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Reversal of T2D, then what?

Waspdog

Member
Messages
16
Okay here’s the deal, two months ago I was diagnosed with T2D, (HgA1c 6.6%) following a heart attack (stent fitted, pump working well). I was prescribed Empagliflozin. My objective following this diagnosis was to get my diabetes under control by rapid weight loss, no carbs, and reducing my blood sugar with a view to reversing T2D. I feel that I am well on the way, I have lost 12kg (BMI 23.8) and blood glucose in the normal range, see attached graph. It will be a couple of months still before I am normal again, but then what?
I want to stop taking Empagliflozin, drink beer and eat bread again. And yes I know I cannot go back to living the way I did before my diagnosis, and should adhere to the rule all things in moderation, but does anybody have any real world experience of coming out of the other side and being normal again? I would love to hear from anybody that has made this journey.
 
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Hello @Waspdog

When I was first diagnosed I was looking forward to the day I could say I had 'cured' my diabetes and go back to being able to eat carbs. I love carbs.

I have now formed an opinion (my personal opinion) that that's not going to happen for me. While some days that makes me sad most days it doesn't. I do 'dirty keto' so have found enough work arounds so usually my life is fine. Yes I do still wish I could eat carbs but even more I would like not to have any of the consequences of uncontrolled diabetes. My health is good and that is my priority over my love for carbs.

I do wish you well and suggest that you read/post in the success testimonials part of the forum.

Good luck.
 
I have just looked at success testimonials, they are inspiring. Maybe I should have posted there but I am well aware that I am not out of the woods yet. Dirty keto - sounds like fun!
 
Waspdog said:
I have just looked at success testimonials, they are inspiring. Maybe I should have posted there but I am well aware that I am not out of the woods yet. Dirty keto - sounds like fun!
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I moved to non diabetic levels but a year after have found carbs will cause issues. Unfortunately for me it seems there is a lifelong issue. Start on the carbs and the weight creeps up and the bloods creep up. I am needing right now to get back to watching my levels as just a few naughty days are showing an impact and I don’t want to go backwards. So I don’t want to scare you or say it’s impossible but it’s a dangerous path as a little piece of bread now and again can easily become a sandwich every meal. They are a good group that can be something you crave I find

however, I was diagnosed well over a decade ago, it could be just an amount of time for me leading to a body that can tolerate small carbs but not too many and if you reverse quickly enough after diagnosis and keep the weight down then it might be possible. We do have some posters who report this has worked for them @Ronancastled I believe is one?
 

Worrying, I want a sandwich and a beer. Are you still, or were ever, on medication? If you stopped was it immediate or gradually, say ½ a pill then ¼ etc…
 
Waspdog said:
Worrying, I want a sandwich and a beer. Are you still, or were ever, on medication? If you stopped was it immediate or gradually, say ½ a pill then ¼ etc…
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I was on:
  • metformin 4 x 500mg
  • Bydureon weekly infection
  • Daplaflaglozin
I reduced in backwards order as they had been added to my regime over the years. So I stopped the drugs and then with doctor support having 3 monthly hba1c and if the levels dropped stopped the next

By the way: there are low carb beers and breads, so what you are after isn’t actually beyond the realm of possibility regardless of how well you may reverse
 
Sorry this isn’t inspiring. But it is real.

I think most of us felt the way you do in the early months, that we’ll get this sorted then get back to real life. I did. Then a some point I thought I accepted I couldn’t and just got on with it. I was never on medication and low carbed and keto’er for nearly 4 yrs in remission. Didn’t hate it as I did get used to it but I did miss the convenience of eating “normally”. Til this last year - when I got more lax at it all for a whole host of reasons. It wasn’t a deliberate choice to push the boundaries but it’s happening. At first the odd slip/bit of normality I got away with. Then it happened more and more often. Perhaps because of the other stuff I had going on, perhaps because I wanted to believe I could get away with it. My weight has gone up and so has my hba1c. Not catastrophically but noticeably . And it’s harder to get back on the wagon than it was initially when spurred on by the shock and determination of diagnosis.

My goal is not to expect normal all on its own - much as I’d love that. It’s to stay healthy in the long term. It’s to achieve normal levels without medication or complications and that means keeping control most of the time through diet. For me it definitely means not trying to “get away” with too much as I apparently can resist anything but temptation. So I’m better not having any of something than teasing myself with a little of it. Others need a little to keep themselves motivated.

Sadly I’ve yet to see anyone “go back to normal” ie pre diagnosis lifestyles for any length of time or with any frequent regularity. We can often achieve good enough control to have special occasions and treats occasionally or our own adapated versions of normality for sure but we’re diabetic and unless we actively control this somehow it rears it head again.

