What Is Diabetes Reversal? (Part II)

To fully understand the concept of diabetes reversal, it is important to understand how diabetes is detected, measured and monitored.

Measuring Diabetes
People with insulin resistance can eventually develop prediabetes which typically progresses to type 2 diabetes. In many cases people do not know they have prediabetes or early diabetes, until symptoms of diabetes occur, leading to medical attention and correct diagnosis. It is important to know that screening blood tests can detect the early stages of diabetes, or prediabetes, or insulin excess.

By measuring the levels of insulin, and glucose (sugar) in the blood, we can know whether someone has excess insulin levels, prediabetes, or diabetes. Eating a meal changes these levels, making them difficult to interpret, therefore clinicians often prefer to measure them while a patient has been fasting overnight or for 8 to 12 hours. The fasting levels of blood glucose may fluctuate widely from day to day, and no single measurement of blood glucose is a reliable indicator of the overall average blood sugar level.

Fortunately, we have a blood test that indicates the average blood sugar level, called the HEMOGLOBIN A1c. We often just shorten the name to "A1c". This test measures how "sugar-coated" the blood cells are, and is an excellent reflection of the overall or average blood glucose control. The higher the A1c, the higher the average blood sugar, and the greater the risk of future diabetes complications. Knowing your A1c means knowing your risk of diabetes or diabetes complications. Normal healthy people have an A1c of less than 6%, meaning less than 6% "sugar coated". In fact, at our hospital laboratory, normal is 5.8% or less, so greater than 5.8% means prediabetes or diabetes. Diabetes experts throughout the world are working together to achieve a consensus about how to use the A1c to define the official cutoff points for prediabetes versus diabetes. Obviously it is one continuum and the definitions or cutoff points are arbitrary. Lacking official cutoff points at this time, I believe it is fair to say that PREDIABETES is roughly an A1c of 5.9% to 6.4%, and DIABETES is roughly an A1c of 6.5% or higher. An A1c over 7% is considered insufficient control of the diabetes, and clinicians often consider increasing the intensity of the diabetes treatment when the A1c surpasses 7%. A1c's in the 8%-10% range are considered poorly controlled diabetes, and A1c's over 10% indicate very poor control, and if such levels are sustained over many years, there is especially high risk for diabetes complications, such as heart attack, stroke, sudden death, blindness or eye damage, foot infections or amputation, or kidney damage possibly leading to chronic dialysis.

Controlling Diabetes
We all recognize that healthy eating, exercise, and weight control are important for controlling diabetes. Doctors, dietitians, diabetes educators, nurses, and other health professionals agree that such lifestyle measures are crucially important. Nevertheless, medications are often used to help control the blood sugar levels. Some medications help reduce the insulin resistance, others stimulate the pancreas to make more insulin, some have a combination of effects.

Recent research studies have suggested that using multiple medications to reduce the A1c much lower than 7% may have little or no substantial advantage over just leaving the A1c at 7%. Unfortunately, there is risk of diabetes complications in all people with diabetes, despite A1c's at or below 7%. In general, people with prediabetes progress to diabetes with gradually increasing A1c's, despite a gradual increase in medication. Eventually, insulin delivered as injections or via a small "insulin pump" is used to replace or augment oral diabetes medications. All diabetes medications have side effects.

Reversing Diabetes With Surgery
Obesity surgery often reverses type 2 diabetes. Gastric bypass surgery, typically performed using the "minimally invasive" approach with a few small incisions, usually normalizes blood sugar within a few hours or days, allowing the elimination of diabetes medications for many years and possibly for one's full life. The rapid rate of diabetes remission indicates that the weight loss is not the initial cause of the diabetes reversal. Rather, the change in the intestinal anatomy causes changes to the digestive process and hormonal balance that, combined with the change in food intake, result in diabetes reversal. The dramatic weight losses, often well over 80 pounds, clearly help sustain the long-lasting remissions. Alternatively, lap-band surgery, involving "minimally invasive" laparascopic placement of an adjustable band that constricts the stomach, results in more moderate weight losses, often in the 40-60 pound range, thereby leading to diabetes remission once a sufficiently low body weight has been reached. Most people with recently diagnosed type 2 diabetes can achieve remission with lap-band. More studies are needed to clarify the duration of remission and reversal rates according to age group, degree of obesity, duration of diabetes, and other factors that might influence the effectiveness of such surgery. Surgery for diabetes reversal or control seems like an extreme measure, however, as surgical techniques and post-surgical management of patients continue to improve, the attractiveness of such measures continues to increase, in my opinion. Still, it just seems "unnatural" to use surgery to reverse or control diabetes, and it is clearly not an ideal solution or anybody's first choice. Personally, I favor it over medication, as a long-term solution for many people who simply can't control their type 2 diabetes through diet and exercise.

