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leosmith

What's reversible?

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leosmith

Maybe it's just me, but I get tired of reading articles titled "Pre-diabetes is curable", only to once again find out that they mean many people can lower their BG back to below pre-diabetes levels. But does that mean pre-diabetes is curable? Not by my definition. By my definition you aren't cured of a disease unless your body returns to the state it was in before the disease developed. So I would like to make a list of pre-diabetes damage that can reversed, because I'm really not sure. Here's my best guess:

 

Reversible:

BG levels

Insulin levels

Pancreas damage

Liver Damage

Kidney damage

 

Irreversible:

Insulin resistance in the cells

 

Is this correct?

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samuraiguy

Since insulin resistance is systemic, not local, I would think that precludes your insulin and BG levels ever being normal again without eating less carbs, exercising more, or taking medication--as opposed to a non-insulin resistant person with your same height, weight, etc... that can eat a ton of carbs, sit on their rump all day, take no meds and still wake with a FBG under 80 mg/dl.  I know the liver can heal, my near cirrhotic fatty liver is all but gone, but I am not sure about kidney and pancreas damage.

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Halves&pieces

I think neropathy MAY be a reversible in addition to what you've listed, but could be wrong. I have read that the nerves surrounding the prostate, post radical prostectomy, can grow back to some degree for example, though very slowly. So, why not nerves elsewhere in the body IF normal BS levels are regained?

 

Perhaps the nerves react differently after being severed from surgery, or the damage is beyond the body to repair itself?

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jims_forum

Very interesting comments. In my opinion; after 30 years as type 2 and today having some interesting improvement as follows:

 

- I got bg down and under control.

- as BG dropped sub 150, my retina's healed and was watched on retina test optics. One could actually see the eyes heal.

 

- my pancreas islets came back on job to point one could watch activity on cgms. In the end not perfect but able to pull all the insulin heavy duty plls - starlix and heavy duty 75/25 insulin.

 

- in the end, found I needed boost of humalog insulin 2 to 5 units 2 hours after meal as boost to my pancreas.

 

I ended up using metformin doses at 11:00 am - 1 hour before lunch and 4:00  pm - 1 hour before dinner and

2 doses late at nght - 10:00 pm and 12:00 am midnight to strangle Dawn effect. Dose size must be sufficient size 500mg to 750 mg to catch livers attention. too small dose or poor metformin pills -liver ignores and has no effect. DO NOT COMBINE 10:00 pm and 12:00 am doses into one dose - does not work!

 

My opinion is that reversible and cured do not apply to type 2 diabetes  Yes some individual narrow medical conditions may be cureable/reversable but type 2 diabetes overall seems at this juncture means changing the operating point and results of the whole glucose generation, consumption and storage My opinion was that one is simply operating body in better operating point.

 

Carb restriction - limitation and strong exercise help to get glucose levels back to better operating point. Metformin helps stop liver flooding body with excess glucose and insulin boost helps augment weaker insulin production due to aging and other issues. Cured - no. One must maintain this new operating point with discipline and eating to ones meter. My sense is that the hunter gatherer body is far too efficient in the times and agriculture of today and we get far too little hard/decent exercise. We do not have to work hard to rustle up our food and we no longer work the pharaoh's stone tomb works moving 2 ton

stone blocks by hand. 

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OldTech

I really dislike the claims of cured and even reversible. I think they should be banned when discussing diabetes and metabolic diseases. The reason is that diabetes is not so much a disease, but a condition that is due to the consumption of excess carbohydrates for which our bodies are not fully adjusted. This mean you have to change your diet and lifestyle in order to regain your health. And if you fall off the wagon you will shortly be back right where you were. The only word that I think is accurate is remission. It is very similar to being an alcoholic - you can only control it by abstaining! 

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Seagal

I think neropathy MAY be a reversible in addition to what you've listed, but could be wrong. I have read that the nerves surrounding the prostate, post radical prostectomy, can grow back to some degree for example, though very slowly. So, why not nerves elsewhere in the body IF normal BS levels are regained?

 

Perhaps the nerves react differently after being severed from surgery, or the damage is beyond the body to repair itself?

 

 

After having two total knee replacements and wondering how long it would be until certain areas of the knee felt normal again, I was told that could take some time since during the surgery, the nerves are cut/severed.  So it stands to reason if they can be repaired (in time) other nerves could be also.  There are areas on both knees that feel numb, but the one done in 2013 is almost normal :)  

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Healthynut

I'm newly diagnosed (October 2, 2015), but I'm living on the hope that Type 2 is somewhat reversible.  I'm not wasting hope on a cure, but after reading mounds of research and discussion, I'm convinced that beta cells can heal and reproduce and that insulin resistance can be improved. 

