The FastDay Forum

I have a friend who is a diabetic taking insulin..He says he can't go on a fasting diet because his administered insulin is determined by his food intake.Is he right? One hears if weight loss potentially curing Type 2 diabetes.

I understand that Type II cannot be 'cured' or reversed, but I am hoping that by better, permanent management the required medication can be reduced or hopefully stopped. I now have to purchase the testing equipment for home testing blood glucose levels as my GP is following the NICE recommendations not to prescribe them, but to rely solely on HbA1c results twice yearly. In other words, we can only see how we have performed retrogradely, and then try to mitigate the damage that may by then have occurred. ( I thought the White Paper of the early 1990s said the NHS had to be a health service, not an illness service? )I think this is closing the door after the horse has bolted. Because I have now taken the step to purchase the strips etc, I can see that 5:2 has had the effect of reducing random glucose levels to as good as 5mmol, and along with steady weight loss, I have great hopes! I have approximately halved my carbohydrate intake, thanks to the very helpful MFP, and I think the NHS needs a radical overhaul of diabetes care methods, involving far better education of the so-called experts. I have posted on other topics on this Forum whereby I think the NHS is dragging its feet on this very important subject, I suspect that is because they are waiting for conclusive evidence of various interventions, and will always dismiss anything anecdotal. Well, I am not prepared to wait that long.
No one 'caring' for me has EVER mentioned my waist measurement, in relation to my height. I have always been told 'oh, you are tall, you can carry it off'.Well, a waist measurement of 37"and a height of 5' 8" was quite unacceptable, wasn't it? In only 5 weeks it is now 34", and blood glucose seems acceptable after all these years, so what does that tell me? I intend to continue this regime, it is doing me the power of good, and I just hope I have caught things in time. Thankyou to everyone who posts here, you have enlightened me, and I now feel empowered to look after my own health like I have not felt for years--- just 'being done to' and complying, as so many of us do, has been damaging for me, so I have little to lose as I see it.

[carorees]

Hi there 150lbs
I am very surprised by what you say. I wrote a degree level distance learning pack for GPs to get a diploma in diabetes care about 15 years ago (commissioned by St George's Hospital). At that time the emphasis was very much on self management with patients monitoring and adjusting treatment (even type 2). Also my cousin was diagnosed with type 2 about a year ago. She lost weight, exercised and adjusted her diet and is now off all meds both for diabetes and hypertension. If diagnosed early while the beta cells in pancreas are still functioning reasonably well, reducing insulin resistance through exercise and weight loss can certainly reverse type 2 diabetes. It is insulin resistance that is the real cause of type 2, so it is curable because insulin resistance is curable. Obesity is linked with insulin resistance as is high blood pressure. High intensity interval training, weight loss, fasting can all reduce insulin resistance, while a low glycaemic load diet can reduce the demand for insulin and protect the functioning of the pancreas.

I think you are right to hope that you make great strides in reversing (even if partially) the diabetes! Well done!

Thank you Caroline, that is just so encouraging. But you can see how I have been led to believe that there is no cure, and to just keep taking the medication. I have never been told anything different, and I am so hoping that I can reduce my medication. But as I am denied the tools to do self monitoring, how am I to control the condition? My GP, only last month, categorically stated I will NOT be given the testing equipment, my medications will NEVER be changed or reduced no matter what I do. So, even buying the equipment, and showing the results, as I do with my B /P home monitoring, is going to be ignored. In other words, there is no hope or light at the end of the tunnel --- but there is, and it is 5:2. My B/P is now down in my boots--- but NO ---I can't reduce the antihypertensives because I am told they are there to protect my kidneys from the effect of diabetes. And NO I can't reduce the statins because, well......... There is no real explanation given for that. Just what am I supposed to do? I am reluctant to change GP ( live in a rural area), but I need more information to back up my request for better care. I am made to feel like an antagonistic, awkward and ungrateful patient. Any suggestions? By the way, I have never had tests done to show if my pancreas has totally packed up, or if there are any beta cells still operative, or indeed, if I am overproducing insulin, which is not functioning properly. Thanks for replying to my post, and sorry if I have gone off on a rant this time, but I am truly frustrated with the whole situation.

[carorees]

I think you should change your GP.

