Is type 2 diabetes reversible? This is a complicated and debated topic because so much of type 2 diabetes is still very much a mystery. And what’s actually going on inside the body of a person with type 2 diabetes isn’t exactly the same from patient to patient.
And the word “reversed” implies a “cure” whereas many would consider it simply a method of managing their blood sugars.
While diet and body weight play a role in insulin resistance, the most recent research continues to prove that the cause of type 2 diabetes is far more complex.
In this article we’ll look at the potential of getting “off your meds,” and the crucial differences between insulin deficiency and insulin resistance. And of course, what steps you can take to improve your own blood sugar levels.
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What does “reversing” diabetes mean?
Does losing weight and improving your sensitivity to insulin “reverse” your diabetes? Or have you simply taken steps to manage it in a way that — for some — led to no longer needing diabetes medications to achieve healthy blood sugar levels?
In a great deal of diabetes research, diabetes “remission” is actually defined as blood sugar levels being at “pre-diabetic” levels rather than non-diabetic levels.
The fact is that type 2 diabetes is a progressive disease for many — versus simply an issue of insulin resistance. The word “progressive” implies the ongoing dysfunction and destruction of beta-cells which play a critical role in the production of insulin.
For patients with beta-cell dysfunction in addition to insulin resistance, the ability to “reverse” diabetes and get off of your meds may not always be possible.
“I want to get off my diabetes meds.”
Can diet, exercise, and weight-loss help a person with type 2 diabetes get off their medications?
The short answer is yes…sort of — but not necessarily for everyone. According to a 2016 study published in Diabetes Care, approximately 40 percent of people with type 2 diabetes can reverse their condition through drastic changes in diet, exercise, and body weight.
Regardless, this leaves 60 percent of the type 2 population that cannot reverse diabetes through diet, exercise, and weight-loss alone because their body is struggling more so with “beta-cell dysfunction” rather than the more commonly known issue of “insulin resistance” which is usually associated with being overweight.
“Clients with type 2 diabetes always ask: can I get off my diabetes meds?” explains diabetes coach and owner of Diabetes Strong, Christel Oerum. “The truth is that some people will be able to, and others won’t.”
Trying to determine who can and who can’t is determined largely by trying.
“You won’t know until you try because there’s no way to test each patient and pinpoint the exact cause of their diabetes,” adds Oerum, who also lives with type 1 diabetes. “Is it a genetically inherited insulin deficiency or is it insulin resistance from weight-gain, inactivity, and an unhealthy diet?”
The answer isn’t as simple as mainstream media has led us to believe.
Let’s take a closer look at the difference between the two these causes of type 2 diabetes.
Understanding insulin deficiency vs. insulin resistance
Insulin deficiency or “beta-cell dysfunction” indicates that the pancreas isn’t producing normal amounts of insulin.
Insulin resistance indicates that the patient’s body isn’t responding normally to the insulin that’s being produced, and it takes more insulin to keep blood sugar levels in a healthy range.
So, which one is the driving factor behind your own type 2 diabetes?
“It is now well recognized that 2 factors are involved: impaired [beta-cell] function and insulin resistance,” explains John E. Gerich, MD, in a study published by the Mayo Clinic Proceedings. “Prospective studies of high-risk populations have shown insulin-resistance and/or insulin-secretory defects before the onset of impaired glucose tolerance.”
While testing for impaired beta-cell function is not possible for the general population at this time, the end result of insulin deficiency or insulin resistance is the same: high blood sugar levels.
“Most of the available evidence favors the view that type 2 diabetes is a heterogeneous disorder in which the major genetic factor is impaired beta-cell function and insulin resistance is the major acquired factor,” explains Gerich.
“Superimposition of insulin resistance on a beta-cell that cannot appropriately compensate leads to deterioration in glucose tolerance. Therefore, clinicians managing type 2 diabetes must reduce insulin resistance and augment and/or replace beta-cell function.”
This means: it’s critical that doctors also focus on reducing insulin resistance — rather than just reducing blood sugar levels — for long-term diabetes management success.
The effort to “reverse” your own type 2 diabetes by improving your sensitivity to insulin through weight-loss, becoming more active, and eating a diet that is lower in processed foods and higher in whole foods and fewer carbs will likely benefit anyone.