On the plus side loads and loads of people have got off medication and stayed off it long term in this forum.

so after all this rambling my answer to the post question is “keep on keeping it reversed” as that is a process which mostly gets easier with knowledge and practice despite my current “blip”
 
Waspdog said:
I want to stop taking Empagliflozin, drink beer and eat bread again.
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Stopping the meds should be fairly easy.. going back to eating "normally" probably isn't something you should desire.

Many of us found that after a fairly extended period away from "normal" food we realised that it wasn't what we should be eating anyway. Not only had it given us T2 diabetes but a host of other health problems that all went away when we ceased eating "normally".

The fallacy that bread and beer is "normal" is the problem.

Single ingredient freshly prepped food is what humanity has thrived on for millennia.
If you want to thrive I'd heartily suggest eating that (mainly meat of course).
 
Not type 2 but do eat low carb so can relate to the cravings for bread if not beer and in my case, chocolate.
It is great that you are imagining the future without the diabetes drugs and staying lean. Sounds as if in order to get to this impressive stage you dived in at the deep end and now need to work out just how carb intolerant you are? Perhaps once off the 'flozin you can invest in a flash glucose monitor (Freestyle libre) and run the beer and sandwich experiment to see how far our of range and for how long ?
But if you find that its hard to stop at 1 sandwich/beer perhaps you will need to frame the choices rather differently. Just like any new habit you have to keeppractising this one until it gets easier!
Many of us are doing the same, slipping up and trying again.
My own method was to have 1 carby day which didn't lead to a binge in my case. Only you know how you would be with a 'cheat day' like this.
Another thing which will help increase your tolerance of carbs /make you more insulin sensitive is to increase your muscle mass by doing some resistance training if you aren't already. I assume you've done some cardiac rehab so have the all clear?
No gym required unless you want a bit of support and guidance!
 

As you suggest experiment with what I can tolerate, which I have started, tentatively. For example I only drink at weekends, today, Sunday, I have had 400ml beer and I expect my glucose to be below 6 in morning. I may eat a slice of bread tomorrow to see what happens.
With the flozin I can reduce to half a pill for a few days. I swim about 1km most days but adding some muscle mass may be a good idea. But slowly slowly, and talk to Doc. Next real target A1C below 6% in about 2 months.
 
Be careful with beer because the alcohol has a short term effect of lowering BG because the alcohol is processed in priority to the carbs - so BG lowers at first and the the effect of the carbs kicks in giving a rise later after all the alcohol has been processed.
 
As folks have said there is a low carb version of beer and bread if you want to go that route. It’s expensive by the way. I have low carb bread maybe once a fortnight.

your drug and excessive amounts of carbs can have nasty side effects so watch out for that too.

I don’t think many of us can go back to eating the same amount of carbs after a dx of type 2 diabetes or free abandon as in the past.

I’m one that can’t have anymore than 130g or less or I spike most of the day and become diabetic again as I was pre diabetic. I’ve also slipped of the wagon well it was burnout for 2 years and what scared the bejesus out of me was insulin

I was also on dapagliflozin 10mg then 5mg. Now none.

I wouldn’t be experimenting with the amounts of your empagliflozin unless under supervision from the doctors as it’s a new dx after all and can be dangerous for you.

do you have a meter, as I’d be doing the eat to it
Raises no more than 2mmol

you’ve only been dx so I’d slow down on wanting the carbs back and change that mindset if you can that you can only have some.

It isn’t a club we wanted to join but we have

good luck with it all and keep posting.
 
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Thanks for the tag @Andydragon

Greetings @Waspdog, welcome to your journey.
Saying I reversed my T2 to the point of eating "normal" again is a bit disingenuous.
I eat about 150g of carbs per day which is just outside the definition of low crab (< 130g)
Indeed a normal non-diabetic eats 300-350g of crabs per day, that ship has sailed & good riddance to it.

What I can do now is eat bread, pasta, potatoes & drink beer without spiking my BG.
It took a year of low carb, exercise, & huge weight loss to get me to that state.
Congrats on losing 12kg, work on maintenance now as your BMI is perfect.
Your biggest advantage is that low diagnostic level, you've been fortunate to have been picked early.

Keep on the low carb route for at least 6 months & then perhaps experiment with some of your old favorites.
The adage is eat to your meter, it will tell you what you need to know
 
Waspdog said:
I have had 400ml beer and I expect my glucose to be below 6 in morning. I may eat a slice of bread tomorrow to see what happens.
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I’d urge you to do two things to make sure you really aren’t playing with fire:

1) Don’t just test in the mornings; test robustly before and after eating and if a combination of fat and carbs is eaten, more often than just at the 2 hour point - a Libre would be ideal for you to see what is going on.
2) Don’t assume that because something doesn’t spike you once, it won’t do on another occasion or if it starts becoming a frequent occurrence. I can ‘get away’ with an indiscretion here and there, but repeat the same indiscretion two or three times in quick succession and it’s a different matter.
 

