Tannith's views on reversing T2

[Tannith]

I am not sure he even said that. In his study I believe he selected people who had been diagnosed for less than 4 years? In which case he wouldn't have had any data for more than 4 years. Also it seems a bit arbitrary, is 5 years with an HbA1c of 50 more likely to do more permanent damage than 3 years at an HbA1c of 90?

"The importance of duration of type 2 diabetes since diagnosis was clear from the Counterbalance dataset, with 60% remission in those with duration <4 years, compared with 21% with duration >8 years.14 Even within the DiRECT study group, which only included people within the first 6 years after diagnosis of type 2 diabetes, those achieving non-diabetic levels of glucose control had a slightly but significantly shorter duration."
https://www.ncbi.nlm.nih.gov › articles › PMC6399621 "Remission primarily depended upon degree of weight loss, with achievement increasing steadily from (7%) with only 0–5 kg weight loss to 86% who lost 15 kg or more." So success depended on duration ofT2 and also on extent of weight loss. I seem to remember reading elsewhere that the starting HBA1C played a part too. No doubt you are right that severity of T 2 could well play a part. Not all the contributory factors have yet been tested.


18

 

[Tannith]

But when will you draw the line? How do you know that will be the reason it failed? Quite simply you don’t.

It might be it never would have because weight was never the cause, loss of weight never the solution, it might be that you have achieved your goal just don’t know it. Even if you had never been diagnosed (ie never had) diabetes this level of 39 is what you would have had at your age anyway. Did you see the links I put up about non diabetics having higher levels as they age as a normal and natural thing not pathological whereas the charts take no account of age.

And it is not your fault and I think this is a deeper problem for you. You didn’t make yourself diabetic and no one can say you haven’t tried to do something about it. Stop beating yourself up.

On every single scale but one, 39 is at the bottom of prediabetes. Not as bad as diabetes, granted, but Prediabetes is serious and often leads to full diabetes without weight loss to prevent that. I don't doubt that older people have worse HBA1C/and other BG test levels than younger ones. I did read your article but I don't see why it should not be pathological just because age is a factor. It is the blood sugar levels that matter in this case, because high ones cause complications.
Nerve Damage Occurs when Blood Sugars Rise over 140 mg/dl (7.8 mmol/L) on Glucose Tolerance Tests

The University of Utah neurologists found that patients who were not known to be diabetic, but who registered 140/mg or higher on the 2-hour sample taken during a glucose tolerance test were much more likely to have a diabetic form of neuropathy than those who had lower blood sugars. Even more telling, the researchers found that the length of time a patient had experienced this nerve pain correlated with how high their blood sugar had risen over 140 mg/dl on the 2-hour glucose tolerance test reading. https://www.bloodsugar101.com/organ-damage-and-blood-sugar-level
Edited to say that on finding 39 was prediabetic I got OGT test and found it was way into diabetic levels. My FBGs were well prediabetic at the time also. I have always tried to take all available tests results into account and am not relying on just the one HBA1C. It just happened to be the HBA1C that alerted me to the problem initially.

 

[HSSS]

On every single scale but one, 39 is at the bottom of prediabetes.

Not accurate.
The USA and Germany have 39 as the first step of prediabetes. The internet is full of charts based on the American levels. Lots of different images isn’t the same as lots of different scales
The U.K, Australia, New Zealand and the WHO all use 42.
I’m quite sure there’s others - probably in both groups, but I haven’t come across them yet so there’s at least 4 using the higher level and 2 the lower. It’s fairly arbitrary anyway and there isn’t a magic wand where damage suddenly occurs, or doesn’t, for everyone.

 

[Oldvatr]

Not accurate.
The USA and Germany have 39 as the first step of prediabetes. The internet is full of charts based on the American levels. Lots of different images isn’t the same as lots of different scales
The U.K, Australia, New Zealand and the WHO all use 42.
I’m quite sure there’s others - probably in both groups, but I haven’t come across them yet so there’s at least 4 using the higher level and 2 the lower. It’s fairly arbitrary anyway and there isn’t a magic wand where damage suddenly occurs, or doesn’t, for everyone.

Roy Taylor uses a definition of Remission as being under 6.5% (48 mmol/mol)

He is also defining what is needed to achieve remission (from DiRECT) as a weight loss of 15kg AND fat loss of 0.5g from the pancreas. This appears to be his latest definition as stated in a recent presentation of the DIRECT study results. You need to achieve both of these for the magic juju to work.

 

[Mr_Pot]

It was in fact 6 years for DiRECT.

http://eprints.gla.ac.uk/153078/

View attachment 49022

Thanks, my memory failed me.

