Diabetes stands as a leading cause of several severe health complications, including blindness, kidney failure, heart attacks, and strokes. Projections estimate that the number of people affected by diabetes will surge to 783 million by 2045.

Despite its widespread impact, there exists no definitive cure for any form of diabetes. While existing treatments aid in symptom management to a certain extent, individuals with diabetes still confront numerous long-term health challenges.

Amidst these challenges, there’s a hopeful possibility of reversing diabetes. This article will discuss this potential and how it can be achieved. Discover the concept of diabetes reversal and practical strategies for achieving a healthier life.

Key Findings

  • Diabetes remission is a more accurate term than diabetes reversal, as it acknowledges the need for ongoing management even if blood glucose levels normalize.
  • Lifestyle changes such as weight management, dietary adjustments, and exercise can help reverse type 2 diabetes.
  • Significant weight loss, coupled with behavioral therapy like Cognitive Behavioral Therapy (CBT), can induce type 2 diabetes remission.
  • Bariatric surgery enhances insulin sensitivity and promotes weight loss, offering a viable option for individuals with diabetes.
  • Various medications, including metformin, sulfonylureas, DPP-4 inhibitors, SGLT2 inhibitors, GLP-1 receptor agonists, and insulin, are commonly used to manage diabetes.
  • Type 1 diabetes enters a honeymoon period where remaining insulin-producing cells temporarily regain function, but lifestyle changes do not influence it.
  • Gestational diabetes typically resolves after childbirth but carries a risk of recurrence in subsequent pregnancies and development into type 2 diabetes.

Can Diabetes be Reversed?

When referring to “diabetes reversal,” it suggests a situation where a person’s blood glucose levels have returned to a normal range after being diagnosed with diabetes. However, “reversal” doesn’t necessarily imply that the underlying factors causing diabetes have been permanently addressed.

In medical terminology, it’s more accurate to use the term “diabetes remission” to reflect the ongoing need for management even if blood glucose levels have normalized. Remission acknowledges that while the person may not currently have diabetes symptoms, they are still at risk of the condition returning if they don’t maintain their lifestyle changes or other treatments.

What is Diabetes Remission?

Diabetes remission, as defined by the American Diabetes Association (ADA), describes a state in which a person’s blood glucose levels have returned to a normal range. This is typically measured by a hemoglobin A1C (HbA1c) test of below 6.5% for at least three months after discontinuing glucose-lowering medication.

This term is particularly applicable to individuals with type 2 diabetes mellitus (T2DM). The ADA’s consensus statement in 2009 proposed three categories of remission for T2DM. These are:

  • Partial remission: Characterized by having HbA1c levels below 6.5% (48 mmol/mol) and fasting glucose levels between 5.6 and 6.9 mmol/l consistently for a minimum of one year without the need for active pharmacological treatment or ongoing antidiabetic procedures.
  • Complete remission: Refers to a return to normal glucose metabolism, characterized by HbA1c levels within the normal range (< 6.0% or 42 mmol/mol) and fasting glucose levels below 5.6 mmol/l without pharmacotherapy for one year.
  • Prolonged remission: Described when complete remission persists for five years or more without pharmacotherapy.

Diabetes Remission vs. Reversal

The terminology used to describe outcomes related to diabetes carries significant implications for both clinical practice and policy decisions. In T2DM, various terms like resolution, reversal, remission, and cure have been suggested to describe positive outcomes resulting from interventions. However, each term comes with its own set of limitations.

The term “resolution” can indicate either a mistaken diagnosis or reaching a state where everything seems permanently normal. “Reversal,” on the other hand, refers specifically to lowering blood sugar levels below the threshold for diagnosing diabetes.

It’s important not to confuse “reversal” with “remission,” which suggests a sustained improvement that might not last indefinitely. While “cure” sounds ideal, it implies a complete return to normal without needing ongoing check-ups or treatment, which can pose challenges in practice.

