Weight loss & improved control

I am a 52-year-old woman, T2, carrying about 20 lbs above the suggested "healthy" BMI. I'm relatively content at my weight, but imagine greater health & confidence if I dropped 10+ pounds.
Have you lost weight & experienced better control of your diabetes? Any T2s who have reduced their meds in this way? Looking for inspiration!!

Hello! I'm not a T2 diabetic, but I am a T1 and also a registered dietitian! If you think that losing some weight would make you feel healthier and more confident, then I would totally go for it. Sounds like you already have the motivation, which is a great start!

I'm not sure what medications you are on, but if you're on insulin, I can almost guarantee that you will experience at least a little better control of your BG levels. But honestly, it would probably improve your control quite a bit. Even a modest weight loss (5% of your current weight) can vastly improve many things, including BG levels!

Let me know if you'd like any advice. I can't really speak from my own personal experience, but I am armed with lots of knowledge about diet and exercise as well as T2 diabetes!

Thanks Alycat!. I'm on Metformin only; quite religious about eating lower carb & exercise. After my dx (3 years ago), I didn't worry much about weight loss--rather concentrated on controlling my diabetes. Got my A1C down to 6.3. My A1C crept up at little this year (to 7), so I thought I'd try pushing a little harder on diet & exercise to shave off some of the extra weight.
If not now, when?

Sounds awesome! I think you will find success, but don't be discouraged if your don't. An A1C of seven is still great! Best of luck to you!

Hi Deborah: Have you considered that you might have slowly progressive Type 1 diabetes, sometimes called latent autoimmune diabetes in adults (LADA)? I suggest that because you are relatively young, close to normal BMI, and your meds (metformin) are not working despite diligent low carb and exercise. Here is a blog I wrote on misdiagnosis. Just suggesting an alternate possibility--is this something you could discuss with your doctor? Best of luck to you!

Not so speak for Deborah, but 52 isn't all that young to get diagnosed with T2 diabetes, especially in this day and age... I suppose LADA is possible, but I would think more-so if she were around 30 (also, incidence is only estimated at 9 in 100,000 T2 diabetics, 0.0001%). I agree to definitely discuss it with the doctor. I am no doctor and cannot make a diagnosis, but if she has a history of T2 diabetes in the family, that would definitely suggest T2 over LADA.

In general, T2 diabetes is a progressive illness. Over time, T2 diabetics need to eventually increase their treatment regimen with either higher doses of medication or more medications, even if they eat right and are active. My grandfather eats very well, is a normal weight, and is very active. He still has to have increases in his medication from time to time. This could explain the slight rise in A1C.

Plenty of T2 in my family. I think the rising A1C had more to do with getting lax with my diet--too many "treats."
Right now I'm not dieting per se. I am trying hard to keep certain trigger foods out of my house & to exercise at a greater pace & for longer duration.

Deborah, First, let me comment that everyone is different and everyone's body will react differently to both medications and lifestyle changes.

I am almost the same age as you, diagnoses T2 around 18 months ago, and approximately the same amount over "optimal weight." In fact, at diagnosis, I had already lost 65lbs, slowly over 7-8 years and was only 5-6lbs "overweight." I am also fairly active (ride a bike almost every day).

Because I could not tolerate oral meds, I am on insulin (and gained a few lbs shortly after starting insulin). My doctors do not consider my weight to be a problem, nor do they believe that my r4egimen for treating diabetes will change if I lost weight - even a relatively significant amount.

That said, I know that I would still have an overall more "healthy" feeling at a somewhat lower weight. While I have not been able to lose any weight since starting insulin, I am still motivated to try. In my experience, 10 pounds represents a significant change in how my body feels; twenty even more so. If hoping for a reduction in D medication motivates you, great, but don't be discouraged if it does not - you will still feel better and feel better about yourself. Besides, the long-term benefits of improved activity and better eating are well documented - not necessarily only in regards to diabetes. It is hard, but it is worth the trouble!

I don't think an a1c of seven is good- You should go for 6 and below to avoid complications, if you can safely do it. And I would definitely ask for antibody testing and c peptide levels to make sure you're not really type 1. Imo this should be done on everyone who has a D diagnosis. Type 1 can happen at any age- my endo said he diagnosed someone as type 1 in their 70's around the time that I was diagnosed. If you're type 1 you will need insulin to manage bg and stay out of dka. Either way I would definitely lose weight, this will help your overall control and you will just be healthier overall. Good luck!

I promise I'm not trying to be a "know-it-all," but I really feel I must refute some of the information you just stated above.

Shooting for an A1C of 6 or below for T2 patients is not necessarily better, as a very famous study, the ACCORD trial, has shown (and other studies subsequent that one). Having the lowest possible A1C that is safe has been shown to be good for T1, but for T2 can actually increase the risk of certain complications, such as cardiovascular events like heart attacks and strokes. Going below 6% A1C does not add any further benefit to reducing complications for T2 diabetes (note that I say specifically T2). Below 7% has been shown to have the most benefit.

Please go to this link if you're interested. http://www.aafp.org/afp/2012/1215/od1.html

Ugh... I totally understand trigger foods. Even as an RD intern, I like to eat sweets and whatnot. It sounds like you know what to do, and I encourage you to do whatever you feel is necessary!

