Type 2 diabetes remission is possible even in people with lower body weight, supporting idea of 'personal fat threshold'

Everyone has a "personal fat threshold," which if exceeded, will allow type 2 diabetes (T2D) to develop, even if they are of a lower body weight.

The ReTUNE Study looked at whether weight loss can also reverse the condition in people with a BMI at or only just above the "normal" range (BMI below 27kg/m2).

Men and women with T2D followed a weight loss program in which they consumed 800 calories a day for two weeks, followed by four to six weeks in which they kept their new weight steady. They completed up to three rounds, until they had lost 10–15% of their body weight.

70% with type 2 diabetes went into remission. Remission is an HbA1c (average blood sugar level) of less than 48mmol/mol for at least 6 months and off all medication. Participants had lost an average of 7.7kg at remission (10.7% of initial weight).

Special MRI scans showed that levels of fat inside the liver and pancreas fell substantially. Even though the average amount of fat in the liver of the study participants would be regarded as unremarkable at 4.1%, this was around three times higher than in healthy controls and it fell to 1.4%. Fat in the pancreas fell from an average of 5.8% to 4.3% and the activity of the insulin-producing cells returned towards normal.

The researchers say that their results clearly demonstrate that T2D is caused by the same factors in normal weight people. This is important because doctors tend to assume that T2D has a different cause in those with lower body weights and aren't usually advised to lose weight before starting on diabetes drugs.

"But if they lost around 10% of their weight, they would have a very good chance of putting their type 2 diabetes into remission," says Professor Roy Taylor.

I lost 30+ lbs. over the past 18 months without dieting. My endocrinologist/family doctor thought the weight loss could be caused by the diabetes medication Jardiance that I've been on for a while now. He sent me for all sorts of tests/CAT scan with dye and contrast to make sure it wasn't something else causing the weight loss, but they found nothing. I currently weigh 142 lbs., at least 50 lbs. less than I did when I was first diagnosed with Type II diabetes over 25 years ago. Unfortunately, statin drugs, diuretics (Thiazide), and beta blockers can cause diabetes, and also raise your blood sugar levels. Were any of those people tested on any of those drugs?

I was prescribed Hydrochlorothiazide for my blood pressure, for at least 30 years which could have been the cause of my diabetes. No one else in my family (parents and three siblings) was ever diagnosed with diabetes, and none of them were prescribed a diuretic or statin drug. I have also been taking Pravastatin and beta blockers for my blood pressure and cholesterol for many years, which may explain why my blood sugar hasn't changed at all, despite my having lost that much weight. I still have to take those medications. I eat twice a day, and limit my carb and sugar intake. If my blood sugar gets down to 84 or below, I begin to experience hypoglycemic symptoms. I guess I should be grateful that I haven't had to use insulin at this point in my life. I have outlived the rest of my family. I was the baby. They all smoked, I didn't. Three died of lung cancer. My only brother died of a massive heart attack at 51. My last sister, the oldest, died in 2014 at the age of 74. I am the only one to have made it to 75. No guarantees that I'll see 76.

The study appears to speak only to those who do not have drug-induced diabetes.

With your medicines, can you shift some to likely better options? For instance, calcium channel blockers and ARBs are preferred now over beta blockers and diuretics, partly due to side effects. ARBs are even better than ACE-Inhibitors.

With the Pravastatin (came out in 1980), newer statins, still about the same price, have fewer side effects. One cholesterol lowering medicine, Zetia (Ezetimibe), even gets rid of statin’s side effects, by not being a statin. That one appears to be $12 a month with GoodRX.

Consider talking with your doctor about improving your medicines. With your weight loss, you might find you can do a lot better.

Thanks for your insight. My doctor already tried to change my blood pressure medication and statin drug. I had been on Lisinopril for a while without any side effects. He changed it to Lisinopril/Hydrochlorothiazide. I reminded him that I had already been on Hydrochlorothiazide for many years, and ended up in the hospital because my electrolyte's were all messed up. The hospital doctor took me off of it. I was reluctant to start taking it, but followed his instructions as written.

