I have stopped taking medication on 17th December 2019.

Dec 2019 is also when I had achieved my goal of losing ten kg and I had lowered my HbA1c to 42. I had been on Metformin for five years after my diagnosis with a HbA1c over 100, but I never managed to get my HbA1c below 60. I took charge in early 2019 when my GP wrote me a prescription for Gliclazide, (which I never took). I read the book "The Fast Diet" by Michael Mosley, who sadly said passed away this year on a Greek Island, and Mimi Spencer. Together with my partner I started the 5+2 diet where I ate only 600 calories and essentially no carbs for 2 days per week. We ate normal on the other days. This went much better than expected, the pounds almost melted away and the blood sugar started dropping. At the time I was travelling a lot for work and being away for one to two weeks per month. Thus I missed fast ways when away, but used travel days for fasting. I never liked airport or train station food anyway.

If anyone would have told me that by Christmas 2024 I would be able to keep my weight at the same level, my HbA1c in the 40s and not take any medication, I would have signed on the dotted line immediately, but I didn't really believe it. But here I am, I still fast for two days a week, without rigorous attention to calories, but stick to no carbs, no lunch, mainly soups and salad and maybe an egg or a bit of fish. I drink water, coffee and tea and don't feel hungry on fast days.