"The current thinking is that Beta Cells are not permentantly destroyed at least in the aerly stages of T2.@Tannith Here is a study you may find interesting.
Previous T2's who achieved full remission through weight loss were followed up for 2 years.
https://diabetes.diabetesjournals.org/content/68/Supplement_1/66-OR
They recovered over 90% of their Beta Cell function in comparison to a non-diabetic control group.
0.94 nmol/min/m2 at 24 months vs 1.02 nmol/min/m2.
The current thinking is that Beta Cells are not permentantly destroyed at least in the aerly stages of T2.
They've either become exhausted, dormant or impaired.
The removal of the excess glucotoxity returns normal function within 12 months.
Unless of course the route to T2 is through another pathway which such as genetic factors.
]His findings are only one study?His findings are only one study? Would need to be replicated in many additional studies under different researchers to be considered dogma. But I agree the idea that significant Beta cell destruction due to insulin resistance and subsequent cell exhaustion can happen before overt BG symptoms sounds sadly too plausible. What is much more interesting are possible mechanisms to reverse such destruction before it becomes irreversible as mentioned above by @Ronancastled. Certainly when I was first diagnosed, my endocrinologist wanted me on injected insulin for 3 months before assessing me for c-peptide (the standard insulin level proxy test), in the hope my beta cells recovered from fatigue - unfortunately I'm T1 so they did not.
How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?"The current thinking is that Beta Cells are not permentantly destroyed at least in the aerly stages of T2.
They've either become exhausted, dormant or impaired.
The removal of the excess glucotoxity returns normal function within 12 months."
What they actually do, according to Prof Taylor, is differentiate. That is they change from beta cells which can produce insulin to normal alpha pancreatic cells which can't produce insulin, but are still alive. Originally it had been thought that they died. It is the removal of lipotoxicity (damage by fat) that specifically restores normal function. People do that by losing weight, as T2s, because of their particular genetics, store excessive amounts of their fat stores on the visceral organs, in particular the pancreas but also the liver, rather than under their skin which is where normoglycaemics store it.
"December 2020 Passed a Rapilose 75g OGTT 3.0 @ 2 Hours " Excellent! Well done you!
This week's FBG results: Fri 4.8; Sat4.7; Sun 4.6;Mon 4.4; Tue 5.4; Wed 5.4 Thur 4.8. Average 4.87 - a drop on last week albeit a small one. I'm obviously moving in the right direction. Starting back on low cal diet today. I am also pleased that I have only put on half a pound over Christmas. I have a bit further to go yet.
Great article. But as far as I know there is no way ordinary people can do an insulin test at home? So we are still left with the FBG and OGT. I have also looked up the other guy you mention - Dr De Fronzo. Interesting stuff also. I wholeheartedly agree that the NHS does not take prediabetes seriously enough. Or early diabetes either. I stopped the v.l.cal diet I was doing in 2017/18 too early because the NHS told me I was no longer diabetic. I was not only still well into the prediabetic range but also into the fully diabetic range by many scoring systems. That could have cost me not only my health but potentially even my life. I am also shocked to see that, (according to Dr De Fronzo, prediabetics have lost 50% beta cell function and diabetics 80% beta cell function. I had not realised that it was nearly as bad as that. Thank you for your very useful post.
Treating the symptoms and not the disease.How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?
Why do you think that?Treating the symptoms and not the disease.
I have never disputed that low carb lowers blood sugar. Why wouldn't it? If you eat less sugar(carbs) there will obviously be less in your bloodstream for your meter to measure.How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?
It's this study]His findings are only one study?
"At least 2 studies I think. One by him, one by another researcher whom he names in the article. One found the 80% and the other the 50% as I recall.
How do you explain those of us on here who are obese, sometimes severely so, have Not lost weight, and remain the weight we had when diagnosed, but maintain, year after year, normal blood glucose levels due to low carbing only?
So why are you not lowering your carbs instead of, or as well as your calories to reduce your blood sugar levels?I have never disputed that low carb lowers blood sugar. Why wouldn't it? If you eat less sugar(carbs) there will obviously be less in your bloodstream for your meter to measure.