Well I guess we will have to disagree, I would never tell someone an a1c of 7 is good- my endo who has been treating type 1 & type 2 adults for many years agrees: he says 6 an under to avoid complications so that is what I will always shoot for myself. The accord study has a lot of flaws.

In addition, type 2 have been given really bad advice for a long time about diet and bg levels, way too high. While having a lower a1c is no guarantee of no complications it is definitely less likely to happen at lower bg levels. There are many other factors that come into play for cvd, but for anyone with D, lower bg will lower help avoid that.

Yes, agree to disagree. But do note that I said below 7. :)

ok.. and you did say: An A1C of seven is still great!

I don't think this is good advice so I'm just adding my input here.

That is true, I did say that. I meant it more as a "Don't despair, you can get it where you want it later." You have to admit that 7% isn't the worst A1C...

Anyways, done making my point.

The Accord studies have been completely refuted. But I agree that Deborah has most likely been correctly diagnosed as Type 2. Since she is not taking insulin then the likelihood of hypoglycemic events is remote. There seems to be an overwhelming push to lower A1C's on this site. When I approached my CDE with my plan to lower my A1C to 6.0 her response was "As you know DCCT and EDIC support lowering BS/A1C to reduce micro vascular complications and promote less CVD but not without a significant risk in hypoglycemia especially in people with type 1. The ADA and AACE support a 6.5-7% as long as hypoglycemia is not an issue or if a person has unawareness.Of course it's your preference and goal but lower because of complications of neuroglycopenia is not always better ( or safer)."
We went back and forth and I settled on 6.5 as a goal. My last A1C was 6.2 and to be honest I am fine with that.

Okay, really not sure where you getting your information on the ACCORD trials being "refuted." I would really like to see evidence for that before you just spout that one out. I do agree with "meee" that the study has its issues, as do all studies.

But a number of other studies have shown similar results with regards to the finding ACCORD found of having no further advantage of lowering below 6% versus below 7%. Also, it's relatively rare and VERY difficult for most T2 diabetic patients to achieve such a low A1C. ANYWAYS, you were more along my point of below 7 is okay.

But seriously, refuted? If you have a valid source for this, it's important for me to know in my profession. I have been in school the past 5 years learning about this stuff and have heard nothing of the sort...

I think it depends how lower A1C goals are done. The accord study appears to have had doctors simply shoot for lower A1C goals for some patients than others, and the result is that the group whose goal was set below 6 for them by their doctor had higher mortality rates (or something to that effect). Well, that's quite different than a patient deciding to be extremely disciplined in controlling their diabetes. Additionally, most (95%) of doctors (and probably endos) are not fans of low carb dieting which makes control a lot easier. The typical patient in the study is probably told to eat ADA levels of carbs and is likely cheating a bit on the diet.

Apparently in the study the standard T2 drugs were used, and frankly the only one I was willing to take back when I was misdiagnosed with T2 was metformin, so they were using a combination of drugs to get that A1C below 6. Even metformin has nasty side effects. So it might just be that the problem isn't some intrinsic difference between T2 and T1, but rather the drug cocktail T2s are put on.

"Medications used included (in order of frequency of use): metformin; thiazolidinediones, or TZD’s (rosiglitazone, pioglitazone); injectable insulins; sulfonylureas (gliclazide, glimepiride, glipizide, glyburide); acarbose and exenatide. Combinations of medications could be used to achieve the A1C goals."

The review also talks about other differences between the intensive treatment group and the other group, and one was pretty striking....
"About 28% of participants in the intensive group gained more than 10 kg (22 pounds) of body weight, compared with about 14% of participants in the standard group." To me, that sounds a lot like the patients were simply getting more meds/insulin without any change in diet or exercise, and more of the glucose in their system was converted to fat resulting in more cardiovascular disease and death. When I tighten the control of my BG, I'm either losing weight or maintaining the same, never gaining.

This also gets into the difference between tight control and having a lot of hypos to get a low A1C. A while back I met someone whose A1C was around 5.6 and I was pretty impressed until he started telling me about how often his BG runs around 50. That's not good, but a T2 doing low carb dieting who is effectively taking meds to counter their food intake, can probably hit that while staying close to 100 almost all the time.

I would argue that the only thing the ACCORD study teaches us is that the standard medical protocols for T2 diabetics (ADA guidelines plus drug coctail) isn't working, and getting more of a bad thing....

This article makes a case... http://asweetlife.org/feature/unraveling-the-mystery-of-the-accord-study-2/

Regarding an A1C below 7, it might be rare, but if they go fairly low carb (cutting out refined sugars, and simple starches), take metformin, and get their weight to where it is needed, I think it would be common to go below 7. If that doesn't work, they can get on an insulin regimin, and most people can get there pretty easily. An A1C of 7 translates to a average BG of about 154, and that's really high IMHO.

Alycat, the percentage of people who have been diagnosed with Type 2 diabetes but in fact have LADA is 10-15% of "Type 2s," most certainly not 0.0001%. The first study on autoantibody positive "Type 2s" was published in The Lancet in 1977 and the percent was 11%. In the UKPDS it was 10%. Many, many studies since then have found the percentage to vary between 10-30%, depending on the population. Misdiagnosis is extremely common, and since Deborah has not had autoantibody testing performed, it is certainly a possibility based on her history.