What meds are you on? Are you on an ACE inhibitor (ramipril or similar), what dose (the min dose for ramipril is 5mg I think)? What diabetic meds? If you are on a sulfonylurea (e.g. glimepiride (Amaryl), glipizide (Minodiab), tolbutamide, glibenclamide (Daonil, Euglucon), orgliclazide (Diamicron)), they work by stimulating insulin production by the pancreas. If you are on metformin, that works by reducing insulin resistance and reducing gluconeogenesis by the liver so reducing the need for insulin from the pancreas.

If you start getting symptoms of hypotension, they would have to reduce the BP meds, ditto hypoglycaemia.

The problem is that so few patients improve their health as you are doing so the docs get a bit jaded! It might be worth seeing if there are any guidelines for stepping down treatment. I'll see if I can find any.

Caroline, you are an absolute star! I use metformin 2 g, (OK with that), pioglitazone 30 mg, Januvia100mg., amias 8 mg, simvastatin 40 mg. I don't expect you to sort my problems out, as the Forum is far bigger than me, but I think I am trying to show that any of us who turn to the internet for guidance are despised by the medics. I use a low glycaemic load diet, and have just found that cinnamon may be of help, but this info has not come from diabetic professionals. What other tips could be out there that many of us may be missing? No wonder we turn to places like this Forum, many thanks.

"any of us who turn to the internet for guidance are despised by the medics" _ I think that depends on the medic. I have quite sensible conversations with my GP rather than just listening to his pronouncements,

http://www.drbriffa.com/2013/03/07/some ... s-suggest/ is an enlightened medic.

Your doctor can prescribe but there's no obligation to take medications you beleive are either harmful or non-productive.

I have a friend who is a diabetic taking insulin..He says he can't go on a fasting diet because his administered insulin is determined by his food intake.Is he right? One hears if weight loss potentially curing Type 2 diabetes.

He should reduce his insulin according to the reduction in calories taken in.

So a fast day will need a lot less insulin than normal. How that is managed depends how he takes the insulin and when. If he's a Type I he should have a clue about the ratio of insulin to carbs etc.

Either way it needs planning with professional guidance.

[carorees]

Caroline, you are an absolute star! I use metformin 2 g, (OK with that), pioglitazone 30 mg, Januvia100mg., amias 8 mg, simvastatin 40 mg. I don't expect you to sort my problems out, as the Forum is far bigger than me, but I think I am trying to show that any of us who turn to the internet for guidance are despised by the medics. I use a low glycaemic load diet, and have just found that cinnamon may be of help, but this info has not come from diabetic professionals. What other tips could be out there that many of us may be missing? No wonder we turn to places like this Forum, many thanks.

Well of your meds pioglitazone works by reducing insulin resistance (via the PPARalpha and GLUT4 transporter genes); I am fairly certain I saw some evidence that PPARalpha is affected by fasting, metformin also reduces insulin resistance and as I said liver gluconeogenesis while Januvia (sitagliptin) works by increasing the amount of two hormones, glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), these hormones have several actions including stimulating the pancreas to produce more insulin but also to reduce blood sugar excursions after a meal by affecting digestion and also reducing appetite.

If you are fasting and reducing weight then you should reduce insulin resistance, exercise will do this too, particularly the HIIT protocol that Dr M introduced us to. I think I saw that HIIT affects GLUT4 much like pioglitazone. So that might be the first med to consider changing. Unfortunately there is no easy way to measure insulin resistance so you would have to discuss with a knowledgeable doctor about your health improvements.

The amias is an ACE inhibitor like ramipril. It is true that it protects renal function and unless you are experiencing debilitating side-effects from it (e.g., hypotension) it is OK to carry on taking it as in fact there is some evidence that there is no lower limit on blood pressure with respect to stroke risk (i.e., the lower you go the lower your stroke risk) so I expect it might be hard to get your doc to reduce it unless your BP is below 90/60! However, my GP has said that she would consider reducing my ramipril if I get my bp below 120/80.

Unfortunately you are right that doctors look askance at folks who turn to the internet for guidance but that is because there is a lot of woo and misinformation out there. However, if you can find reputable studies/scientific review papers to support your views they are generally willing to talk. I had a brief argument with my doc about my total cholesterol levels which were high but then my HDL was also very high and I showed her the studies that found tc:HDL ratio is a better indicator of cardiovascular risk and she was happy with that and agreed I did not need a statin. It does help that I have a PhD in medical research I know, but I do think that most GPs are aware that they don't know everything and are open to ideas if they appear to come from a reputable source.

