You see it everywhere. On tabloids in checkout lines, on magazine stands, and in who knows how many messages in your email SPAM folder.
Headlines that claim easy ways to reverse or even cure diabetes. But Is it possible? Can diabetes be cured or reversed?
Short story – nope. But like many things with diabetes, there’s so much more to talk about on this topic.
First things first
First, it’s important to know there are multiple types of diabetes, and the differences between type 1 and type 2 are important for this conversation. In a nutshell, type 1 diabetes is an autoimmune condition and insulin is required. Full stop.
With type 2 diabetes, at least at first, insulin is being produced but the body can’t use it properly.
Causes for both are not well understood yet. Not everyone with the genetic makeup/antibodies for type 1 diabetes actually develops type 1 diabetes. So what triggers the autoimmune attack in type 1 diabetes? Nobody knows for sure.
Likewise, popular opinion says that type 2 diabetes is all about lifestyle and weight. That is part of the puzzle, but it’s much more complicated than that. Otherwise, every overweight person would also have type 2 diabetes, and that’s not the case.
A matter of definitions
For many, type 2 diabetes can be managed with diet and exercise. Sometimes that works well enough to eliminate any additional medication or other treatments. But is that a cure?
What happens if the exercise stops or the diet goes back to what it was before? In almost all cases, blood sugars will be high again and something needs to be done. We can’t call that a cure.
What about reversing diabetes? Or having your diabetes in remission? Those words still feel strange to me somehow.
The point of well-managed diabetes is great blood sugar numbers. If you check your blood sugar or get normal lab results, you’re doing a great job! You’re making choices to manage your weight and/or blood sugar – which is a form of treatment, isn’t it?
With luck, you’ll reach a point where those choices become solid habits and you don’t think about it much anymore. Congratulations on being so well-managed that it doesn’t use up much of your time and energy! That’s great!
Joslin Diabetes Center attacks this issue head-on.
There is no cure for diabetes. Neither type 1 diabetes or type 2 diabetes ever goes away.
Patients diagnosed with type 2 diabetes may discover that if they are overweight at diagnosis and then lose weight and begin regular physical activity, their blood glucose returns to normal. Does this mean diabetes has disappeared? No. The development of type 2 diabetes is a gradual process, too, in which the body becomes unable to produce enough insulin for its needs and/or the body's cells become resistant to insulin's effects. Gradually the patient goes from having "impaired glucose tolerance" — a decreased but still adequate ability to convert food into energy — to having "diabetes." If the patient were to gain weight back or scale back on their physical activity program, high blood glucose would return. If they were to overeat at a meal, their blood glucose probably would continue to go higher than someone without diabetes. Also, the decreased insulin production and/or increased insulin resistance that led to the initial diabetes diagnosis will gradually intensify over the years and during periods of stress. In time, the patient who could maintain normal blood glucose with diet and exercise alone may discover that he or she needs to add oral diabetes medications — or perhaps even insulin injections — to keep blood glucose in a healthy range.
The section on weight loss surgery and then the section on diet, exercise, and weight loss are both interesting and worth reading. Note that the article does use a few terms I don’t agree with (remission, relapse, etc.) but choose to look past in this case.
What about transplants and the like?
Some people with diabetes (usually type 1) have transplant-type treatments (islet cell transplants or pancreas transplants) which can be very effective at managing blood sugars for long periods of time. However, these treatments carry their own sets of risks and drawbacks, such as the need to take immunosuppressant drugs for the transplants.
Many people opt for these treatments because they are dealing with disruptive complications from diabetes. As such, for them, the drawbacks of doing some sort of transplant are less than the disruption of not doing it.
But that’s not usually the case for most people living with diabetes. What’s the saying, the devil you know vs. the devil you don’t? Not to mention the limited supply of donor pancreases and islet cells.
Also, some people with diabetes who need a kidney transplant opt to include a pancreas as well (if a matching donor organ can be found). That makes sense - the need for immunosuppressant meds doesn’t change and the surgery is already happening, so why not?
Whatever your treatment is
If you’ve found a way to manage your blood sugars, that’s the most important thing. Don’t change what ain’t broken! Call it whatever you want at that point as long as you stay on track.
But what about you?
How do YOU feel about this topic? What words do you use and why?