 

(I wish I knew whether my problem is (1) insulin resistance or (2) damaged ability to produce insulin or (3) both.  Is there a test or some way to know for sure?)

 

My rough understanding (which is always subject to correction by new and more accurate information) is that blood sugar spikes over 140 or so kill beta cells, especially those in the process of reproducing.  So if I can maintain my blood sugar in a normal range, my beta cells will have the opportunity to reproduce and I'll stop murdering the ones I have left.

 

As for insulin resistance, I'm convinced that working out anaerobically as well as aerobically decreases such resistance.

 

If any of y'all are going to burst my bubble on this, please do it gently. :)

 

 

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OldTech

I'm newly diagnosed (October 2, 2015), but I'm living on the hope that Type 2 is somewhat reversible.  I'm not wasting hope on a cure, but after reading mounds of research and discussion, I'm convinced that beta cells can heal and reproduce and that insulin resistance can be improved. 

 

(I wish I knew whether my problem is (1) insulin resistance or (2) damaged ability to produce insulin or (3) both.  Is there a test or some way to know for sure?)

 

My rough understanding (which is always subject to correction by new and more accurate information) is that blood sugar spikes over 140 or so kill beta cells, especially those in the process of reproducing.  So if I can maintain my blood sugar in a normal range, my beta cells will have the opportunity to reproduce and I'll stop murdering the ones I have left.

 

As for insulin resistance, I'm convinced that working out anaerobically as well as aerobically decreases such resistance.

 

If any of y'all are going to burst my bubble on this, please do it gently. :)

 

I have seen a paper saying that spikes above 110 damage beta cells in in-vtro tests (for example in a petri dish). That's one of the reasons why I try to keep my blood glucose under 10, but not the primary reason.

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Jody

I, too, hate hearing the word 'cured' applied to Type 2.  I agree - a CURE would be for me to be able to go to a movie, have a large popcorn and a box of milk duds and not go over 140 - LOL! 

 

I will be happy, though, if I can continue to eat moderately low carb (about 30 per meal) and not progress.  Over 110 causes damage, OldTech?  Sigh ... I thought I was doing good trying to keep mine under 120 after meals.  110 ... really?  I guess if it's in a petri dish, I will take it with a grain of salt - lots of things happen in petri dishes that don't happen in bodies.  -_-

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OldTech

Over 110 causes damage, OldTech?  Sigh ... I thought I was doing good trying to keep mine under 120 after meals.  110 ... really?  I guess if it's in a petri dish, I will take it with a grain of salt - lots of things happen in petri dishes that don't happen in bodies.  -_-

 

That's correct. I should add I don't think we really know what level starts to cause damage in the body. I suspect that it varies from individual to individual over time based on multiple other interactions so it is all but unknowable. All we really know is that lower should cause less damage. It is also likely that the response curve is nonlinear so that we get diminishing benefits as we approach normoglycemia. 

 

BTW: Staying under 120 was my first goal after being diagnosed. It took me a year on a keto diet along with resistant starch, intermittent fasting, and metformin before I could stay under 100.

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Ela

Leo, I share your frustration with this "reversible" B.S.. 

 

What is reversible though are the symptoms and some organ damage.  But here is the question: what condition is reversible?  If you are allergic to strawberries for example, not eating them will reverse your allergy?  So in a year or so you'll able to eat them again without a problem? 

 

The thing is that shortage of insulin and damage to islets or insulin resistance are not the whole story about why some of us have high BG.  There are different theories that include gut flora, overactive liver, hormonal misbalance.  Doctors don't even try to pinpoint to what actually makes YOUR blood sugar to raise.  For me for example a strenuous exercise is equal 30 carbs of white bread, as it gives me about the same spike.  My doctor doesn't believe it.... 

 

But we are lucky that we can see on our meters and with patience and diligence it's possible to figure out each individual regimen to reverse the symptoms and basically make your whole body healthier.  Other health problems are not that easily monitored. 

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jwags

I think diabetic symptoms can be managed but diabetes cannot be reversed. Most of us have to change the way we eat and exercise, on top of taking meds, I don't think we can undo damage that is already done. I had some minute damage in my eyes when I was dx'd almost 9 years ago. They called it microanyirisms. My vision got better as my bg fell and I thought everything was OK. This month I was dx'd with Retinopathy and Diabetic Macular Edema. I have kept very tight control over my bgs and I eat fairly low carb. So my diabetes has not reversed at all. I actually have to work harder now than 9 years ago.

