Article 13: Diabetes Reversal – A wholistic approach

Dr. Suranjana Basak

Consultant Diabetologist, Endocrinologist – Reliance Hospital, Navi Mumbai

We don’t call it diabetes reversal, because this might sound like it’s permanent, and there’s no guarantee that your diabetes has gone forever.

We don’t call it diabetes reversal, because this might sound like it’s permanent, and there’s no guarantee that your diabetes has gone forever.

But yes, it may be possible to put your type 2 diabetes into remission. This is when your blood sugar levels are below the diabetes range and you don’t need to take diabetes medication anymore. This could be life-changing.

The prevalence of diabetes mellitus is increasing in India. According to the International Diabetes Federation 2015, there are around 69.2 million people with diabetes mellitus in India. The age of presentation in Asian Indian diabetics is a decade lesser than that in Caucasians. The prevalence of obesity is also increasing in India, especially in children, leading to an increased prevalence of type 2 diabetes mellitus (type 2 DM). Recently, there is a shift in the age of onset of type 2 DM to a younger age in India.

In 2014, 8.5% of adults aged 18 years and older had diabetes. In 2019, diabetes was the direct cause of 1.5 million deaths and 48% of all deaths due to diabetes occurred before the age of 70 years. Between 2000 and 2016, there was a 5% increase in premature mortality rates (i.e. before the age of 70) from diabetes. In high-income countries the premature mortality rate due to diabetes decreased from 2000 to 2010 but then increased in 2010-2016. In lower-middle-income countries, the premature mortality rate due to diabetes increased across both periods.

By contrast, the probability of dying from any one of the four main noncommunicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases or diabetes) between the ages of 30 and 70 decreased by 18% globally between 2000 and 2016. 

How do you reverse diabetes?

The strongest evidence we have at the moment suggests that type 2 diabetes is mainly put into remission by weight loss. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis. However, we do know of people who have put their diabetes into remission 25 years after diagnosis. 

If you have obesity, your diabetes is more likely to go into remission if you lose a substantial amount of weight – 15kg – as quickly and safely as possible following diagnosis.

It’s important to know that not everyone who loses this much weight will be able to put their diabetes into remission. But losing 15kg comes with a lot of health benefits, even if you don’t lead to  remission. Research shows that getting support to lose just 5% of your body weight can have huge benefits for your health. Losing extra weight can lead to:

•    fewer medications
•    better blood sugar levels
•    a lower risk of complications.

How can you put diabetes into remission?

The strongest evidence we have suggests that diabetes is mainly put into remission by weight loss

If you have obesity, you are more likely to put your diabetes into remission if you lose a substantial amount of weight – 15kg (or 2 stone 5lbs) – as quickly and safely as possible following your diagnosis. 

If you do want to start losing weight quickly to work towards remission, it’s important to talk to a healthcare professional before you begin, to make sure it’s right for you. Also, you may need to reduce or stop any medications – insulin or sulphonylurea, for example – before you begin losing weight. 

Rapid weight loss is not advised if you are a healthy weight, under 18, pregnant, breastfeeding or have ever been diagnosed with an eating disorder.

How can losing weight help put your diabetes into remission?

To understand how losing weight can help someone go into remission, we need to understand why having obesity can lead to type 2 diabetes. 

If someone’s carrying extra weight around their middle, fat can build up around important organs like the liver and pancreas. This makes it more difficult for those organs to work properly, leading to type 2 diabetes.

But not everyone who develops type 2 diabetes has obesity. There are other factors, like age, ethnicity and family history that play a role in our risk of type 2 too. These factors influence how well the liver and pancreas work, and also where we store our fat.

We can’t change those things, but we can usually change our weight. 

Our scientists believe that just as storing fat around the liver and pancreas affects how type 2 develops, losing fat affects remission.

Can anyone with type 2 diabetes go into remission? There’s lots we’re still trying to understand. For example, we don’t know how or whether every person with type 2 diabetes can go into remission. 

Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis. But, we know some people have put their diabetes into remission 25 years after being diagnosed.

We are funding further research to try and find ways for more people to go into remission. For example, the ReTUNE study is looking at how people who don’t have obesity can put their diabetes into remission. 

How can I get started?

So far, there is strong research evidence for two approaches that can lead to remission. Both involve losing a significant amount of weight fairly rapidly. One is to follow an intensive, low-calorie weight-loss programme of around 850 calories a day. The other approach is weight-loss or bariatric surgery, which helps you to feel full quicker and so helps you to reduce the amount you eat.

But while these are the approaches with the best quality research to put your type 2 diabetes into remission, there are other, more gradual approaches. We know that some people in remission got there by losing weight through the Mediterranean diet or a low-carb diet. Everyone’s different and what works for some may not for others. 

You should  ask your diabetes team for help with weight loss.They’ll be able to see if there’s a weight management service in your area, where you’ll get support and advice from a dietitian. Whichever approach you consider, it’s important to seek support from your healthcare team.

Weight loss surgery for diabetes remission

Diets aren’t the only way people with type 2 diabetes have gone into remission – some have had bariatric or weight-loss surgery. One study found that almost a third (30.4%) of people who had surgery were in remission after 15 years. Surgery is no quick fix, but it should be an option for those who want it.

Weight loss planner

This will enable you to set goals and track your progress. By putting a plan in place and noting down your progress, you’ll be able to see the positive changes you’re making. Start with eating a nutritious, healthy diet incorporating low calorie foods. Even if you’re committed to healthy eating, it’s important to choose your carbohydrates carefully. You’ll also want to eat fewer of certain carbs to help reverse prediabetes.

For the most part, you want to eat complex carbohydrates, which are unprocessed carbs. These include:

  • vegetables
  • whole grains
  • beans

These carbs are rich in fiber and keep you full longer. They also take longer to break down, so they absorb into your body at a slower rate. This helps prevent blood sugar spikes.

Avoid or limit simple carbohydrates, which absorb quickly and cause an immediate spike in blood sugar. Simple carbohydrates include:

  • candy
  • yogurt
  • honey
  • juices
  • certain fruits

Refined carbohydrates are also fast-acting and should be limited or avoided. These include:

  • white rice
  • white bread
  • pizza dough
  • breakfast cereals
  • pastries
  • pasta

Exercise regularly

It is not only great for energy and mental health, it can also lower your blood sugar by increasing insulin sensitivity. This allows the cells in your body to use insulin more efficiently.Ideally, you’ll want to have 30 to 60 minutes of moderate physical activity at least 5 days a week. Exercises can include:

  • walking
  • biking
  • jogging
  • swimming
  • aerobics
  • playing sports

Drink more water

Drinking water is another excellent way to help reverse prediabetes and prevent type 2 diabetes. Water helps control blood glucose levels, and it’s also a healthy substitute for sodas and fruit juices. Those beverages are typically high in sugar.

Treat sleep apnea

Keep in mind, too, that sleep apnea has been associated with insulin resistance. With this condition, breathing stops repeatedly throughout the night due to relaxation of the throat muscles.

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