It is the burning question most, if not all, people with diabetes type 2 have: can my diabetes be reversed?
There is so much information, thousands of articles, home remedies that promise readers the ultimate chance to reverse their diabetes. It sounds too good to be true.
However, as with all things on the net and with our health, we must be wary of what we read and what is fed to us as information. Most articles recommend healthy eating and exercising as a way of reversing your diabetes.
These are two lifestyle changes that are easy to do if you put your mind into it. Does it work though? If it does, how can you go about doing this or where should you start? We reached out to 28 experts in the field who spilled the beans to us about the reversal of diabetes type 2 and whether it is a myth or a reality. To find out more, please keep reading.
1. Cheryl Orlansky RDN LD CDE
Diabetes is a progressive disease however it CAN be reversed. Bariatric surgery results have proven that losing weight in morbidly obese patients with Type 2 Diabetes reverses the disease state. Bariatric surgery outcomes have been studied over 10 years with lower rates of mortality and morbidity. Bypass surgery patients normalize blood sugars within days of the procedure.
Other factors may play a role in this disease reversal such as; less food intake, hormonal system changes such as the incretin system, possible malabsorption of nutrients and others are being researched besides weight loss. Diabetes Care; May 2017, 40(5)
Many patients with Type 2 diabetes can manage their disease with lifestyle factors very well without medication and are very well controlled. Patients with Type 1 diabetes will always have Type 1 and will always need a sufficient supply of exogenous insulin. At this time, there is no cure for diabetes.
In patients with Type 2 diabetes that are not morbidly obese and do not undergo bariatric surgery; the disease won't be reversed. In fact, as the disease progresses, the pancreas releases less insulin over the years and the cells of the pancreas do not regenerate. Therefore, the disease is managed differently over time.
2. Janet Howard-Ducsay RN BA/BSN CDE
In discussing self management with the person with diabetes I focus on how healthy lifestyle behaviors can change the treatment plan. Introducing healthy lifestyle behaviors by providing consistent and predictable meals, daily activity, healthy coping and consistent medication management can improve overall glucose control and may change the overall treatment plan for managing diabetes.
I review with the patient that management does not reproduce insulin making beta cells but may reduce the rapid speed in which they are utilized. I review that activity may improve the manner in which insulin is utilized.
I encourage predictable meal planning and healthy coping of their overall stress as a manner in which to reduce excessive glucose production. All of these physiologic changes are what Type 2 diabetes is.
These lifestyle behaviors are not a cure but an optimal way to manage and possibly improve and ease the overall treatment plan for the person with Type 2 diabetes.
We recommend reading the following articles for more infomration on diabetes:
3. Molly McElwee-Malloy, RN, CDE
There has been a good amount of attention and time spent on discussing the “reversal” of diabetes, but there's not been a lot of good facts to explain what this means. First, type 1 diabetes (an autoimmune disease) cannot be reversed, cured or avoided – period. It can be managed with insulin and made easier with good lifestyle choices like staying active and eating a healthy diet.
Pre-diabetes and type 2 diabetes can be made easier to control through medication, smart lifestyle choices including exercise and diet. They cannot, however, be cured. The idea of “reversing” a disease is attractive because it makes us think we can get something and then “fix” it.
Once a person enters pre-diabetes where their hemoglobin HbA1c starts rising above 5.7% they have entered the disease process. The patient – if made aware that they have pre-diabetes and has access to educational support – has the opportunity to prevent the pre-diabetes from developing into type 2 diabetes.
They will always have the pre-diabetes diagnosis and have the potential to develop type 2 diabetes if aggressive dietary, exercise and or medication is not followed. It is possible to achieve a normal non-diabetic HbA1c after this – virtually not having any clinical evidence of the pre-diabetes, however the disease process is still there and being held at bay.
If the person stops the interventions or is predisposed to having diabetes due to risk factors out of their control, they can and will develop type 2 diabetes. It's worth noting that there are genetic and other non-adjustable risk factors (ethnicity for example) that contribute to the development of type 2 diabetes.