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TX_Clint

Somethings are reversible and some not. I have a jacket that is reversible, my car has a reverse gear. However, diabetes is like underwear, NOT reversible no matter how much you wash.

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ronmesnard

Reversible:


BG levels 


Insulin levels


Pancreas impairment


Mild nerve damade


 


Irreversible:


Insulin resistance in the cells


Pancreas damage due to b-cell death


Kidney damage


Liver Damage


Serious nerve damage


 


Depending on your genetics you may kill b-cells.  By a survey taken here about 75% of us kill b-cells.  Diabetes is progressive for these persons.  All they can do is slow down the progression by keeping their BG low.  The other 25% only have to deal with insulin resistance.  If they reduce their BGs to normal their pancreas will completely heal.


 


During pre-D you may also be able be able to completely heal your pancreas even if you have the bad genes.  During pre-D if you have the bad genes your b-cells are poisoned in a way that they can't heal.  If you get your BGs under control before all your cells are permanently damaged you can have a recovering pancreas.  I think that is what they mean by curable.  I think that is a fair description.  You will always be insulin resistant but you can have a fully functional pancreas.  You have so many more options when you can produce a normal quantity of insulin. They believe complete b-cell damage occurs near the end of pre-D.  The b-cells are still alive but can't multiply normally like healthy b-cells.  


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OldTech

 

Reversible:

BG levels 

Insulin levels

Pancreas impairment

Mild nerve damade

 

Irreversible:

Insulin resistance in the cells

Pancreas damage due to b-cell death

Kidney damage

Liver Damage

Serious nerve damage

 

Depending on your genetics you may kill b-cells.  By a survey taken here about 75% of us kill b-cells.  Diabetes is progressive for these persons.  All they can do is slow down the progression by keeping their BG low.  The other 25% only have to deal with insulin resistance.  If they reduce their BGs to normal their pancreas will completely heal.

 

During pre-D you may also be able be able to completely heal your pancreas even if you have the bad genes.  During pre-D if you have the bad genes your b-cells are poisoned in a way that they can't heal.  If you get your BGs under control before all your cells are permanently damaged you can have a recovering pancreas.  I think that is what they mean by curable.  I think that is a fair description.  You will always be insulin resistant but you can have a fully functional pancreas.  You have so many more options when you can produce a normal quantity of insulin. They believe complete b-cell damage occurs near the end of pre-D.  The b-cells are still alive but can't multiply normally like healthy b-cells.  

 

 

I think that your list is too precise. There are a lot of grey areas. I know of at least one case in which a type 1 diabetic had kidney damage some 40 years ago, started a very low carb diet, and now has reversed most of his complications including the liver damage. That is Dr. Bernstien. Nerves can regrow although slowly (months and years). Likewise, our vascular system can route around damaged vessels. And we don't understand insulin resistance. I now think that one cause of insulin resistance is due to microvascular damage. If so that would explain why vasodilators have been shown to help reverse insulin resistance. And likewise for glycation damage. Since cells have different lifecycles, reversal of glycation damage takes time (months, years, and decades) depending upon the cell lifecycle and normoglycemia.

 

That said, I do agree that there is likely a point of no return for some complications only there is no way to know for sure.

 

From a practical viewpoint, if you want the best chance of reversing or preventing additional complications you should choose a ketogenic diet with essential medications and strive to minimize both glucose and insulin levels. You may be pleasantly surprised! But don't expect miracles over night. It takes time.

 

Also, keep in mind that reversal of complications is not a popular research topic. We still have lots to learn about reversing complications and that includes us.

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ronmesnard

I can agree with that.  Minor damage can usually heal over time while major damage doesn't.

 

BP drugs modify insulin resistance some make it worse some make it better.  

 

 

In their study of 2,656 men and women without type 2 diabetes(average age 50.6), researchers discovered that by the end of the 5.9 year median follow-up, 190 people developed type 2 diabetes. The most important predictor: high systolic blood pressure while patents were sleeping.

...

 

Blood pressure normally decreases during the night by 10% or more. But in those with diabetes, blood pressure is more likely to remain high during sleep. This pattern, known as non-dipping, which can also occur in those with hypertension, is linked with glucose intolerance and other metabolic conditions. Growing evidence suggests that non-dippers face a variety of increased cardiovascular risks.

....

 

Higher doses of thiazide diuretics (i.e., ≥25 mg/day) have been shown to worsen glycemic control, while even average doses of beta blockers can reduce insulin sensitivity. Evidence suggests, however, that these drugs work synergistically with other types of hypertension drugs including ACE inhibitors and ARBs, he said, which have been shown to reduce the incidence of diabetes.

