Can Type 2 Diabetes Be Reversed?

"The primary means by which people with type 2 diabetes achieve remission is by losing significant amounts of weight"

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

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8 Responses to Can Type 2 Diabetes Be Reversed?

  1. Keith says:

    Yep, for me diet & exercise seems to do the trick for me.

  2. PI says:

    ” ……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.”

    Are you saying that this is BECAUSE people are slipping into old habits or is this happening regardless? What about people who do NOT slip?? Does the T2 disease still progress?

    • From Nora Saul, Manager of Nutrition Services:
      Dear PI,
      Unfortunately, the natural history of the disease is a slow, progressive decline in beta cell mass over time. However, healthy eating habits and exercise can extend this time frame.

  3. Victoria Mayes says:

    Nice to see this article about remission and would love to see stories about how long some people have been able to maintain remission as we are hopeful for very long term.

    My husband was diagnosed with type 2 just over 5 years ago at age 64. At the time, his fasting blood sugar was 155 and A1c was 6.4. With diet and exercise, his A1c was down to 5.6 and fasting glucose was 103 after 3 months. He has been able to maintain this for five years by maintaining weight at normal BMI (lost 45 lbs total) and keeping CHO consumption at around about 40% of calories along with regular exercise. A1c this week was 5.5.

  4. PI says:

    Nora – I was quite depressed when I read your answer – so I also would like more info from people who have successfully maintained their remission over a very long time. I am a 71yo F who has been low carbing and exercising since diagnosis in early 2010 and has maintained an HbAic of ~5.3. My usual FBG is ~4.7.

    I’m looking forward to seeing replies from people with many many years of remission.

  5. Pingback: News & Views | War On Diabetes

  6. Gary says:

    It may be true that DM can only be halted for a time, or slowed, and that lifestyle changes must be maintained indefinitely to avoid or minimize typical hyperglycemic damage to the body.

    However, whether in cancer, or DM, or any other chronic disease, gaining time is the name of the game. That time means a better quality of life for a longer period of time, and a chance for the smart guys to find a better treatment or even a cure. And make no mistake about it, the pharmaceutical company that finds the cure for DM will become wealthy enough to own the planet. You can bet your blood meter that they are burning aneles at both ends to be the first with a cure. And it seems to be a more more likely possibility than a cure for many other things.

    Hang in there, folks!

  7. This is one of the hot topics for quite a few years. I tried to reverse diabetes myself and let me tell you it’s not easy as it seems. You need to work quite hard to reverse it. I was able to do it within 5 weeks and I don’t know how much time it requires to do for an average patient. The secret to reversing it is to remain focused on using the right diet and exercise routines.

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