1/10 Pre-Diabetes 🤔

On #WorldDiabetesDay perhaps we should spend some time thinking about *preventing* type 2 diabetes

Here's a short thread on what I think folk should know about pre-diabetes

References at end

#MedTwitter #tweetorial #LCHF
2/10 Pre-diabetes has many names, often with subtle differences in definition

It's often called:

Impaired glucose tolerence, IGT
Impaired fasting glycaemia
Intermediate hyperglycaemia (preferred by @WHO )
High Risk State of Developing Diabetes (preferred by @AmDiabetesAssn )
3/10 Pre-diabetes is *NOT A DISEASE*

This is really important

It's a *RISK FACTOR* for developing type 2 diabetes

Other risk factors include:

Age >40 (>25 if S Asian)
Family History
Being overweight
People of Asian, African-Caribbean or black African origin, even if born in🇬🇧
4/10 Estimates (see refs) are that 35.3% of adults in 🇬🇧now have pre-diabetes 😲

Similar situation in🇺🇸 where 50% of those >65 have pre-diabetes. That's an estimated 79 million adults in🇺🇸

Projections suggest there will be 472 million people in the 🌍 with pre-diabetes by 2030
5/10 Progression:

5-10% of people with pre-diabetes progress to type 2 diabetes *each year*

@AmDiabetesAssn estimate up to 70% with pre-diabetes will eventually develop type 2 diabetes

👆THIS DOES NOT NEED TO HAPPEN

Some will revert back to normal
6/10 What can be done to prevent progression to type 2 diabetes? There's good evidence that these work:

Dietary change
Exercise
Weight loss (if overweight)
Medications 🤔
7/10 A landmark study from *real world* general practice published in @BMJNutrition offers real #hope

This (my!) #NHS 🇬🇧practice reversed pre-diabetes in *93%* 😲 of those who opted to⬇️ their intake of sugar + starchy carbs aka #LCHF

That's 93%!🎉

nutrition.bmj.com/content/early/…
8/10 Our simple diet sheet on how to⬇️sugar + starchy carbs is here👇

nutrition.bmj.com/content/bmjnph…

Simple infographics from @lowcarbGP on the sugariness of common foods are here 👇

phcuk.org/sugar/

This means that nearly all those with pre-diabetes are able to reverse it👍
9/10 Reversing type 2 diabetes and pre-diabetes can save an absolute fortune

My practice (10k patients) saves the NHS >£50k EACH YEAR by offering our patients #LCHF + lifestyle change

Medicine could be revolutionised if all healthcare providers offered this

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More from @DocRunner1

3 Nov
1/11 I think that the most important piece of research since 2017 about putting #type2diabetes into remission was published today in @BMJNutrition

The results are simply astonishing 😲

A twitter thread.... #MedTwitter #LCHF

Here's the paper👇

nutrition.bmj.com/content/early/…
2/11 The study is by @lowcarbGP @jen_unwin + others and looks at reversing T2DM and pre-diabetes by lifestyle change, in particular by ⬇️sugar and starchy carbs
3/11 The study builds on the work of Prof Roy Taylor's DiRECT Study which found that *severe* calorie restriction could put T2DM into remission👍
More info here 👇
directclinicaltrial.org.uk

This was great news but SO many people find calorie restriction IMPOSSIBLE TO SUSTAIN 🤔🤷‍♂️
Read 11 tweets
30 Jun
1/11 WHAT IS THE BEST DIET FOR HUMANS?

A Twitter thread...

I've spent the last 10 years wondering about this. A TED Talk and paper by @segal_eran (refs at end) has completely blown my mind 🤯
He provides some of the answers - but they may not be what you think

Here goes....
2/11 The incidence of diet-related disease has ⬆️⬆️ in last 30 years

In 🇺🇸 70% of population are overweight, diabetic or have NAFLD (fatty liver)

38% are obese 😲

10% have type 2 diabetes 😲

Diet and lifestyle are the major drivers
3/11 So why don't we know what is the best diet for humans?

