Type 2 diabetes (which used to be called adult-onset or non-insulin-dependent diabetes) can be a life-long, chronic disease in which the body either does not produce enough insulin or the cells don’t respond to the insulin correctly. Because of these two problems, there isn’t enough insulin to move the glucose from the blood into the cells. When glucose builds up in the blood instead of going into cells, the body’s cells can’t function properly.
Type 2 diabetes is more likely to occur in people who are over the age of 40, overweight, or have a family history in diabetes. However, more and more younger people, including adolescents, are developing type 2 diabetes.
According to recent research, type 2 diabetes cannot be cured, but it can go into remission or at least partial remission. Remission means that the symptoms of the disease abate for a period of time. The primary means by which people with type 2 diabetes achieve remission is by losing significant amounts of weight.
We talk of remission and not a cure because it isn’t permanent. The beta cells have been damaged and the underlying genetic factors contributing to the person’s susceptibility to diabetes remain intact. Over time the disease process reasserts itself and continued destruction of the beta cells ensues. An environmental insult such as weight gain can bring back the symptomatic glucose intolerance.
Donna Younger, MD Joslin clinic physician says that this is a complicated topic. “Obese individuals with type 2 diabetes are usually very insulin resistant. When they lose weight their bodies often have sufficient insulin available to maintain blood glucose in the normal range if they continue to follow a healthy diet and exercise regularly. There are some people who can deviate from dietary modifications and continue to achieve euglycemia, but this is much rarer.”
Patients may also go into remission when prior to treatment they were glucose toxic. Glucose toxicity can temporarily shut down insulin production from the beta cell. When this is relieved the beta cells begin to function again. This is seen in patients who have had untreated diabetes for a long time and whose A1C are severely elevated. They may require insulin for a short period of time and then can often revert to pills or lifestyle control.
Although remission can be achieved by standard medical means of lifestyle manipulation, many remissions are a consequence of gastric bypass surgery. These patients often experience complete, albeit temporary, (it can be for years) reversal of hyperglycemia. It is the change in hormonal milieu driven by the surgery that leads to improved glucose metabolism even before significant weight loss occurs.
However, having a gastric bypass is a drastic step to take and should only be considered by those whose BMI and medical complications put them at risk for serious health complications.
For most people behavior modification (initially with or without medications) can help bring type 2 diabetes into excellent control.
Excess weight increases insulin resistance, so by shedding just 7 to 10 percent of your bodyweight, your cells will be better able to respond to the insulin your body makes.
The key to losing weight is finding a meal plan and a workout regimen that will best suite you and your lifestyle. The best meal plan is one that will teach you to make healthy food choices and control food portions that you can follow for a lifetime. Don’t worry -a meal plan isn’t a strict diet where you can no longer eat and enjoy your favorite foods-it’s all about giving you guidance to shape your eating pattern.
Through these significant lifestyle changes you could be well on your way to controlling your diabetes. But this is certainly not the case for everyone with type 2 diabetes. Over time your blood glucose levels could start to increase even if you’re following your healthy meal plan and staying active—this is just part of the disease progression.
Don’t get discouraged, it is common for people to slip back into their old habits. Talking to a registered dietitian or diabetes educator, or even signing up for a refresher course on diabetes—like Joslin’s DO IT program—, can help you get motivated again.
If you have any questions about your diet, a registered dietitian is a good source of information. Make an appointment with one of Joslin’s certified diabetes educator dietitians by calling (617) 732-2440, or learn more by visiting http://www.joslin.org/care/nutrition_programs.html