Type 2 diabetes (formerly known as adult-onset or non-insulin-dependent diabetes) can be a life-long, chronic disease in which the body either does not produce enough insulin or the cells in out body doesn’t respond to insulin correctly. Because of these two problems, there isn’t enough insulin to move the glucose from the blood into the cells. When glucose builds up in the blood instead of going into cells, the body’s cells can’t function properly.
Type 2 diabetes is more likely to occur in people who are over the age of 40, overweight, or have a family history in diabetes. Certain ethnic and racial groups also have higher risk for type 2 diabetes, including black, Hispanic/Latino, American Indian, Asian American and Pacific Islander. However, over the past decade the incidence of type2 diabetes has been increasing in adolescents and the young adult population.
According to recent research, type 2 diabetes cannot be cured, but individuals can have glucose levels that return to non-diabetes range, (complete remission) or pre-diabetes glucose level (partial remission) The primary means by which people with type 2 diabetes achieve remission is by losing significant amounts of weight.
We talk of remission and not a cure because it isn’t permanent. The beta cells have been damaged and the underlying genetic factors contributing to the person’s susceptibility to diabetes remain intact. Over time the disease process reasserts itself and continued destruction of the beta cells ensues. An environmental insult such as weight gain can bring back the symptomatic glucose intolerance.
Patients may also go into remission when prior to treatment they were glucose toxic. Glucose toxicity can temporarily shut down insulin production from the beta cell. When glucose levels are lowered the beta cells begin to function again. This is often seen in people who have had untreated diabetes for a long time and whose A1c level is acutely elevated. They may require insulin for a short period of time and once the glucose level is lowered and the beta cells start to function again they then can often revert to pills or lifestyle management.
Although remission can be achieved by standard medical means of lifestyle manipulation, many remissions are a consequence of gastric bypass surgery. These individuals often experience complete, or temporary (it can be for years), reversal of high glucose levels. It is the change in hormonal setting driven by the surgery that leads to improved glucose metabolism even before significant weight loss occurs.
Gastric bypass is a considered generally by those whose BMI and medical conditions put them at risk for serious health complications. For most people behavior modification (initially with or without medications) with lifestyle changes can help manage type 2 diabetes. Excess weight increases insulin resistance, so by shedding just 7 to 10 percent of bodyweight, the body’s cells will be better able to respond to the insulin.
The key to losing weight is finding a meal plan and an activity regimen that will best suit one’s lifestyle. The best meal plan is one that will help you to make healthy food choices that you can follow for a lifetime. Don’t worry -a meal plan isn’t a strict diet where you can no longer eat and enjoy your favorite foods-it’s all about giving you guidance to shape your eating pattern.
Through these significant lifestyle changes you could be well on your way to managing your diabetes. Don’t get discouraged if you slip back to your old habits – it is common for many people.
Talking to a registered dietitian or diabetes educator, or even signing up for a refresher course on diabetes—like Joslin’s DO IT program — may help you get motivated again. If it’s weight loss you are most interest in consider Joslin’s Why WAIT program.