It is also worth noting and all of this advice can be followed and a person can still develop type 2 diabetes. Following strict guidelines and taking medications is not a 100% promise that type 2 diabetes will be prevented.
A patient diagnosed with type 2 diabetes (HbA1c of 6.5% or above) will always have type 2 diabetes. Interventions such as medication (including insulin), staying active and making good diet choices must be maintained to prevent the disease from progressing further. However, even if the patient undergoes strict medication, diet and exercise adherence and manages to lower the HbA1c they will still have type 2 diabetes.
The idea of “reversing” is describing the well managed type 2 diabetes that can be maintained without the outcome of complications (eye disease, kidney disease, etc.). And it is totally possible to have type 2 (or type 1 diabetes for that matter) and have no complications – however, this takes careful management and is largely driven by the patient and their access to quality healthcare.
So, can you “reverse” diabetes? No – but you can manage it very well with the help of a Certified Diabetes Educator (CDE) and a knowledgeable primary care physician or endocrinologist. There are even prescription apps available to bridge the care that your clinicians can give you between visits and apps that offer virtual CDE's for greater assistance.
There are a lot of choices and support for managing diabetes well and I encourage all persons with diabetes to make sure they have all the support and education they need to live the best life with diabetes they can. After 18 years of type 1 diabetes and no complications, I can promise you the hard work is worth it.
4. Madelene Richert, RN, CDE, CPT
I do not know of any way of reversing Type 2 Diabetes without surgical intervention. To clarify, become non-diabetic.
Type 2 Diabetes is controllable and the two best ways to do this is by eating real food and exercising. Food has become the celebratory enemy. Weekends are not holidays but just days off work.
Exercise is a privilege that many people are unable to do and you want to do it while you are still able to.
Keeping a food journal continues to be one of the best weight loss plans. One of the most common statements I hear from patients is , “I really just don't eat”. If that were true, you would lose weight. It takes 9 calories to sustain a pound of weight. So what you weight times nine is how many calories you are eating.
Please remember, diabetes is controllable. You can do it! Visit with a CDE and learn how you can control it!
5. Maureen Boccella, R.D., L.D.N., M.S., C.D.E.
Type 2 diabetes is on the rise and is associated with insulin resistance. There are many factors which contribute to developing this disease some of which are modifiable and some of which are nonmodifiable. Modifiable risks which individuals can impact include weight, diet and exercise. It has been reported that gastric bypass patients who have T2DM are “cured” of the disease after surgery. That is a more drastic measure which many people are not ready or willing to consider.
If the T2DM has been recently diagnosed, there is a greater likelihood of being able to reverse the disease. Doing this requires losing approximately 5-10% of current body weight, balancing carbs and protein and engaging in daily physical exercise. A diabetes educator (C.D.E.) is the expert who can help put together a plan for realistic and permanent lifestyle changes.
6. Karen Harouse-Bell MS, RDN, CDE, LDN
Take a moment to look around. One out of every three adults you see has prediabetes. If this statistic were headline news in regards to a contagious disease, people would most likely stop in their tracks and seek help. This, however, is not the situation with prediabetes.
I believe in most cases, type 2 diabetes can be prevented or delayed. But to accomplish this, we must remember… words matter.
Healthcare professionals must say it. Use the word prediabetes to emphasize the benefits resulting from a lifestyle modification program such as the DPP, finding that it is the ideal first-line treatment to halt the progression of diabetes.
Use it as a motivator to make lifestyle changes and join a class. Use it so your patients hear it. Too often “softer” words are chosen, which do not have as much value and consequence as the word prediabetes.
The dictionary defines the word “prevention” as the act of stopping something bad from happening (https://www.merriam-webster.com/dictionary/prevention). As I often tell my children to choose their words carefully, we must choose the word prediabetes to begin the journey of diabetes prevention.
If you want to read more about diabetes, here are some articles:
7. Judith Vance, MN, MPH, FNP
In my opinion, type 2 diabetes can be reversed with use of a GLP1 agonist such as Victoza to restore beta cell mass and significant weight loss to normal BMI.
Initially a long acting insulin such as Levemir may be required to normalize blood glucose.