Taking these factors into account, the expert panel convened by the ADA concluded that “diabetes remission” is the most fitting term. This term acknowledges that diabetes may not always be actively progressing while suggesting that significant improvement may not be lasting. More importantly, it highlights the idea that ongoing support and regular monitoring is required to prevent relapse.

How Do You Achieve Diabetes Remission?

Glucometer for checking sugar level, freshly coctail from fruits and vegetables

Diabetes remission involves diverse approaches, including weight management, dietary adjustments, and regular exercise. In addition, bariatric surgery presents a viable option for individuals seeking enhanced blood sugar control.

Can diabetes be reversed with diet?

Dietary choices are a key driver of insulin resistance, which can increase the risk of diabetes, especially in an aging, more sedentary population. Studies suggest that many people with type 2 diabetes can reverse it through dietary modifications.

Here are some dietary suggestions to help turn around type 2 diabetes.

  • Reduce the consumption of added sugars and processed foods: This includes refined grains such as white flour and white rice. Minimize the intake of sugary beverages, including sodas and fruit juices. Opt for hydrating choices like water, seltzer, and unsweetened tea or coffee.
  • Substitute refined grains with whole grains: Whole grains, like whole-grain bread, cereals, and brown rice, are linked to a lower diabetes risk. A recent review of 16 cohort studies showed a 0.68 relative risk reduction with three daily servings of whole grains. Intact whole grains such as farro, quinoa, corn, and oatmeal are even more beneficial.
  • Boost fiber intake: Fiber regulates post-meal glucose levels and is fermented by gut bacteria to produce short-chain fatty acids, improving glucose response and insulin sensitivity. It also lowers calorie density and promotes fullness. Additionally, it’s associated with decreased inflammation markers, potentially improving insulin sensitivity. 

Incorporate high-fiber foods such as:

  • Vegetables (broccoli, spinach, carrots, sweet potatoes, and kale)
  • Fruits (apples, oranges, bananas, strawberries, raspberries, and pears)
  • Legumes (lentils, beans, chickpeas, peas, edamame, and soy)
  • Nuts and seeds (almonds, chia seeds, flaxseeds, and sunflower seeds)
  • Increase the consumption of non-starchy fruits and vegetables:  Non-starchy fruits and vegetables are typically low in calories. Moreover, their natural sugars are balanced by their fiber content, which helps prevent spikes in blood sugar levels, making them an excellent choice for individuals with T2DM.

Aim for at least half of your daily food intake. Emphasize colorful varieties, focusing on cruciferous vegetables like broccoli, cauliflower, Brussels sprouts, and fiber-rich fruits such as berries.

  • Limit meat consumption: Recent meta-analyses have found an association between meat consumption and the risk of T2DM. Estimates show that for every 100 grams of total red meat consumed per day, the risk of developing T2DM increases by 13% to 19%.

Similarly, for every 50 grams of processed meat consumed per day, the risk increases by 19% to 51%. Reducing or eliminating red meat from the diet in favor of poultry, eggs, dairy, and fish can substantially lower the risk of T2DM.

  • Choose healthier fats: Animal protein and fats have been linked to worsening insulin resistance and a higher incidence of type 2 diabetes in both metabolic and large cohort studies. Consider plant-based oils like extra-virgin olive oil and canola oil. Moreover, Omega-3 fats in sources like walnuts, flax seeds, and certain fish offer additional health benefits.

Reminder

Before making any alterations to your dietary habits, consult first with your healthcare provider. Not all dietary regimens are suitable or safe for everyone.

Can diabetes be reversed with exercise?

Engaging in regular physical activity significantly impacts diabetes management by enhancing insulin sensitivity and regulating blood glucose levels. According to the ADA, individuals with diabetes should aim for at least 150 minutes per week of moderate aerobic exercises like running, swimming, or cycling, supplemented with strength training twice a week.

Regular exercise offers numerous benefits for individuals with diabetes, whether it’s type 1, type 2, or other forms. These include:

  • Improved insulin sensitivity
  • Blood pressure regulation
  • Cholesterol management
  • Weight management
  • Increased energy and better sleep
  • Joint health and flexibility
  • Mental well-being
  • HbA1c improvement

Can diabetes be reversed with weight loss?

