Can Type 2 Diabetes Really Be Reversed?

0:00
Welcome to the Diabetes Digital Podcast.

I’m Wendy.

And I’m Jess, and we’re best friends, registered dietitians and diabetes educators.

Through our telehealth platform, Diabetes digital.co, we offer accessible and personalized virtual nutrition counseling for people with diabetes and pre diabetes.

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Visit diabetesdigital.co That’s Co to book your first appointment.

We accept insurance and offer affordable self pay options.

Now let’s get into today’s episode.

Welcome back to another episode of the Diabetes Digital Podcast presented by Food Heaven.

0:35
And today we are addressing a hot topic in the world of diabetes, which is, can type 2 diabetes be reversed?

We have so many patients in the past who have said they want to reverse their diabetes or cure their diabetes, and there are a lot of books and programs.

0:54
My mom even keeps sending me them on the Internet that talk about diabetes reversal and it implies that diabetes can be reversed.

But is that something that is actually true?

So we’re going to get into all of that today.

But first, our disclaimer that this podcast is for informational purposes only and should not be considered a substitute for medical advice.

1:15
Yep.

So let’s start by defining reversal versus remission because there’s a very important difference.

Reversal would mean that the diabetes is completely gone.

It’s like you never had it.

While remission is defined as a reduction of the seriousness or intensity of the disease, and it can also be referred to as a temporary recovery, It’s important to go over the difference first between pre diabetes and diabetes because that distinction is really what’s going to break the answer of this whole reversal question.

1:52
So pre diabetes, it’s the precursor to diabetes.

It’s almost like a warning sign in the blood work that shows that there’s something happening where your body is not able to metabolize blood sugars normally.

It also shows that blood sugar management strategies should be implemented, IE nutrition movement, stress reduction.

2:17
These things should be implemented to try to prevent the advancement of pre diabetes into type 2 diabetes.

OK.

So let’s get into the numbers of it all.

Last week, we talked about A1C or hemoglobin A1C, which is a measure of your average blood glucose over three months.

2:34
And if anybody has an A1C of 6.5% or higher, they are considered to have diabetes.

So A1C of 6.5% or higher is in a diabetes range.

Now for those who are wondering, OK well what is pre diabetes?

2:51
So pre diabetes is anything between 5.7 and 6.4%.

And then normal quote UN quote normal or like out of risk for pre diabetes diabetes is anything under 5.7.

3:07
So your A1C may be 5.3 or 5.4 or 5.6.

OK, so now to answer the big question of the day, and I don’t want to be a killjoy, but despite what you may see online, type 2 diabetes cannot be reversed.

3:24
I repeat, type 2 diabetes cannot be reversed.

However, having said that, it can be managed well and put into remission.

So let’s talk about exactly what we mean by that.

So let’s say your A1C is below 6.5% and you’re not taking any medications and you may be thinking, well, I obviously reversed my diabetes because my A1C is no longer within the diabetes range.

3:48
But the reason we would use the term remission over reversal is because technically you have been diagnosed with type 2 diabetes, which indicates your body has had challenges regulating blood sugars in the past.

So even though your A1C may have gone down, and it may be 6.4 or 5.9 because you have been diagnosed with diabetes in the past, you technically still have diabetes, but it can be in remission and you cannot have any symptoms or complications of diabetes.

4:20
And that is the goal for so many folks.

Yeah.

And one of the most important reasons for this is age, because as people get older, the function of the pancreas, it tends to go down.

This is absolutely normal.

4:36
So whether you have diabetes, you don’t have diabetes or organs, they just don’t work as effectively as we get older.

It’s just something that happens in the body.

So if you’ve already been shown to have blood sugar dysregulation, it’s likely that as you get older, the problem might come up again.

4:57
We definitely want to avoid terms like cure.

There’s definitely a place for remission when it comes to type 2 diabetes.

But with cure, which is something that’s commonly used in like the world of diabetes, it’s problematic because it suggests that all aspects of the condition are now normal and that you don’t need any clinical follow up.

5:18
You don’t need management.

You don’t have to look out for, like those risks that are associated with type 2 diabetes.

And if you’ve been diagnosed in the past, you have to stay on top of your blood work because at any given moment it could come back up because you’ve been shown to have some issues in the past.

5:35
So I would recommend blood work twice a year just to be on the safe side, but at least annually you want to make sure that you know you’re getting your work up done.

If you’ve had pre diabetes as well.

These are just things that you want to be on top of because you are at a higher risk for spiking back up again.

5:54
So as we mentioned, you cannot reverse diabetes and although we don’t use that term reversal for diabetes, we do use it for pre diabetes.

So just to give you a little more data on pre diabetes, so from 2017 to 2020 and for US adults 18 and older, 38% of all US adults had pre diabetes based on their fasting glucose or their A1C level.

6:21
Also this doesn’t account for those who didn’t get tested for pre diabetes and only found out something was wrong with their A1C when it was in the diabetic range.

