T2 or NAFLD? ...or, a funny thing happened on the way to the surgery

[Chris24Main]

With the all-seeing eyes of hindsight, I realised I had been suffering from insulin resistance decades before I became T2. If only I'd known - if only more of us knew about it, both medical professionals and everyday people. So much grief could have been avoided by those of us who would have been willing to make what would then have been small changes. Better late than never, though.

This is precisely the point - almost nobody has even heard of Insulin Resistance, and I think you could go years as a diagnosed T2DM and have no clue as to what it is.. yet it has huge implications to all sorts of non-invasive disease, and already affects the majority of the population (at least that is true in America, so will shortly be true here in the UK, and will more or less be the case everywhere).

The problem is that you don't suffer from Insulin Restistance, any more than you suffer directly from coffee, or alcohol, or excercise - resistance - you just do more..

Then, because of the way that more insulin -> more insulin resistance, it's a spiral that may take 20 years to turn into something that you will suffer from, but you will...

And - it's easy to feel that people in general don't actually change their behaviour, but if you look at the bigger picture statistics - populations do - it's just that the advice is wrong - but generally the consumption of Saturated fat and Carbs have changed at a societal level since the advice changed in the Seventies.. pretty much as the advice went -

If people understood that actually, the effect of smoking drove that advice, and we need to stop demonising fat, and reduce starch and sugar... my bet is that you would see a real change..

It's just difficult to maintain the current food and drug supply if that were widely understood...

 

[Chris24Main]

@Melgar - fascinated to hear that you are insulin sensitive - you continue to throw curveballs... (and I mean that lightly)

It kind of makes sense of a couple of things, but I don't want to speculate openly as if I'm trivialising..

One point to consider though - in your case, clearly.. I mean, clearly; you do not come from a starting point of too much digested glucose and insulin. Then, you are taking this med which further reduces blood glucose...

That would suggest you are, more that most, producing Glucagon more often than insulin (which would explain the kind of "glucose over-compensation" that you describe - you are, or have to be, more effective at creating glucose in your liver) - and I wonder what the effects may be of being constantly in that state (as opposed to being constantly in the state of producing insulin - this all being about; the body is designed to be in a balance between producing insulin and glucagon)

Now, I remember something (just not clearly enough) from Dr Rob Cywes - essentially saying that once someone (in his case following a Carnivore diet) had reversed insulin resistance.. you get to a point of being insulin sensitive (which is good, insulin affecting 100 and more processes and every cell in your body, so being sensitive is a good thing) - to a point where you can be insulin deficient (which is a bad thing for all the same reasons)

and the advice was that (and this could be two years into a plan to reverse insulin resistance, will not be and should not be quick, but may be within your time frame) one should consider deliberately eating something (in his case, dairy products, just some cream in his coffee) in order to stimulate an insulin response, to avoid becoming insulin deficient over time..

Please (and I'm sure you won't otherwise I would not say this) do not take any of that as advice or an attempt to diagnose anything.. just food for thought (which I now realise is a horribly a propos phrase)

 

[Chris24Main]

Final thought - I get that the dogma around OA being a wear and tear thing is well bedded in, and I can see that there is a connection to lots of walking etc (for what it's worth, I was hugely into the kind of fast walking you describe, and stopped because my foot and knee were starting to suffer, so I do sympathise) - and I do note that you use weights, but if OA was about "grinding joints down" - why would it spread? why fingers and toes unless it was something ..systemic (ie, cellular, related to metabolism)

https://www.amazon.ca/Why-We-Get-Sick-Epidemic/dp/1953295770/ref=sr_1_1?crid=39U7B58A3IL46&dib=eyJ2IjoiMSJ9.cG72GfLUJdEZHu1bUxKQ3I4RDTEntXNmtaPjbkAp7jodasIlt_Tg7PNnTHdjY0t4WPZqjX-O5qgsNyipTv43Gv7K4gnSYqEbGkvU_0Jt5bP0dJrwCCjNyQPdi2VMnFZaS9Yekdv9jHA4RbYDH17VPA.q8hY2Yt42JcaA228VHp8gWWknAa4SArG9QfxBcO5vl8&dib_tag=se&keywords=why+we+get+sick+by+benjamin+bikman&qid=1721294434&s=books&sprefix=why+we+get+si%2Cstripbooks%2C228&sr=1-1

I know you're a fast reader - you could probably finish this quicker than I can and tell me about it... but I've found it incredibly illuminating.

