According to a report published by the National Library of Medicine, there are approximately 425 million people with type 2 diabetes worldwide, with 30.2 million being from the United States.¹ This depicts the extent of this medical condition in our society.
Fortunately, if you or your loved one is diagnosed with type 2 diabetes, it’s no longer a life sentence like it was before. An increasing number of people manage to completely reverse their high blood glucose levels through life-changing, new treatment strategies.
Before we delve into the details, what is type 2 diabetes, and who is likely to develop this medical condition?
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Every cell in the human body needs energy to function efficiently. Typically, the body obtains this energy by extracting glucose (or sugar) from the energy-rich foods we consume, such as cereals (carbs), or from stored fuel called glycogen, which is found in our liver and muscles.
The glucose is absorbed from the digestive tract, liver, or muscles into the bloodstream. To use this glucose for energy, the body needs a hormone called insulin to transport the glucose inside our cells, where it is metabolized to form energy.
The insulin hormone (along with digestive enzymes) is made and stored in the pancreas, located in the upper abdomen behind the stomach.
In type 2 diabetes, genetic, environmental, and lifestyle factors can result in damage to the pancreas that then decreases insulin levels in the body. These same factors can also prevent insulin from transporting glucose easily into the cells for energy production.
This interference with insulin and glucose transport is referred to as insulin resistance. Both the decreased insulin production by the pancreas and the insulin resistance lead to less glucose being transported into cells for essential energy and higher levels of glucose circulating in the bloodstream.
If left untreated, high levels of blood glucose can cause dysfunction and tissue damage throughout the body. These effects are expressed as different signs and symptoms of type 2 diabetes.
Type 2 diabetes has many signs and symptoms, most of which develop slowly. It can take several years for these to show up.
The following are the main signs and symptoms of type 2 diabetes:
Tingling in the hands or feet
Darkened skin areas around the armpit and neck regions
Genetics and family history play a very strong role in the development of type 2 diabetes. In fact, there’s a stronger link² between family history/lineage and type 2 diabetes than there is between family history and type 1 diabetes.
Environmental and lifestyle factors (such as diet, exercise, stress, pollutants, and climate) also strongly influence the development of type 2 diabetes. Additionally, people above 40 are more likely to develop the disease, although recent studies³ have reported a rise in cases among young people due to the adoption of a more sedentary lifestyle.
Obesity or being overweight
Lack of exercise due to a sedentary lifestyle
The pattern of fat distribution in the body, namely a concentration of fatty tissue around the organs in the abdomen
Ethnic and racial background—Black, Hispanic, Native American, and Asian people are highly susceptible to type 2 diabetes
Currently, there is no prescription drug that can cure type 2 diabetes. However, a state of remission is identified in an increasing number of people, using new approaches to therapy and lifestyle modification. This has led researchers to replace the word “cure” with “remission.”
Remission is a decrease in or disappearance of the signs and symptoms of a medical condition. It’s important to be aware, however, that type 2 diabetes in remission can become symptomatic type 2 diabetes again if the strategies that led to its remission are completely abandoned.
Remission, therefore, is not a cure but a suppression of the underlying medical condition.
The term “reversible” is used in the medical context to denote a return to optimal bodily functioning. It does not mean the absence of ailment or disease.
Therefore, type 2 diabetes is reversible through the process of remission, whereby blood glucose levels can be returned to optimal levels by following appropriate treatment strategies. One widely accepted definition of remission in type 2 diabetes requires that blood glucose levels remain in the normal range once glucose-lowering medications are ceased.
Specialists treating people with type 2 diabetes often recommend that they continue taking some types of protective/preventive medication long-term. This is because the risk of heart disease, stroke, kidney disease, and other medical conditions associated with diabetes remains even after type 2 diabetes is in remission. Lifestyle strategies will also need to continue long-term to ensure lasting remission and other health benefits.
When discussing type 2 diabetes remission and reversal, it’s worth remembering that due to the genetic and familial factors that contribute to the condition, it cannot currently be cured. (However, there is hope that gene and related therapies may allow for a cure in the future.)
Type 2 diabetes remission is the best evidence of its reversal. To date, most cases of type 2 diabetes remission have been achieved after a period of intensive weight loss through lifestyle changes, medication, and/or bariatric (weight loss) surgery.