 

[Mr_Pot]

I did read your article but I don't see why it should not be pathological just because age is a factor. It is the blood sugar levels that matter in this case, because high ones cause complications.

It is the blood sugar levels that matter but those blood sugar levels are not always accurately represented by HbA1c. There are several factors, including the lifetime of red blood cells and anemia that affect the accuracy of an HbA1c test. It may be that HbA1c naturally increases with age without there being an increase in blood glucose.

 

[lucylocket61]

Nerve Damage Occurs when Blood Sugars Rise over 140 mg/dl (7.8 mmol/L) on Glucose Tolerance Tests

this is partly why we are trying to dissuade you from doing them as often as you are, and without medical supervision.

 

[Tannith]

This is why I think it is important to make a decision based on all three tests which are available to us.
"Clinically, patients with overt T2DM have either HbA1c ≥6.5% OR an FPG ≥7.0 mmol/L OR a 2-hour post-OGTT or random plasma glucose value ≥11.1 mmol/L. There is always some risk of developing T2DM when these values are abnormal, as described above, and this risk becomes disproportionately greater as the results in subjects approach the higher end of the “normal”spectrum." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982570/
And preferably strive for results no higher than the middle of normal for these tests. Obviously the OGT is the most important one for the decision to attempt/stop weight loss diet, as it is the only one that gets closest to testing purely beta cell function, uncluttered with the carb intake or restrictionduring ordinary meals.

 

[Oldvatr]

<<<<<
Obviously the OGT is the most important one for the decision to attempt/stop weight loss diet, as it is the only one that gets closest to testing purely beta cell function, uncluttered with the carb intake or restrictionduring ordinary meals.

Once again you have oversimplified the message and twisted it to suit your POV,

OGTT is a test of response, and primarily of the First Insulin Response function. It is testing everything from the amylase generation in the mouth, through the metabolism of simple carbs and the passage of glucose into the bloodstream. It also tests the ability of the body to process blood glucose not just by beta cells producing insulin, but also the way insulin works in the Krebs cycle to reduce the glucose by storage into not just the adipose tissue cells, but also the mitochondria in the muscle cells. Both of these functions can be impaired by Insulin Resistance or Poor Insulin release from the pancreas. It also tests the kidney function that filters and excretes the excess glucose from the OGTT, I mention the first response, but there is a second response that the OGTT does not test at all, and this is the basal insulin release that comes from the second release of insulin in response to other enzymes that are generated in the duodenum, and this second release is the really important one that gives a slow-release and does most of the storage to reduce glucose levels. This basal function is not tested by the OGTT.

So the OGTT is only testing the initial insulin release and abatement functions. but there is more than just the beta cells involved, and more things that can go wrong in T2D. There is also at least 2 different forms of Insulin Resistance involved in T2D and the work by Taylor only identifies one, the resistance to release of insulin from the pancreas There is much more to diabetes than that,

 

[Dudette1]

You know, after reading these comments, all I’m going to say to tam is you need to calm down. All I’m seeing is you pushing something that you are only partly in control of, if you want to do it then go ahead and do it. Yes share your thoughts and feelings, it would be boring if we was all the same, but at the end of this, None of us are fully in control and we do what we can to manage it.My dad always said “if you can’t do anything about it, why worry about it” we can’t do anything so we don’t worry, all we do is manage. You seem obsessive about the whole thing and in the end, other things could happen to us, we can try to prolong or help us have a bit longer but you worrying and posting doom on here, when other people are just wanting to deal with what they have now. If you believe it will work,do it, if it doesn’t work then your doom will only intensify till you find something else to latch onto. That’s what junk science is. Remember when “smoothies are good for you”, yet are packed with sugar so they taste nice, but all fitness freaks jumped on it and didn’t lose any weight! There isn’t a cure! I’ve thought about it before but I accept what is..unless there’s a real scientific breakthrough telling us that, you are reaching. Do what makes you happy, new comers will see this and think it’s over for them with what you are writing. And let’s face it, we all think that to start with, or I know I did. but we give advice and manage. Do you go to doctors everyday and check you have 100% healthy cells, and if they told you, well you should have drank lemonade from 5yrs old then they would be 100% but if you drink more lemonade now it might help keep them at 99% are you going to worry about how you didn’t drink it at 5yrs old or just try drinking more lemonade now to help manage! You can’t change what is now,you can only manage and let real scientists do their jobs.I wish you well in whatever you choose but thinking of impending doom isn’t going to help with stress on trying to get something you may never get. If you was positive thinking and writing then I’m sure people may have a better understanding towards you and give advice with what you are saying, but you are saying it’s 2 late and so on. How is that doing you any good? I’m sick of the word manage now someone punch me. A guy on my Snapchat said he had been diagnosed and needed to get his blood sugars lower, I advised him how lower carb can help with this and he said, it’s ok I know what to do, he constantly posts rice, shreddies, chips..I’m not correcting him again, I tried to help what worked for me but I won’t push this is what you have to do. I know I shouldn’t eat potatoes as it causes my blood to raise, but once a week I have them. I know the advice but once a week I have a jacket spud because I’m not in control I’m in manage control. And I do what works for me and doesn’t make me worry or unhappy.some people can eat chocolate others can’t, our bodies are different and we have to accept them, whatever you do be happy about it, feeling the gloom obviously isn’t making you happy.

