A Dietitian’s Journey – remission from Type 2 Diabetes

My journey began on March 5, 2017 when I was a fat Dietitian with all the benchmark symptoms of Metabolic Syndrome including Type 2 Diabetes, high blood pressure, high LDL cholesterol and triglycerides, abdominal adiposity (i.e. “a belly”) and high BMI (high weight for height). Physically I was a mess but my biggest problem was that I was in denial. It had been months since I had monitored my own blood sugar or blood pressure even though I had been diagnosed with Type 2 Diabetes 10 years earlier. I knew better.

I would occasionally step on the scale and weigh myself, but how my clothes fit (or didn’t) already told the story. I was overweight. Actually, I was obese.

Shortly before my own turning point in March 2017, I had two girlfriends my own age – one who I knew since high school and one since university die of preventable diet-related disease within two months of each other. Both were in healthcare and took care of others practicing their profession, just as I do. I had two degrees on the wall but didn’t take care of myself.

March 5, 2017 all that changed. That was the day that the pain of remaining the same became greater than the pain of changing. So I changed.  That story and the progress since then are in previous articles in A Dietitian’s Journey.

Like many others, I once believed that “Diabetes is a chronic, progressive, disease” and that it will only get worse in time. I realize now that if I had continued to eat more carbs than my body could handle, then it most certainly would have gotten worse but I have almost 11 month of evidence that supports that if I don’t, it CAN and DOES get better.

I am not “cured” by any means, but my symptoms are now in what the American Diabetes Association defines as partial  remission and I may very well be able to achieve full remission, as I continue to eat a low carb diet. I will only know in time.

To achieve remission with Type 2 Diabetes (T2D) is like someone being in remission with Celiac disease; we can get well and stay well provided that we don’t eat the foods that we can’t tolerate; for a Celiac that’s gluten and for someone with T2D it is more carbohydrates than their body can handle.

I do eat some carbohydrate each day, mostly as non-starchy vegetables, the occasional berries or pomegranate seeds on a salad, as well as some nuts and seeds but I am careful to keep the amount at any one time below what my body can process while maintain blood glucose control as close to a ‘normal’ (non-Diabetic) level as possible.

This article explains how and why my body is no longer able to handle more than a small amount of carbohydrate at a time.

The good news is that I no longer meet the criteria for diagnosis with Type 2 Diabetes, as demonstrated by the  Diagnostic Criteria[1] for the disease:

Abbreviations: 2hPG , 2-hour plasma glucose; A1C , glycated hemoglobin; FPG , fasting plasma glucose; IFG , impaired fasting glucose; IGT , impaired glucose tolerance; OGTT , oral glucose tolerance test; PG , plasma glucose.

Diabetes Partial Remission and Remission

It does not appear that Diabetes Canada define these concepts, however the American Diabetes Association (ADA) defines “remission” as having test results below the range for Diabetes (i.e. Fasting Blood Glucose less than or equal to 5.5 mmol/L (100 mg/dL) without taking Diabetes medications or having bariatric surgery.

Partial remission” according to the ADA is having test results lower than the range for Diabetes i.e. Fasting Blood  Glucose less than or equal to 5.5 – 6.9 mmol/L (100–125 mg/dL) or HbA1C between 5.7 – 6.4%  for at least 1 year.

  1. my Fasting Blood Glucose is less than or equal to 7.0 mmol/L , so I no longer meet the diagnostic criteria and fall in the partial remission range.  As you can see from the following picture, the average of my  twenty-four Fasting Blood Glucose readings from January 1 2018 – January 24, 2018 has  been 6.0 mmol/L. Out of the 24 glucometer readings (with a meter that I standardized with the lab when I had my tests done), only once was my blood sugar higher than the cutoff. This would indicate that I am in partial remission, by the ADA definition.

    glucometer readings average fasting
    Self monitored blood glucose – January 1 2018 – January 24, 2018 – averages

  2. I have taken seventy-five glucometer readings during the month of January so far (see photos at the bottom of this article) and none of them were greater than or equal to 11.1 mmol/L. Here is a graph of my January results:

    glucometer readings graph
    Self monitored blood glucose – January 1 2018 – January 24, 2018 – graph

3. My 3 month glycated hemoglobin test, also known as a HbA1C (or “A1C” for short) is less than or equal to 6.5 %  which means that I no longer meet the criteria for the disease and my results fall in the range for partial remission.

non-diabetic HbA1c
Glycated Hemoglobin below criteria for Type 2 Diabetes – January 23, 2018

Cholesterol and Lipids

My LDL was at the high-end cutoff two years ago, after only 4 months on a low carb high healthy fat diet, it was approaching what is considered by the existing / popular standards of “optimal LDL” for someone who is high risk (family history of cardiovascular disease).

