If you have prediabetes or type 2 diabetes, will diet, weight loss, and exercise give you a clean bill of health?
A lot of people ask me if they can reverse diabetes or prediabetes. For some, the answer will be yes. But not for everyone. It’s more complicated than a simple yes or no across the board. I know. I know. We all want a simple answer, but the human body just isn’t simple. And diabetes just isn’t simple. And what makes it even harder is that I can’t say who will experience a reversal and who won’t. I do know some things about who’s the most likely person to reverse diabetes or prediabetes though. More on that in a bit.
And to be clear, I’m talking about type 2 diabetes here, not type 1. Type 1 diabetes is an autoimmune disorder, and people with type 1 diabetes require insulin by injection or pump to live.
To me, reversing diabetes or dialing back prediabetes means to have a long-lasting metabolic improvement without additional medications. Since type 2 diabetes and prediabetes are characterized by insulin resistance, people with diabetes or prediabetes often have high blood pressure, abnormal cholesterol and triglyceride levels, nonalcoholic fatty liver disease and other health problems, along with high blood sugar levels.
Why is Reversing Diabetes So Complicated?
We have good evidence that diet, weight management and physical activity improve all of these health concerns. But even with excellent health habits and weight loss, lots of people with prediabetes will move on to full blown diabetes. And lots of people with type 2 diabetes will still require medications for blood sugar management, blood pressure control and more.
You might reverse diabetes, but it’s not a cure
Even if you are able to get your blood sugar level in the normal range for months or years, there’s no guarantee that lifestyle changes will keep them there indefinitely without medications. Type 2 diabetes tends to progress over time – and this isn’t the fault of the person with diabetes! Diabetes progresses because the beta-cells of the pancreas – the cells that make your body’s insulin – continue to fail. We can reverse diabetes. We can put it into remission. But we don’t have a cure for diabetes.
How diabetes progresses
Before you were diagnosed with type 2 diabetes, you probably had blood sugar levels in the prediabetes range for a few years. This is true even if you weren’t diagnosed with prediabetes. Both prediabetes and type 2 diabetes are characterized by a combination of insulin resistance and loss of insulin-making ability. It’s a double whammy with some of the body’s cells stubbornly refusing to use insulin properly and the beta-cells of the pancreas unable to produce enough insulin to make up for this resistance.
The longer you’ve had diabetes, the more likely you’ll need medications because of loss of insulin-producing capacity.
I congratulate my patients with type 2 diabetes when they’re able to dial back insulin resistance enough to no longer require medications. Same for those who are able to reverse prediabetes adequately to bring numbers to the healthy level. But again, this isn’t a cure, and that’s because of loss of beta-cell function (your body’s ability to produce insulin).
Find out the Best Prediabetes Diet.
Take action today
The best day for a reversal is today! The longer you’ve had insulin resistance, the more beta-cell function you’ve probably lost. In other words, everyday the window of opportunity to reverse diabetes or prediabetes – and even to delay their progression – closes another little bit. Even if you change your lifestyle enough and even if you lose enough weight to reverse insulin resistance, you might not have enough insulin producing capacity to maintain normal blood sugar levels without the assistance of medications. And if you do, you might not always. That’s why I always insist that a reversal isn’t a cure.
A diabetes remission is to achieve normal blood sugar levels without medications for at least 1 year. A prolonged diabetes remission is to experience the same normal blood sugar levels for 5 years. A remission or a reversal of any type usually requires some weight loss. Some people experience a diabetes remission through intensive lifestyle therapy. More often, we see remissions following weight loss surgery. But even after dropping huge amounts of weight, it’s not uncommon to see the loss of diabetes remission over time. Many people will stay in remission for a year or two, but not longer. Even those who stay in remission for 5 years are at risk of losing it.
Predictors of diabetes remission
In general, losing more weight, having had diabetes for a short time, and being in better blood sugar control are predictors of diabetes remission. This is what I meant above when I talked about that window of opportunity. The longer you’ve had diabetes, the harder it is to see a lasting reversal because of the loss of beta-cell function.
- Take action early when your blood sugar control is better and while you have more beta-cell function
- Lose weight if necessary
- Lose as much as reasonably possible
Any weight loss is good
If you have overweight or obesity, losing any amount of weight is good. Dropping a few pounds can have profound benefit. In a fascinating study among people at high risk for developing type 2 diabetes, losing only 5% of body weight (10 pounds for someone starting at 200 pounds) improved insulin sensitivity in the fat, muscle and liver cells. This small weight loss also improved the function of the pancreas’s beta-cells and reduced the amount of fat in the liver. As weight loss continued first to 11% and then to 16% of starting weight, the participants experienced greater improvements. Their muscle cells became even more sensitive to insulin; they lost more fat from their livers; and the function of their beta-cells improved even more. Now that’s what I call pretty darn awesome!