Also, at the advice of a Physician's Assistant at my Cardiologist's office, he took me off the Pravastatin, and put me on Atorvastatin. I only see the Cardiologist once a year, and that's for sonograms on my carotid arteries and heart. Last year, the heart murmur I have had for years disappeared, and they attributed that to the loss of weight. The Cardiologist prescribes no medication for me. This year I didn't get to see him, but saw his P.A. for the first time, and two weeks later that office called wanting to change my statin medication. I told them I wasn't going to take any new medication from someone I see only once a year, and told them the P.A. would have to talk to my Endocrinologist first since he also serves as my family doctor, and prescribes all my medications for me. He eventually approved the change, and within six days of starting the Atorvastatin, my urine had turned dark orange, and I began having very bad side effects...weakness, fatigue, severe joint pain. I called my doctor's office. He had me come in and had blood drawn. Everything they tested me for was either too high, or too low. My kidney and liver enzymes were out of sight. The day after I had the blood work done, I woke up sweating profusely, had the shakes, my heart was racing, and I had a pain in my left shoulder that ran down to my hand. I drove myself to the emergency room. They did all sorts of tests, and CAT scans, and told me to stop taking the Atorvastatin, and the Lisinopril/Hydrochlorothiazide. It took several weeks for my system to get rid of that crap, and start feeling normal again. I'm back on the Pravastatin and plain Lisinopril without any issues.

A month earlier, my doctor had prescribed Fosamax for the Osteoporosis in my right hip. Years ago, when I was going through my change, and because a bone density test showed Osteopenia, my Gynecologist prescribed Actonel. I took it for quite a while until blood work showed my liver enzymes were very high. They did a sonogram on my liver because they thought I had liver cancer, which I didn't. They told me to stop taking the Actonel because it was the reason my liver enzymes were out of kilter. When I learned that Fosamax and Actonel have the same drug ingredients and drug classification, I stopped taking it, as it is quite possible that it, along with the Atorvastatin, was also contributing to the high liver enzymes.

After I stopped taking the Actonel, my Gynecologist put me on Calcitonin, a nasal spray, which I used for quite a while without any problems. She also had me on calcium supplements. At some point, after having blood work done, it showed my calcium levels were very high, and I was told to stop using the Calcitonin and taking the calcium supplements. I was diagnosed with an overactive parathyroid. My calcium levels remain high to this day.

My Endocrinologist is retiring in December. I'll be seeing him next month for the last time, then another Endocrinologist will be replacing him. I now have to find another family doctor. They provided me with a list of doctors to contact. They're all at the same medical center.

Consider Vitamin K and K2-MK4 to get your blood calcium into your bones. K2-M7 might work for that, but wasn't tested in the study I'm referencing.

Also consider the non-statin I mentioned, and bring these up with your doctor

And an ARB and Calcium-channel blocker can do great for blood pressure, and won't have anywhere near the side effects of your current high blood pressure medicines. My wife takes telmisartan and amlodipine, because I did the research and those two allowed the best overall impact with no side effects of any note. Telmisartan had just come off patent three years earlier and her doctor didn't know that and was fine with prescribing these two.

How bad is your cholesterol and do you have any known plaques in your cardiovascular system?

"If you stopped your statin, what would your cholesterol shoot up to?"

During the time period when I went off the Atorvastatin, to the time my doctor put me back on the Pravastatin, both my good and bad cholesterol shot up a lot. My good cholesterol has always been within normal range when I was on Pravastatin. My bad cholesterol was just slightly over the normal range. I go for fasting blood work before each appointment with him. My next fasting bloodwork next month will show the new numbers after being back on the Pravastatin for a couple of months.

I appreciate your advice, but I don't do over the counter supplements of any kind unless my doctor prescribes them, and he never has. Other than the Calcium supplements I took years ago as directed by my Gynecologist, none of my other doctors have ever told me to take supplements of any kind. I take several other medications for various health issues, and won't fool around with experimenting with supplements that may adversely interact with my prescription medications, especially after having experienced adverse reactions from some of the prescription medications I have been prescribed over the years. Supplements can kill people too, as well as prescription meds.

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