Anybody got the answers?

I have been diagnosed type 2 for 5 years and been on treament. I have had Metformin from the start. I was diagnosed in hospital following a stroke, so was paralysed and immobile and on their “diabetic diet” ( high in carbs). they added gliclazide to the mix, which did bring the BGs down to about 13. They were happy with this and I didn’t know enough not to be. I learned to walk and was discharged. I ffollowed their treatment plans and got down to about 8-10. Doctors were pleased. HbA1c around 7%. then I started going out and about a bit and reading. I got Bernstein, reduced my carbs and found I could cope without the gliclazide if I walked loads and ate no carbs. BGs now down about 5 . I discovered David Mendosa, when he was still known as Rick, and got on to GI diet. and Starlix. Bgs now below 5 most of the time. Much more reading and I completely ditched the Gliclazide, because all this time my weight had been creaping up, one sneaky kg at a time. I reached 107kg(235pounds) and got worried. Gym exercises bore me to death, so I walked and walked. MANY miles and did water exercise classes. My mobility improved. until I walk almost without a limp.( but weight went down only a bit 103kg 225pounds) A year ago I went really low carb and weight started to come down properly. In that time I lost 15 kg.(33 pounds) and 2 dress sizes. I thought I had ALL the answers. I read everything, joined several internet groups including this one and kept bg tight. preferably about 4 then I read everything I could about all medications available and found my Starlix tends to promote weight gain and I’m battling to lose. Now, in addition, I can’t monitor bg so closely, because my test strips are severely rationed. So I decided to try without even the 1or 2 Starlix 60s I had been taking per day. I still take up to 4 Metformin 500s, but All I’ve read about Metformin says it’s pretty safe and I got over the tummy grumblies 4 years ago.
For the last week, I’ve been doing an experiment. I’m using precious strips begged from the doctor to keep a check on bg and eating carefully, still walking loads and not having any Starlix. First couple of days bg crept up a bit to 6.5. I was determined it wouldn’t go above 7 whatever I had to do, so I took 1 Starlix and it went back to 4.1. Since then none and I’ve kept below 6 at all measurements. Weight has come down another kg and I have discovered some gratifying side effects. For the last 5 years, I had NEVER slept through a whole night without anything up to 4 bathroom visits. This week I’m sleeping through to 6 am! and I had struggled to avoid constipation. No more.
Who out there knows about these things? I’d love an explanation.
I’ll keep the Starlix by me in case I need them, but avoid taking them if I don’t have to.
Does this mean I still have some functioning beta cells, although I was told they’d burn out in about 5 years of treatment?
My doctor has said that low carb is not recommended, but he accepts that I do it and insists that I cannot avoid complications ( I have slight retinopathy from pre-diagnosis) and that I will definitely end up on insulin. Not if I can help it I won’t. It’s taken me over a year to lose this weight and feel so well and I’m NOTgoing back!

your awesome… you inspire me!

At the time you were diagnosed, it was believed that T2 diabetes is always a progressive condition, caused by destruction of the beta cells, and that they would slowly die off (but a lot more slowly than in T1) so that one would need multiple oral medications, and eventually, insulin.

In the interrim, we have found that there are many different causes and types of T2 (which is why there are so many different types of T2 drugs that do, or don’t, work for patients). Most T2 in the obese has at least some component of the pancreas not being able to produce enough insulin for the food that is circulating through the (much larger) body. The fat cells IIRC also release a hormone that prevents insulin from working correctly. T2 does not always mean destruction of beta cells from anything other than overwork and (in some cases) the inability to release insulin properly.

When T2 is mostly an effect of obesity and/or insulin resistance, the beta cells are mostly intact, intensive lifestyle management (diet and exercise, and significant weight loss) can both maintain beta cell function and increase insulin sensitivity (since the fat cells aren’t being fed enough to release insulin-blocking hormones). As your body has less mass through which to circulate blood, needing less insulin, and fewer biochemical blocks to insulin sensitivity, you may need fewer medications, and lower doses, to maintain normal blood glucose levels. I can name several people in the diabetes online community who have lessened their dependence on oral antidiabetics, or been able to go completely off antidiabetics, in conjunction with weight loss. Whether we will be able to maintain this status over the next five, ten, twenty years or longer… we’ll have to see.

So, needing less medication to maintain the same levels as you lose weight can be pretty normal. Doctors just aren’t all that used to patients who are willing to “beat the 'betes” with that level of intensive lifestyle management, and require a bit more prodding from us for us to receive appropriate medical care.

As far as the low-carb diet goes, the various professional diabetes communities have yet to embrace it either for weight loss or for glycemic control, though they are not as adamantly against it as they used to be. The issues one fears will arise include higher total cholesterol, LDL, VLDL, and tryglyceride levels from higher fat consumption and increase in the development of kidney disease from higher protein consumption. Current belief suggests that higher lipid levels may be due less to total percentage of fats in the diet than to the consumption of transfats, of high-fructose corn syrup, and of excess caloric intake in general. There are still questions about protein and kidney function, but in absence of clinical drop in kidney function, higher levels of dietary protein may not be as unhealthy as feared.

As for me, I find my dietary answer is in eating fewer processed foods, less sodium overall, and fewer refined foods. I’ve been (diabetes) medication-free for over four years, so take that as you will.