It is worth noting that NovoNordisk's Victoza is the only GLP1 agent that is approved in chronic renal disease.
In my high risk diabetes practice in Green Valley, AZ, all patients on Victoza, were able to achieve a HgA1C of 7. This group of approximately 50+ senior adults previously had HgA1Cs of over 8 and up to 11-12 when referred to me.
8. Michele Bedwell, MS RD CDE
Type 2 DM can be reversed in some patients who choose to have bariatric surgery. Lifestyle changes certainly can control blood sugars with little to no medications but usually do not reverse diabetes due to ongoing decline in beta cell function.
If patients are motivated to make lifestyle changes, I usually encourage them to consume a lower carb meal plan, adequate protein at each meal, large volumes of low carbohydrate vegetables, and at least 150 minutes per week of exercise (a combination of resistance and cardio) for maximal benefit.
These changes can decrease insulin needs, allow for weight loss, and improve insulin sensitivity. Hopefully, there will be more breakthroughs in diabetes as we learn more about the microbiome, GLP1, and other gut factors.
9. Lisa Stollman, MA, RDN, CDE, CDN
After you are diagnosed with diabetes, by following a healthy lifestyle, which includes a healthy diet along with exercise, you may be able to decrease your blood glucose levels to within normal range. Utilizing SMBG (self monitoring of blood glucose), you can see how different foods, as well as meals, influence your blood glucose levels. Doing SMBG along with a healthy diet and exercise is key to getting your diabetes under good control.
Although your blood glucose levels can appear in the normal range, this does not mean that your prior history of diabetes won't return. Type 2 diabetes can go into remission with lifestyle management. But the remission stage can easily be reversed if you don't stay on track with your healthy lifestyle.
If you would like help lowering your blood glucose levels with diet, make an appointment with a Registered Dietitian Nutritionist (RDN). Visit www.eatright.org to find a RDN in your locale.
10. Jane Eyre Schuster, RD, LD, CDE
There are many studies showing that by initialing lose 5% of current body weight and getting 150 minutes of exercise weekly can and do return many folks' blood glucose levels back into a normal range. However we must continue these actions as lifestyle changes, not just a means to an end. The human body is incredible forgiving and will always move towards health when given the opportunity to do so.
Cutting out the refined, processed starches and sugars, BG rebound into a normal range very quickly. My experience is when people begin to be more conscious of their food intake and physical activity, which happens immediately after being diagnosed with pre diabetes or diabetes, they begin to make better food choices and cut out the foods they know are not healthy.
Most of those foods are refined, processed starches and sugars. Lots of diets place people on a restricted plan that doesn't allow the refined, processed starches and sugars, and people lose weight, regain good BG control and feel better. However, in most cases, the weight comes back and weight creeps up and BG begins rising again due to the inability to sustain many of these diets.
Lifestyle changes with diet, exercise and mental health over time are the most powerful tools to “reverse” diabetes. Being conscious of what we are doing gives us the opportunity to make conscious decisions in the moment and move our food choices up to the top of our priority list rather than the reaction and guilt after the moment.
WE MAKE BETTER CHOICES WHEN WE ARE CONSCIOUS OF WHAT WE ARE DOING! Learning how to keep our diet and exercise habits at the top of our priority lists is the challenging part. Because with the speed of light, it inevitably ends back down on the bottom of our priorities. There is where diabetes hangs out and waits for us to return.
11. Amanda L. Gilbert, RN, MSN
From my professional experience as an inpatient diabetes educator, many patients are able to reduce or stop their diabetic medications through lifestyle changes, such as diet and exercise. Through these adjustments their A1C improves, they lose weight, and do not require the same interventions as when they were diagnosed.
Many of my patients with several comorbidities elect to have weight loss surgery, such as gastric banding, in order to lose the amount of weight needed to improve their diabetes, blood pressure, cholesterol, and other risks that follow obesity.
However, once someone has a tremendous improvement and no longer needs to take diabetes medications they do not need to assume it is “gone for good.” Different factors can cause their glucose to rise again, such as gaining weight or not following a diabetic diet.