Reversing Diabetes With Diet and Exercise
We know that weight loss, via healthy diet and exercise, can delay or possibly prevent the onset of type 2 diabetes in people with prediabetes. We also know that many people with prediabetes or type 2 diabetes have been able to restore normal blood sugar levels by improving their diet and/or exercising more. Unfortunately, such people are the exceptions, and most people do not achieve or sustain sufficient lifestyle changes to avoid progression of diabetes, once diagnosed. There are no published research studies that convincingly demonstrate the value of lifestyle change for achieving durable diabetes remissions in typical patients, at least not yet. Researchers around the world are working together to evaluate the effects of weight loss through diet and exercise, on diabetes control, and once those results are published, we will gain a better understanding of the relationship between weight loss and risk of diabetes progression and complications.

Meanwhile, I am convinced that reversing prediabetes and type 2 diabetes, as much as possible, through diet, exercise, and weight loss, is the best approach. Health care providers and patients have not done all they can to work together to use lifestyle methods to beat diabetes. Unhealthy lifestyle habits are the root cause of type 2 diabetes and reversing the underlying cause is the principal way to reverse diabetes. I do not use the word "cure" because the diabetes will re-emerge if the lifestyle changes are not sustained, and can even relapse despite ongoing adherence and weight loss. Whether patients can sustain remissions for decades remains to be seen.

Defining Diabetes Remission
There is no official definition for type 2 diabetes remission. The general concept is normal blood sugar levels without diabetes medication. However, if a person stops diabetes medication and has a few normal blood sugar readings, that is clearly not sufficient. Diabetes is officially defined as fasting glucose over125 mg/dL. Prediabetes involves fasting glucose levels in the 105-125 mg/dL range and A1c9s in the 5.9-6.4% range. Is getting into the prediabetes range considered remission? There is no official answer and therefore the topic is up for debate.

Lacking an official definition, I arbitrarily define DIABETES REMISSION as an A1c of 6.0% or less with no diabetes medications for at least 2 months, in a person formerly diagnosed with type 2 diabetes. One could use a different definition, but this one is mine. If someone has been diagnosed with type 2 diabetes, I do not use the term prediabetes to describe an improvement. I define DIABETES RELAPSE as an A1c of 6.5% or higher in someone who was previously in diabetes remission. I define PREDIABETES as an A1c of 5.9-6.4% in someone who has not met the definition of diabetes. I define REMISSION of PREDIABETES as an A1c of 5.8% or less in someone who has met criteria for prediabetes but not diabetes. RELAPSE of PREDIABETES is a return to A1c in the 5.9-6.4% range.

— Michael Dansinger, MD

What Is Diabetes Reversal? (Part I)

When I discuss "diabetes reversal" this is what I'm talking about:

First, I'm talking about Type 2 Diabetes, the kind that is associated with being overweight or obese. Type 1 diabetes, also known as autoimmune diabetes, which usually develops in childhood or early adulthood, is not what I'm talking about. Around 80-90% of diabetes is type 2.

Second, when I talk about "Diabetes Reversal" I'm talking about trying to put the diabetes into REMISSION, meaning that the blood sugar levels are normal without diabetes medication. In other words, the disease is undetectable.

Third, if the diabetes is too far advanced or if you have been on diabetes medication for too long, the diabetes might not be fully reversible, or may quickly relapse.

