Type 2 Question

Weight loss does seem to help some people, though not all. I lost nearly 5½ stone, but in about 18 months, on a mainly low carb diet. My last HbA1c was 35 mmol/mol, so I appear to be in remission. It's impossible to tell if it's down to the weight loss or the low(ish) carb way of eating. I took Metformin for a couple of weeks in the beginning, but decided to try diet only.

But well done on the weight loss. You seem to have kept it off.

Jono60 said:

I was diagnosed type 2 early 2020 hba1c was 55mol/mol.
I lost. 5 5stone in three months thro diet and excercise and 4 years down the line I am still out of diabetic range I have never taken medication. My question is my weight is stable and hba1c still good. Is this sustained weight lost likely to keep me out of diabetic range. Iam eating fairly normal food.

Although my weight loss was quite rapid I would not suggest it for anyone This was done by very low carb diet and ex cercise and I don't appear to have had any bad effects. BUtI would advise for people to take proper dietary advice

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The short answer is yes, probably. After losing that much weight and seeing results that good you will probably stay below the diabetic HbA1c range until you reach quite an old age, so long as you don't put on weight, though how much carbs you eat probably shouldn't be ignored entirely. It now seems highly likely that the great majority of Type 2 diabetes cases, while caused by genetic factors, are triggered by a set of problems that are caused by genetic sensitivity to fat stored in the wrong places. The root cause of Type 2, the trigger, is usually excess liver fat. So long as you can keep fat from building up in your liver you should be fine.

I started writing a description of the science I've learned so far but one post on a forum won't do it. I've begun writing up much of what I've learned to date and I'll post a link here once I'm done with the first draft. In simple terms though - try to exercise and try to build muscle mass if you're young enough, or try to preserve it if you are of an age where building muscle is very difficult. Muscle mass and liver fat levels are related. The two main factors that cause Type 2 to get worse in most people over time are probably elevated blood triglyceride levels, which you've likely solved through weight loss, and decreasing muscle mass. Most people put on weight and lose muscle as they get older and Type 2 is much more common in older people than young people though their genetics haven't changed. Keep weight stable and maintain (or gain) muscle mass and you may prevent Type 2 progression from starting up again until well into late old age, so old that it might not matter very much.

On the carbs though, if you had a HbA1c of 55 mmol/mol it's highly likely that you have at least a slightly damaged pancreas. This may not show up in your HbA1c result but would show up if you were to test your blood glucose around an hour after eating to see how high it's going. It's entirely possible to have what's called Impaired Glucose Tolerance (IGT), a problem with having unhealthily high blood glucose levels for a couple of hours after eating, without that showing up on HbA1c result. The World Health Organisation don't even use HbA1c to define prediabetes, they use two other factors, one of which is the Oral Glucose Tolerance Test (OGTT) which measures IGT. It might be worth testing your blood after eating, or using a Continuous Glucose Monitor (CGM) for a couple of weeks so that you can see graphs of your blood glucose levels after eating. The Freestyle Libre 2, a CGM made by Abbot, is available on a free trial in the UK (last time I checked). IGT is not associated with diabetic complications such as damage to eyesight but it has been shown to be linked to cardiovascular problems - heart disease. The science is thin on this subject but I believe it worth considering. There is at least one person on this forum who reports having experienced diabetic symptoms before ever having a high HbA1c result. IGT might explain that.

In my own case my last HbA1c result was 34 mmol/mol after losing around 5 stone while eating a moderate amount of carbs daily, but still on medications. I've started reducing my medications but watching my blood glucose levels after eating carefully so as to minimize any risk of heart disease that might exist. HbA1c is a very important metric but reflects average levels over many months. I believe that levels immediately after eating, even for a couple of hours per day, may also be important for long-term health.

Congratulations by the way! 'Robust remission' is a very fine thing!

Brilliant result @Jono60 - you should feel extremely chuffed with that. Enviable indeed.

This will probably seem like a retort to @HairySmurf but it isn't supposed to be, I think we agree on much more than we disagree.

The key to understanding the question you are asking (can I feel like I'm in control of my weight and how that effects blood sugar) is .. well, what is it that controls this, biologically?

The answer is undoubtedly - hormones - we have stimuli from things we eat, and stress and sleep, and genetics, and all sorts - and the result is that we produce certain hormones, and they drive our behaviour - in the cells, in the organs, and as whole humans (like, we feel hungry, or motivated to do that exercise or not).

All of that is (at least in my mind) totally beyond question, and non-controversial. Take one step beyond that, into which hormones, and in response to what types of food, and why, and you get into much more tricky territory. There are agendas, biases, and .. it's just difficult to explain and prove, so a lot of what is said as fact, is really opinion.

For me - I think that safely reversing T2DM is a challenging task, that has to take into account the individual, their beliefs and willingness to learn and motivation to change for the long term. That's a world away from what you are asking though. For anyone not trying to reverse the effects of 10-20 years of a thing slowly happening to them, it's a much more fundamental question -

What really is healthy lifestyle given the choices available?

And - it's a tricky question to answer - there is a flood of articles in every type of media every day, selling this view, or that product, or this diet or that supplement. it's overwhelming (and in my opinion deliberately so).

It's somewhat surprising to look into the history of nutrition, and food production, and medicine, and realise that the current way of thinking is actually fairly new, somewhat knee-jerk and based on fairly shaky evidence ... but it's enormously entrenched.

Go a little back - and for hundreds of years, the prevailing view was that "sugars and starches are fattening".
People did more, and generally had less to eat, but I think it still works as a maxim to live by.

I don't think (and I'm way way down the metabolism rabbit hole) it ever needed to be more complicated than that. Much of the complication comes from a refusal to accept that the current thinking might be wrong - "we can explain this new paradox if we invoke that this particular fatty acid chain is more prevalent in this particular food, so this population that eats this food is different to the rest of us" - most of the thinking is just nonsense, as Mr Occam would attest.

or put more specifically - everything still has an effect; you have to see your whole life as a balance, and we are complicated and unique... but sugars and starches are fattening because they drive insulin - and when insulin is high, you cannot help but store energy as fat, and drive the feedback loop that is insulin resistance, so it just makes you less likely to be healthy in the long term.

You will know, yourself, whether you are feeling well, and whether your weight or waist size is creeping up - there are many ways to keep tabs on it, and you will know what works for you - do whatever you feel most comfortable with, but just know that the biggest lever you can pull, is the one marked "sugars and starches".