What happens when you reverse type 2 diabetes?

Jack Woodfield
By Jack Woodfield
9th July 2015
In Depth, Opinion
 
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When people with type 2 diabetes reverse their dependency on medication, they effectively reverse their diabetes, but what happens next?

Coming off medication can represent the progression of type 2 diabetes being quelled, but this is not a cure, and a lot of hard work is still required to ensure you do not go back on to medication.

In order to reverse type 2 diabetes in the long-term, it pays to know why it develops. Type 2 occurs when high insulin production over time leads to insulin resistance, which in turn results in raised blood glucose levels.

Blood glucose-lowering medication, such as metformin, may be prescribed, as might insulin for those who have had type 2 diabetes for a long time.

Taking the pressure off insulin-producing beta cells is crucial in reversing type 2 diabetes. According to endocrinologist Dr. David Cavan, this can be achieved through watching what you eat, getting more active and self-monitoring blood glucose levels.

Eating a diabetes-friendly diet is important, especially if you are overweight, as this can improve one’s sensitivity to insulin, which means less insulin needs to be produced.

A low-carbohydrate diet is beneficial, as carb consumption necessitates insulin production. Eating slowly-absorbed carbs will also prevent postprandial hyperglycemia.

Getting more exercise will also improve insulin sensitivity, while cutting down on alcohol will reduce your calorie intake and prevent weight gain around your middle – which can promote insulin resistance.

There are also more extreme methods of reversing type 2 diabetes.

Regular exercise will also improve insulin sensitivity, and therefore reduce the demand placed on beta cells

Regular exercise will improve insulin sensitivity, and require less insulin to be produced

The Newcastle Diet study, which involved eating 600 calories per day for eight weeks, led to seven of 11 participants being free from type 2 diabetes. MRI scans showed the diet led to fat reduction within the pancreas and liver of participants and resulted in significantly improved blood glucose levels.

After three months, the seven subjects had returned to eating normally after receiving advice on eating healthily and portion size. All of them managed to stay off medication.

One of the limitations of the Newcastle Diet, however, was its small size. This is why Diabetes UK are currently funding their largest ever research project into an ultra-low calorie liquid diet, and its potential for sending type 2 into long-term remission.

Another dramatic method of reversing type 2 diabetes is bariatric surgery, which can be done through procedures such as a gastric bypass or gastric banding.

An American trial recently found that obese type 2 diabetes patients had greater remission following weight-loss surgery than those who underwent lifestyle changes alone, but we’ll explore these findings in detail later on.

The literature is increasing regarding the efficacy of bariatric surgery in reversing type 2 diabetes in patients with a BMI over 30. It is an extreme procedure, though, and common complications include nutritional deficiency and fatigue.

While the weight loss can send type 2 diabetes into remission, it is keeping to disciplined dietary improvements that will keep the condition reversed for years after the surgery.

Most weight-loss procedures involve patients keeping to a strict diet before the surgery, and afterwards to ensure long-term remission.

While the weight loss can send type 2 diabetes into remission, it is keeping to disciplined dietary improvements that will keep the condition reversed for years after the surgery.

That, in essence, is the aspect of reversing type 2 diabetes in the long-term.

Whether you use the Newcastle diet, have weight-loss surgery, or commit to lifestyle interventions, a tremendous amount of commitment and hard work is required to not fall back into bad habits.

A 2011 study investigating bariatric surgery found that 83 per cent of gastric bypass patients and 62 per cent of gastric banding patients were off their type 2 medication after two years. However, only 36 per cent maintained normal blood glucose levels without medication after ten years.

That is why the aforementioned study, the one that highlights surgery as being more beneficial than lifestyle changes alone, is misleading.

The University of Pittsburgh researchers used The Diabetes Prevention Program’s description of lifestyle intervention, based around a “diet low in fat” and 150 minutes of exercise per week.

A low-fat diet can lead to weight loss, but it will not have a big impact in reducing blood glucose levels. Carbohydrate is our body’s primary source of energy, and eating a high-carb, low-fat diet in remission from type 2 diabetes will again burden upon insulin production.

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Eating low-carb after remission from type 2 diabetes will prevent insulin production being burdened

In contrast, there is evidence to suggest a low-carb diet can improve weight loss and blood glucose control – the two crucial elements of remaining in remission from type 2 diabetes.

The effiacy of a very-low calorie diet in achieving remission from type 2 diabetes has been shown, while low-carb diets are also effective. A 2014 study led to 15 per cent of participants experiencing remission for a year and maintain this through long-term lifestyle changes – five per cent achieved remission over a six-year period.

Maintaining remission through a low-carb diet seems like a solid plan, but as of yet no research studies have backed this up.

One much-debated aspect of type 2 diabetes management is the self-monitoring of blood glucose levels, where education and commitment are vital in getting the most from testing. Similarly, this level of education and commitment is also required to remain in remission.

Unless you understand how your body is affected by type 2 diabetes, and fully throw yourself into reversing the condition long-term, you could be prescribed medication again if things aren’t going well.

Achieving remission is no mean feat, and involves a number of intrusive lifestyle chances, but your hard work in keeping weight off and keeping blood glucose levels is just as essential upon entering remission.

Many will struggle to accomplish long-term reversal of type 2 diabetes. It is not easy. But it is achievable.

What do you think?