Fourth, it takes hard work and sacrifice to master the eating and exercise strategies that reverse the diabetes. I can show you the way, but I can't make you do it. You have to want it badly enough to make it happen.

I suspect that 75-80% of people with type 2 diabetes can potentially reverse their disease to the point of full remission. These remissions can last for years. Perhaps lifelong remissions are possible!

In the coming weeks and months I'll discuss more about how diabetes reversal works and how to do it. Remember, you know you'll succeed once you decide you'll never give up trying.

How Type 2 Diabetes Develops

To really understand diabetes reversal, it is important to first understand how type 2 diabetes develops.

Type 2 diabetes is traditionally considered to be a progressive disease. It works like this. As we all know, we must eat food for energy. Unfortunately, people with diabetes have a problem getting the energy from food into the muscles and organs that depend on that energy to work properly. In all people, with or without diabetes, the food we eat is digested and absorbed into the blood stream, causing the blood sugar level to rise. The cells of our body tissues, especially cells in muscles and organs, are designed to use that sugar for energy, and our cells have a specific way to let that sugar in. The cells of our bodies require INSULIN, a hormone made by the pancreas organ and secreted into the blood stream, to get the sugar from the blood stream through the cell surface membrane, to the inside of the cells where the sugar can be used for energy. In normal healthy people, the insulin hormone attaches to the surface of cells in a manner that is analogous to a key unlocking a door to let the sugar into the cell. In contrast, in people with type 2 diabetes, the cells do not recognize the insulin properly, and the sugar doesn't get into the cells very efficiently, like a door with a blocked up keyhole. The sugar can't get into the cells very efficiently, resulting in high blood sugar levels.

Why is the keyhole blocked up? In other words, why don't the cells recognize the insulin? This is what we call INSULIN RESISTANCE, which results from a combination of unhealthy eating, excess body fat, lack of exercise, and genetic predisposition. For example, being overweight or obese leads to excess fat levels in the blood and in the muscles and organs, that "jams the keyholes" or causes the cell surfaces to recognize insulin less efficiently.

In the face of insulin resistance, the body makes MORE insulin hormone. The pancreas organ makes twice as much insulin as normal, in order to get the sugar from the blood into the cells. Many overweight people live their full lives with high insulin levels and do not develop type 2 diabetes. Others may seem healthy for 10 or 20 or even 50 years with increased insulin levels before developing diabetes. In fact, a person does not develop type 2 diabetes unless the pancreas becomes so overworked, that it cannot continue to do "double duty", and can no longer make so much extra insulin. Only then does the blood sugar level start to rise abnormally, in which case we recognize this as PREDIABETES. Over time, as the insulin-producing cells of the pancreas continue to wear out, the blood sugar levels rise further and we recognize this as type 2 diabetes. Therefore it is the COMBINATION of insulin resistance PLUS the weakened ability to make excess insulin that leads to type 2 diabetes.

Why does the pancreas, or the insulin-producing cells of the pancreas, weaken in some people faster than in others? Scientists are working hard to learn more about this, but in fact we don't have a good enough understanding for me to propose a satisfactory answer. The simplistic answer is that some people just have better luck than others. It is common to see individual differences in the way an organ or body part responds to overuse. For example, some people exposed to lots of noise eventually need hearing aids, others never do. Some joggers eventually get bad knees, others do not. Excess alcohol over many years sometimes causes severe liver disease, sometimes it doesn't. These differences are often genetic, but may also depend on the presence or absence of other environmental factors that we often just don't recognize.

DIABETES REVERSAL is about reversing the underlying insulin resistance and strengthening the insulin-producing cells of the pancreas, aiming to normalize the blood sugar levels without diabetes medication. In future postings I'll explain more about this.

— Michael Dansinger, MD

The Diabetes Reversal Equation

Thank you, WebMD! I'm especially grateful for the opportunity to connect with the type 2 diabetes (and prediabetes) community. I'm excited to share what I've learned about weight loss, nutrition, popular diets, exercise, obesity, diabetes, medical research, and medical practice.