 

[BadgerPaul]

Thanks this is almost a mirror image of my experience,reading and life. I’m 72 a year ago after reading lots of books I started to reduce my insulin. I’ve lost over 5 stone and don’t have insulin. Still on metformin but thinking of stopping it. Trying to go keto but difficult. The morning spike isn’t helping. Trying to miss breakfast. But it’s probably my favorite meal.
Any advice or thoughts would be appreciated

 

[Chris24Main]

Hi @BadgerPaul - if that means you've trawled through 13 pages of this thread - good work!!

So, I try not to offer advice as a general principle - I think of this thread as a safe space to think out loud, so to speak; the stuff I talk about may make it sound like I'm pushing one thing or the other - and of course I have my opinions - but what I'm really trying to do is break this whole thing down from the inside out (cellular biology) at the same time as from the outside in (thinking about us as human beings, that need sleep, and good mental health, and quality of life as we get older etc) and how everything interacts - and then how can we distill all of that into a simple narrative that is a better one for us than the one we seem to agree on (less saturated fat, Calories in vs Calories out) which is not working for so many people..

So, with that as the longest caveat in the world... if you've lost 5 stone in your seventies, there is nothing I can tell you that you don't know - good for you!!

I'm curious what you mean by "you don't have insulin" -
Metformin is a tough one... it turns out it's essentially a historic herbal medicine (now formulated, but not far from the original extract) and we don't 100% know everything about how it works. It's main use of course is to reduce your blood glucose by hampering your liver from producing glucose from stores. In that sense it works, and the side effects and risks are low, but for me; (and I only offer my experience) - when I felt that my blood glucose was under control from diet and fasting, I stopped taking it, and have agreed that plan with my GP. I would only advise having a conversation about it during your next visit.
Many people here feel happy taking it, and many don't .. it sounds to me like you have things working well, uncontrolled change is not generally good..

Keto - yes, that's a big undertaking - and it's difficult to determine what is right to have as a goal. Personally, I think anything you can do to reduce sugar and starch is most of the way there.. and steady away... but there are as many opinions on this as stars in the sky.. mine is no better or worse than anyone.

 

[BadgerPaul]

Hi Chrs24Main Sorry reference my insulin. I was injecting 70ml twice a day at my peak. Under guidance from my GP and many books ( The Diabetes Code, Glucose Revolution, Living Low Carb and Blood Sugar 101 ). So with pressure from my daughter and son in law (whose father had died from type one ) I made the decision that I needed to stop the insulin. Slowly I reduced the insulin and started controlling my diet. The best decision I ever made.
As I’ve said my problems at the moment are.
1) my early morning spike before breakfast.
2) should I stop metformin ?
3) should I be Keto. My weight has levelled out at an average of 83kg.

I’m struggling with these issues and hunting for answers.
For example I had it in mind after six months of stopping my insulin injections. I was going to start reducing my Metformin. But I’m not sure. As I understand it is coming to the end of its license (30 years) so the side effects are well known. Some of which are good for us.
I believe that my liver is damaged not giving a secondary shot of insulin. I believe this is due to the years of insulin injections and my age.
To top this off about 14 weeks ago I had part of my intestines removed due to a blockage. I have lots of thoughts as to why. But I want to believe it wasn’t my diet. But probably hereditary as my father had the operation 4 times???

 

[Melgar]

@Melgar - fascinated to hear that you are insulin sensitive - you continue to throw curveballs... (and I mean that lightly)

It kind of makes sense of a couple of things, but I don't want to speculate openly as if I'm trivialising..

One point to consider though - in your case, clearly.. I mean, clearly; you do not come from a starting point of too much digested glucose and insulin. Then, you are taking this med which further reduces blood glucose...