Therefore, once a person has been diagnosed with diabetes they need to always check their glucose at home and follow-up with their PCP to have their A1C monitored regularly.
12. Carole Edwards, RN, BSN, MA, CDE
Can We Reverse Type 2 Diabetes?
This is a great question that is somewhat controversial in the diabetes world. We all know the person that was on multiple diabetes medications, lost a moderate to significant (10-20% weight loss) amount of body mass, that now no longer requires medications for his/her diabetes.
This is truly a cause for celebration. For all practical purposes, after the weight loss and glucometer readings are in the normal range & the A1c reading is in the normal range, this person has effectively reversed their diabetes.
Conversely, it must be understood that this person has an increased risk of developing diabetes if the weight gain sneaks back on. I believe this person needs at least a yearly A1c lab test to make certain that he/she hasn't had a return of higher blood sugars.
If the person has reverted to old eating habits and/or decreasing physical activity and gaining weight, the A1c should be repeated sooner than once yearly.
The argument has been that the Type 2 Diabetes isn't really reversed, but in my mind's eye, as long as the person stays the same weight & physical activity level, it is reasonable to conclude for the time-being that, indeed, the disease is reversed. That person needs to be aware that they have accomplished an amazing achievement.
As health promoters, we need to support this person with their weight loss journey. Knowing and seeing all the comorbidities and complications that accompany diabetes, as a diabetes educator, I believe there needs to be more treatment studies devoted to weight loss, obesity treatment, weight loss surgeries, & weight loss pharmaceuticals.
13. Marina Chaparro, RDN,CDE, MPH
Type 2 diabetes can be delayed and in many instances reversed, but the moment a person stops following a healthy lifestyle and goes back to unhealthy habits, the risk prevails. The number one risk factor for type 2 diabetes is weight. Over 80% of people who develop type 2 diabetes are overweight or obese.
That is why losing even 5% of your body weight can help delay the onset of type 2 diabetes. It's important to note that, certain lifestyle modifications such as exercising regularly and eating a balanced diet can delay the onset of type 2 diabetes; however, the exact reversal is not a sure thing.
Type 1 diabetes is not reversible as it is an autoimmune disease, independent of weight and eating habits. The exact cause of type 1 diabetes is not known.
Some individuals like Hispanics, African Americans have a higher genetic susceptibility of developing type 2 diabetes, regardless of weight. Despite this, engaging in healthy habits from the start will only improve your quality of life.
14. Janice Baker, MBA, RD, CDE, CNSC, BC-ADM
As with many questions about diabetes, there are several factors to take into consideration. One is how early into diagnoses efforts at managing diabetes begin.
At early stages of diabetes, preferably during the pre-diabetes stage, lifestyle efforts such as changes in eating and activity habits may make a significant difference in insulin resistance and slow down or possibly halt progression to type 2 diabetes.
As time progresses, persistent hyperglycemia along with other metabolic factors such as beta cell dysfunction, lipo/glucotoxicity, fatty liver, and sarcopenia may decrease the risk of reversal. Hereditary or autoimmune factors (ie LADA, often referred to as type 1.5 diabetes) may also reduce the probability of diabetes reversal.
Frailty, immobility, medications, coexisting medical conditions may also adversely influence glycemic control.
Thus it is important to individualize therapies, including medications, lifestyle recommendations and goals of care to meet individual needs.
I mention to my patients that diabetes may be put into “remission” however it may resurface as metabolic/lifestyle or other factors change.
15. Karen Fisher, MS, RD, LDN, CDE
As a registered dietitian nutritionist and certified diabetes educator, I am frequently asked that question. In the 30 years I've been practicing, I have witnessed normalization of glucose levels in many individuals diagnosed with type 2 diabetes, occuring when lifestyle changes of improved eating habits and regular exercise are made.
The success in bringing down A1c and glucose levels is usually attributed to weight loss, but I see it occur without weight loss as well.
When we move our bodies on a daily basis as nature intended, and eat minimally processed foods, we give our bodies the ability to function efficiently, including using the fuels from our food without an accumulation of excess glucose in the bloodstream.