 

[zand]

You know, after reading these comments, all I’m going to say to tam is you need to calm down. All I’m seeing is you pushing something that you are only partly in control of, if you want to do it then go ahead and do it. Yes share your thoughts and feelings, it would be boring if we was all the same, but at the end of this, None of us are fully in control and we do what we can to manage it.My dad always said “if you can’t do anything about it, why worry about it” we can’t do anything so we don’t worry, all we do is manage. You seem obsessive about the whole thing and in the end, other things could happen to us, we can try to prolong or help us have a bit longer but you worrying and posting doom on here, when other people are just wanting to deal with what they have now. If you believe it will work,do it, if it doesn’t work then your doom will only intensify till you find something else to latch onto. That’s what junk science is. Remember when “smoothies are good for you”, yet are packed with sugar so they taste nice, but all fitness freaks jumped on it and didn’t lose any weight! There isn’t a cure! I’ve thought about it before but I accept what is..unless there’s a real scientific breakthrough telling us that, you are reaching. Do what makes you happy, new comers will see this and think it’s over for them with what you are writing. And let’s face it, we all think that to start with, or I know I did. but we give advice and manage. Do you go to doctors everyday and check you have 100% healthy cells, and if they told you, well you should have drank lemonade from 5yrs old then they would be 100% but if you drink more lemonade now it might help keep them at 99% are you going to worry about how you didn’t drink it at 5yrs old or just try drinking more lemonade now to help manage! You can’t change what is now,you can only manage and let real scientists do their jobs.I wish you well in whatever you choose but thinking of impending doom isn’t going to help with stress on trying to get something you may never get. If you was positive thinking and writing then I’m sure people may have a better understanding towards you and give advice with what you are saying, but you are saying it’s 2 late and so on. How is that doing you any good? I’m sick of the word manage now someone punch me. A guy on my Snapchat said he had been diagnosed and needed to get his blood sugars lower, I advised him how lower carb can help with this and he said, it’s ok I know what to do, he constantly posts rice, shreddies, chips..I’m not correcting him again, I tried to help what worked for me but I won’t push this is what you have to do. I know I shouldn’t eat potatoes as it causes my blood to raise, but once a week I have them. I know the advice but once a week I have a jacket spud because I’m not in control I’m in manage control. And I do what works for me and doesn’t make me worry or unhappy.some people can eat chocolate others can’t, our bodies are different and we have to accept them, whatever you do be happy about it, feeling the gloom obviously isn’t making you happy.

This is one of the best posts I have ever read!

 

[Mbaker]

On every single scale but one, 39 is at the bottom of prediabetes. Not as bad as diabetes, granted, but Prediabetes is serious and often leads to full diabetes without weight loss to prevent that. I don't doubt that older people have worse HBA1C/and other BG test levels than younger ones. I did read your article but I don't see why it should not be pathological just because age is a factor. It is the blood sugar levels that matter in this case, because high ones cause complications.
Nerve Damage Occurs when Blood Sugars Rise over 140 mg/dl (7.8 mmol/L) on Glucose Tolerance Tests

The University of Utah neurologists found that patients who were not known to be diabetic, but who registered 140/mg or higher on the 2-hour sample taken during a glucose tolerance test were much more likely to have a diabetic form of neuropathy than those who had lower blood sugars. Even more telling, the researchers found that the length of time a patient had experienced this nerve pain correlated with how high their blood sugar had risen over 140 mg/dl on the 2-hour glucose tolerance test reading. https://www.bloodsugar101.com/organ-damage-and-blood-sugar-level
Edited to say that on finding 39 was prediabetic I got OGT test and found it was way into diabetic levels. My FBGs were well prediabetic at the time also. I have always tried to take all available tests results into account and am not relying on just the one HBA1C. It just happened to be the HBA1C that alerted me to the problem initially.