Research shows that a strict dietary regimen leading to weight loss, approximately 33 lbs, can induce type 2 diabetes remission. Weight reduction improves both insulin secretion and hepatic insulin sensitivity in T2DM.

Behavioral therapy, particularly Cognitive Behavioral Therapy (CBT), is a valuable addition to weight reduction programs. CBT helps improve diet control, stress management, motivation to exercise, and coping skills, thus enhancing the likelihood of achieving weight loss goals.

Motivational Interview Techniques (MIT) are also effective in promoting behavioral change and improving adherence to the weight reduction program, particularly in primary care settings.

Bariatric Surgery for Weight Loss

Bariatric surgery has evolved beyond mere weight loss for individuals with diabetes. This surgical intervention enhances the body’s ability to produce and utilize insulin effectively, improving blood sugar control.

Various types of bariatric surgery are available, each with its unique mechanism and benefits:

  • Gastric Band: Also known as a laparoscopic adjustable gastric band, this procedure consists of an inflatable silicone band placed around the upper part of the stomach, creating a small pouch to limit food intake.

The band can be adjusted by adding or removing saline solution through a port placed under the skin, allowing for control over the size of the pouch and the rate of weight loss. This procedure is reversible and minimally invasive compared to other weight loss surgeries.

  • Gastric Bypass: During the procedure, the surgeon creates a smaller stomach pouch by dividing the stomach and connecting it to the small intestine. This reduces the amount of food the stomach can hold and bypasses a portion of the small intestine, leading to reduced food intake and decreased absorption of nutrients and calories.

Gastric bypass surgery, also known as Roux-en-Y gastric bypass, is typically performed laparoscopically and is irreversible, offering significant and sustained weight loss for many patients.

  • Sleeve Gastrectomy: This is a procedure in which a large portion of the stomach is removed, leaving a smaller sleeve-shaped stomach. This smaller stomach restricts the amount of food eaten, leading to weight loss.

Sleeve gastrectomy reduces the production of ghrelin, a hormone that stimulates hunger, which helps patients feel less hungry and more satisfied with smaller portions of food. It’s a minimally invasive procedure often performed laparoscopically and has become increasingly popular as a standalone weight-loss surgery option.

Definition

Performing a surgery “laparoscopically” means using small incisions and specialized instruments, including a camera called a laparoscope, to perform the procedure. Instead of making a large incision, several small incisions are made in the abdomen, through which the surgeon inserts thin tubes (called trocars) to access the surgical area.

The laparoscope, equipped with a camera, allows the surgeon to view the inside of the abdomen on a monitor, guiding them through the procedure. Laparoscopic surgery is minimally invasive compared to traditional open surgery, resulting in smaller scars, less pain, and quicker recovery times for patients.

Can diabetes be reversed with fasting?

According to a recent study, intermittent fasting has shown promise in diabetes remission. The study involved a 3-month intermittent fasting intervention with 36 participants who had diabetes.

Remarkably, nearly 90% of the participants, including those who were on blood sugar-lowering medications and insulin, were able to reduce their diabetes medication intake after intermittent fasting. Additionally, 55% of these individuals achieved complete diabetes remission.

These findings challenge the conventional belief that diabetes remission is only possible in individuals with a shorter duration of diabetes. In fact, 65% of the participants who achieved diabetes remission had been living with the condition for more than six years.

Can diabetes be reversed without medication?

Nurse injecting insulin into diabetic girl's belly.

Lifestyle changes are essential for managing diabetes. However, medications also play a pivotal role in controlling blood sugar levels and reducing the risk of complications.