My LDL was 2.60 mmol/L (1.14 mg/dl), my triglycerides (TG) were 0.64 mmol/L and my HDL was 1.97 mmol/L. 

Using more significant measures, my TG:HDL ratio was 0.32 (with <0.87 considered ideal). A very low TG:HDL ratio is associated with lots of large, fluffy LDL – the kind associated the lowest risk of cardiovascular disease  (CVD) such as heart attack and stroke. It is the higher density, small LDL particles that are associated with CVD.

Blood Pressure

My blood pressure has been ranging from between just below the normal range to pre-hypertension for months, but to protect my kidneys I am continuing to take a “baby dose” of Ramipril® (2.5 mg per day) that I asked the doctor to put me on until my blood pressure is consistently below normal and the meds need to be reduced or discontinued.  The dose I’m on is the smallest it comes in and my doctor has switched me to tablets, which can be split if my blood pressure is consistently on the low side.

Weight and Waist Circumference

Weight

I’ve lost 35 pounds.  I feel better about how I look than I have in many years, and I am a little more than half way there.  I am celebrating my progress, but not letting it be ‘enough’ because health-wise, it isn’t. To truly reduce my risk of heart attack and stroke, I need to lose another 25 pounds, or whatever weight will actually put my waist circumference at half my height.

Waist Circumference

I’ve loss 7 inches off my waist. That’s more than 1/2 a foot!  Crazy, eh?  I only have another 3 inches to lose off my waist for me be in the low-risk category and I am guessing that will correlate to another 30 pounds of weight loss.  Maybe it will be less, maybe more, but my weight loss goal is whatever it takes for my waist to be half my heightThe scale won’t determine my goal, the tape measure will.

My hard earned success in achieving partial remission from Type 2 Diabetes and these significant improvements in metabolic markers would be very short-lived if I began to eat more carbohydrates than my body can handle. I am still learning how much of which kinds of foods I can eat while maintaining my blood glucose levels but my own “n=1 results” seems to indicate that  full remission of Type 2 Diabetes may very well be possible. The literature seems to support that it is possible- but whether I can achieve that level has yet to be seen.  I still have much more to achieve, but I am definitely on the road to better health!

If you would like to know how I can help you on your own health and nutrition journey, please send me a note using the “Contact Me” form above.

To our good health,

Joy

If you would like to read well-researched, credible “Science Made Simple”  articles on the use of a low carb or ketogenic diet for weight loss, as well as to significantly improve and even reverse the symptoms of Type 2 Diabetes, high cholesterol and other metabolic-related symptoms, please  click here.

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Copyright ©2018 The LCHF-Dietitian (a division of BetterByDesign Nutrition Ltd.) 

LEGAL NOTICE: The contents of this blog, including text, images and cited statistics as well as all other material contained here (the “content”) are for information purposes only.  The content is not intended to be a substitute for professional advice, medical diagnosis and/or treatment and is not suitable for self-administration without the knowledge of your physician and regular monitoring by your physician. Do not disregard medical advice and always consult your physician with any questions you may have regarding a medical condition or before implementing anything  you have read or heard in our content.


P.S. For those that would like to see the “numbers” to understand my progress to date, below are 10 photographs showing all my glucometer readings since March 5, 2017 until today.

Blood Glucose Mar 5 2017 – January 24 2018 – pg 1

Blood Glucose Mar 5 2017 – January 24 2018 – pg 2

Blood Glucose Mar 5 2017 – January 24 2018 – pg 3
Blood Glucose Mar 5 2017 – January 24 2018 – pg 4
Blood Glucose Mar 5 2017 – January 24 2018 – pg 5

Blood Glucose Mar 5 2017 – January 24 2018 – pg 6

Blood Glucose Mar 5 2017 – January 24 2018 – pg 7
Blood Glucose Mar 5 2017 – January 24 2018 – pg 8
Blood Glucose Mar 5 2017 – January 24 2018 – pg 9
Blood Glucose Mar 5 2017 – January 24 2018 – pg 10

References

  1. Canadian Diabetes Association Clinical Practice Guidelines Expert Committee. Canadian Diabetes Association 2013 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada. Can J Diabetes 2013;37(suppl 1):S1-S212, Chapter 3
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Author: Joy Kiddie, MSc, RD

Joy Y Kiddie MSc., RD - I'm a Registered Dietitian in private practice in British Columbia, Canada that provides low carb and ketogenic services in-person in my Coquitlam office, as well as by Distance Consultation (using Skype / telephone).