Hello All,
I'm 31 and have just been diagnosed with T2D. It's my own fault, at diagnosis I weighed 150kg. I have just had 2 babies and I'm scared I won't be able to be the father they need in the future. I've started trying for weight loss, aiming for remission (as I know this is the best route I have available to me) and since November I've gone from 150kg to 136.2kg, and my target is <100kg by October, and then 80kg is the end goal. However, I HATE the diet. Carbs are my weakness; I love pasta, pizza, a sandwich, etc).
1) If I manage to achieve remission and maintain the weight loss, will I be able to eat these things (granted in moderation) again?
2) Can remission be maintained for good? I read somewhere that insulin sensitivity increases the longer you've been in remission?
Thanks
Hi and welcome.
The issue with T2D, and the reason why T2D is so prevalent now and wasn't (say) 40-50 years ago is (in my opinion) the greatly increased amount of processed carbohydrate and sugar in the modern diet, coupled with official advice to eat as much carb as possible and as little fat. For many of us, our insulin response simply cannot deal with that level of sugars in the system on a daily basis. It's been suggested that looking at this as an addiction problem rather than a nutrition problem might give a better basis to deal with it.
I've probably been diabetic since around 2010 which is when my symptoms started, and my BG has certainly been abnormal since 2013ish, which is where my GP records first mention it (although nobody told me). Countback would also take me to my condition starting around 2009-10. At (eventual) diagnosis in 2019 I'd gained over 70lbs from my 2010 weight, and my scales wouldn't cope, so I don't know how heavy I was when I started. The other point is that in my case weight loss followed (by some way) achieving normal BGs - you'll read lots of things claiming that you can only achieve normal BGs through significant weight loss - not true, in my case at least. I had normal BGs in four months after starting very low carb in December 2019, but most weight loss happened later.
The issue I found with "carb substitutes" is that none of them get anywhere close to matching the hit you get from real carb. I have tried a number of "pastas" and "breads" etc and although they sometimes look OK the best I can really hope for is that they are just tasteless. I don't see much point in eating stuff I don't like. So steadily in the last six years I've dropped any attempt to have anything other than straightforward meat/fish/vegetable/dairy. I can cope with legumes etc in the amounts I eat them. I've had a subscription to SRSLY low-carb bread for years, but I'm not getting through the supply these days.
The other thing is that high blood glucose is only one symptom of "T2 diabetes". It causes its own set of problems, and I'm not suggesting for a moment that it shouldn't be brought back to normal (sub-42) levels. But it's not the only thing - there's what caused those of us with T2 to be unable to control our blood glucose in the first place. In my case I have no idea what that is, and I suspect there may be different answers for different people.
As far as remission goes, by remission I mean an absence of diabetic symptoms and normal (ie sub 42 mmol/l) blood glucose levels, without glucose lowering medication. There are a number of definitions of "remission" around, and some claim that remission can be declared while still having abnormal blood glucose. I disagree. Remission is absence of symptoms and high blood glucose is definitely a T2 symptom....
What I'm getting around to saying is that if you achieve normal blood glucose levels, you have successfully managed one important symptom but the underlying condition is still there. There are a number of accounts on this forum from people who controlled their BG, and then went back to eating carb. And wound up back where they started.
So for me, having not had an abnormal HbA1c since January 2020, the answer to your first question is no, I cannot advise that you would be able to do that. I certainly eat some types of carb in limited quantities on rare occasions these days: pasta maybe every 3 or 4 months, for example. Bread on the same basis - it's simply not part of my regular diet and never will be. As for things like cakes and biscuits, I don't think I've had anything like that since Christmas 2019.
The second question - I have had normal blood glucose for about six years. I'm hoping that I can maintain that as others have, for longer periods. That should be possible if I avoid the main cause of having high levels of glucose in my body - ie not putting the carbs and sugar in my mouth in the first place. That's entirely in my hands.
I have also read the same thing about "insulin sensitivity" - but as I've never been tested for anything to do with insulin, I have no good idea whether it's so in my case. My BG will hit nine plus etc 35-45 minutes after a small amount of carb (eg from the milk in a small latte), but be back at starting levels by 60 minutes. It might be taken as evidence to show that my insulin can deal with the limited amount of carb I eat, but I don't think it follows that I have become more "insulin sensitive" - an alternative explanantion is that there's just less carb.
Best of luck. The key thing is finding what works for you, and what you can live with.