Several types of medications are commonly prescribed to manage diabetes. Here are some common categories of diabetes medications:

  • Metformin: This is often the first-line medication for type 2 diabetes. It works by decreasing glucose production in the liver and improving insulin sensitivity in the muscles. Brand names of metformin include Glucophage and Glumetza.
  • Sulfonylureas: Examples include glipizide, glyburide, and glimepiride. These medications stimulate the pancreas to release more insulin, lowering blood sugar levels.
  • DPP-4 inhibitors: Drugs such as sitagliptin (Januvia), saxagliptin, and linagliptin work by blocking the enzyme DPP-4. This enzyme helps regulate blood sugar levels by increasing insulin release and decreasing glucagon production.
  • SGLT2 inhibitors: Canagliflozin (Invokana), dapagliflozin (Farxiga), and empagliflozin (Jardiance) are examples. They work by preventing the kidneys from reabsorbing glucose into the blood, thus increasing glucose excretion in the urine.
  • GLP-1 receptor agonists: Medications like semaglutide (Ozempic), liraglutide (Victoza), and dulaglutide (Trulicity) mimic the action of the hormone GLP-1, which stimulates insulin secretion, suppresses glucagon secretion, and slows gastric emptying.
  • Insulin: This hormone is essential for regulating blood sugar levels. There are different types of insulin, including rapid-acting, short-acting, intermediate-acting, and long-acting. Examples include:
  • Thiazolidinediones (TZDs): Rosiglitazone and pioglitazone are examples. They work by improving insulin sensitivity in the body’s tissues.
  • Meglitinides: Repaglinide and nateglinide stimulate insulin secretion from the pancreas, similar to sulfonylureas, but they have a shorter duration of action.
  • Alpha-glucosidase inhibitors: Acarbose and miglitol slow down the digestion of carbohydrates in the intestines, which helps to lower blood sugar levels after meals.

These medications can be used alone or in combination. The choice of medication depends on various factors, including the type of diabetes, individual health status, and any other medical conditions present.

Remission in Different Types of Diabetes

People may have heard of the more common types of diabetes, like type 1, type 2, and gestational. However, there are actually many other types of diabetes that aren’t as well known.

Can type 1 diabetes be reversed?

The remission phase, also known as the honeymoon period, in type 1 diabetes differs from the remission seen in type 2 diabetes. In type 1 diabetes, the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas, causing a deficiency in insulin production.

The honeymoon period occurs when the remaining insulin-producing cells in the pancreas temporarily regain some function. During this phase, individuals may need less insulin or experience better blood sugar control. However, the honeymoon phase is natural to the progression of type 1 diabetes and is not influenced by lifestyle changes.

Despite the temporary improvement during the honeymoon phase, the ongoing destruction of beta cells leads to a decline in insulin production over time. Individuals with type 1 diabetes will eventually require increased insulin doses as the disease progresses.

Can type 3 diabetes be reversed?

Type 3 diabetes is a term coined by some researchers to suggest a potential link between insulin resistance and dysfunction in insulin-like growth factors within the brain, potentially contributing to Alzheimer’s disease. However, it’s not officially recognized within the medical community. Further research is necessary to fully understand the relationship between diabetes and Alzheimer’s disease.

Alzheimer’s disease and other forms of dementia are irreversible conditions. While interventions may help slow down the progression and enhance quality of life, these conditions typically worsen over time.

Can type 3c diabetes be reversed?

At present, type 3c diabetes cannot be reversed. Type 3c diabetes is a form of diabetes resulting from damage to the pancreas. When the pancreas is impaired, it struggles to produce sufficient insulin, making it challenging for the body to regulate blood sugar levels.

This damage can also affect other hormones produced by the pancreas that regulate blood sugar. Individuals with type 3c diabetes may experience both high blood sugar levels (hyperglycemia) and low blood sugar levels (hypoglycemia). In some cases, it can also lead to malnutrition.

Can LADA be reversed?

Latent autoimmune diabetes in adults (LADA), also known as type 1.5 diabetes, is a unique form of diabetes that typically emerges in adulthood and progresses gradually over time.

Like type 1 diabetes, LADA occurs when the pancreas fails to produce insulin due to an autoimmune process damaging pancreatic cells. However, unlike type 1 diabetes, where this process occurs rapidly, in LADA, it happens slowly, resembling the progression seen in type 2 diabetes. Hence, the term “type 1.5 diabetes.”