Lifestyle changes include having healthier eating habits, increasing exercise or activity levels, reducing stress or learning how to manage it well, decreasing alcohol intake, and quitting smoking. Research indicates that smoking changes the natural cues that guide the processing of sugars by the body.
If you have diabetes, smoking can lead to lower insulin levels, greater insulin resistance, increased appetite, and weight gain.
If possible, working with experts in lifestyle modification (either in person or online) can help you improve your type 2 diabetes. It’s always wise to consult a member of your diabetes health care, your doctor, physician assistant, or clinical nurse practitioner before starting any new diet or exercise regimen.
You may wish to consider the following lifestyle changes:
Follow a lower-carbohydrate eating plan or Mediterranean Diet
Eat less sugar and fewer processed foods
Choose complex carbohydrates
Eat more fiber-rich plant foods and healthy fats
Increase soluble fiber intake
Choose healthy sources of protein
Eat smaller portion sizes
Increase aerobic and resistance exercise
Before taking supplements, read the article about vitamins and diabetes
Bariatric surgery refers to surgical procedures that reduce the size of your stomach and the amount you need to eat to feel full. A number of large studies have now demonstrated type 2 diabetes remission following bariatric surgery.
However, the surgery carries with it the risks of general anesthesia and the surgical procedure itself. It requires a significant commitment physically and emotionally. Intensive postoperative follow-up, including nutritional and psychological support, is required to ensure the best possible outcome.
Remission is more likely to occur in people who have had type 2 diabetes for less than five years and who don’t yet take insulin.
Trying to achieve type 2 diabetes remission requires close consultation with your diabetes healthcare team because intensive lifestyle and medication changes require careful monitoring and support.
The health benefits of weight loss, increased physical activity, and improved blood glucose levels are still significant even if type 2 diabetes remission isn’t possible. This is because they reduce the risk for diabetes-related complications (organ damage) and can also lead to a decreased need for some glucose-lowering medications.
For people who are overweight or obese and have type 2 diabetes, substantial weight loss is usually needed to achieve remission. For most people, this means losing around 10% to 15% of body weight through intensive dietary and other lifestyle changes, medication, or bariatric surgery.
It’s not possible to put a timeline on achieving remission because each person with type 2 diabetes will respond differently to the various treatment strategies; for some, remission may not be possible.
Remember that any amount of weight loss will help improve type 2 diabetes for people who are overweight or obese, regardless of whether they achieve remission or not.
Type 2 diabetes is a progressive condition. It means that it can get worse over time if left untreated, if there are other medical conditions or medications making it worse, or if it’s just not possible to make changes to diet, activity levels, or the environment. Some people are also unable to access a diabetes care team or medication.
In these situations, type 2 diabetes can continue to damage the pancreas until it can no longer make enough insulin to meet the body’s needs. Once this happens, prescribed insulin treatment is necessary to prevent very high blood glucose levels and serious illness or even death.
Around 50% of people with type 2 diabetes⁴ will need insulin after 6 to 10 years of being diagnosed with diabetes.
The good news is that if steps are taken early enough to effectively treat type 2 diabetes (through lifestyle changes, medication, and weight loss), insulin therapy may never be needed.
On the other hand, if insulin therapy has already been started and these same changes are made, resulting in significant weight loss, then it may be possible to decrease the dose of insulin or even to stop it altogether.
(Insulin therapy should never be stopped without guidance from an experienced diabetes healthcare practitioner.)
Type 2 diabetes might be a chronic illness, but it is not a life sentence. For some people, the condition can be reversed to the point of remission. It’s also likely that there will be a cure for type 2 diabetes in the future.
In the meantime, a combination of medication and healthy lifestyle practices can help you live your best life when diagnosed with type 2 diabetes.
Myths & facts | Diabetes Australia
Diabetes symptoms | American Diabetes Association
Type 2 diabetes remission (2021)
Smoking and diabetes | Center for Disease Control and Prevention
What is the Mediterranean diet? | Heart Attack and Stroke Syndrome
Carbohydrates and blood sugar | Harvard T.H. Chan
Fiber: The carb that helps you manage diabetes | Center for Disease Control and Prevention
The importance of exercise when you have diabetes | Harvard Health Publishing
Vitamins & diabetes | American Diabetes Association