And this happens all of the time and I think you know especially Wendy and I who have worked with a lot of patients with diabetes, they never knew and maybe the doctor just didn’t tell them.

6:40
And so that’s why it’s really important for us to advocate for ourselves to get this information so that we can potentially make some lifestyle changes before we get into the diabetes range.

But just kind of wrapping up that point, while you can’t go from diabetes to not having diabetes or reversing diabetes, you can say that you reverse your pre diabetes.

7:01
So it’s a little different between the two.

Yeah.

And these are controversial topics in the world’s of diabetes.

I think that like the regulating boards, they’ve kind of struggled with like what the proper terms are and it’s still all out for debate.

7:18
So you know, this might change in the future, but we’re going more so with like what the established guidelines and recommendations are for terminology.

So just want to don’t come for us, please.

Because it’s just like.

We didn’t write the rules, and I’m sure there’s a lot of interpretations of all of these things.

7:37
And we’re just doing our best to share what we know.

And hopefully this is helpful.

And I also will say that for me, whenever I see a organization or some course and it claims to cure diabetes, that is always a red flag for me.

7:55
And so maybe that’s the point of this episode is if you do have diabetes and you’re seeing these platforms claiming to cure it, know that like technically you can’t reverse diabetes.

And so that should maybe be a red flag.

Yeah.

Part of the reason why people are drawn to those things is because there’s so much stigma around a diabetes diagnosis.

8:16
And like I think we really have to look beyond that stigma and shame that comes with having the label diabetes attached to like your identity.

Because you know, the the truth is that as we get older, we start having different types of issues and some are stigmatized more than others.

8:36
But diabetes is another chronic condition that can happen to anyone and can be treated with so many different types of interventions.

I think maybe part of the reason why people might be drawn to like cure reversal is because they really want to disassociate from having that condition attached to them.

8:55
But so many people have pre diabetes and diabetes especially at this point we said like close to 50% in the US there’s no reason to feel ashamed at all.

It’s just such a complicated condition and it can happen to anyone.

So just want to put that out there and we spoke about this in our previous episode, but you know just in terms of how pre diabetes and diabetes would be diagnosed, there’s the A1C test which is very popular.

9:18
If the A1C is coming out over 6.4% that’s going to usually result in a diabetes diagnosis.

There’s also the fasting glucose test which if it’s over 125 that might indicate that you have diabetes, There’s oral glucose tolerance.

9:35
So there’s different, you know, types of tests that can be used in medical settings and you would want to talk to your provider to see you know what the right combination of test is for you.

Yes, and just because type 2 diabetes can’t be reversed, that does not mean it cannot be managed really, really well.

9:53
It is still totally possible to live a full life, even when adding blood sugar management techniques, which often times are just overall health promoting behaviors.

Yes.

And nutrition is such a huge component.

And I mean, of course, we’re going to say that as dietitians, but really like nutrition is going to have a huge impact on your blood sugars.

10:15
And one of our favorite tools is the My Plate method.

We’ve spoken about this method so much on the Food Heaven podcast, which is a previous podcast.

And we want to talk about it today because it’s really going to help you with planning out what a balance plate is going to look like.

10:32
And in thinking about macro nutrients, which are carbs, protein, fats, we want to try to have a balance of all of those for blood sugar management.

Because typically what we hear is, and you don’t hear this from dietitians, but you hear this from like health coaches or like people that don’t have a formal education, nutrition.

10:53
They’re like, oh, eliminate the carbs.

You should cut out the carbs, all carbs, including complex carbs, nutritious carbs, cut them out and it’s going to help your diabetes.

And a lot of people come to us thinking and that’s what they should be doing and you actually should be doing the opposite.

We want you to include carbohydrates into your meals.

11:11
It’s just trying to be a little more strategic about the types of carbs that you are including.

Trying to include carbs that are high in fiber that are going to have vitamins and minerals that have a very rich nutrient profile.

And then balancing those out with protein, with fat, with other types of fiber, you know, vegetables and things like that so that your blood sugars are a little more stable.

11:34
And with the My Plate method, just to give you all like a visual, it recommends having half of your plate be non starchy vegetables.

So that would be, you know, broccoli, kale, spinach, eggplant, okra, you know whatever.

11:50
It could be cooked or raw, it doesn’t really matter.

And then 1/4 eco parts protein and carb, there’s flexibility in that.

Some people find that they feel better adding a little more protein than carb.

Some people find that they have to have like a consistent amount of carbs, especially if they’re on like insulin, for example, because it just helps them keep their blood sugars more stable throughout the day.

12:12
It’s flexible.

Some people might kind of play with their portions, whether it’s for lunch or dinner, depending on what their needs are.

So you can play around with it, But that’s kind of like the general guideline with yes.

And in addition to nutrition, sometimes people might need to lean on medications.

12:28
And we also want to reduce stigma around medications because there’s a fear.