Many individuals diagnosed with diabetes are under the misconception that major changes in their eating and excercise need to occur for there to be a success in managing the condition.
This contributes to the fact that as many as 90% of those with diabetes never receive any education on how to be an active participant in the control of their numbers.
The beauty of diabetes education is that nutrition and diabetes experts can give simple yet effective suggestions for small changes that can have a big impact in managing glucose.
Basic changes like adding protein to a sweet and reducing the portion and frequency of consumption work much better for those with diabetes and a sweet tooth than the notion that they should never eat sweets again, only to feel guilty when inevitably doing so.
Whether the diabetes is reversed, or the glucose levels are being managed within a normal range, is a topic of debate and may largely be a matter of semantics. Complications of diabetes don't automatically come with the diagnosis, they occur with chronic high glucose levels.
Working with their primary care provider, specialists and diabetes educators, those with diabetes can control their numbers, and whether we call their diabetes 'reversed' or perhaps more correctly, 'managed', the closer to normal glucose levels, the better health people with diabetes will have.
16. Beth Silvers RD CDE LDN MS CPT PWD
Yes and no. If you learn to live a healthier lifestyle and stay with it for your remaining years, then yes it can be reversed. This assumes you realized your diagnosis early and you are able to get your A1c below 6%. If you realized your diabetes too late or your A1c is not coming down without insulin then probably not. This is easier to reverse when you are overweight or obese but not so if your BMI is below 25.
This healthy lifestyle we refer to is being active 150 minutes or more each week and eating a meal plan low in fat and processed sugar with 3-5 vegetables and 2-3 fruits a day most days. It does not require low or no carbohydrate diet like Atkins or counting carbohydrates every meal. Most folks do better when they spread the carbohydrates out evenly over the day.
And live well whether you reverse your diabetes or just keep it in your side car
17. Heather Comartin BScN RN CDE
No, type 2 diabetes is not reversible, but it can be controlled and that is what everyone should aim for. An A1C of 6.4 or even a 5.5 shows control and is something to be very proud of. It may mean you can come off your medication, or stop checking 4 times a day, but you still have diabetes.
Your diabetes is in control and you still need to monitor it daily or once a week. A perfect example is a patient who thru weight loss, and following his meal plan was able to get his A1C down below 6.5. His doctor was very happy and took him off his medications and told him he didn't need to check his sugar.
About a year later, he came to our classes after losing part of his foot and was severely depressed. He was depressed because he put his meter and his diabetes up on the shelf in the closet and forgot about it, he thought he had reversed it.
18. Nancy L. Schwartz, RD, LMNT, CDE
I do not believe it can be an actual reversal, more of a remission. If no longer needing medication to control blood sugar looks like reversal it is only possible if the person maintains regular exercise and a healthy weight. The length of time one has diabetes plays a role as does one's genes. There are some thin people who have type 2 diabetes due to heredity.
Weight and lifestyle are things that can be changed, and they are important parts of overall health. If one can manage on lifestyle alone that's great, but if medication is necessary, the person should take advantage of the treatment that's going to keep blood sugar, blood pressure and cholesterol in check. They are ALL important.
19. Fryn Schafer RDN, CD, CDE, LCDE-IN
Well, that depends on the definition of 'reversed'. If it means the disease goes away, then no it is not reversed. If is means the need to use medication to control blood sugar is reduced or eliminated, then yes. The explanation is found in the basic pathophysiology of DMT2, the hallmark of which is insulin resistance.
This creates an internal environment that requires the pancreatic bata cells to work very hard to produce enough insulin to feed those 'resistant' cells. Beta cells can produce enough inulin for a while but once blood sugar levels are rising above normal, a good percentage of those cells have worked themselves to death.
They cannot be revived. If, before that happens, insulin resistance is reduced, remaining beta cells can continue health and viable for sometime, although T2, to date, tends to be progressive.
Lifestyle changes resulting in weight management and increased well being are very effective in the treatment of early DMT2 because the pressure on the beta cells becomes more manageable. If changes are not made before beta cell demise, then medication is likely necessary for life.
20. Chandra Bivens Carty
Can DM2 be cured?