That would suggest you are, more that most, producing Glucagon more often than insulin (which would explain the kind of "glucose over-compensation" that you describe - you are, or have to be, more effective at creating glucose in your liver) - and I wonder what the effects may be of being constantly in that state (as opposed to being constantly in the state of producing insulin - this all being about; the body is designed to be in a balance between producing insulin and glucagon)

Now, I remember something (just not clearly enough) from Dr Rob Cywes - essentially saying that once someone (in his case following a Carnivore diet) had reversed insulin resistance.. you get to a point of being insulin sensitive (which is good, insulin affecting 100 and more processes and every cell in your body, so being sensitive is a good thing) - to a point where you can be insulin deficient (which is a bad thing for all the same reasons)

and the advice was that (and this could be two years into a plan to reverse insulin resistance, will not be and should not be quick, but may be within your time frame) one should consider deliberately eating something (in his case, dairy products, just some cream in his coffee) in order to stimulate an insulin response, to avoid becoming insulin deficient over time..

Please (and I'm sure you won't otherwise I would not say this) do not take any of that as advice or an attempt to diagnose anything.. just food for thought (which I now realise is a horribly a propos phrase)

I don’t think I’ve ever had insulin resistance, or if I have then slightly so. As you know ive been a long distance runner for most of my life, so likely that kept it at bay, if I was inclined to become insulin resistant. My blood sugars can be all over the place, from very low (1.9) when my liver fails to correct my falling blood sugars, to high well for me anyways, like 14.0. I know that’s not particularly high. I always measure my blood sugars against my brother’s which reached the nasty 40’s. So diabetic life can get a hell of a lot worse than a mere 14 ! The 14 is with exercise and not eating too many carbs. And do you know what’s weird, I can have several days of normality.

So you think too much glycogen. Thats interesting. I’ll check that out. My Dr doesn’t know, he thinks I have an iffy pancreas, possibly autoimmune but we shall see. My previous Dr didn’t know either having ruled out a pancreatic tumour.
Ive given up trying to find out and I’m just going with it.
A big yes on your view point about the OA ! My CRP s would be very high if I had an inflammatory disease . 1.1 is raised for sure, not like a normal 0.3 , but I would expect it to be higher. An interesting post @Chris24Main on IR.
I’ll check out the link.

 

[Chris24Main]

@BadgerPaul - that makes sense - I was taking insulin for half a year due to ..uncertainty in my diagnosis... so I totally get both the worry about stopping that (you get completely fixed on the idea around control with the dosage, it's difficult to feel safe) - in my case, I had been for months thinking that my CGM readings at times could not make sense unless I was producing some insulin. My experience is that my Pancreas seemed to have recovered pretty well, and it sounds similar to you. Well done for taking that step..

I also struggled to figure out what was going on with my morning spike... but for me anyway, nothing was so impactful across the board as cutting out sugar and starch. It takes some time for your body to adjust, but when I started to see that I was still getting a significant raise in blood sugar in the morning even after a day of eating nothing, I started to relax and recognise that your body will provide what you need. It isn't all about diet.

As for the Metformin question, I really cannot advise one thing or the other, you need to talk it through with your team. For me, I was fasting every other day, and decided that as long as I monitored everything very carefully, I shouldn't be taking Metformin or Statins on an empty stomach (and sought forgiveness rather than permission from my GP - which I got); but my situation was very different to yours, and I had only just started Metformin. Big changes should always be avoided if possible, and for me it was a little change.

As for Keto - as someone who measures ketone levels every day, clearly I have an opinion, but I don't like absolutes - I still don't really know exactly what "Keto" means - I think it means different things to different people.

Lots of people here have had great results by lowering carbs (which again can have lots of meanings, but to me means reducing sugars, starches and seed oils as close to zero as possible, but enjoying everything else - I love me a cauliflower...) and increasing good quality fats (again - different meanings - but to me simply means learning to understand that saturated fat is not bad.. but seed oils of all types are really to be avoided)

The Diabetes Code is really essential reading -

Hope that helps, and happy to keep talking, but given you've just had surgery - you understand that I cannot go anywhere near making any suggestions.. though I applaud the progress you are already making ...