That's exactly what I was going to say!

I also use a libre for holidays as I know that's when temptation will constantly test me. I've just come back from 10 days all inclusive. Making sensible choices but having 6 spikes as the bread crept in and the wine kept being topped up and I "treated" myself to afternoon tea twice (!) reaffirms I am a diabetic. Dirty keto 95% of the time might be just enough to keep me in check, but I continue to monitor just in case it doesn't

We each have to find our own way, for life
 
Waspdog said:
Worrying, I want a sandwich and a beer. Are you still, or were ever, on medication? If you stopped was it immediate or gradually, say ½ a pill then ¼ etc…
Click to expand...
depends on you, I manage to have small amount of carbs without an issue so long as I'm careful and am on my metformin, I was managing with diet only for a while...until I wasn't...took a year for me to no longer be managing by diet alone, in that time I also found out that I can't go keto without causing other issues. If you manage to bring your diabetes under control it normally needs to be kept under control, and whilst you can maybe relax on what you can eat and what meds you are taking the chances are you will not be able to go back to eating and drinking the same as before.

Now I eat small amounts of carbs at every meal and take my new metformin 3 times a day (could probably still manage on twice a day if I was willing/able to pay for the slow release form again) and mostly manage without an issue. I still miss certain foods, and will have occasional cheat days.
 
Firstly, thank you all for your helpful comments.
So what I am understanding from your replies is a little confusing. While we all strive for reversal, it is never complete!
Let me explain. Reversal is generally regarded as getting A1C down to, and maintaining it at, an agreed level. Complete reversal would mean going back to a “normal” diet but with moderation with respect to carbs. After all it was probably this over indulgence that made you T2D.
However, your replies indicate that even years after getting A1C in hand, more care has to be taken with diet than someone who has a similar A1C but has never had it elevated to the point of being T2D.
For example, I wouldn’t expect to eat a doorstep sandwich with a couple of beers everyday and stay in reversal. However, I would expect to be able to do this, say, every couple of weeks, as would a non-diabetic, without dropping back into being T2D.
So, if my train of thought is correct, something has fundamentally changed, that can’t been reversed.
Could this be irreversible liver function? Or might it be just old age and deteriorating metabolic function; few of us are spring chickens!
 

Everyone is different, and you will have to decide what you can do and how you want to live with this disease for yourself but when people talk about "reversal of t2d" they do not mean they are cured, they mean they are managing their diabetes without medication and to do that requires a concentrated effort to maintain, often a restricted diet, exercise, and or weight-loss. The weight-loss part of this appears to be the most important, that and not having had type 2 diabetes for long also effects the outcome of trying this. If you can lose weight, and therefore lower the fat levels in your liver and pancreas, it might allow your body's beta cells in the pancreas to start working again as they should. In which case you will be able to maintain on a "normal" level without medication much more easily, but you would still need to be careful about the carbs, and the fats, and keeping your weight down, as you will be at a higher risk for those cells to stop working properly again.

I had early onset type 2 (or possible secondary diabetes) because of my PCOS, which was not diagnosed, and that has meant a change in my body's ability to deal with sugar that isn't fixable, when I go back to normal levels with a restricted diet it is because I'm on the restricted diet and not because my body has reverted to normal. That said, and as I mentioned before, I do need to eat carbs with most meals, I will often have a couple of slices of wholemeal bread for a sandwich and will sometimes have a beer, but I need to be on my metformin to do that. I tried for a while with just diet but even if I managed to keep my levels well if I had a cheat day it was noticeable in my bloods...however, one here or there isn't going to be a major issue I think, it's whether you can do that and not slip back towards too many cheat days that might be the bigger problem.

Good luck.
 
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Waspdog said:
, I would expect to be able to do this, say, every couple of weeks, as would a non-diabetic, without dropping back into being T2D.
Click to expand...

The HbA1c is a sort of 3 month average so your sandwich and a couple of beers every 2 weeks would add up to 6 sandwiches & 12 beers over the 3 months. I doubt if that would cause much of an increase to your HbA1c, almost certainly not enough to put you back into T2 levels, unless of course you were almost there anyway.
The real danger is that it's unlikely to stay at a sandwich & 2 beers every fortnight, after a few months or even weeks that fortnight becomes once a week and then maybe a couple of days a week.
The focus and determination you have shown in the few months since your diagnosis is admirable, but difficult to maintain, you're already thinking of ways to add more carbs.
Carb creep is a very real danger and once you start negotiating with carbs it's a very slippery slope that leads straight back to T2
 

I’m beginning to get the picture. Carb creep - I like that. Thanks, but no binges just yet.
 
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