Bariatric surgery leads to improvement and even curing DM2 but the mechanisms are different. Meijer R “Bariatric surgery as a novel treatment for type 2 diabetes mellitus ArchSurg.2011 Jun;146(6):744-50
The reasons the surgical gastric banding or the adjustable silicone sleeve improves diabetes control is because it decreases food intake and body weight with a slowing of gastric emptying.
The Roux-en-Y gastric bypass and biliary-pancreatic diversion, not only restricts the food but it causes malabsorption , as well as this procedure bypass the foregut resulting in increase weight loss and elevation of enteroglucagon level.
Other studies suggest that metabolic surgeries improve glycemic control. There is improved insulin resistance the mechanism is not quite clear. There maybe enhanced postprandial GLP-1 response and remission of type 2 diabetes. Dimitrios J., Annals of Surgery. 2010;252(6):966-971
21. Maureen Sullivan-Tevault, RN, MS, BSN, CEN, CDE
When it comes to type 2 diabetes, a lot of discussion has been around a single question: Can type 2 diabetes be reversed? In order to fully understand the question, one must first define the word, “reverse”.
“Reverse” has several meanings. As a verb, it means to move backward; as an adjective, it means going in the direction opposite to that previously stated; as a noun, it means a complete change of direction or action. One word, several meanings….much like the word diabetes itself.
Diabetes is confirmed by laboratory (blood) levels:
- A fasting blood glucose level of 126mg/dl (on two separate occasions)
- An A1C level greater than 6.5%
Most persons diagnosed with type 2 diabetes have some areas in their life that could benefit from diet and exercise, as well as lifestyle changes:
- Improvement in diet (fresh fruits, vegetables, whole grains, lean meats)
- Weight loss (5-7% weight loss)
- Increased activity (aim towards goal of 150minutes/week)
- Stress reduction
- Smoking cessation(including E-cigs, cigars, chewing tobacco)
Successfully addressing diet and activity issues often results in reducing blood glucose levels. Often times, medication dosages can be reduced, even discontinued. A type 2 diabetic can be “diet controlled” in some instances; thus, “reversing” the need for medication at this time.
To clarify a “best case scenario”, the blood glucose level has been lowered; the need for medication has been reversed/stopped; the (diabetic) condition is now diet controlled.
On a personal note, I always encourage full disclosure of a history of diabetes, even if currently diet controlled. Although a glucose level may now be within normal range, certain medical treatments/medications/illnesses may trigger a hyperglycemic (high blood glucose) level. The fully informed medical provider will closely monitor these patients and prevent uncontrolled glucose spikes from occurring.
22. Sandra J. Arevalo, MPH, RDN, CDN, CLC, CDE
Diabetes Type 2 is a condition that cannot be cured however, it can be IMPROVED.
This could happen when there is an improvement in insulin sensitivity. Diets that are high in carbohydrates (such as sweets and starchy foods, such as rice, potatoes, pasta or bread) cause weight gain, mainly around the abdominal area.
This causes the Beta cells in your pancreas to produce more insulin. The higher your insulin, the hungrier you feel, the more you eat, and the more weight you gain. Due to the already increasing amounts of insulin your body's cells then respond to this process refusing the insulin.
This is called insulin resistance. Insulin resistance causes your blood sugar to rise. You can reverse this process by adopting a diet that is low in carbohydrates and high in fiber, weight loss, and regular exercise. Some people who need to lose more than 100 pounds might need to get bariatric surgery to help the weight loss process.
Diabetes Type 2 might be reversible but not cured because when you gain the weight back, neglecting your diet and exercise, insulin resistance attacks again.
23. Grace Rivers, RDN, LD, CDE, CHC
Type 2 diabetes can be controlled to the point where it looks as though diabetes has gone away. This is sometimes seen when someone has lost a significant amount of weight. The blood sugar levels may be in a safe category and diabetes meds may have been decreased or discontinued.
As time goes on, however, blood sugar levels can begin to rise again. Diabetes is a progressive disease which means that what is done today to care for it, may not work as well a year or two from now. A key to keeping blood sugar levels under control is to be active, watch portions of all foods, include all food groups and visit your doctor to make sure the blood sugar levels are staying at a safe level.
