Certain risk factors associated with type 2 diabetes are modifiable in nature
When the discussion is around diabetes, type 2 diabetes is considered to be the preventable one. Certain risk factors associated with type 2 diabetes are modifiable in nature.
However, the question whether it is possible to reverse diabetes without medication, can get millions of answers interpreted in different ways. Based on the severity, the extent to which the blood sugar level fluctuates, the age, the sex and the type of lifestyle one leads, different inferences can be made on this.
Several ads and posters make tall claims of 'curing' diabetes within 'few days' 'without any medicine.' We at ETimes-TOI spoke to several experts on this matter.
"Diabetes relentlessly tends to progress with time"
Diabetes relentlessly tends to progress with time and becomes more and more difficult to control, says Dr. Harish Kumar, Clinical Professor and Head, Centre of endocrinology and diabetes, Amrita Hospital, Kochi.
So, you cannot expect Type II diabetes to get reversed by itself, Dr Kumar says.
Adding more information to this statement, Dr Kumar says once you get diabetes, even if it is at an early stage, and you don’t take care of your diet or institute lifestyle modification, then it will not reverse itself, in fact, what happens is usually the opposite.
"Lifestyle changes matter a lot"
We all know we are living a faulty lifestyle. We also know that a bad lifestyle is just like an open invitation to life altering diseases. However, we tend to do less about changing it.
On this, Dr Suhail Durani, Consultant Endocrinology, Fortis Gurgaon and Fortis C says with significant lifestyle modification, diabetes can be reversed.
Backing this, Dr. Dilip Gude, Senior Consultant Physician, Yashoda hospitals, Hyderabad says, those with strong genetic predisposition such as having both parents as diabetics, may find it harder or impossible for such remission of diabetes. But most others who become diabetic owing to high total body fat can hope to achieve a reversal of diabetes when they get their BMI to less than 23.”
Who can actually attain reverse diabetes?
"Patients with type two diabetes at a short duration of diabetes, those who are overweight and obese can benefit from this concept," says Dr Durani.
He explains that, "there's basically a vicious cycle pattern in people with type two diabetes. They take a diet heavy in calories, particularly high refined carbohydrates, which leads to high insulin levels in the bloodstream, in order to cope up with this high and quick acting carb intake. This then leads to weight gain around the belly, what we call central obesity, and, in turn it consistently leads to high insulin levels in the body cells, getting resistant to insulin and ultimately leading to weight gain."
What contributes to weight gain in diabetes patients?
When the body becomes resistant to insulin, this leads to high insulin levels in the body and at the same time increases the blood sugar levels, explains Dr Durani.
This puts a burden on pancreas which then tries to cope up with this insulin resistant state to produce more insulin and higher sugar levels leads to feelings of lethargy and high insulin levels leads to increased hunger, the expert adds.
This hunger leads to overeating and lethargy leads to less physical activity and all this leads to weight gain. And ultimately, the insulin resistance weight gain leads to damage to beta cells in the pancreas and the pancreas starts struggling to produce enough insulin and there is a steeper rise in blood sugar levels, which leads to more recognisable symptoms of diabetes such as thirst and frequent need to urinate, he says.
On insulin resistance, Dr Gude says in as much as 1/3rd of the patients the diabetes is because of this condition and over 80% of Type 2 diabetic patients are overweight or obese.
What are the challenges?
The biggest challenge, Dr Gude says, is that most patients are on two classes of antidiabetic medicines sulfonylureas and insulin which are both causative of being overweight owing to the anabolic nature of insulin. If antidiabetic agents that help patients reduce weight such as Gliflozins, and GLP1RAs are used one can hope to improve insulin sensitivity and reduce total body fat. This helps patients decrease their daily insulin requirement and/or sulfonylurea dose grossly which ultimately leads to weight loss. Such weight loss in about 30% of diabetic patients can lead to remission of diabetes.
He says, if one can bring the BMI (Body mass index) to less than 23, about 30% of the diabetes patients can be cured of this condition.
“Exercise and diet are integral to decrease body fat and control diabetes. When a combination of such intense fat lowering measures in overweight or obese diabetic patients is adapted, including diet, exercise and weight loss inducing antidiabetic drugs, one can definitely expect remission or reversal of diabetes,” he says.
The humble truth is...
"So, lifestyle changes can certainly make a difference but only in early diabetes, once it has progressed or advanced considerably, or the patient has had diabetes for a few years, one cannot expect a reversal anymore," says Dr Harish Kumar.
Apart from lifestyle changes, certain large-scale drug trials which have been done across the world have shown that some of the medicines which have been studied have the ability to prevent the progression of diabetes and reverse early type II diabetes in some cases, he adds.
On the medications, Dr Gude says, when a combination of intense fat lowering measures in overweight or obese diabetic patients is adapted, including diet, exercise and weight loss inducing antidiabetic drugs, one can definitely expect remission or reversal of diabetes.
Emphasizing on diet and body weight, Dr Durani suggests going for a low calorie diet, exercise, and weight management in order to increase insulin sensitivity.