 

[Chris24Main]

@Melgar - Glucacon. Not Glycogen. (Unbelievably similar words for such different things...)

Interestingly enough, we've all been insulin resistant at one point - going through puberty requires a period of insulin resistance, but I'll leave you to read Ben Bickman to make sense of that one....

Also - I don't think that insulin resistance is something that is impossible with continuous exercise - Indeed it's a hazard for athletes in general. A close relative of a work colleague has just had surgery related to vascular damage (diagnosed as prediabetic - meaning insulin resistant), and she's a triathlete in her 30's.

Saying that, I'm not suggesting that I know anything about your state of insulin sensitivity at any point in your life. I was just thinking that with your blood sugar so low so often, your liver should be trying to produce more (more often than most) - meaning that you would be in a state of elevated Glucagon production in your Pancreas more often, which may result in you actually being insulin deficient at some times. Given then that insulin has such a huge impact everywhere, this may have lots of complicated and difficult to figure out consequences.. but I would not dare go further than that...

But - confusingly - insulin deficiency (at least as I understand it) - being the lack of sufficient insulin, can have some of the same effects as insulin resistance - being the reduction in effectiveness of insulin - even though it's almost a diametrically opposite path to get there...

And please - I feel like I'm hanging on by my fingertips here --- this is kind of like joining up all the dots from multiple sources. I'm only offering this because I think you know it's in good faith and may be useful. I do not have any medical training of my own to back any of this up...

 

[BadgerPaul]

Thanks chris24main.
Your words are very interesting and appreciated.
@Melgar - was also interesting. As in my youth I was very involved with sports ( rugby, canoeing, marathon running, cycling finally weightlifting. ) the running, cycling, and canoeing were all long distance events (cycling up to 12 hours, running up to 30 miles and canoeing 3 hours)
It’s always interested me to understand why was I so successful at events needing stamina.
My thoughts have always been that my body is good at supplying energy to my muscles. On stopping my long distance sports I started putting weight on. Finally finding I was type 2.
I asked the medical team about this. Only to be told it had nothing to do with type 2. I questioned was I always technically Diabetic but controlling my sugar by training??
The specialist said the medical profession were finding that a lot of athletes were becoming diabetic in later life.
Interestingly possible that if I was more aware of the medical situation. I could have saved myself a lot of stress.

 

[Chris24Main]

Gordon Bennet - how can it possibly be nothing to do with type 2.?

What that really means (angry face) is - well, you're not fat, so it can't be your fault, like all these other people we deal with... man, the sheer ignorant prejudice...

It makes me so angry - that ignorance spreads the way of thinking that leads to and perpetuates the problem. It also means that the treatment is so often skewed, for people across the weight range.

If it was more widely understood that Type 2 DM is simply what happens when your body stops keeping up with your Insulin Resistance (which can be caused by many things, but for sure is helped by eating fewer sugars and starches) - this whole thing would be a lot easier, and there would be far fewer ill people..

Think about athletes carb loading for competition, especially endurance athletes - it's practically an occupational hazard.

 

[BadgerPaul]

Chris24main
Well said sir we are on the same page. But it appears that the medical community aren’t there yet. Haha
I carb loaded two or three times a year for special events. It was hard to do. But it really did work I would feel unbeatable.
Funny it’s that feeling I think I’m working hard for on a permanent basis haha

 

[HSSS]

Gordon Bennet - how can it possibly be nothing to do with type 2.?

What that really means (angry face) is - well, you're not fat, so it can't be your fault, like all these other people we deal with... man, the sheer ignorant prejudice...

It makes me so angry - that ignorance spreads the way of thinking that leads to and perpetuates the problem. It also means that the treatment is so often skewed, for people across the weight range.

If it was more widely understood that Type 2 DM is simply what happens when your body stops keeping up with your Insulin Resistance (which can be caused by many things, but for sure is helped by eating fewer sugars and starches) - this whole thing would be a lot easier, and there would be far fewer ill people..

Think about athletes carb loading for competition, especially endurance athletes - it's practically an occupational hazard.

Every time I hear about an active, even athletic, person being outraged they have type 2 I feel sad. They are the living proof that current guidance and widespread understanding is inadequate.