24. Rachel Freeman APD CDE
The answer is no, not entirely. And it depends on the cause or contributing factors to type 2 diabetes. For an older person who has developed type 2 diabetes later in life because of their family history and/or age, where their beta cells of their pancreas have deteriorated, there is, unfortunately, no way to reverse type 2 diabetes.
If however, type 2 diabetes is a result of insulin resistance and being overweight, there is excellent evidence that exercise, decreasing added sugars and saturated fats in the diet, choosing low glycaemic index foods and losing weight - particularly around the abdominal region, can improve blood glucose levels to the extent that it seems like diabetes has been reversed.
This essentially means that the type 2 diabetes is being managed at a level that seems as if the diabetes isn't there at all. Choosing a healthy diet, exercising regularly and maintaining a healthy weight is the key. Eventually, what will likely happen is that blood glucose levels will increase again at a later time, as the person gets older, or if the person returns to an inactive and unhealthy lifestyle and regains weight because the beta cells of the pancreas have already been stressed.
The good news though is that this can be delayed, and we can do something about preventing and managing the early stages of diabetes through simple lifestyle modifications, and the body will remember these efforts if they can be maintained early in the diagnosis and for as long as possible. This in turn will delay the progression of diabetes and development of diabetes complications.
25. Jessica Crandall RDN,CDE
Diabetes once diagnosed is always in the backdrop- typically it is a progressive disease however some clients are able to prevent progression of the disease to where it is really at a halt if you are able to lose a modest amount of weight, implement healthy eating behaviors as well as activity.
For example, the DPP results showing 150 minutes of activity per week and healthy eating habits resulting in a weight loss of 5-7 % of total body weight resulted in a 58% reduction in diabetes progression.
For every 2.2 pounds of weight loss, diabetes risk was reduced by 13%.
So to clarify I don't ever say that it is reversed but it can be in the backdrop or in remission....
26. Jenna Kress, RD, CDE
Research is promising showing Type 2 diabetes may be put into a state of remission with intensive interventive and significant lifestyle changes such as after large weight loss and strict diet and exercise. Remission of diabetes means there are no signs or symptoms of it, and blood sugars are in non-diabetes ranges without the use of medication.
However, the alternate term “reversed” often being used, may confuse people and mistake the good control of diabetes (remission) as a complete cure. Unfortunately, there is no current long term cure yet, and if one had gained back the weight they had lost or went back to old lifestyle habits, Type 2 diabetes would come back and sign and symptoms would present.
As more research continues it would be beneficial to strive for controlled Type 2 diabetes or remission, through interventions that will work for the individual for long term quality of life.
27. Alison Massey MS, RD, LDN, CDE
During the initial stages of Type 2 diabetes weight loss (if needed), as well as lifestyle changes, can sometimes but not always help individuals reduce their A1c back into a prediabetes level, however they still technically have Type 2 diabetes.
In this case, the Type 2 diabetes is managed by lifestyle modifications. Weight loss surgery is also an effective method for managing Type 2 diabetes but this doesn't mean that the individual won't necessarily have issues with blood glucose levels in the future especially if weight is regained.
Type 2 diabetes is a chronic disease (meaning there isn't a "cure") and tends to be progressive. The longer that someone has been living with Type 2 diabetes the less insulin their beta cells may be producing. This doesn't mean that lifestyle modification is irrelevant--but does mean that individuals should work on accepting their Type 2 diabetes diagnosis so they can focus on managing their diabetes in the best way possible.
28. Meghan Jardine, MS, MBA, RDN, LD, CDE
As a registered dietitian and certified diabetes educator, I learned through formal training that type 2 diabetes is irreversible. However, as a nutrition researcher and health care provider, I see different results—in different people.
The good news is diabetes is not a static condition and a type 2 diabetes diagnosis doesn't mean the condition will progressively get worse. Mounting research finds plant-based eating patterns can prevent, manage, and, in some cases, eliminate diabetes symptoms, significantly reducing or eliminating the need for medication and insulin.
