Is it possible to reverse diabetes?

Glucose, a type of natural sugar, is absorbed from the food we consume, after which it enters the blood. Insulin, a hormone secreted by the pancreas helps push glucose in to body-cells which then convert this glucose into energy. Diabetes is a condition in which the pancreas is not able to produce enough insulin to utilize the blood-sugar (type-1 diabetes), or the insulin produced is not utilized efficiently by the body for energy conversion (type-2 diabetes).

What is HbA1C?

Glycated haemoglobin or Glycohemoglobin (chemically indicated as HbA1c, HgbA1C, Hb1C or just A1C) is a form of haemoglobin that is linked to blood-sugar chemically. Compared to galactose and fructose, which are other forms of natural sugar, glucose does not bond with haemoglobin spontaneously. When such bonds are found in the blood, it is an indication that there is excess blood-sugar. That is why, it is used as a metric to measure the extent of diabetes in a person. A person is said to have diabetes when his A1C level is 6.5% or more. He/she is said to be normal, when these levels are below 5.7%, while 5.7% to 6.4% indicates prediabetes.

Types of diabetes

Diabetes reversal is a worthwhile goal for all diabetics. However, before we understand how to achieve diabetes reversal, we must be familiar with the types of diabetes. That will indicate whether the diabetes is reversable or not.

• Type 1 diabetes is an auto-immune disorder in which the body doesn’t make insulin. The body’s immune system for no reason starts attacking and killing the cells in the pancreas that make insulin. While this is diagnosed at a young age, it can develop at any age, and such patients must take insulin every day. Type-1 diabetes cannot be reversed.
• LADA (Latent Autoimmune diabetes of Adulthood): Similar to type-1 diabetes, but this progresses slowly compared to type-1. Cannot be reversed.
• Genetic diabetes: Another irreversible kind of diabetes.
• Pancreatic diabetes: Here, the pancreas is damaged because of years of alcohol abuse or some genetic abnormality. Cannot be reversed.
• Gestational diabetes: Some pregnant women develop this condition which goes away upon childbirth. However, such women are at higher risk of type-2 diabetes later in life.
• Type 2 diabetes: The most common form of diabetes. Here, the body doesn’t make or use insulin well, and is said to be ‘insulin-resistant’. This can be diagnosed at any age, however, its more common in middle-aged and older adults, hence called age-related diabetes. This is the only form of diabetes that can be reversed.

Health risks from high insulin levels

High blood-sugar has the effect of raising insulin levels in the body. High insulin levels in the body are not good in the long-term as it has the following consequences:

• Significantly increases the risk for type-2 diabetes
• It leads to salt retention and water retention, both of which raise blood pressure
• It increases the risk of atherosclerosis or clogged arteries, which raises the risk for heart attacks
• It increases very-low-density-lipoprotein, or VLDL, a type of blood fat and one of the types of bad cholesterol, which raises the risk for heart disease, heart attacks and stroke.
• Encourages the development of certain types of cancers
• In women, it causes the ovaries to produce excess testosterone, which raises the risk for polycystic ovarian syndrome/disease (PCOS/PCOD).

What is Diabetes Reversal?

With drastic changes in lifestyle in the last couple of decades, there is a global surge in the number of type-2 diabetes cases, creating a pandemic of sorts. While newer forms of treatment are emerging, Diabetes Reversal has also come to the fore. This is a program that initiates the person into several lifestyle changes that help achieve reversal of the condition. These changes must be maintained for the rest of one’s life, with or without a physician’s supervision.

The person is said to have achieved diabetes reversal, or ‘remission’ when his/her A1c level is below 48 mmol/mol, or less than 6.5% for 3 months or more, without taking medication and/or without taking insulin, in this period.

However, diabetes remission does not mean that diabetes has gone away for good. The person must maintain lifestyle changes for the rest of his/her life and constantly check his/her blood-glucose levels. In case of any rise in these levels, appropriate treatment must be taken in consultation with a general physician or diabetologist.

How is Diabetes Reversal achieved?

Obesity or being overweight is one of the most significant risk-factors for developing and sustaining diabetes. This automatically implies, diabetes reversal must be focused on reducing and maintaining the person’s weight above all. This is done through a combination of correct diet and regular exercise. Other measures include improving nutrition and mental health as these affect the overall health of the person which in turn either aids in, or prevents successful reversal.