I feel sad they have bought into the “it’s your own fault no matter what, you’re lazy or fat or both“ mantra. It’s also conflating the symptoms of type 2 with the cause of it. If your blood glucose is high it’s hard to lose fat/not gain fat and hard to exercise as the glucose isn’t providing energy (because it’s being stored as fat) so we’re tired and lethargic.

Now that’s not to say being “lazy” or “fat” in reality doesn’t have an effect as they do, nor that eating the wrong food and living an indulgent lifestyle isn’t harmful as it can be, but that it’s oversimplifying the causes of type two and putting everyone into that singular box.

 

[AndBreathe]

@Chris24Main - I admire your optimism that (many) people would be interested in changing their lifestyle if they knew about insulin resistance.

People have known for a long time smoking is bad for them, but many still do. We’ve known carrying excess weight can lead to debilitating arthritis and more, yet rates of obesity are rising, not falling.

In my many years of Change Management, there has to be a real, tangible reason for sustained change. The probability argument tends not to cut it on any scale.

Change is hard when folks really want it. when they’d really rather not bother it is hard in a whole new magnitude.

Edited only to correct iPad, or was it my abysmal spelling.

 

[zand]

I would have loved to know about insulin resistance years ago when I was dieting hard and not losing weight. I bought weight loss books but nothing really helped. Then I found a book about metabolic syndrome and learnt about insulin resistance. I started to change my diet immediately but unfortunately it was too late to stop T2 developing. I'm sure there are others out there who just need the right key but just aren't given it. It's soul destroying when HCPs nag you to lose weight but don't tell you how to do so.

 

[AloeSvea]

@Chris24Main - I admire your optimism that (many) people would be interested in changing their lifestyle if they knew about insulin resistance.

People have known for a long time smoking is bad for them, but many still do. We’ve known carrying excess weight can lead to debilitating arthritis and more, yet rates of obesity are rising, not falling.

In my many years of Change Management, there has to be a real, tangible reason for sustained change. The probability argument tends not to cut it on any scale.

Chanhe is hard when folks really want it. when they’d really rather not bother it is hard in a whole new magnitude.

I think a lot about this too. I do genuinely believe comprehensive change of shopping, cooking, and eating habits is a very big deal. I know it was for me. And then there is the difficulty of living outside the box re food and drink when the box is your friends and family. And in many cases - one's whole community.

I was really lucky that my immediate nearest and dearest understood me and my situation really well, and were incredibly supportive, (re the fact that T2D is a serious disease in the first place, bizarrely, and that an overhaul of food and drink was immediately in order). I really don't blame folks with T2D who find that just way too hard to do, with different lives, personalities and communities.

My own take on insulin resistance (IR) is that it is not the bogey-man in the picture. Insulin resistance is the initial physical response to too much glucose and insulin that would otherwise kill our cells (glucose and insulin toxicity at cellular level).Keeping that excess glucose and insulin out of our cells is a life saver. We either get better, ie get our metabolism working again with lowered toxicity and IR, and our cells become healthy or at least healthier and insulin sensitive again, or, as well as it can, to sustain our lives. IR is the 'thing' buying us time. The blood glucose regulation system, and the fatty acid-glucose cycle is truly wondrous, and it's not wondrous that a sick food and drink environment would, and could, and does, destroy it.

 

[Melgar]

Ha, no idea why I put Glycogen , thanks for catching that one @Chris24Main . Just thought I’d mention it.

I was one of those sad people who was shocked I had diabetes. Shocked and angry. I could not get my head around the reasons for it. It always struck me that if you are Type 1 , it’s autoimmune and there is nothing you can do. Not your fault. The discourse around Type 2 however, is completely different. Websites list the causes, bad diet, being over weight and lack of exercise. There is an underlying blame attached to these short lists. Had you eaten better then you would not be diabetic. That’s why we get members in a state of distress thinking they’ve brought their diabetes on themselves. Then the medical community perpetuates this guilt by sending you off with dietary advice, and an exercise plan. They tell you to lose weight and here you are take this prescription for Metformin, see you in a year.