And especially in communities of color because we all maybe had a relative who we saw struggling with diabetes or maybe there was an amputation.

And often times people might associate a person getting on insulin with having all of these different problems or getting an amputation.

12:51
But insulin is not going to be causing harm in these instances.

It’s going to be something that is needed in order to help manage blood sugar levels.

And so there could be other factors at play, right.

So I just want to point that out that sometimes we need medication and it’s a life saving and we should take it and kind of you know follow the advice of your healthcare team.

13:13
So it’s really important to meet with your team regularly and to make sure that the management practices you put in place are working.

And this will likely include a primary care doctor, a dietician, an eye doctor and a podiatrist at minimum.

Often times there may be more like we mentioned possibly kidney doctor.

13:31
And so we want to monitor those blood sugar levels regularly and have checkups to get that guidance and support and to monitor progress whether it’s with your diabetes or with your pre diabetes.

Absolutely.

And not everyone is going to start on insulin.

If you have type one diabetes, yes, you will start on insulin.

13:49
Sometimes.

If you have gestational diabetes or other different types, you might as well.

But often times, people with type 2 will start on a medication called metformin, which can improve insulin sensitivity and lower blood glucose levels over time.

So it’s important to note that medication shouldn’t be considered a substitute for lifestyle changes, but a complementary approach when appropriate.

14:12
Yep, absolutely.

And other complementary things that you can do include stress management.

We’ve spoken about the impact that stress can have on your blood sugar.

So really trying to find different techniques that will help you reduce stress, whether it’s breathing, stretching, talking to your loved ones, you know, like whatever helps.

14:31
Sometimes talking to your loved ones makes you more stressed out.

Just try to tap into whatever works to try to get your stress levels down.

Sleep is also huge.

It has a big role with blood sugar regulation.

So similar to stress, you know when you’re not getting enough sleep, it becomes harder on the body to regulate blood sugar.

14:52
Your stress hormones go up and you know this can wreak havoc on the body, not just for diabetes, but just your overall health.

So aim for 7:00 to 9:00 hours of uninterrupted sleep each night.

Try to get you know that optimal temperature going.

I believe it’s around like 60 to 65°.

15:11
But you know, also doing things like the blackout curtains, getting an eye mask, like all those small things can help with just getting better sleep.

And then lastly, just want to mention movement, it’s so, so, so important for managing your blood sugar levels.

15:27
It helps with insulin sensitivity.

And really ask yourself like what is it that you enjoy?

Because you know for a lot of people like the gym is not really their jam.

So if you enjoy walking, you enjoy boxing, you enjoy dancing, Like, just think about what you actually actually enjoy doing and go with that.

15:45
Because if you’re forcing yourself to do something because you want to lose weight or because you’re trying to get your blood sugars down, the likelihood of you sticking to that is not going to be so high long term.

And the recommendation is 150 minutes a week.

So I mean that adds up to maybe like 30 minutes a day for five days.

16:04
So try to incorporate some movement into your day.

Now to wrap it all up, while diabetes cannot be entirely reversed, remission is possible with the right support and sometimes the right team by your side.

Diabetes doesn’t have to be something that you’re ashamed about and you can live a long and healthy life with the diagnosis.

16:25
And the truth is, there’s so many factors that have contributed to you having diabetes.

And, you know, people might have you thinking that it’s all about eating too much sugar.

And that is not the case whatsoever.

It is a very complicated disease.

So there’s so many considerations when it comes to managing diabetes.

16:43
So it’s important to really look at the whole person and what are the realistic behavior changes that can be implemented Now.

If you’re somebody who needs some help with implementing behavior changes, we have created the perfect company for you.

It’s called Diabetes Digital and it’s a online platform, a nutrition platform that is specifically tailored to individuals with diabetes and pre diabetes where we pair you with a registered dietitian and you’ll have long in depth sessions to talk about not only while you’re eating but all these other self-care things like movement and stress.

17:20
And you will be able to focus on reducing your risk for diabetes or improving your diabetes.

And our website isdiabetesdigital.co, we have a membership option which is a self pay option for folks out of network.

17:37
And we also have in network insurance options and we are in network with a lot of different insurance providers like Blue Shield of California, Aetna, Medicare, Health Net, American Specialty, Health United, Cigna, New York Ship.

I believe we’re also working on getting a network with the Empire Plan of New York and we’re adding different networks every month.

17:57
So definitely head on over to diabetesdigital.co and go to our quiz that’s called Get Started.

You’ll see it all over our website ordiabetesdigital.co slash Get started and you’ll be able to take our 32nd quiz to see which plan you qualify for.

18:16
So yeah, come on and join us and we are there to help you on your journey.

Thanks for joining us for today’s episode.

If you’re interested in nutrition counseling with one of our expert dietitians to help improve your pre diabetes or diabetes, visit us@diabetesdigital.co.

18:33
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18:53
We’ll catch you later.

Bye.