I think the cross over point you reference regarding the 140 mg/dl (7.8) nerve damage is one that everyone should take stock of and several moments of contemplation. Whilst this number might vary individually by a fraction here and there, my understanding is that this is universal for diagnosed and undiagnosed, when continual excursions into these realms occur, which explains why those with pre-diabetes get complications as well and that eating styles that go above this limit should be treated with scepticism and caution.

The same goes for the 2 hour post-prandial - I appreciate you making both these points, that cross all of the protocols.

 

[Tannith]

I think the cross over point you reference regarding the 140 mg/dl (7.8) nerve damage is one that everyone should take stock of and several moments of contemplation. Whilst this number might vary individually by a fraction here and there, my understanding is that this is universal for diagnosed and undiagnosed, when continual excursions into these realms occur, which explains why those with pre-diabetes get complications as well and that eating styles that go above this limit should be treated with scepticism and caution.

The same goes for the 2 hour post-prandial - I appreciate you making both these points, that cross all of the protocols.

Nerve damage, eye damage macro blood vessel damage and even, I think, kidney damage can all start at or even below the prediabetic range. Jenny Ruhl ( a low carb supporter) has written extensively on this in her book and online noes "blood sugar 101. I think that whatever your approach to controlling/managing/remitting or reversing your T2 you ignore this at your peril

 

[Oldvatr]

Nerve damage, eye damage macro blood vessel damage and even, I think, kidney damage can all start at or even below the prediabetic range. Jenny Ruhr ( a low carb supporter) has written extensively on this in her book and online noes "blood sugar 101. I think that whatever your approach to controlling/managing/remitting or reversing your T2 you ignore this at your peril

These guys are a better authority since they are experts in diabetes care in USA since before I was born,
https://www.mayoclinic.org/diseases-conditions/diabetic-neuropathy/symptoms-causes/syc-20371580

The upper safety control limit they suggest is an HbA1c of 7% ( 53 mmol/mol UK)
According to this site's converter this equates to an average blood sugar of 8.5 mmol/l

 

[Mike d]

@Dudette1 .... I'm reminded by that old classic. "Misery loves company"

Great post.

 

[zand]

Nerve damage, eye damage macro blood vessel damage and even, I think, kidney damage can all start at or even below the prediabetic range. Jenny Ruhl ( a low carb supporter) has written extensively on this in her book and online noes "blood sugar 101. I think that whatever your approach to controlling/managing/remitting or reversing your T2 you ignore this at your peril

Things do tend to deteriorate as we age anyway.
I had nerve damage in my leg from a heart procedure. They told me it would never heal. 8 years on it is now fine.
All any of us can do is our best. As @Dudette1 pointed out, being in this constant state of stress because your BGs are only nearly perfect isn't doing you any good. We have to think about our whole health not just prediabetes.

 

[Dudette1]

@Dudette1 .... I'm reminded by that old classic. "Misery loves company"

Great post.

That is my favourite quote I use, love it

 

[Drfarxan]

There is a missing puzzle with type 2 diabetes reversal/remission and it looks like the answer is in the gut. Duration doesn't matter cause t2 diabetics who had by-pass surgery their blood sugar and HbA1c start to improve before they lose any weight and they had diabetes for 10-15 years. They reverse their diabetes completely only problem is they continue with the same diet. If they went low carb they would have been cured.

 

[Oldvatr]

There is a missing puzzle with type 2 diabetes reversal/remission and it looks like the answer is in the gut. Duration doesn't matter cause t2 diabetics who had by-pass surgery their blood sugar and HbA1c start to improve before they lose any weight and they had diabetes for 10-15 years. They reverse their diabetes completely only problem is they continue with the same diet. If they went low carb they would have been cured.

Good point. What is missing from the report on bariatric intervention above is the important information that there are at least 4 basic variants on how that surgery is performed, and only one of them leads to remission of diabetes (I believe it is the Roux-Y they mention) As it points out, only about 50% achieve remission, and they can lose it again if they ignore the diet rules (I believe it is called the Belfast Diet) This is about the same ballpark number as the ND trials suggest they achieved, so this indicates that both procedures are only partial success stories.

Edit to add: Belfast Diet is a very low-calorie zero sucrose diet.

 

[Oldvatr]

I have not read this article in full yet, but it seems to be relevant to this discussion, so I will share it now.
https://academic.oup.com/qjmed/article/96/4/281/1528567

Edit to add: Seems we are all Doomed. Not a very positive study, and in many ways it seems to have a flavour that suggests the authors are looking for something to hang a thesis on. Their findings may apply to the general T2D populace on Eatwell, but I propose that we are able to move beyond it. Certainly it does not reflect my personal experience. As one who has had T2D for nearly 30 years now, I have been able to recover my stage 1 response, and my beta cells seem to have recovered too.