Can You Reverse Type 2 Diabetes?

Although there's no cure for type 2 diabetes, studies show it's possible for some people to reverse it. Through diet changes and weight loss, you may be able to reach and hold normal blood sugar levels without medication.

This doesn't mean you're completely cured. Type 2 diabetes is an ongoing disease. Even if you're in remission, which means you aren't taking medication and your blood sugar levels stay in a healthy range, there's always a chance that symptoms will return. But it's possible for some people to go years without trouble controlling their glucose and the health concerns that come with diabetes.

So how can you reverse diabetes? The key seems to be weight loss. Not only can shedding pounds help you manage your diabetes, sometimes losing enough weight could help you live diabetes-free -- especially if you've only had the disease for a few years and haven't needed insulin.

Low-Calorie Diet

Several studies in England have looked at the effects of a very low-calorie diet on diabetes. Two had people follow a mostly liquid diet of 625-850 calories a day for 2-5 months, followed by a less restricted diet designed to help them keep off the weight they lost. Both studies found that nearly half the people who took part reversed their diabetes and kept their blood glucose near the normal range for at least 6 months to a year.

This type of diet is extreme. It means working with a professional and being very controlled with how many calories you eat. But the chance that it could send you into remission may give you strong motivation to stick to it.

Most of the people who reversed their type 2 diabetes lost 30 pounds or more. They also hadn't had diabetes as long as those who weren't as successful. So it's important to get started on a weight loss plan as soon as possible after you're diagnosed.

What Happens

When you have type 2 diabetes, cells that help your body control your blood sugar stop working right. Doctors used to think they were shut down for good, but research shows that certain cells may come back. People who lost weight had lower levels of fat in their liver and pancreas, and for some of them, that helped the beta cells in their pancreas that release insulin and control blood sugar start working again.

The odds of rescuing those cells are best early on. That suggests it may be better for doctors to help people lose a lot of weight after a diagnosis, rather than make small lifestyle changes and manage symptoms with medication.

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Exercise

More physical activity is a way to improve diabetes, but it may be tough to lose enough weight to go into remission with workouts alone. When combined with changes to your eating, though, exercise helps. A modest, lower-calorie diet plus a big step-up in burning calories could put you on the path to remission.

A study that had people aim for 10,000 steps a day and at least 2 1/2 hours of moderate exercise a week -- along with cutting 500-750 calories a day and following a specific insulin and medication routine -- saw more than half of them reach near-normal blood sugar without medication. Some were able to keep those levels long-term, too.

The bottom line: It's the weight loss that really matters. Exercise can help you get there, but expect to change your diet as well.

Bariatric Surgery

This type of surgery helps you lose weight by changing your stomach and digestive system to limit how much you can eat. Aside from helping you lose weight, it may help reverse diabetes in other ways, although scientists don't yet know exactly why. One theory is that it affects the hormones in your gut to help your body control blood glucose.

Researchers estimate that upwards of three-quarters of people see their diabetes reversed after bariatric surgery. Gastric bypass and gastric sleeve (also called sleeve gastrectomy) surgery have better long-term results than gastric banding.

Bariatric surgery is generally an option only when your BMI is 35 or higher. It works best for people who've had the disease for 5 years or less and don't use insulin.

If you're obese and recently diagnosed, it's something to talk about with your doctor. Because it's surgery, there are serious risks. But most people who have it done end up reversing their diabetes.

Fasting

Fasting can be a practical way to lose weight because it's fairly straightforward, but it's not a mainstream treatment for type 2 diabetes.

A very small study found therapeutic fasting -- going without food and drink with calories for a set amount of time -- can help reverse type 2 diabetes. Three people with diabetes followed a diet program of three 24-hour fasts each week for several months. They would eat only dinner on days they fasted, and lunch and dinner on days they didn't fast, focusing on low-carbohydrate meals.

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Two of the people in the study were able to stop taking all diabetes medication, and the third stopped three of his four medications. Within 1-3 weeks, all three of them could stop taking insulin. They lost between 10% and 18% of their body weight, or 20-23 pounds.

Another study showed that eating very few calories (500-600) 2 days a week and a normal diet the other days helped people with type 2 diabetes lose weight and lower their blood sugar levels just as much as limiting calories to 1,200-1,500 every day.

If you want to try fasting, you should work with your doctor so you get the right information and support to do it safely.

What Doesn't Work

When it comes to reversing diabetes, there's no magic pill. If you see a product that claims to cure diabetes or replace your prescribed diabetes medication, beware. The FDA cautions that many illegally marketed things are unproven and possibly dangerous, including:

  • Dietary supplements
  • Over-the-counter drugs
  • Alternative medicines
  • Homeopathic products
  • Prescription drugs

They found some products that claimed to be "all natural" had prescription drugs that weren't listed as ingredients. Those could change the way other medications you're taking work or cause you to take too much of a drug without realizing it.

WebMD Medical Reference Reviewed by Michael Dansinger, MD on December 18, 2018

Sources

SOURCES:

Mayo Clinic: "Type 2 diabetes: Diagnosis & treatment," "Bariatric surgery."

World Journal of Diabetes: "Reversibility of diabetes mellitus: Narrative review of the evidence."

Diabetes Care: "Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders," "How Do We Define Cure of Diabetes?" "Incidence of Remission in Adults With Type 2 Diabetes: The Diabetes & Aging Study," "Bariatric Surgery for Type 2 Diabetes Reversal: The Risks," "Type 2 Diabetes Remission Rates After Laparoscopic Gastric Bypass and Gastric Banding: Results of the Longitudinal Assessment of Bariatric Surgery Study."

The Lancet: "Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial."

Cell Metabolism: "Remission of Human Type 2 Diabetes Requires Decrease in Liver and Pancreas Fat Content but Is Dependent upon Capacity for β Cell Recovery."

Annals of Internal Medicine: "Effects of aerobic training, resistance training, or both on glycemic control in type 2 diabetes: a randomized trial."

Georgian Medical News: "Clinical Case of Type 2 Diabetes Remission."

Journal of Clinical Endocrinology & Metabolism: "Piloting a Remission Strategy in Type 2 Diabetes: Results of a Randomized Controlled Trial."

Cleveland Clinic Journal of Medicine: "Bariatric surgery for type 2 diabetes: Weighing the impact for obese patients."

Journal of Laparoendoscopic and Advanced Surgical Techniques Part A: "Obese Patients with Type 2 Diabetes: Outcomes After Laparoscopic Sleeve Gastrectomy."

Annals of Surgery: "Effect of laparoscopic Roux-en Y gastric bypass on type 2 diabetes mellitus."

BMJ: "Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin."

JAMA Network Open: "Effect of Intermittent Compared With Continuous Energy Restricted Diet on Glycemic Control in Patients With Type 2 Diabetes: A Randomized Noninferiority Trial."

FDA: "Beware of Illegally Marketed Diabetes Treatments."

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