Sort of got there

[Ditzy47]

I've been on the low carb program, lost some weight, felt better, had some unrelated health problems and had, reluctantly, to go abroad for several weeks. Before I went, my Hbac1 was 43 and the doc said that meant pediabetic. Am still low carving but no longer keto. Does this result mean that I'm not diabetic and therefore no longer need my retinal screening and if I lower it even more will that mean I don't have to worry about eating sweet puddings or chocolates again? (Within reason of course and for treats - I don't have a sweet tooth anyway so not likely to indulge and go back to being T2). I suppose what I'm asking is, if you reverse the diabetes, does that make everything the same as a non diabetic who can drink a glass of orange juice or a normal coke?

 

[Resurgam]

For decades before diagnosis I did not drink orange juice or coke - either I subconsciously knew that there was something bad for me or the horrible taste put me off.
I have very sensitive taste sense - I used to work for Allied Lyons the food people testing food after storage in various set conditions.
Having had normal Hba1c readings for six months now, if I do want to consume more carbs I don't bother with the foods or drinks for ordinary folk.
Coke? No no moscato d'asti lightly chilled, in a flute glass, please.

 

[Dark Horse]

I've been on the low carb program, lost some weight, felt better, had some unrelated health problems and had, reluctantly, to go abroad for several weeks. Before I went, my Hbac1 was 43 and the doc said that meant pediabetic. Am still low carving but no longer keto. Does this result mean that I'm not diabetic and therefore no longer need my retinal screening and if I lower it even more will that mean I don't have to worry about eating sweet puddings or chocolates again? (Within reason of course and for treats - I don't have a sweet tooth anyway so not likely to indulge and go back to being T2). I suppose what I'm asking is, if you reverse the diabetes, does that make everything the same as a non diabetic who can drink a glass of orange juice or a normal coke?

Regarding retinal screening, Public Health England say:-

"Current evidence shows that all people with diabetes should be screened for diabetic retinopathy for life once there has been a definite diagnosis of diabetes, excluding gestational diabetes."
https://phescreening.blog.gov.uk/20...dont-slip-through-diabetic-eye-screening-net/
​

In other words, even if people have managed to put their diabetes into remission through diet etc., they should still attend yearly diabetic eye screening. If you read the link you can see that there have sometimes been problems because GPs haven't always realised this.

 

[Ditzy47]

Thank you, Dark Horse, that's good to know because I do find it a horrible bind. I have had a macular hole in one eye that got so bad it tore the retina resulting in an operation and being six days face down, every minute of that time. I still can't see that well for the scarring and have now grown the expected cataract that will be done in a couple of weeks. It now seems I have a macular hole in the other eye and need to make sure I report any distortion of vision because that will mean it is dragging the retina and needs to be dealt with immediately, before it tears. I wasn't sure whether, with all this going on I still needed the screening because i have an idea they only look at what they are looking for and not for anything else. When I went yesterday for my pre-op, the nurse taking details listened to me saying I had been diabetic but my latest test showed pre-diabetic so she said, 'Not diabetic then'. And that was that so if I have slipped back above the line since the test, they aren't going to consider it.

 

[Dark Horse]

Thank you, Dark Horse, that's good to know because I do find it a horrible bind. I have had a macular hole in one eye that got so bad it tore the retina resulting in an operation and being six days face down, every minute of that time. I still can't see that well for the scarring and have now grown the expected cataract that will be done in a couple of weeks. It now seems I have a macular hole in the other eye and need to make sure I report any distortion of vision because that will mean it is dragging the retina and needs to be dealt with immediately, before it tears. I wasn't sure whether, with all this going on I still needed the screening because i have an idea they only look at what they are looking for and not for anything else. When I went yesterday for my pre-op, the nurse taking details listened to me saying I had been diabetic but my latest test showed pre-diabetic so she said, 'Not diabetic then'. And that was that so if I have slipped back above the line since the test, they aren't going to consider it.

If you were ever diagnosed as diabetic you still need to be on the Diabetic Eye Screening Programme's register. However,if you have attended an appointment at the eye clinic where both your eyes were checked for retinopathy, the hospital should send the Screening Programme a copy of the letter they send to your GP. The results can be entered onto the eye screening specialist software and will count as a 'screening' even though it has been done in the hospital. The Screening Programme will not call you again for screening until a year has elapsed since the last recorded retinopathy check.

