You’d think that once you have a diagnosis, it’s for life - right? Type 2 Diabetes has long been perceived as a chronic, incurable and progressive condition, but could this paradigm be changing? Is the best outcome just to slow down its progression, or could it be possible to stop, and even reverse it?
Some shocking facts:
- There are approximately
425 million people living with diabetes worldwide, and this is rising.
- About 50% of people living with diabetes don’t know they have it.
- It costs the NHS least
£10 billion a year. Thats 10% of of the total annual healthcare budget. Almost 80% is used on treating complications.
Let's start with the basics
Diabetes is a disease where there is too much sugar (glucose) in your blood due to a problem with the production of, or response to a hormone called insulin. There are 2 main types - type 1 and type 2, and both can lead to serious health complications. Other types include gestational diabetes and drug-induced diabetes, but that deserves a textbook in itself - so we won’t go into this here.
Type 1
An autoimmune condition where your body attacks and destroys the insulin producing cells in your pancreas. People with Type 1 diabetes cannot produce any insulin, and will therefore need lifelong insulin therapy.
Type 2
In type 2 diabetes, your body still can produce insulin, but not enough of it. In addition, your cells do not respond to insulin as effectively - this is what we call insulin resistance. The pancreas tries to increase production of insulin to cope with the high sugar levels in your blood, but eventually, it can’t keep up as well. Imagine running on a treadmill that gets steeper and steeper until you’re basically vertical.
What does it mean to go into “remission”? Is it the same as “reversal”?
Now, if I’m being pedantic about terminology, using the word “reverse” is not ideal as it is still possible to go back into having diabetes after periods of remission. Saying it has been reversed also makes people stop going for regular diabetes checks - not good. Many people can, and have put their diabetes into remission though, and here we look at what exactly that means.Remission is when your long term sugar levels (HbA1c) fall below a diagnostic level for over 3 months, without the need for any glucose-lowering medication.The formal
diagnostic criterion (the definition physicians use!) for “remission” is a hemoglobin A1C (HbA1c) test of below 6.5% for at least 3 months after stopping glucose-lowering medication
HbA1c sounds complex, but it is essentially an average measure of your blood glucose levels over the last 3 months, as opposed to the finger prick tests or the continuous glucose monitors people where on their arms, which measure your blood glucose levels at that exact point of time. It is a better long term measure of glucose levels in your blood.So we have a reasonable amount of anecdotal evidence of people with type 2 diabetes going into remission, proving it can indeed be possible - but how can you do it, and how does it work?
How does Diabetes remission work?
One large contributing factor to diabetes is a build up of fat around your liver and pancreas - 2 very important organs for regulating sugar levels. Your pancreas makes insulin, a hormone that lowers sugar levels, whilst your liver helps store and release sugar when your body needs it. A build up of fat inside them starts to impair their ability to do their job (imagine trying to run a marathon in a sumo suit). Losing weight, and by default losing fat, can help them get back to doing their job better. For some people, this means no longer needing to take their blood sugar lowering medications.It’s difficult to know how much fat you have stored inside your liver and pancreas, as even people who don’t look overweight or have a lot of subcutaneous fat, can be storing large amounts of visceral fat. Regardless of your external appearance, we all have different levels of fat we can store before it starts affecting organ function. But the best way to reduce excess fat is to lose weight.
The answer to the big question about remission and reversal is…it depends. Whether diabetes is reversible depends on firstly, what type of diabetes you have, how far this has progressed and if you have developed any complications.Remission can be possible for many people with Type 2 diabetes, and the best evidence we have today suggests it is mainly done through weight loss. The caveat though is that not everyone who loses weight can lower their sugar levels enough to go into remission without the need for medication. But for a large number of people, it is still indeed possible.Reversal, implying a degree of permanency, would then boil down to motivation on making those lifestyle changes or adhering to a medical regime to complement those changes.In the next article, I’ll be looking into some practical, evidence-based steps on how to set diabetes into remission. Stay tuned.
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