The good news though is that this can be delayed, and we can do something about preventing and managing the early stages of diabetes through simple lifestyle modifications, and the body will remember these efforts if they can be maintained early in the diagnosis and for as long as possible. This in turn will delay the progression of diabetes and development of diabetes complications.
Ordinary calorie restriction through any diet can lead to weight loss and make it easier to manage blood sugar. Intermittent fasting is thought to go a step further by lowering serum insulin, which triggers the body to burn stored sugar, called glycogen, along with fat, in the absence of glucose from food, Dr. Fung says. These processes (called glycogenolysis and lipolysis, respectively) can temporarily lower blood sugar and cause weight loss.
I’m glad you talk about personal tolerance. My doc wants me to go on a ketogenic diet, but even when on the Autoimmune Paleo Diet, my adrenals would go a bit nuts. I can’t go any longer than 6 hours without food overnight…my adrenals start pumping out the adrenalin after about 3 to 6 hours of sleep (no matter what I eat or don’t eat before bed) and I wake up with anxiety. Adding a bit of carbs (3/4 cup at dinner and 1/2 cup at lunch) has allowed me to go a full 6 hours (would love 7 or 8) but it still feels terrible when I wake up.
According to a review of clinical trials published in December 2014 in JAMA Surgery, people with diabetes who underwent bariatric surgery had greater weight loss than those who received nonsurgical treatment, and the surgery was more effective in helping obese participants get diabetes under control. An article on the notable Surgical Treatment and Medications Potentially Eradicate Diabetes Efficiently trial, which was published in February 2017 in the New England Journal of Medicine, suggests that gastric bypass surgery and sleeve gastrectomy helped people with diabetes attain better glycemic control than medication alone. Compared with the medication-only group, people who underwent the surgeries also saw greater reductions in heart disease risk and medication use, as well as an improved quality of life.
Studies conducted in the United States and Europe showed that drivers with type 1 diabetes had twice as many collisions as their non-diabetic spouses, demonstrating the increased risk of driving collisions in the type 1 diabetes population. Diabetes can compromise driving safety in several ways. First, long-term complications of diabetes can interfere with the safe operation of a vehicle. For example, diabetic retinopathy (loss of peripheral vision or visual acuity), or peripheral neuropathy (loss of feeling in the feet) can impair a driver’s ability to read street signs, control the speed of the vehicle, apply appropriate pressure to the brakes, etc.
Storage of liver fat can only occur when daily calorie intake exceeds expenditure. Sucrose overfeeding for 3 weeks has been shown to cause a 30% increase in liver fat content (37). The associated metabolic stress on hepatocytes was reflected by a simultaneous 30% rise in serum alanine aminotransferase (ALT) levels, and both liver fat and serum ALT returned to normal levels during a subsequent hypocaloric diet. Superimposed upon a positive calorie balance, the extent of portal vein hyperinsulinemia determines how rapidly conversion of excess sugars to fatty acid occurs in the liver. In groups of both obese and nonobese subjects, it was found that those with higher plasma insulin levels have markedly increased rates of hepatic de novo lipogenesis (2,38,39). Conversely, in type 1 diabetes the relatively low insulin concentration in the portal vein (as a consequence of insulin injection into subcutaneous tissue) is associated with subnormal liver fat content (40). Initiation of subcutaneous insulin therapy in type 2 diabetes brings about a decrease in portal insulin delivery by suppression of pancreatic insulin secretion and, hence, a decrease in liver fat (41). Hypocaloric diet (42), physical activity (43), or thiazolidinedione use (23,44) each reduces insulin secretion and decreases liver fat content. Newly synthesized triacylglycerol in the liver will be either oxidized, exported, or stored as hepatic triacylglycerol. Because transport of fatty acid into mitochondria for oxidation is inhibited by the malonyl-CoA produced during de novo lipogenesis, newly synthesized triacylglycerol is preferentially directed toward storage or export. Hence, hepatic fat content and plasma VLDL triacylglycerol levels are increased.