Problems sometimes arise when patients think that as they're attending an eye clinic their retinopathy is being checked - unfortunately this doesn't happen at all types of eye clinic appointment. It is worth reminding the ophthalmologist that you are diabetic and that the Screening Programme needs a copy of your feedback letter (preferably with an NSC grading) as sometimes they forget!

Regarding macular holes, these are sometimes picked up at diabetic eye screening but as the focus is on looking for diabetic retinopathy, there is no guarantee that they will be.

In short, you may not need an eye screening appointment if your eyes have been examined for retinopathy during your cataract/macular hole appointments. However, you still need to be on the Diabetic Eye Screening Programme's database so you can be invited for screening if you are no longer being checked in the hospital.

 

[Grateful]

I suppose what I'm asking is, if you reverse the diabetes, does that make everything the same as a non diabetic who can drink a glass of orange juice or a normal coke?

(With the caveat that I am not a doctor, just a lay person who has researched this particular issue ad nauseam.)

Type 2 diabetes cannot be "cured," with the exception of some extreme cases who have bariatric surgery for example. That is why the terms used are "reversed" or "put into remission."

To retain the benefits of low-carb, you must stay on that lifestyle for the rest of your life. Notice that I call it "lifestyle." It is not a short-term "diet" that you can adopt for a few months to "fix" the problem.

Unfortunately the only way you can test this proposition is to go ahead and abandon the low-carb approach. Then see what happens to your blood glucose level in the following months and years. According to current medical knowledge, it will rise, and continue rising, until you are back at "diabetic" levels.

It does depend on what kind of low-carb approach you were using. You may be able to play around with the total amount of carbs, while still keeping within a low/moderate-carb approach, and still have "good" numbers.

We also have our own goals for control. Personally I went for the lowest possible number (see signature) and adopted a fairly extreme low-carb regime to obtain it. I just hate the idea of ever having to take meds (but am perfectly willing to take them if there is no other choice). Others -- including my doctor by the way -- would be perfectly happy with a higher blood-glucose number as long as I showed control/stability at below-diabetic levels.

 

[woodywhippet61]

At my last DN clinic I was offered the choice of coming off the Diabetic Register (because they no longer consider me to be diabetic) which would mean no longer having the routine screening and tests or remaining on it and having them.

As I believe that my T2 is in remission and that it will return if I go back to the way that I used to eat/drink and also because I want the screening/tests I stayed on it.

 

[LittleGreyCat]

I've been on the low carb program, lost some weight, felt better, had some unrelated health problems and had, reluctantly, to go abroad for several weeks. Before I went, my Hbac1 was 43 and the doc said that meant pediabetic. Am still low carving but no longer keto. Does this result mean that I'm not diabetic and therefore no longer need my retinal screening and if I lower it even more will that mean I don't have to worry about eating sweet puddings or chocolates again? (Within reason of course and for treats - I don't have a sweet tooth anyway so not likely to indulge and go back to being T2). I suppose what I'm asking is, if you reverse the diabetes, does that make everything the same as a non diabetic who can drink a glass of orange juice or a normal coke?

Look at it the other way round.

If you have reversed your diabetes then you are effectively non-diabetic and you can wallow in a bath tub of sugar without your BG going through the roof.

If you have managed your diabetes through low carbohydrate eating, such that your HbA1c is now down to normal levels then all you have established is that your eating regime is effective in managing your diabetes, and seems a good thing to maintain.

With respect, pre-Diabetic means that you have problems regulating your blood glucose but your current levels aren't high enough to justify a diagnosis of Diabetese with no previous history. It does not mean that you are cured. People with pre-Diabetes are on their last and final warning to do something before it is too late.

Your value of 43/6.1% is very close to my current value. Penultimate one was 5.8% and last one was 6.2%. There is absolutely no doubt that I am Diabetic even though I am managing to keep my numbers between "normal" and "Pre-Diabetic".

Assuming you have a test meter (you don't say) then you can easily check if you are diabetic by eating carby/sugary things for a couple of days and monitoring your BG for spikes. If your insulin response is back to normal then you should not see any spikes, and your BG should be back to normal within 2 hours. of eating

You should still be wary, because it is now thought that T2 Diabetics may well have spent many years with Insulin Resistance (IR) and elevated insulin levels. Only when the IR overloads the capacity of the pancreas to produce enough insulin to force your BG back down do you get full blown Diabetes. So a fasting glucose test plus a measurement of your Insulin Resistance would probably be needed to confirm that you were in proper remission.