Unlike type 2 diabetes, LADA is an autoimmune disease and cannot be reversed through changes in diet and lifestyle.

Can gestational diabetes be reversed?

Gestational diabetes is a form of diabetes that arises during pregnancy in women who did not have it before. It typically manifests in the middle of pregnancy, prompting doctors to screen for it between 24 and 28 weeks of gestation.

Though it often resolves after childbirth, there’s a 30% to 70% chance of its recurrence in subsequent pregnancies. Additionally, half of women who experience gestational diabetes will later develop type 2 diabetes. Maintaining healthy eating and exercise habits, post-pregnancy is recommended even after gestational diabetes has subsided.

Can prediabetes be reversed?

Prediabetes serves as a warning sign for the development of type 2 diabetes. It indicates elevated blood sugar levels that aren’t high enough to classify as Type 2 diabetes. This condition is widespread, with an estimated 84 million adults in the US affected.

Alarmingly, over 80% of individuals with prediabetes are unaware of their condition since it typically presents with no symptoms. On a positive note, prediabetes can be reversed through adopting healthy lifestyle changes.

Takeaway

Different methods, such as dietary adjustments, regular physical activity, weight management, and, in certain cases, interventions such as bariatric surgery or intermittent fasting, have shown promise in achieving diabetes remission. However, the effectiveness of these methods can vary based on individual factors such as genetics, duration of the condition, and overall health.

It’s important to distinguish between different types of diabetes and their respective possibilities for remission. While type 2 diabetes can often be managed through lifestyle changes, other forms such as type 1, type 3c, LADA, and gestational diabetes present distinct challenges and cannot be approached in the same manner.

Moreover, prediabetes acts as a crucial warning sign, providing an opportunity for intervention before the onset of type 2 diabetes. By adopting healthy lifestyle habits, individuals with prediabetes can potentially mitigate their condition and lower their risk of developing diabetes.

Frequently Asked Questions

What are the early signs of diabetes?

Warning signs of diabetes include increased hunger and fatigue. When your body lacks insulin or becomes resistant to it, glucose can’t enter your cells for energy, leaving you feeling hungrier and more tired than usual.

Additionally, frequent urination and increased thirst are common symptoms. High blood sugar levels can prevent your kidneys from reabsorbing glucose, leading to more urine production and dehydration. Dry mouth and itchy skin may also occur due to dehydration.

Lastly, blurred vision can result from changing fluid levels in your body, causing swelling in the lenses of your eyes. If you notice any of these symptoms, consult a healthcare professional for proper evaluation and diagnosis.

Is it possible to permanently reverse diabetes?

Reversing diabetes permanently is currently not feasible, and there will always be a risk of blood sugar levels rising again. However, healthcare professionals can assist in managing glucose levels, which can slow the progression of diabetes and mitigate the risk of complications.

What’s the difference between insulin resistance, prediabetes and diabetes?

Insulin resistance, prediabetes, and diabetes are interrelated but have distinct characteristics. Insulin resistance occurs when cells become less responsive to insulin, leading to elevated blood sugar levels. It precedes prediabetes and type 2 diabetes.

Prediabetes is a stage where blood sugar levels are higher than normal but not yet at diabetic levels, serving as an intermediate stage. Diabetes is a chronic condition marked by elevated blood sugar levels due to insufficient insulin production, insulin resistance, or both.

Can diabetic neuropathy be reversed?

Diabetic neuropathy can’t be reversed, as nerve damage is often irreversible. However, with effective blood glucose management and proper care, it’s possible to prevent further deterioration and potentially improve symptoms.

Can ED from diabetes be reversed?

Erectile dysfunction (ED) resulting from diabetes can be a complex issue. Prolonged high blood sugar levels can damage the small blood vessels that supply the penis, leading to microvascular disease or microvascular endothelial dysfunction. Men with diabetes and high blood pressure face an increased likelihood of ED.

While existing damage to nerves and blood vessels caused by diabetes cannot be reversed, over 95% of men can overcome ED with appropriate treatment. Effective management includes careful blood sugar control and addressing other contributing factors to ED.

