Ask a Doctor: Is it possible to reverse my diabetes?

From washingtonpost.com

Advice by Dave A. Chokshi, MD, MS

Lifestyle changes and weight-loss surgery can lower weight and lead to reversal of Type 2 diabetes for some people

Q. Can I reverse my diabetes? Can I get off my medications, or will I have to stay on them for my whole life?

A. There is no cure for diabetes, but it is reversible in some cases.

Diabetes mellitus is a condition in which blood sugar levels are too high. Its root cause is a problem with insulin, a hormone produced by the pancreas, which serves as a kind of passport, allowing sugar to travel from blood vessels into our body’s cells.

In Type 1 diabetes, the pancreas produces little to no insulin, while in Type 2 diabetes, the body stops responding to insulin properly. In both types, elevated blood sugar can damage our bodies, leading to heart disease, kidney problems, nerve issues and even blindness.

Weight loss — even 5 to 10 percent — can improve blood sugar levels and lessen the need for medications for Type 2 diabetes. More radical lifestyle changes — overhauling your diet and exercising more — and weight-loss (bariatric) surgery can lower weight and lead to reversal of Type 2 diabetes for some people.

Type 1 diabetes, which is caused by an autoimmune response against part of the pancreas, cannot be reversed — though scientists are working on a cure.

Testing for diabetes

Millions of Americans have diabetes but haven’t yet been diagnosed. A one-minute CDC risk tool can help you determine whether you should seek such testing or you can ask your doctor about testing. Common tests either check your blood sugar directly (blood glucose) or measure an average of your blood sugar level over the past two to three months (haemoglobin A1c).

Testing may show that you have diabetes or prediabetes. Prediabetes means you have higher blood sugar than normal, but not yet high enough for a diabetes diagnosis. You should think of it as the yellow in a traffic light: There is a significant risk of it progressing to diabetes without changes to your lifestyle.

Type 2 diabetes can sometimes be reversed without medications

We know that Type 2 diabetes can be reversed. A study in the United Kingdom, known as the Diabetes Remission Clinical Trial (DiRECT), showed that patients could reduce blood sugar below diabetic levels — with about a third of patients sustaining that control for at least two years, without medication.

Study participants had to be committed; initially, all diabetes drugs were stopped and meals were replaced with a strict 800-calories-a-day diet that was mostly healthy shakes. Then real food was gradually reintroduced, and patients were supported by dietitians, nurses, and tailored workbooks to maintain their weight loss.

If this sounds intense to you — it is. But so is injecting yourself with insulin every day! To me, the most important lesson of the DiRECT trial is how important it is to find a nutritional plan that you can stick with for the long haul.

Anyone who has tried to lose weight knows the toughest part is keeping it off. My advice is to think about what nutritional changes you can sustain over years, not weeks.

A Mediterranean diet has perhaps the strongest long-term scientific evidence supporting its use in Type 2 diabetes. Plant-based and vegetarian diets have also been shown to be effective for the prevention and treatment of Type 2 diabetes. Low-carbohydrate (including “keto”) diets and intermittent fasting have less scientific support but work for some — those options should be discussed with a nutritionist or doctor.

https://www.washingtonpost.com/wellness/2023/04/17/diabetes-reverse-weight-loss/