 

[Bluetit1802]

At my last DN clinic I was offered the choice of coming off the Diabetic Register (because they no longer consider me to be diabetic) which would mean no longer having the routine screening and tests or remaining on it and having them.

As I believe that my T2 is in remission and that it will return if I go back to the way that I used to eat/drink and also because I want the screening/tests I stayed on it.

I was also nagged to come off the register on my previous two annual DN reviews, but declined. I was informed emphatically that I would still receive the annual retinal screening, foot checks, and annual DN review with the relevant blood tests. The only difference would be my interim 6 monthly blood tests would be stopped. The continuation of the eye checks has definitely been confirmed by Public Health England (see post #3 by @Dark Horse ). The reason I declined was the removal of the 6 month blood tests - not the HbA1c as I couldn't give a donkey's whisker for that, but the cholesterol and kidney/liver function tests etc.

 

[woodywhippet61]

I was also nagged to come off the register on my previous two annual DN reviews, but declined. I was informed emphatically that I would still receive the annual retinal screening, foot checks, and annual DN review with the relevant blood tests. The only difference would be my interim 6 monthly blood tests would be stopped. The continuation of the eye checks has definitely been confirmed by Public Health England (see post #3 by @Dark Horse ). The reason I declined was the removal of the 6 month blood tests - not the HbA1c as I couldn't give a donkey's whisker for that, but the cholesterol and kidney/liver function tests etc.

Interesting re the tests. For me with my fatty liver it's important to me. Also the psychological effect of being tested helps me. I was first diagnosed pre-diabetic and had absolutely no real idea what it meant or maybe I hid from it. Because of my poor liver function tests and vitamin deficiencies I was being blood tested it felt like all of the time (every month maybe) and in the end I just couldn't cope. Oddly the fact that I was pre-diabetic was just not addressed by my Dr or me.

I am aware that I will slip backwards so need the 6 months tests. 6 months is so much closer than a year in my mind as well as in reality.

BTW I'm in Wales not England so things might be different.

 

[Biggles2]

In short, you may not need an eye screening appointment if your eyes have been examined for retinopathy during your cataract/macular hole appointments. However, you still need to be on the Diabetic Eye Screening Programme's database so you can be invited for screening if you are no longer being checked in the hospital.

Agreed. Also, with your eye history @Ditzy47, you have to be tenacious about being your own best advocate. You do not want to fall between the cracks, and this is always a possibility in service areas where demand for services sometimes outpaces capacity. This is especially true where quality targets introduced in one area lead to unintended outcomes downstream, such as longer wait times for follow up for those conditions or populations not subject to target monitoring.

When there are rewards and penalties built into a system the old saying will always ring true: ‘what gets measured, gets done’.

Here is a link to (followed by a snippet from) a 2016 article from The Royal College of Ophthalmologists which describes this issue very well: https://www.rcophth.ac.uk/2016/03/i...al-eye-services-risks-patients-losing-vision/:

“The reality is that increasing demand for eye clinic appointments comes from patients with chronic eye diseases, such as macular degeneration, glaucoma and diabetic eye disease. These patients are the most vulnerable and at the greatest risk of irreversible loss of vision. These conditions require long-term ‘return’ or ‘follow-up’ appointments for repeat monitoring and regular treatment procedures.
These follow-up appointments are more likely to be postponed or simply be lost in the system for months, and sometimes years, to accommodate new referrals in already oversubscribed clinics.”​

 

[AloeSvea]

I've been on the low carb program, lost some weight, felt better, had some unrelated health problems and had, reluctantly, to go abroad for several weeks. Before I went, my Hbac1 was 43 and the doc said that meant pediabetic. Am still low carving but no longer keto. Does this result mean that I'm not diabetic and therefore no longer need my retinal screening and if I lower it even more will that mean I don't have to worry about eating sweet puddings or chocolates again? (Within reason of course and for treats - I don't have a sweet tooth anyway so not likely to indulge and go back to being T2). I suppose what I'm asking is, if you reverse the diabetes, does that make everything the same as a non diabetic who can drink a glass of orange juice or a normal coke?

I would not say you were no longer diabetic when you have intermediate hyperglycaemia, still, with an HBA1c of 43. But that is because my HBA1c is in that range and I identify, as you will, as a person with intermediate hyperglycaemia.

I consider the low-carbing thing is for life. Ditto retinal screening! Liver and vascular health is just too important for as long a life as I can wangle, considering my continued wonky blood glucose and insulin regulation.