It's because we are asking the wrong question

Much of what constitutes the best diet depends on the individual human every bit as much the food

Nutrition needs to be personally tailored to each individual
Read 11 tweets
19 Jun
1/8 Use of defibrillators in the community. Is it worth it?

5 years ago I wasn't so convinced but now I've changed my mind. Here's why

A short Twitter thread....

#MedTwitter #TeamGP @rcgp @k8coleman24 @DrAbdulZubairu @Trisha_the_doc @irishayesha @Mummydoc1 @DrAmirKhanGP Image
2/8 I've been prompted to tweet about this after hearing some wonderful news today. A year ago @DrPaulaPowell1 and I assisted at a cardiac arrest on the beautiful but remote Isle of Lewis. David survived and posted a really moving video on FaceBook
Image
3/8 David's was the 3rd community cardiac arrest I have been involved with in the last 5 years

All 3 people required defibrillation (electric shock) and all 3 were conscious and talking by the time they left the scene 👍
But that's unusual....
Read 8 tweets
25 Apr
1/8 In the midst of a pandemic that predominantly affects people with poor metabolic health, why is nobody talking about nutrition?

A Twitter thread..

This is the ELEPHANT IN THE ROOM discussed in the fab @EuropeScientist article by @DrAseemMalhotra 👍

europeanscientist.com/en/article-of-… elephant in the room
2/8 Evidence (refs at end) tells us some medical conditions are strongly associated with poor outcomes and death ⚠️in #Covid_19 eg:

Hypertension (high BP) 2.5x⬆️
Diabetes 10x⬆️
Overweight/obesity (accounts for 73% of 🇬🇧hospital admissions with #COVID19 )
Heart disease 10x⬆️risk
3/8 What have these conditions got in common?

ANSWER: They're all associated with poor metabolic health

Some people can be TOFI - Thin Outside Fat Inside

It's not just about your weight says @DrAseemMalhotra

"THERE’S NO SUCH THING AS A HEALTHY WEIGHT, ONLY A HEALTHY PERSON"
Read 8 tweets
6 Dec 19
1/16
Ever wondered why doctors and people with type 2 diabetes are getting so excited about low carbohydrate diets? 🤔

73 patients at my surgery have now reversed their type 2 diabetes 🙌

#medthread #tweetorial #medtwitter

Here's a tweetorial of how it's done👇
2/16
As Diabetes Lead GP at my surgery for 25 years I achieved little/no success with @PHE_uk recommended "Eatwell Plate"
One day @lowcarbGP shared some success he had with offering LCHF (low carb, healthy fat) eating to people with type 2 diabetes

Does it work?🤷‍♂️

How? 🤷‍♂️
3/16
Important to understand if there's > 1 teaspoon (5g) sugar/glucose in your blood then insulin PUSHES it into cells where it is deposited as FAT and TRIGLYCERIDE
Read 16 tweets
19 Aug 19
I’ve been “lent” a #cgm (continuous glucose monitor) so I’m fascinated to see what I can learn over the next 2 wks about how my life affects my sugar
I’m NOT diabetic or pre-diabetic and plan to monitor the impact of different foods and activities
@grahamsphillips @Diabetescouk
1st observation is that application of #cgm is painless and adherence to skin is secure
Surprised my ave glucose is 6.3mmol/l
3 x glucose by finger prick finds #cgm over-reads by 0.9-1.5mmol/l (have allowed for 10min delay in #cgm but assumes sticks accurate) 🤔
@DrScottMurray
Effect of exercise: 50min hard interval session running in the pinewoods shoots my glucose up to 9.8 from 5.9 just before I set off. In <1 hour it’s back to 5.9
Conclusion: Exercise puts my sugar up. Surprised at this but @lowcarbGP noticed the same
Read 49 tweets

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