Can Type 2 Diabetes Be Reversible?

By Deborah Jeanne Sergeant

Type 2 diabetes affects nearly one in 10 Americans, according to the Centers for Disease Control and Prevention (CDC). Although most people who have Type 2 diabetes are over age 45, the CDC states that diabetes is on the rise among younger people. The CDC explains how Type 2 diabetes is caused on its website:

“Insulin is a hormone made by your pancreas that acts like a key to let blood sugar into the cells in your body for use as energy. If you have Type 2 diabetes, cells don’t respond normally to insulin; this is called insulin resistance. Your pancreas makes more insulin to try to get cells to respond. Eventually your pancreas can’t keep up, and your blood sugar rises, setting the stage for pre-diabetes and Type 2 diabetes. High blood sugar is damaging to the body and can cause other serious health problems, such as heart disease, vision loss, and kidney disease.”

Once someone has been diagnosed with Type 2 diabetes, can lifestyle changes in diet and exercise reverse it — even cure it?

The experts say no, but lifestyle changes can prevent Type 2 diabetes and, for those diagnosed with Type 2 diabetes, reduce dependence upon medication and the risk of complications that can accompany Type 2 diabetes: heart disease, vision loss, and kidney disease.

“It’s really important to learn how to manage the condition; it is manageable,” said Nikki Kmicinski, registered dietitian and director of business development at Western New York Integrated Care Collaborative, Inc. in Buffalo.

The organization operates Choose Healthy Diabetes Self-Management, an evidence-based program through period group meetings teaches participants how to manage their disease to reduce its risks.

“They learn what questions to ask and why it’s important to manage medication,” Kmicinski said.

Participants meet weekly for 16 weeks and then monthly for the year-long program.

“The outcomes really show people learn how to change those habits,” she said.

Although the lifestyle changes may reduce medication needs (under physician supervision) and risk of complications, “once they have diabetes confirmed by blood work, and their blood sugars are up in a certain range, that’s irreversible,” Kmicinski said. “It causes damage to the body.”

Reverting to their previous diet and sedentary lifestyle will undo any progress they’ve made.

“They can reduce symptoms and long-term complications by taking this seriously and making healthy changes,” Kmicinski said.

Some people with diabetes may not receive as much help with managing their disease from their doctor upon diagnosis because providers often have limited time to discuss the ramifications of diabetes and the interventions that can best help patients manage it. That’s why Kmicinski recommends seeing a certified diabetes educator.

“We set goals each week and go over topics to make healthy changes,” she said.

Debra Stacey, psychiatric nurse practitioner affiliated with WNY Medical, PC in Buffalo, has also practiced as a diabetes educator. She said that one of the biggest changes many diabetics can make right away is to cut out soda.

“Some have two to three servings a day,” she said. “Whether diet or regular, they have health implications. In most cases, the replacements for sugar are less healthy than the actual sugar.”

She also said that many people don’t understand that it’s carbohydrates — not specifically sugar — that raise blood glucose levels dangerously high for diabetics. Foods like rolls, bread and pasta can also spike blood sugar.

For controlling blood sugar and weight, portion control also makes a difference. Stacey said that many people don’t accurately estimate portions and eat far too much of each food. For example, filling a common cereal bowl is likely several servings of cereal, not the 8-oz. standard serving that doesn’t even fill half the bowl.

“We were all taught we should eat what’s on our plate,” she added.

Too often, the plates hold nutrient-void calories that are too high in simple carbohydrates such as French fries, white bread, rolls or fried foods. These are also foods high in calories.

As a result, many eat far too many calories for their body’s needs. Since many people have become emotional eaters, screening for mental health issues is also vital to reducing the effects of Type 2 diabetes. Stacy said that many diabetics have mental health issues that require addressing to help them solve their eating problems. Therapy or medication may help treat those problems that are related to diet and exercise.

“It’s difficult to make those changes and make them stick,” she said. “We join a gym but don’t stick with it. I’ve had the most success treating diabetic patients from a mental health standpoint. It’s difficult as you get older to lose weight and change habits. We have a lot of medications that can help people.”

She said that although many diabetics realize they should exercise, they don’t understand the correlation between what they eat and what they do. A leisurely stroll to the mailbox or down the block won’t torch the double latte. That’s likely more a three-hour walk.

It’s also important to increase the difficulty of exercise once the body becomes accustomed to that level and begins hoarding calories.

“No matter what it is, the body likes homeostasis,” Stacey said. “If you walk 30 minutes every day for a while, eventually it won’t make as much of difference.”

Of course, it’s better than nothing, but for weight loss, the body adapts to that level of exercise and tends to stubbornly hold onto fat stores.

With lifelong changes to diet and activity, “you can absolutely get off medication,” Stacey said. “And for prevention, with weight loss, healthy eating and exercise, I’ve seen about 60% or more in a reduction of the incidences of diabetes.”