At the Physicians Committee for Responsible Medicine, we conducted a randomized controlled diabetes trial and found participants who ate a low-fat vegan diet lost more weight, had greater reductions in hemoglobin A1C, and had greater improvements with cholesterol than the control group (those following a conventional diabetes diet).
Some in the vegan diet group eliminated the need for medications altogether, and their blood glucose numbers and A1C fell into a healthy range. These results could be classified as reversing the disease since reverse technically means to turn in the opposite direction.
How does it work?
Here are the five dietary guidelines used in the studies:
Eliminate all animal products: Steer clear from meat, fish, dairy products, and eggs.
Limit high-fat foods: Avoid added oils, pastries, fried foods, and limit olives, avocado, nuts, and seeds.
Fill up with fiber: Fill your plate with whole grains, fruits, vegetables, and legumes (beans, peas, and lentils). Aim to consume at least 40 grams of fiber per day.
Focus on low glycemic index foods: While reducing fat and increasing fiber can significantly improve insulin sensitivity, low glycemic index (GI) foods reduce after-meal blood glucose levels. Low GI foods include pumpernickel or rye bread, oats, beans, bran cereals, most fruit, and sweet potatoes, compared to higher GI foods such as white potatoes, processed foods, and cold cereals.
Take a vitamin B12 supplement: Anyone following a plant-based diet should supplement with vitamin B12. This nutrient is readily available in fortified cereals, plant-based milks, and vitamin-enriched products.
Following these five principles can significantly influence blood glucose levels. However, not everyone responds the same. Some people with have immediate low blood glucose levels. Others may experience a slow and steady improvement of glucose control. Some may have temporary high glucose levels. Our experience is that this is transient and most people will improve.
It's important to check your glucose more often and discuss medication adjustments with your primary care provider. The important factor to remember is that, just like weight loss, the lifestyle changes need to stick. Once the animal products and high-fat foods come back into the diet, glucose levels start to rise and diabetes symptoms reappear.
29. Jayne Lehmann BN(Ed) DipAppSc(Nsg) FRCNA RN CDE
Once you have diabetes, it is there for life. I help people to get their blood glucose levels back to or as near as possible the normal range. Firstly this will help you to feel better in the short term but it also helps to protect your blood vessels which can become very irritated and damaged by high glucose levels. Focussing on healthy eating, limiting unprocessed foods and getting a wide variety of fruits and vegetables in the diet helps.
Try to keep carbohydrate amounts stable across the day (some choose lower carbohydrate targets), stand more and sit less and include activities that increase the heart rate and also strength based activities most days across the week. Think about the amount of stress you experience to see how it is increasing your blood glucose levels. If you smoke – stop because it is speeding up the damage to your blood vessels. If you drink alcohol, limit how much you drink.
Even if you aim to lose 5% of your body weight, if overweight, you are likely to see a fall in your blood glucose levels back into the normal range but even then we can’t say diabetes has been reversed or gone away. These actions build-up the body’s ability to respond to rising levels but if you get sick, eat more carbohydrate or gain some weight, more than likely your blood glucose levels will be on the rise again into the diabetes range.
It is well worth putting in extra effort when first diagnosed with type 2 diabetes because it is likely to give you a bigger health benefit for effort ten years down the track with less damage to your small blood vessels. That’s a good return on investment because after all these things are recommended for everybody if they want to be healthy!
Reversing diabetes type 2 does not happen overnight.
While views on how it can be reversed are many, the idea is the same: it can be reversed but cannot be cured. It is important to understand the difference between the two terms. As experts suggest above, pre-diabetes and type 2 diabetes can be made easier to control through medication, smart lifestyle choices including exercise and diet.
Reversal of diabetes means that you are off medication, however, that you are managing your diabetes by engaging in a healthier lifestyle. If you shed the extra pound, eat healthy and are active, you may no longer need the medications but you will have to keep engaging in those lifestyle changes.
We hope that this expert round table has shed some light into the topic of diabetes reversal. Please share your comments with us and our readers in the box below.
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TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on May 31, 2023