The aim of this blog, "Conquering Diabetes" is to discuss all topics related to overcoming and reversing type 2 diabetes. Together we'll share our insights and experiences in all things relevant to reversal of type 2 diabetes. Much more than eating right and exercise, we need to explore the way doctors, nurses, dietitians, chefs, personal trainers, politicians, health insurance companies, hospitals and clinics, patients, parents, and children all have a role or potential role in reversing the diabetes epidemic. We'll explore various eating strategies, exercise, our love/hate relationship with unhealthy food, share our own stories, and create our vision for a healthier future.

My mission, my passion, my calling, is to coach patients with type 2 diabetes in the eating and exercise strategies that normalize blood sugar, and to train other health professionals and the general public in the methods I use to reverse diabetes.

In the weeks and months to come I'm looking forward working together. Together we can and must overcome type 2 diabetes for the sake of ourselves and our children and their children. Join me now. We can't afford to leave this work to the next generation. We can only do this if we build momentum and grow together. Together let's learn how to reverse diabetes as individuals and eventually as a nation, and solve the "Diabetes Reversal Equation".

Click here for video version of my poem below

A Diabetes Drama for President Obama

Dear President Obama, I'm calling for you! You've inspired the nation, we're long overdue.

We need a strong leader in this time of trouble, who can help us see that our own strength can double.

The healthcare system is in severe crisis! The costs are astounding, with spiraling prices.

For excessive tests and costly machines, we're stuck in a rut, with the same old routines.

The annual cost of a common disease, is more than the wars that we fight overseas!

One-seventy billion a year for diabetes?!! That is the enemy that might just defeat us!

Twenty percent of all healthcare expenses, on patients who have this--a shock to the senses!

One in three children may contract this illness, as adults or teens due to our stillness!

Here is a war that we should have engaged, millions have died and you bet I'm enraged!!!

Most of these patients get complications, even though we treat them with many medications.

Blindness and limb loss and chronic dialysis, result from our failure to heed the analysis.

You need not be an economist or scholar, we can reverse this for pennies on the dollar!

Diabetes type 2, which is ninety percent, is due to the life style habits doctors lament.

Until we overcome the underlying cause, we remain paralyzed in the enemy's jaws.

We know what it takes to get there in theory, but previous leaders have been too leery,

To make it happen on a national scale, to invest the resources to ensure we prevail.

We now know the weight loss it takes to reverse the majority of cases of this diabetes curse.

Coaching for weight loss of forty pounds initially seems like its way out of bounds.

But I've learned how to do this on a routine basis, for men and women of all ages and races.

A caloric reduction of twenty-five percent, is enough to achieve this glorious ascent

Out of the grips of this terrible killer, transforming sorrow into a thriller.

The key isn't diet type, it's all about adherence, and removing the obstacles that cause interference.

Weekly coaching by an authority, can normalize glucose for the majority,

Who sufficiently fear blindness or amputation, or stroke or dementia, or loss of sensation.

But doctors need training in the methods I've learned, to reverse diabetes, in those sufficiently concerned.

And we need a president who can leap into action, who knows what it takes to get enough traction.

Inspiring doctors to learn to achieve, reversal rates that initially seem hard to believe

Is the way to wage war on this foe we must beat, so we don't have to endure the burden of defeat.

A wealth of huge savings awaits in the confines, of Americans' increasingly expanding waistlines.

To tap it we must be clever and inventive, and carefully craft the right incentive.

Sharing a portion of the recovered wealth will stimulate people to recover their health.

Every sustained diabetes remission, annually documented by a qualified clinician,

Could reward the patient with a nice tax break, while all Americans share in the take.

Success on a national scale will save dollars in billions, eyes, kidneys, limbs, and lives by the millions!

The first country to achieve diabetes domination, will be the great envy of every other nation!

When great presidents propose with conviction, an American challenge to crush an affliction,

It brings out the best in our glorious nation, in these times when we desperately crave inspiration!

Believe with me now, that we can rise to the occasion, and solve the diabetes reversal equation!

—Michael Dansinger, MD