Defining diabetes remission

In this article, the term “diabetes remission” is often debated, and there are several definitions. At diaTribe and in the DiRECT trial, remission is defined as an A1C below 6.5% without needing to use any diabetes medications for at least two to three months.

I don’t know how remission can be defined but by a 2-3 month period of A1C doesn’t seem rational - seeing that I was told that 1 cycle of a A1C is 3 months.
Also when I was 1st diagnosed, I had it drilled into me to forget about miracle cures and remission.

Well they are talking about Type 2 which can, in some select cases, be brought into remission. Because insulin production can continue and the insulin sensitivity can resume. But I’d not expect a miracle to happen.

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You can pretty much define remission any way you want. How important, is it really, to define remission in the first place? Remission or not, you are still diabetic, and remission only means that for a period of time, you are controlling your diabetes within a certain low range using exercise, and food and that as long as you stick to that lifestyle, you remain in remission. Increase your carb consumption and decrease your level of exercise, and you will promptly put yourself back out of remission. The 3-month A1C cycle is not linear, and your blood glucose level, looking back every week for the past 3 months, has the greatest effect on your A1C in the past week and then has less and less effect as you go back each subsequent week. Hence weeks 9-13 have very little effect on your A1C.

Looking around, it appears that remission is more of a feel-good term used to market products, services, or a way of eating such as a low-carb diet. It does not, however, alter the fact that you are diabetic or sometimes even stretched to say that you are cured in any way. You just have good control of your diabetes and minimize your long term risks.

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Every few years I get a C-Peptide test. After 49 years I get my hopes up every time that I might have magic remission. So far no luck. But of course a man can hope.

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This use of reversal, remission and cure are only relevant to to type 2 diabetes mellitus. It is possible for someone to achieve near or normal blood glucose management in the early stages of type 2 DM. The best term for this in my opinion is remission. Reversal smacks of a cure and there is not cure for T2DM, not now, in 5 years or maybe forever.

The medical community doesn’t like the use of remission because that is reserved for diseases like cancers. Perhaps suspension of symptoms would be a better choice.

In my history as a type 2, I had 10 years of “suspension of symptoms” but it was in no way a cure. I was (and am) on a low carb diet and bicycling daily up to 250 miles per week. If I was cured then I should’ve been able to indulge in a giant baked potato followed by a big slice of apple pie. Or I could have let the bike be covered in spider webs.

Worse after 10 years of great BG management, the disease progressed to me needing pharmaceutical help. First was Metformin, gradually increased to the max dose, then Lantus and finally MDI.

I think it is possible for someone diagnosed pre-diabetic, that is in the very early stages of T2DM, to managed with diet and exercise for the rest of their lives. But someone like me diagnosed with a fBG of 450+mg/dl the hand was dealt with the Ace of Spades for my Beta cells. I was probably already losing Beta cell mass before I was diagnosed.

This paper suggesting that T2DM is in remission after 3 months of normalized BG is just foolish.

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I just thought of a new phrase to replace reversal/remission, diabetes recovery.:crazy_face:

I think maybe it’s just “ lowering the bar” where you cal limit your intake to get below the intake where your body can’t manage. This bar gets lower and lower until you can’t get under it anymore. Kind of like playing limbo.

I have been reading and studying insulin resistance, as it affects type 1s. Some people get upset by the term, but insulin sensitivity is essentially the same concept.

I’ve been learning what causes increase in sensitivity and what lowers it.
It’s an amazingly complex issue that works with the liver and the fat cells, muscle cells and pancreas. It is so much more complex than I expected.
Changing sensitivity is also a normal natural thing. It’s only when it gets out of balance that it’s a problem.
Kind of like my immune system is whack and caused type 1.

I struggle to even know how much insulin I should need, not based on what I need, because I know that. It’s about 45 units per day. But I wonder what a healthy person produces in a day because I want to aim for that.

