Up to 90 per cent of people with diabetes have type 2 diabetes, a condition that causes a person's blood sugar level to become too high. But can you reverse it? We speak to family GP Dr Roger Henderson about how you can learn to manage the condition:
What is type 2 diabetes?
There has been much written in the news recently about the possibility of people being able to 'reverse' their diabetes by using certain diets, but before looking at whether this is or is not possible it's important to understand exactly what diabetes is in the first place. This is a condition where the blood sugar level is higher than normal.
There are two main types of diabetes:
- Type 1 diabetes: Type 1 diabetes (also called insulin-dependent diabetes) is usually seen in young people
- Type 2 diabetes: Type 2 diabetes (usually non insulin-dependent diabetes) tends to affect adults over 40 and overweight people.
💡 Other types of diabetes include gestational diabetes that is only associated with pregnancy, and secondary diabetes where the diabetes is caused by other conditions (eg inflammation of the pancreas) or by certain medications such as steroids.
Insulin is a hormone produced by the pancreas gland in the abdomen, and this controls the use of glucose (sugar) within the body. The blood sugar level will rise if the pancreas produces little or no insulin (Type 1 diabetes), or if the pancreas produces insulin, but it's inadequate for the body's needs and its effectiveness is reduced (Type 2 diabetes).
Type 2 diabetes is undoubtedly related to factors associated with a Western lifestyle, since it's most common in people who are overweight and who don't get enough exercise.
Symptoms of diabetes
Typical symptoms of diabetes include:
- Increased thirst.
- Frequent urination.
- Weight loss, although appetite often increases (especially in Type 1 diabetes).
- Itchiness, especially around the genitals.
- Recurrent infections on the skin, such as boils.
How diabetes can be managed
Diabetes is treated in two ways: a combination of healthy diet and exercise, and/or medication using tablets or insulin injections. A well-balanced diet low in sugar is best but calorie intake and watching your weight is still vital.
There are different types of tablets used for treating Type 2 diabetes. Some of these increase the amount of insulin secreted by the pancreas.
Some increase the action of insulin in the body and others delay the absorption of glucose from the digestive system.
Treatment for diabetes depends on the individual and so is tailored for each person with diabetes. Insulin injections are used in Type 1 diabetes and in some cases of Type 2, and increase the amount of insulin in your body and so bring down the blood sugar level.
What about the long-term prospects?
In the long-term, diabetes is best monitored through routine check-ups by your doctor and/or annual check-ups at the hospital on an outpatient basis. Monitoring your blood sugar levels is a vital part of treatment, especially in Type 1 diabetes where levels can change markedly.
This can be done easily at home with a small blood glucose metre, and depending on the reading, you may need to adjust your diet, the amount you exercise or your insulin intake. Their purpose is to determine if treatment is satisfactory and to look out for any evidence of longer-term complications such as eye or kidney disease.
The importance of glucose control
Recent studies have shown that strict glucose control can significantly reduce or even stop complications developing in the future, so this means keeping the blood sugar level as close to normal as possible.
These studies have also confirmed the need for people with diabetes to reduce their risk of atherosclerosis (fatty deposits in your arteries), because if you have Type 2 diabetes, you have a four to five times greater risk of developing serious problems with your circulation that can lead to a heart attack or a stroke.
How to reduce your risk
Ways of reducing your risk of developing Type 2 diabetes include:
✔️ Stop smoking! Head over to our quit smoking section for tips.
✔️ Research: Be aware of the symptoms of diabetes if you have a history of it in your family.
✔️ Diet: Cut refined sugar out of your diet.
✔️ Blood pressure check: Have your blood pressure checked regularly and treated if it is high.
✔️ Cholesterol level check: Know what your cholesterol level is and reduce this if it is high by eating a low-fat diet.
✔️ Lose weight: If you are overweight or obese, now is the time to lose weight. This is the single biggest way of reducing your risk of developing diabetes. Waist circumference is particularly important here as a waist size greater than 89cm in women and 102cm in men significantly increases the risk of developing diabetes.
Can diabetes be reversed?
So, is it actually possible to 'reverse' diabetes? (And by this, most doctors mean achieving a very significant improvement in long-term insulin sensitivity). Well, not if you have Type 1 – you will need insulin for life.
However, some early studies do suggest that in Type 2 diabetes, sticking to a diet known as a VLC (very low calorie) diet can achieve significant weight loss, reduce insulin resistance and allow people with Type 2 diabetes to reduce or even come off diabetes medication altogether.
What is a very low calorie diet?
This is most definitely not for the faint-hearted as it involves sticking rigidly to a 800kcal/day diet where 600 calories are made up from meal shakes and the rest from non-starchy vegetables. This is a punishing regimen and an extreme form of dieting and should never be considered without seeking medical advice first. It is also virtually impossible to continue long-term over months or years.
💡 One Newcastle study used MRI scans in people on these diets and found that the apparent reversal in their diabetes and improved diabetic control appeared to be linked to significant reductions in fat storage within the liver and pancreas.
My own view is that rather than go onto such an extreme diet, by reducing your calorie intake to 1200-1500 kcals/day along with at least 175 minutes per week of aerobic exercise you should lose weight and in doing so either slow or stop progression of Type 2 diabetes.
Maintaining a healthy weight
As many people find out however, even if they are able to reduce or come off their medication altogether if they lose enough weight, if they put those pounds back on again then their diabetes control worsens and medication needs to be started again. Results are also usually best in people who lose the most weight or who have mild or newly diagnosed diabetes.
The basic facts remain with Type 2 diabetes – overweight is bad, normal weight is better.
A lifelong commitment to a healthy lifestyle can be more effective than medication in many people with this problem but this is often very hard for people to do, or to stick with.