When stress occurs, whatever the source, the hypothalamus signals the adrenals to release cortisol (and adrenaline). These hormones are life-saving in true “fight or flight” situations like running away from a charging animal or hoisting a car off a small child, but they cause big problems when they are regularly produced in excess. Excess cortisol can contribute to hormone imbalance in the body since the body uses hormones like progesterone to manufacture cortisol. Excess cortisol absent of a charging animal can also interfere with the body’s ability to regulate blood sugar, reduce fat burning ability, raise insulin, suppress thyroid function and cause gain in belly fat.
“Decreasing caloric intake for any reason brings with it a rapid improvement in glucose control,” said Dr. Robert Lash, the chairman of the Endocrine Society’s clinical affairs committee and a professor of internal medicine at the University of Michigan. “What’s exciting here is that the improvements in glucose control persisted when the participants went back to eating a diet with a normal number of calories.”
Green tea contains the bioflavinoid epigallocatechin gallate (EGCG), which has been shown to be a safe and effective antioxidant. In a study in Japan, green tea was shown to reduce the risk for Type 2 Diabetes Mellitus onset. It has been shown to improve glucose tolerance in patients, and decrease blood sugar production and over-secretion in Type 2 Diabetes Mellitus patients. Green tea has also been shown to have an effective anti-angiogenesis factor, that is, it reduces problematic overgrowth of blood vessels, which may have a significant effect on preventing diabetic retinopathy. It has also been shown to promote fat oxidation and thermogenesis. Last, green tea can provide antioxidant protection for the pancreas and the fatty liver. A good dose is 200 to 400 mg a day. It’s also beneficial to drink organic green tea.
The accepted view has been that the β-cell dysfunction of established diabetes progresses inexorably (79,82,83), whereas insulin resistance can be modified at least to some extent. However, it is now clear that the β-cell defect, not solely hepatic insulin resistance, may be reversible by weight loss at least early in the course of type 2 diabetes (21,84). The low insulin sensitivity of muscle tissue does not change materially either during the onset of diabetes or during subsequent reversal. Overall, the information on the inhibitory effects of excess fat on β-cell function and apoptosis permits a new understanding of the etiology and time course of type 2 diabetes.
Mr. Tutty said he jumped at the chance, becoming one of 30 men and women ages 25 to 80 to sign up. Mr. Tutty was one of 13 participants whose fasting plasma glucose dropped, and during the six-month follow-up remained below the seven millimole per liter (or 126 milligrams per deciliter) that defines diabetes. Although Mr. Tutty completed the study nearly three years ago, his fasting blood sugars continue to range from 5.2 to 5.6 mmol/L, he said.
“I have many ways to help patients manage diabetes, but it’s very hard to reverse,” says Dr. Rita Louard, director of the Clinical Diabetes Program at Montefiore Health System in Bronx, New York. Still, some diabetes experts will use the word “reverse” when talking about this topic, Louard says, acknowledging the controversy that exists when discussing diabetes reversal.
Other medications such as metformin or the DPP4 drug class are weight neutral. While this won’t make things worse, they won’t make things better either. Since weight loss is the key to reversing type 2 diabetes, medications won’t make things better. Medications make blood sugars (the symptom) better, but not the diabetes (the actual disease). We’ve been pretending that the symptom is the disease.We can pretend the disease is better, but that doesn’t make it true. That’s the reason most doctors think type 2 diabetes a chronic and progressive disease. We’ve been using the wrong treatment. We’ve been prescribing drugs for a dietary disease. No wonder it doesn’t work.
Implementing integrative and functional medical nutrition therapy, I helped the patient understand that she could reverse the trajectory she was on by making lifestyle changes—and that’s what she did. We engaged in shared decision making in our ongoing nutrition consultations. Over the course of one year, her physiology and health status changed for the better. Her A1c dropped from 7.2% to 5.6%, and she no longer required medications. She continues to adhere to her new lifestyle program and is confident she’ll remain free of a diabetes diagnosis.
Many manufacturers offer pen delivery systems. Such systems resemble the ink cartridge in a fountain pen. A small, pen-sized device holds an insulin cartridge (usually containing 300 units). Cartridges are available for the most widely used insulin formulations. The amount of insulin to be injected is dialed in, by turning the bottom of the pen until the required number of units is seen in the dose-viewing window. The tip of the pen consists of a needle that is replaced with each injection. A release mechanism allows the needle to penetrate just under the skin and deliver the required amount of insulin.