However, reversing your diabetes to the point of no longer needing diabetes medications to sustain non-diabetic blood sugar levels isn’t a guarantee if the overall insulin deficiency isn’t something that can be repaired.
Let’s look first at the lesser-known issue of insulin deficiency, or “beta-cell dysfunction.”
“Insulin deficiency” or “beta-cell dysfunction”
There are several names for it, but what they all mean is that while the beta-cells are still intact, they are not producing normal amounts of insulin.
People with type 2 diabetes are often shamed for causing it themselves through weight-gain and poor nutrition choices, but the facts point to an inherited gene that causes dysfunctional insulin production.
The debate over whether type 2 diabetes results from insulin resistance or “loss of beta-cell function” (lack of insulin) is becoming more clear, explains authors A. August and S. Beale in the article, “Deteriorating beta‐cell function in type 2 diabetes: a long‐term model” in the QJM: An International Journal of Medicine.
“There is consensus on the primary role of secretory dysfunction from the time that hyperglycemia is established. Several trials have now chronicled continuing loss of effective beta‐cell function as the key determinant of deteriorating glycaemic control and progressive failure of all types of therapy.”
This means: it’s clear that insulin resistance is not actually the primary contributor to the diagnosis of type 2 diabetes, but instead an impairment in the body’s ability to produce normal amounts of insulin.
What weight-loss surgery reveals about insulin deficiency
Gastric bypass — or weight-loss surgery — for example, is becoming a more common treatment method for those with obesity and type 2 diabetes. While it does lead to dramatic weight-loss over the course of weeks and months, it also leads to an immediate normalization of blood sugar levels for many.
This normalization of blood sugar levels isn’t the result of weight-loss and insulin sensitivity because it happens dramatically and often within the first week after surgery.
It is well established that by resurfacing the lining of the small intestines during gastric bypass surgery, the patient’s insulin production almost immediately increases, too, as explained in recent studies published in Diabetes Care.
The lining of the small intestines plays a major role in the production of insulin. When food is digested in the stomach, it then travels to the small intestine. The glucose produced from the digested food is then absorbed into the bloodstream.
This entire process is what tells the pancreas to produce more insulin to transport that glucose throughout the body and regulate blood sugar levels.
Dr. George Grunberger, FACP, FACE, the founder of the Grunberger Diabetes Institute in Michigan, told Healthline News that he’s been trying to convince the Food and Drug Administration to acknowledge the safety and efficacy of other procedures involving the lining of the small intestines being researched in other countries.
“These types of procedures have proven to improve glucose tolerance virtually immediately,” Grunberger said. “This means it isn’t the result of calorie restriction or weight loss, but in merely interrupting that normal interaction with the mucosal lining.”
The benefits to patients with type 2 diabetes are tremendous.
“If you catch people early in the game of diabetes,” said Grunberger, “you can put diabetes into remission by renewing or blocking the interaction with the lining of the small intestines, but for how long? We don’t know yet.”
In his own practice, Grunberger said he sees an “80 to 95 percent success rate in achieving diabetic remission” after patients undergo gastric bypass or gastric sleeve procedures.
Regarding the patients who regain their lost weight, Grunberger said they indeed develop type 2 diabetes again, too.
Insulin resistance: genetically inherited, self-induced through poor habits, or the result of insulin deficiency?
“The studies of high-risk populations imply that insulin resistance, like type 2 diabetes itself, has a genetic component and that heritable differences in insulin sensitivity may be one element of a ‘susceptibility genotype’ predisposing members of high-risk populations to type 2 diabetes,” explains Gerich in the Mayo Clinic Proceedings.
This means: certain genes can dramatically increase your risk of developing type 2 diabetes.
Does it mean you’re doomed? Not necessarily — but it does mean a patient with a genetic disposition towards developing type 2 diabetes could strive to deter their inheritance by making healthy lifestyle choices to prevent the further development of insulin resistance.
Gerich’s research also concluded that it’s still unclear whether a genetic predisposition towards developing insulin resistance depended largely on the patient gaining weight — or if that insulin resistance would be present without weight-gain.
