Most people think diabetes reversal is some sort of permanent cure. But there’s no guarantee that it has gone forever and is known to have returned whenever people have been lax about their body discipline. But it is possible for people with Type 2 diabetes to go into remission. Way back in 1986, we reported remission of 45 cases of Type 2 diabetes with just a modest weight loss of five to 10 kg. Subsequently, many of my patients have gone into remission and been able to hold it for long periods of time.
This is a stage when your blood sugar levels are below the diabetes range and you don’t need to take medication anymore. According to the American Diabetes Association, remission is defined as a phase where any person with diabetes, who had been taking medication in the form of tablets or insulin and had a HbA1C (average blood sugar) count higher than 6.5 per cent, is able to stay off medication for three months and bring counts lower than 6.5 per cent. This improved status lasts for a few weeks or months. But with a vigilant lifestyle, it can last longer too. This happens primarily because of weight loss. A loss of 10 to 15 kg of body weight in the Western population and just 5 kg in the Indian population can cause remission. The higher the weight loss, the longer the remission.
CAN ANYBODY WITH DIABETES ACHIEVE REMISSION?
No. Only people with Type 2 diabetes can roll back numbers. This is not possible in Type 1 diabetes, which involves an insulin-dependent management protocol, or other kinds of diabetes such as fibro calculous pancreatic diabetes, secondary diabetes and so on.
WHAT IS THE ABCDE MANTRA FOR REMISSION OF TYPE 2 DIABETES?
A: This stands for HbA1C count, which should be below nine per cent for remission to take place completely. The higher the count, the lesser the possibility.
B: This is body weight or the body mass index (BMI). Faster weight loss means faster remission.
C: This refers to C peptide, which is a measure of insulin secretion in the body. A test measures the amount of C-peptide in your blood or urine. It can reveal how well diabetes treatments are working and determines how well your pancreas is making insulin.
D: This means the duration for which you have been dealing with diabetes. If your condition has developed over five to ten years old or a shorter period, the chances of remission are high. It is less likely in people who have been living with diabetes for 15 and 20 years.
E: This is an enthusiastic and motivated person, who is determined to achieve remission.
HOW TO ACHIEVE REMISSION
Remission is significantly dependent on dietary restrictions. You need a low calorie diet. If you have 2,000 to 2,500 calories per day, bring it down to 800 calories and remission can happen even before weight loss sets in. But once weight loss happens, it has to be sustained.
HOW DOES REMISSION OCCUR?
Type 2 diabetes is because of insulin resistance and defective insulin secretion. Insulin resistance happens because of excessive fat accumulation in the liver, muscles and other places in the body. In obesity, the abdominal fat moves to the liver and produces insulin resistance; the insulin is not able to work as well as it should.
When you lose weight and go on a very low cal diet, the liver fats start melting away within a week. Consequently, the insulin resistance goes away and insulin sensitivity is restored. If the calorie restriction is continued for a longer period, say two to three months, then the fat in the pancreas begins to melt. As a consequence, the pancreatic insulin secretion by the beta cells improves. With both these defects gone, the person can achieve remission.
HOW DO YOU SUSTAIN THE PHASE OF REMISSION?
The problem with remission is that it is not a permanent situation and the moment you start feeding yourself more calories, especially in the form of carbohydrates, the fat starts re-accumulating in the liver and the pancreas. This is what I call the re-reversal of diabetes, where the blood sugar comes back with a vengeance, like a stubborn cancer, with worse levels than ever before. This typically happens when people believe they are cured and, therefore, can afford to binge-eat, forget rules and stop physical exercise. This happens in a large number of my patients.
My advice is not to think you are “cured.” It is good you have achieved remission but then try to keep it that way as long as possible. There are many herbal supplements in the market which are being recommended as magic pills for remission. But none of these is guaranteed to work on your blood sugar levels. Here weight loss drugs like Semaglutide can promote remission by helping you drop your weight faster. However, these drugs have to be continued and when stopped, the weight loss effect goes away and the diabetes can return.
In summary, remember that remission is a goal which can be attempted and achieved by some people but needs perseverance. So do not take short cut methods or rely on the myth in social media that insulin resistance is the sole cause of diabetes. This isn’t true. Almost all obese people have insulin resistance but only a small proportion develops diabetes. This proportion comprises those who already have insulin deficiency. If you do not have insulin deficiency, Type 2 diabetes rarely occurs.
FOOD RATIO FOR DIABETES REMISSION
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The optimal nutritional requirement for remission of newly-diagnosed diabetes has been found to be 49 to 54 per cent for carbohydrates that are needed in energy consumption, proteins 19 to 20 per cent, fat 21 to 26 per cent and dietary fibres five to six per cent. Women need to cut their carbohydrate consumption by around two per cent more than the men to achieve the same results. Similarly, older individuals have to reduce their carbohydrate consumption by one per cent more than the young and increase protein intake by one per cent.
For remission from pre-diabetes, the recommendations are 50 to 56 per cent carbohydrates, 18 to 20 per cent protein, 21 to 27 per cent fat, and three-five per cent dietary fibre. Physically inactive individuals are recommended a four per cent greater reduction in carbohydrates as against active individuals.
IDEAL FOOD PLATTER
So, what would an ideal plate look like? Vegetables, not the starchy ones like potato, should make up half the plate. These could be any green leafy vegetables, beans, cabbage, cauliflower; these can be changed every day. A quarter of the plate should be protein such as fish, chicken or soyabean. A small quantity of rice or one or maximum two chapatis should make up the other quarter.