The low cal diet is a long term one. In the study quoted by @ Ronancastled it lasted 5 months and in other similar studies a minimum of 3 months. " maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months, 0.94 (0.57 to 1.24) (p=0.017 from baseline) at 12 months, "As the figures are dropping by not dieting, how is your dieting helping?
I give up.The low cal diet is a long term one. In the study quoted by @ Ronancastled it lasted 5 months and in other similar studies a minimum of 3 months. " maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months,"
This is a diet where you have to patiently wait for results and not expect them the minute you reduce your calories. I would not expect my exhausted beta cells to leap up from their sick beds and immediately start dancing.
For the same reason, I imagine, that YOU are not doing the low cal diet that I chose. We chose different diets. At least as a first choice. That is our privilege. If mine doesn't work because I left it too late as I have now had T2 for 4 years at least, then I should consider the other 2 choices available to me ie metformin or low carb in that order.So why are you not lowering your carbs instead of, or as well as your calories to reduce your blood sugar levels?
I have had type 2 diabetes since 2008 and managed to turn it around with low carb and exercise. Whether lowering calories or carbs had the most impact on weight loss I can’t say but in this year I have moved from 78 to non diabetic hba1c and 1000mg metformin a day (maybe zero in 3 months time) from double that and other drugs and also lost 30kg weightFor the same reason, I imagine, that YOU are not doing the low cal diet that I chose. We chose different diets. At least as a first choice. That is our privilege. If mine doesn't work because I left it too late as I have now had T2 for 4 years at least, then I should consider the other 2 choices available to me ie metformin or low carb in that order.
Until a year or so ago, the NHS had only one known outcome - premature death from organ failure caused by diabetes, There was only one main treatment offered by the NHS, namely inevitable progression via increasing medication towards insulin dependency. Then the NHS delayed this inevitable outcome by (a) weight loss by limb amputation or (b) weight loss by bariatric surgery.I have had type 2 diabetes since 2008 and managed to turn it around with low carb and exercise. Whether lowering calories or carbs had the most impact on weight loss I can’t say but in this year I have moved from 78 to non diabetic hba1c and 1000mg metformin a day (maybe zero in 3 months time) from double that and other drugs and also lost 30kg weight
but I do know that higher carbs causes my bloods to go higher. So I do believe a type 2 diet does need carbs to be considered
I don’t believe there is such a thing as leaving it too late
The low cal diet is a long term one. In the study quoted by @ Ronancastled it lasted 5 months and in other similar studies a minimum of 3 months. " maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months,"
This is a diet where you have to patiently wait for results and not expect them the minute you reduce your calories. I would not expect my exhausted beta cells to leap up from their sick beds and immediately start dancing.
Pragmatically the NHS was set up to deal with acute infectious diseases in the mid 20th century and it has had a great track record on this. But tragically it has never evolved to deal with preventive medicine (and dentistry) which is why so many opportunities re diabetes and so other conditions are only managed reactively on symptoms.Until a year or so ago, the NHS had only one known outcome - premature death from organ failure caused by diabetes, There was only one main treatment offered by the NHS, namely inevitable progression via increasing medication towards insulin dependency. Then the NHS delayed this inevitable outcome by (a) weight loss by limb amputation or (b) weight loss by bariatric surgery.
Then Prof Taylor came online with his study which was to emulate option (b) through severe dietary means. That was the purpose of the ND diet, just a cost-saving exercise. Serendipity occurred, and they found a way to use the diet to control and give Remission from T2D like what they used to offer by surgery. That is what the ND diet achieved, and it is now able to be offered as an NHS approved treatment.
Low carb so far has not had the same recognition by the NHS, hence the question that started this topic in the OP. There are many here using LC diets to gain remission from T2D but the only scientific study to date has been the one run by David Unwin in his Southport surgery. There have been moves to add LC diet to the guidelines by NICE, and in the USA the ADA and AHA have both adopted LC. But here in the UK, neither of the formal bodies have accepted it, mainly because the BDA and nutritionists will not accept it as a valid diet.
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