Which of course leads to the confusing issue of which came first: the insulin resistance or the weight gain?
Gerich later adds, “To date, no genetic defect has been found in patients with typical type 2 diabetes that might cause their diabetes to be due solely to insulin resistance.”
This means: that patients with a genetic likelihood of becoming insulin resistant have shown to have other genetic markers for developing type 2 diabetes, too.
More recent research continues to support the evidence that insulin resistance is not the primary factor at play, even in patients who are obese.
“Type 2 diabetes mellitus is a multifactorial disease…due to reduced both insulin secretion and insulin sensitivity,” reports a 2008 study, Abnormalities in insulin secretion in type 2 diabetes mellitus.
“The interplay between insulin secretory defect and insulin resistance is now better understood,” explains the study.
Which comes first: diabetes or weight-gain?
An additional explanation to support the idea that type 2 diabetes is not simply the result of weight-gain is that a significant number of overweight and obese people do not ever develop type 2 diabetes. This indicates an additional factor is at play.
Much like “the chicken or the egg” debate, the weight-gain some patients experience leading up to their type 2 diabetes diagnosis may actually be the result of inadequate insulin production rather than lifestyle-induced insulin resistance.
And further: thin people can develop type 2 diabetes, too.
“Unfortunately, many people think that weight is the only risk factor for type 2 diabetes,” explains the American Diabetes Association, “but many people with type 2 diabetes are at a normal weight or only moderately overweight.”
In 2015, 9.4 percent of the United States adult population had type 2 diabetes, according to the Centers for Disease Control & Prevention (CDC).
Meanwhile, approximately 40 percent of the US adult population is overweight or obese.
If being overweight alone was the cause of type 2 diabetes, the rates would presumably be startling higher.
In conclusion: is type 2 diabetes reversible?
Sort of. In the end, it really comes down to two things:
- Your personal opinion of what “reversed” vs. “managed” means.
- Whether or not your body is struggling with insulin production rather than insulin resistance.
What can you do to potentially reduce your need for diabetes medications?
When it comes to insulin resistance, it doesn’t matter whether your diabetes is primarily the result of insulin dysfunction or insulin resistance.
Either way, anyone will benefit from creating healthier habits — if your habits aren’t already quite healthy!
Insulin resistance affects everyone — even those without diabetes. Making an effort to improve your own sensitivity to insulin is always worthwhile. And the simplest things you can do to improve your sensitivity to insulin are also the most straight-forward.
Improve your diet
Whether you have diabetes or not, we all live in a world filled with processed junk at every corner! Striving to eat more real food — which means food that doesn’t contain a long list of ingredients but is instead described in one word, like apples, broccoli, chicken, eggs — and so on.
Forget about fad diets and cutting out all the carbs or trying to reach ketosis or any other restrictive set of rules, and just start by trying to eat more real food, cook more of your meals at home, and increase the number of times per day that you’re eating vegetables. It sounds over-simplified, but it’s really not: choose real food. Make processed indulgences a smaller percentage of what you eat in a day or a week.
Get moving — that includes simply walking!
You don’t have to join CrossFit to get the benefits of exercise. Walking for 30 minutes after lunch can have an incredible impact on anyone’s health. Did you know walking actually burns more body-fat that running?
Forget the pressure to be the perfect Gym Rat or the idea that the only worthwhile exercise is jogging. Just start by going for a walk every day for 15 to 30 minutes. You might even find that you feel really good after that walk, leaving you looking forward to your next one.
Don’t get obsessed with the scale
The scale can be misleading and seeing the same number two weeks in a row can leave you feeling like everything you’re doing isn’t helping. Start by focusing on your habits, not the number on the scale. Step on the scale after one month of new habits. If the number hasn’t budged at all, consider making further changes or working with a coach. Focus on good habits. Good habits will lead to results, but sometimes that takes longer than we’d like!
It’s never too late to start evolving your relationship with food and your understanding of your own health. If you’re living with any type of diabetes, making your overall health a priority will inevitably improve your blood sugars, too.
For more information on improving your health, consider reading these guides on Diabetes Strong:
- The complete guide to lowering your A1c (average blood sugar)
- The complete guide to losing weight when you live with diabetes
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