Combining lifestyle modifications, diabetes management, mental health support, and the use of ED medications can lead to successful outcomes in treating ED in individuals with diabetes.

Can diabetes be cured completely?

No, diabetes cannot be cured completely. However, it can go into remission. Remission means the disease is under control but may return without ongoing management.

How long can diabetes remission last?

The duration of remission in diabetes is uncertain, with anecdotal evidence suggesting it can last for up to 15 years. However, achieving remission is a continuous process. Even when in remission, it’s crucial to maintain glucose management to sustain it.

How long does it typically take to achieve remission?

The duration of remission in diabetes is variable and depends on individual factors such as blood sugar levels, duration of high levels, and presence of obesity.

Can diabetes be cured by walking?

While walking and regular physical activity can have significant benefits for managing diabetes, such as improving insulin sensitivity and aiding weight loss, it cannot cure diabetes on its own. Diabetes is a complex metabolic condition influenced by various factors, including genetics, lifestyle, and environmental factors. Therefore, while walking and exercise are important components of diabetes management, they should be combined with other treatments such as medication, dietary changes, and regular monitoring of blood sugar levels for effective management of the condition.

Why are regular check-ups important for managing diabetes effectively?

Regular check-ups offer a range of benefits for managing diabetes. They enable healthcare providers to monitor blood sugar levels, identifying trends that may require treatment adjustments. Additionally, check-ups allow for early detection and intervention of potential complications such as heart disease, kidney issues, eye problems, and nerve damage. Furthermore, these appointments provide opportunities for medication management, lifestyle guidance, and education to empower patients in effectively managing their diabetes.

Sources

American Diabetes Association. (2022, Jul). Gestational Diabetes and Pregnancy. CDC. https://www.cdc.gov/pregnancy/diabetes-gestational.html

Aune, D., et al. (2013, Nov). Whole grain and refined grain consumption and the risk of type 2 diabetes: a systematic review and dose-response meta-analysis of cohort studies. NCBI. https://pubmed.ncbi.nlm.nih.gov/24158434/

Castro, M. R. (2023, Jun). Latent autoimmune diabetes in adults (LADA): What Is It?. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/type-1-diabetes/expert-answers/lada-diabetes/faq-20057880

Diabetes UK. (NA). diabetes and exercise. Retrieved from https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/exercise

Diabetes UK. (NA). weight loss surgery for type 2 diabetes. Retrieved from https://www.diabetes.org.uk/guide-to-diabetes/managing-your-diabetes/treating-your-diabetes/weight-loss-surgery

Endocrine Society. (2022, Dec). Intermittent fasting may reverse type 2 diabetes. Retrieved from https://www.endocrine.org/news-and-advocacy/news-room/2022/intermittent-fasting-may-reverse-type-2-diabetes

Fuat, M. S. A., et al. (2021, Jan). Type 2 diabetes remission: How does it work?. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8088740/

Harvard Health Publishing Staff. (2023, Oct). Healthy lifestyle can prevent diabetes (and even reverse it). Harvard Health Publishing. https://www.health.harvard.edu/blog/healthy-lifestyle-can-prevent-diabetes-and-even-reverse-it-2018090514698

Holst, J., & Madsbad, S. (2021, Feb). What is Diabetes Remission?. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7947138/

Kim, Y., et al. (2015, Mar). A review of potential metabolic etiologies of the observed association between red meat consumption and development of type 2 diabetes mellitus. NCBI. https://pubmed.ncbi.nlm.nih.gov/25838035/

McMacken, M., & Shah, S. (2017, May). A plant-based diet for the prevention and treatment of type 2 diabetes. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5466941/

Riddle, M., et al. (2021, Aug). Consensus Report: Definition and Interpretation of Remission in Type 2 Diabetes. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8929179/

Tang, R., et al. (2019, Dec). The Remission Phase in Type 1 Diabetes: Role of Hyperglycemia Rectification in Immune Modulation. NCBI. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6901662/