I read, very recently, in a comment section on Type 2 diabetes, in a National paper, the poster quipped type 2s spend too long in the crisp aisle. No thought behind the comment, just a buy-in repeating a thoroughly ignorant trope.

I can relate to athletes being shocked at a type 2 diagnosis. Why do athletes get type 2? They see the narratives , bad diet, overweight, in active. No wonder. It’s two sides of the same coin. They are fit, and what do you say to someone who eats a healthy diet and is fit? And outside of the diabetic community who has even heard of insulin resistance or a depleted cell mass in the pancreas. Very few, but the world and its dog can recite bad diet and obesity as the cause. That’s a pretty powerful narrative and it will be a hard one to break.

And If you are thin, lean and very fit where do you go with that diet/weight/lack of activity narrative. There is nowhere to go with it. The reality is if you are thin/lean and very fit and you have type 2 diabetes there are very few options. The only thing that came from my very low carb diet was weight loss that I didnt need to lose. As much as people want to lose weight, one doesn’t want to look like they need A good meal either. I have read too many reports about thin and fit T2 diabetics with very poor outcomes. Contrast this with over weight individuals who can put their diabetes in remission by change of diet and weight loss and their outcome is significantly greater.
With no real clear cut answer from the medical research community as to why some people develop insulin resistance, and no real understanding as to why some people lose beta cell mass, we are no further forward.

 

[Melgar]

I think a lot about this too. I do genuinely believe comprehensive change of shopping, cooking, and eating habits is a very big deal. I know it was for me. And then there is the difficulty of living outside the box re food and drink when the box is your friends and family. And in many cases - one's whole community.

I was really lucky that my immediate nearest and dearest understood me and my situation really well, and were incredibly supportive, (re the fact that T2D is a serious disease in the first place, bizarrely, and that an overhaul of food and drink was immediately in order). I really don't blame folks with T2D who find that just way too hard to do, with different lives, personalities and communities.

My own take on insulin resistance (IR) is that it is not the bogey-man in the picture. Insulin resistance is the initial physical response to too much glucose and insulin that would otherwise kill our cells (glucose and insulin toxicity at cellular level).Keeping that excess glucose and insulin out of our cells is a life saver. We either get better, ie get our metabolism working again with lowered toxicity and IR, and our cells become healthy or at least healthier and insulin sensitive again, or, as well as it can, to sustain our lives. IR is the 'thing' buying us time. The blood glucose regulation system, and the fatty acid-glucose cycle is truly wondrous, and it's not wondrous that a sick food and drink environment would, and could, and does, destroy it.

You may well be right @AloeSvea . There does seem to be a link between inflammation and insulin resistant states such as obesity. Research has suggested that obesity and the development of inflammation are the major components of insulin resistance.
My question is, if an individual who exercises regularly, eats a well balanced diet , not very low carb, but balanced with veggies, meat and a few carbs, has an optimum weight , and fat distribution, how do they find themselves in an insulin resistant state ? And what life style changes can they make that doesn‘t involve dropping so much weight they become under weight. Which in itself can cause health problems.

 

[Melgar]

One click @Chris24Main and ‘Why we get sick’ is mine. I’ll have a read of it a bit later. Thanks for the link. Maybe all my questions will be answered.i have many lol

 

[HSSS]

@Chris24Main - I admire your optimism that (many) people would be interested in changing their lifestyle if they knew about insulin resistance.

People have known for a long time smoking is bad for them, but many still do. We’ve known carrying excess weight can lead to debilitating arthritis and more, yet rates of obesity are rising, not falling.

In my many years of Change Management, there has to be a real, tangible reason for sustained change. The probability argument tends not to cut it on any scale.

Chanhe is hard when folks really want it. when they’d really rather not bother it is hard in a whole new magnitude.

I agree change is hard. And that not all follow the existing advice. But.

Change is even harder when we don’t have the appropriate tools, knowledge or understanding why everything we keep trying keeps failing and despondency and a sense of futility sets in.

And whilst some still smoke it’s massively fewer than it used to be and many successful in change did it because of better tools and support, alongside an environment that stopped normalising and enabling the self destructive behaviour.