Accordingly, all Diabetes Reversal programs include the following:

1. Weight-loss through natural means

• Weight-loss is achieved through a combination of calorie restriction and regular exercise. Calorie restriction implies that the person consumes slightly lesser quantity of food than previously, and also eats more often as against 3 large meals in a day.
• The person must consume nearly half of his/her food in the form of fresh fruits and vegetables, a quarter from proteins (lentils, beans and pulses, low diary and lean meat), and a quarter of healthy fats such as olive oil, almond oil, ghee and groundnut oil.
• Refined oils and refined flours must be avoided. Whole-grains like wheat, brown rice and millets are preferred over white rice and maida (refined wheat-flour) as the latter can spike blood-sugar levels quickly.
• Exercise is very important to reduce and maintain the weight. The person must do cardiovascular exercises (treadmill, brisk walking, swimming), yoga and weight-training to reduce fat levels in the body, and increase muscle mass which helps burn blood-sugar rapidly.
• Also, when fat levels in the body are high, the liver and pancreas are coated in fat which reduces their performance. Once these fat layers are melted down and eliminated from the body, these organs perform more efficiently. Production of Insulin and all other hormones get regulated.

2. Weight-loss through surgery

In some obese people (Body-Mass Index or BMI higher than 35), or those suffering from sleep apnea, high BP and high cholesterol levels in the body, diet and exercise alone are not enough to achieve weight-loss. Such people will require surgical procedures such as stomach stapling or bariatric surgery that either help reduce food consumption or suck out excess fat from the body. There are various types of bariatric surgery such as gastric bypass, gastric sleeve and gastric banding.

3. Healthy diet

A diet low in salt, sugar and fat help prevent blood pressure spikes, blood-sugar spikes and weight-gain. Further, a wide range of fresh fruits and vegetables along with whole grains and healthy fats provide the required nutrition for the body. Accordingly, there are some guidelines.

• The following must be avoided as much as possible: White bread or anything made from refined wheat-flour (such as cakes, biscuits, pasta, naan, bathura), white rice, sweetened yogurt, sweetened breakfast cereals, fruit juices with added sugar, snacks with added salt and sugary beverages.
• Healthy fats like ghee, almond oil, olive oil and peanut oil should be consumed, but in moderation, as excess of them will lead to weight-gain.
• While exercising, its good to eat a small snack like a protein bar, or peanut chikki, to prevent a drop in blood-sugar.
• Fresh fruits and vegetables that contain a lot of fibre are good for the gut bacteria which aid in digestion (which prevents weight-gain) and also mental health.

4. Medication

Some patients may also require medication once in a while and these will be prescribed by the doctor. Metformin, a drug given to people with prediabetes to prevent them from developing the condition is also given to achieve reversal. GLP-1 agonists and SGLT-2 inhibitors are 2 classes of medicines that are given to achieve better blood-sugar control and prevent weight-gain. Qysmia (phentermine and topiramate) is a drug given to people with high BMI, as it helps reduce appetite and hence calorific intake.

5. Sleep

There is a strong link between sleep and good metabolism, proper digestion, energy levels and weight-loss. So diabetics should ensure 7 to 7.5 hours of sleep on normal days and more on stressed days. This is a sure aid in diabetes reversal.

6. Mental Health

Diabetics are more prone to depression and anxiety. To prevent these and to manage stress better, the person must indulge in their favourite hobbies, or do Yoga and meditation every now and then. Travel and spending time with friends and family also achieve the same effect.

Outlook

The simple answer to the question – can diabetes be reversed – is yes. But one must realize that diabetes reversal is not a short-term treatment program. Its about lifestyle changes that must be maintained for the rest of one’s life. This may seem like several compromises in your life but the overall health benefits are tremendous and outweigh what all you must give up for the same.

If you or any of your dear ones are suffering from diabetes, consult a reputed hospital. A qualified diabetologist will educate you about diabetes reversal and initiate a reversal program for you at the earliest, with expert supervision.

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Reviewed by Dr Suresh S Venkita, Group Medical Director, Kauvery Hospitals

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Kauvery Hospital is globally known for its multidisciplinary services at all its Centers of Excellence, and for its comprehensive, Avant-Grade technology, especially in diagnostics and remedial care in heart diseases, transplantation, vascular and neurosciences medicine. Located in the heart of Trichy (Tennur, Royal Road and Alexandria Road (Cantonment), Chennai, Hosur, Salem, Tirunelveli and Bengaluru, the hospital also renders adult and pediatric trauma care.

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