 

 

 

http://www.endocrineweb.com/news/diabetes/17799-taking-blood-pressure-meds-nighttime-may-prevent-type-2-diabetes

 

Certain BP meds prevent insulin resistance, and reduce the RAAS effect that reduces b-cell insulin output and the killing of b-cells

ACE inhibitors and ARBs have long been used to prevent cardiovascular and renal damage in diabetic patients.5-7 Recent studies suggest that drugs that decrease the formation or actions of Ang II may also reduce the incidence of diabetes.8,9 We review here the evidence that the RAAS is activated in obesity and diabetes, including the mechanisms by which Ang II induces insulin resistance and affects pancreatic inflammation and apoptosis. We also examine recent data implicating aldosterone as a major effector in the development of insulin resistance and decreased pancreatic β-cell function. Finally, we consider the implications of these studies for the development of pharmacologic strategies to reduce incident diabetes.

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3223326/

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Robb15

Doc says I can keep my neuropathy from getting worse but it will never be gone.

On that same note, my Doc told me my prediabetes was cured because my fbg was down to 91 and A1C was 5.5.  I tried to tell her it only improved because I was on a greatly restricted carb diet.. said if I ate a meal with 30 g oif carbs my 1 hr reading would be over 170.  She said she doesn't go by one hour readings.  So, yeah, Docs... gotta love em, and take everything they say with a grain of salt.

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Bishop

On that same note, my Doc told me my prediabetes was cured because my fbg was down to 91 and A1C was 5.5.  I tried to tell her it only improved because I was on a greatly restricted carb diet.. said if I ate a meal with 30 g oif carbs my 1 hr reading would be over 170.  She said she doesn't go by one hour readings.  So, yeah, Docs... gotta love em, and take everything they say with a grain of salt.

 

Not to revive one of the hundreds of threads on this topic along with the emotional intensity and all, but the most common analogy I've heard now for the 5th time from both doctors and the speakers at various support groups I've tolerated has been:

 

Diabetes is like sugar poisoning the same way sunburn is like sun poisoning.  

If your sunburn heals, you're cured, or the damage has been somewhat reversed (they all know this isn't true at all even in the sunburn case, but I digress).

But if you go back into the sun at that same dosage, you'll be burned again.  The same way if you return to a high sugar WOE, you'll have problems.

And genes matter here too - some folks can hang out in the sun for hours, no problem, while others burn in less than an hour - same amount of sun or less.  

That said, you keep the cycle going - keep on going to the beach with no protection or portion control when it comes to sun - and bad, irreversible things can happen, including skin cancer/melanomas.

 

There was at least one other analogy used, but I forgot what it was.  To be fair, no matter what I think about that analogy above and how it can be broken, I'd like to believe a ton of these folks were genuinely trying to help, motivate, provide hope, and such.

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Kalisiin

I really dislike the claims of cured and even reversible. I think they should be banned when discussing diabetes and metabolic diseases. The reason is that diabetes is not so much a disease, but a condition that is due to the consumption of excess carbohydrates for which our bodies are not fully adjusted. This mean you have to change your diet and lifestyle in order to regain your health. And if you fall off the wagon you will shortly be back right where you were. The only word that I think is accurate is remission. It is very similar to being an alcoholic - you can only control it by abstaining! 

Remission is the very term I use.  And for precisely the same reasons.

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Fraser

I prefer the term well controlled ; )

For those who are successful at dealing with it every day

 

Do you consider yourself well controlled?

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Fraser

Well maybe a bit too controlled. Bs 2 hrs after dinner 70. Oh well better that I need to pump it up a bit than being too high.

At least I will sleep well tonight. )

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ronmesnard

Cured has a better 'ring' to it.  Part of the medical communities job is to motivate persons to do the right thing.  If using the word cured instead of remission get 1% more persons to do the right thing I think it is a fine idea even though oldtech is correct.

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OldTech

Yep 'cured' has a better ring to it especially for the various organization (ADA, DCUK) trying so hard to find a cure. All they need is your money. It also works well for researchers. They too just need your money. Then there are the marketers. And they too just need your money. 

 

In the meantime, while the focus on a cure, millions are still being diagnosed with diabetes, obesity, and other metabolic diseases. And don't forget the millions of mistreated patients whose lives are being made more miserable and shorter because of our misguided protocols.

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TX_Clint

I just heard on the news that the incidences of diabetes has begun to decrease. Of course they gave all kinds of possible causes except the most logical one of better identification and treatment of pre-diabetics causing fewer people to be diagnosed as diabetic.

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