I recently was reading about fat cells and why they resist insulin. But they work like bubble wrap. When they are full, they resist anymore energy. When they are flattened, they want more. It’s the normal waining and waxing of metabolism.

I caught an episode of my 600 lb life and see these people who are 600/700 lbs and they are not diabetic, I mean some are but most are not. So we can let go of the idea that type2 is just about body fat. It’s only part of it. This nut has not been cracked yet.

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You have just raised enough questions without any signs of any type of solutions in the new future…
Which just isn’t unfortunate but a ongoing tragedy for (as I’ve heard) more than 10% of the world’s population

I have to work insanely hard just to have my current A1C of 5.8. Drastic measures like one meal a day and under 50-60 grams of carbs most days. Thirty grams of those daily carbs come from Kidney beans every other day or else my digestion locks up. I would discard the beans if there wasn’t a massive benefit to having them. I don’t even like them.

My mother wolfs down pizza and pasta all day, fried foods, horrid diet and has an A1c of 5.2 at the age of 75. All this after a life of bad eating, she also sits on the couch all day long and was a 2 pack a day smoker for 30 years. I would call that remission if I could do all that and have a 5.2 A1C. It makes me angry sometimes, but I’m glad she doesn’t have to deal with this horrible disease. Some do really well without meds. My brother is trying to go this route, but with 500 mgs of Metformin a day. His A1C was 11.6. Only caught because he’s trying to get a commercial drivers license and his company made him get metabolic testing.

I used to joke with my mom that he had Diabetes and would end up being diagnosed one day in the hospital because my brother thinks all doctors are quacks. Him eating low carb and actually taking medicine made my jaw drop. He also has stage 1 hypertension. The kicker is, my brother is as thin as sheet of paper. He has never been overweight in his life and is very active. Visceral fat can be present even in thin bodies. This isn’t just a fat persons disease. My family has a long line of type 1 and type 2 diabetics. It just happened to skip my mom and hit me and my brother.

You’d be able to sit on the couch all day playing candy crush while sucking down home made pizza’s like my mother and has an A1C of 5.2. If I had a good insulin resistance again, I might get myself into trouble and start grazing on food though. I wish I could bike again. I used to ride miles a day, but my leg got taken out by blood clots and circulation is permanently shot.

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I’d give anything to take my mothers pancreas out for a test drive lol.

Eating like that is not healthy for anyone, diabetes or not, type 1 or type 2. Sure some people live like that and live a long life.
It’s isn’t the rule it’s an exception. Most people who eat the way you describe are obese and have clogged arteries and won’t live to see old age. There is no judgement involved in that statement, Only facts.
I watched a documentary about people who live past 100. And one thing every one of the participants had in common was that they were never overweight their entire lives.
Also 70% were vegetarian. That includes vegans, and those who eat dairy and eggs. Still, we should pay attention to the data if we want to live long lives.

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I would not use the term “recovery”, because it presumes one is diabetes-free (just like “reversal”). “Remission” is the correct term based on current medical knowledge because of the presumption (possibly evidence-backed?) that the maintenance of a non-diabetic A1c (which, BTW, is not 6.5 - treatment goal - but 5.7 or under - “normal, non-diabetic”) is consistent with lack of diabetes-related systemic damage. Diabetes still lurks in the background, ready to pop back up if you gain weight or dramatically change your lifestyle again, very similar to the way that you can be in remission from cancer, but it will always come back again, years or decades later (if you don’t die of something else in the meantime).
FWIW: after diagnosis, 21 years ago, I went through Intensive Lifestyle Management (my own choice and direction), went from 223 lb down to 128 and got off all medicataions (blood pressure and blood glucose) and stayed there for about seven years even while not maintaining that lifestyle. It was sedentary jobs and eat-this-junk-food-fast-on-very-short-meal-breaks pressure that brought the weight back up in chunks, eventually leading me back onto both blood pressure and diabetes medications.

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