T2D Reversal and "Steady State"

Hey, everyone:

I have made a lot of strides during the first half of 2021. By following strict keto, employing Zone 2, Zone 5 and resistance training, intermittent fasting and tracking on a CGM, I have lost 40 lbs, reduced A1c from over 8 to 5.6 as of early July, experienced only occasional excursions above 140 BG, taken points off my cholesterol, etc. For now, it appears that I have achieved some “control” over my condition.

I have read a lot of sunny projections of “reversing T2D” and am skeptical. While I do see evidence of more “normal” insulin behavior (eg. BG returning to baseline 2 hrs after meals a lot of times), I am trying to figure out what goals are reasonable for me to achieve.

For me, the objective is to achieve a “steady state” routine – a standard range of meals, workouts, fasts, etc., that allow me to maintain my condition without having to pay constant attention.

But I’m also interested in what’s achievable? <5 A1c? Reintroduction of “lower glycemic carbs” (I have started to add in small amounts of 100% cocoa or blueberries), <100 cholesterol, etc.?

Interested in your perspectives.



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You can definitely improve type2. You are reducing insulin resistance and limiting carbs and exercising.
However you haven’t really reversed it.
You have only brought the Bar low enough so your body isn’t overwhelmed.
It seems that with type 2, it will come back even with your changes.
You are doing great right now. The more time that you keep things in line, the better you will feel and you will stave off complications.
Just keep an eye on your sugars, don’t think that the need for meds at some point means you failed.
It’s just the course of the disease


You have definitely made great strides toward better health. I think your main focus now should be on sustaining those health improvements for the long run.

I would not place an emphasis on A1c reduction but instead work on your time in range (TIR) and glucose variability numbers that your CGM gives you. The A1c is just not as precise as we think of it. It does not represent your glycemia nearly as well as TIR and SD and CV.

The standard TIR limits are 70-180 mg/dL but don’t be afraid to tighten those up. If you are now easily meeting an 80% TIR 70-180, try measuring your performance for 70-140.

Glucose variability is an important metabolic measure. Ou bodies prefer less glucose volatility. I would shoot for a standard deviation (SD) of < 25 mg/dL and a coefficient of variation (CV) of < 25%. You can move these goals downward if you find that you’re easily meeting them.

I’m curious if and how your doctor may be supporting your effective efforts. Good luck and good job!

@Terry4 Thanks for the advice. Already working on 70-140.

WRT/ my doctor, I have had extremely mixed results. I am in the process of switching away from a primary care physician who preaches a low fat diet (with some reduction of high glycemic carbs) and discourages TRE and intermittent fasting. I haven’t been able to see an Endocrinologist despite receiving a referral in March (my appointment is in October).

I have just joined Virta (www.virtahealth.com) and had a great conversation with their intake doctor on Friday. Sounds like their program won’t be much different from what I’m doing now.

One question: how are SD and CV measured?

These are both statistics that are calculated from the glucose data sourced from the CGM. If you want to know about the actual arithmetic that calculates SD, just do a google search and you should be able to find that. Maybe a YouTube search would find a good video that explains it. SD measures how far the data set is dispersed from the average or mean.

The CV is simply the SD/average. So if the SD = 25 mg/dL and the average is 100 mg/dL, the CV = 25/100 = 25%.

I am very interested in what you learn about and experience with Virta. I’m hoping you write about it here. If you prefer more privacy than that, I’d be grateful if you sent me a private message. I have a close family member who is considering Virta.

By the way, if you work on TIR and variability, your A1c will follow.

@Terry4 I’ll definitely share my experiences with Virta. Please note that I already practice keto and I am already at a weight that is pretty good (190 lbs at 6’0") so I may not need to change very much with their program. Extremely impressed so far – I really appreciated the knowledge/expertise of the MD who did my intake interview. I’m awaiting the startup kit and app creds.

My SD calculation question is probably a stupid one. Essentially, is this the same SD that I calculated in statistics class or something specific to the field of glucose management?

Thanks for the comments on controlling variability. I’ll work on identifying and reducing the spikes.

They are the same.