Thanks PhilT, it is good that you can have a discussion with your GP. I like stuff by Dr Briffa, but like a lot of papers on statin side effects, even he doesn't actually specify what they are, other than memory sluggishness. When taking multiple meds like me, and being told that I risk having a stroke or cardiac event if I stop any of them, what's a mere mortal supposed to do? Yes, at my nurse-led diabetic follow ups I get asked the 2 questions :-
1) are you depressed?
2) do you have memory loss?
At 65, I think we all know where that last one is leading--- as it couldn't possibly be caused by the medications, despite research to suggest that. I can't get any decent response when I quote internet research, it just gets dismissed out of hand. Look at the case that Dr Briffa quoted about the diabetic who had made great inroads with his condition, but was being pressurised by his consultant to up his carbohydrates in line with the 'balanced' diet continually quoted by NHS professionals. Many of us are up against a brick wall, believe me. I am very appreciative of all the contributions made on this Forum, both general and nerdy stuff. Many thanks.

Caroline, that is the most useful information I have ever been given, and I really must thank you. I don't like hogging this forum with my situation, but I would say there will be many people out there who will benefit from this info. I can't be the only oe asking these questions, although I do appreciate that GPs must get fed up with folks who don't follow their instructions. but I have always complied to the letter, and I think it only fair that my lie of enquiry gets fair consideration.

[carorees]

150lbs, have a look at this paper about intensive lifestyle interventions (i.e., weight loss) vs simply using medications to treat Type 2.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2875414/

They talk about the problems of polypharmacy including side effects and costs and also how weight reduction and exercise can reduce the number of meds. If you look at the number of drugs the participants were taking at the start and end of the 1 year study you can see that the ILI group reduced their meds.

Pharmacologic treatment of hyperglycemia, hypertension, and hyperlipidemia has been shown to reduce CVD risk in people with diabetes, and this triad is now the cornerstone of optimal-care goals in the chronic disease management of type 2 diabetes (5). Clinical trials and clinical experience show that polypharmacy is the rule in meeting current optimal-care goals (6,8). The term “triple therapy” has entered the lexicon of clinical diabetes care, and five or more prescription drugs are often required to adequately treat diabetes, hypertension, and hyperlipidemia (6,20). Unfortunately, polypharmacy comes at a price of increased cost, side effects, risk of adverse drug interactions, decreased compliance, and decreased quality of life (9,10,21,22). Moreover, recent results from the ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial raise questions about the benefits of aggressive glycemic control, at least when achieved through the use of multiple diabetes medications (23). At 1 year, DSE participants in the Look AHEAD study reaching optimal-care goals were taking, on average, almost four medications daily for management of diabetes, hypertension, and hyperlipidemia at an estimated cost of almost $200/month. Their ILI optimal-care counterparts were taking slightly more than three medications daily at an estimated cost of $155/month.

Several studies (11–13) of weight loss interventions in people with type 2 diabetes have reported reductions in medication use and/or cost. These studies have typically been uncontrolled weight loss interventions applied to small groups of patients. Benefits have primarily been seen in diabetes medication requirements, with usually smaller effects when assessed on medications prescribed for treatment of hypertension and hyperlipidemia. These studies support the premise that effective programs for people with type 2 diabetes that achieve long-term weight loss and increase physical activity hold the promise of improving cardiovascular risk parameters while minimizing the use of pharmacologic agents.

Unfortunately, the LOOK Ahead trial was eventually stopped because lifestyle interventions alone were not enough to prevent the progress of the underlying Type2 diabetes. However, remember that had the participants achieved and maintained the weight loss goals things may have been different. However, it is these kinds of findings that make your doc very reluctant to consider reducing the medications because experience says you are unlikely to be able to maintain the changes. You will just have to prove him wrong!

[carorees]

I'm going to move these posts to a new thread as they are OT regarding low blood sugar effects.

Thanks again, Caroline, I am going to read it now. Your words about a GP being reluctant to change medication sound understandable, and are therefore more acceptable, now that an explanation has been given..

An excellent paper, Caroline. I feel more at ease now, and more accepting of the fact that it is unlikely that I will come off much medication. But I also have a better understanding of the need to keep my weight down, and keep physically fit. I know NHS and Government are continually saying these things, but I don't think there is enough emphasis or explanation given to proper diet, portion control and continuous monitoring. I have every intention of following the present regime, and thank you so much for getting me to this point of understanding. A great days work!