Advice for type 2 diabetes patients seeking a healthier, happier lifestyle
For patients with type 2 diabetes, managing the disease can be a burden. However, with medical planning, diligence and awareness, it may be possible to eliminate the symptoms. Education is the most important aspect of treatment, as it’s necessary to understand exactly what your goals are and how to guide your body to reach them. We spoke with Maruja Diaz-Arjonilla, MD, a board-certified endocrinology, diabetes and metabolism specialist at St. Joseph Heritage Medical Group, who navigates the latest research to give us a better understanding of how patients with type 2 diabetes might achieve remission.
Q: What does it mean to put diabetes into remission? Is it the same thing as reversing the disease?
A: In certain cases, intensive medical treatment can put type 2 diabetes into remission--that is, the right therapies might enable your glucose levels to remain normal without using diabetes medication. “Reversal” and “remission" have both been used somewhat interchangeably, however, "reversal" suggests that the disease goes away permanently. I prefer the term “remission” because there is always a risk of relapse--a chance for your symptoms to reoccur if you are not consistent with treatment or diet and exercise.
If you can maintain normal blood sugar levels for more than one year without medication, you are in what we would call "complete remission." Of course, you'll still need regular testing to see if your blood sugar, blood pressure and cholesterol are in check and to look out for any problems with your eyes, feet and kidneys.
Successfully achieving remission depends on several factors including the severity of your case, your genetic background and how long you've had the disease. Unfortunately, not everyone with type 2 diabetes will be able to put it into remission, and the best strategy for those people is to control blood sugar levels and decrease the fat that the body stores.
Q: Could you explain the recent study in the Journal of Clinical Endocrinology & Metabolism? Should patients be encouraged by these studies or skeptical?
A: You should absolutely be encouraged by the findings in this study. To sum it up, patients in this study achieved normal glucose levels – and some even achieved remission - through significant lifestyle changes like weight loss and medication.
If you're like most patients, engaging in a healthier lifestyle will allow you to at some point take fewer medications, not to mention the overall benefits like reducing the risk of heart disease. However, the idea of no longer needing medications at all should be taken cautiously, and you must take care to work closely with your physician and follow the treatment plan that's right for you.
Q: What type of patients might be successful with remission?
A: I think it is possible for almost anyone with type 2 diabetes to attempt remission, especially if they enter into treatment early in the course of the disease. This includes women with gestational diabetes--diabetes that arises during pregnancy. Having gestational diabetes means you are more likely to develop diabetes in the future, whether or not it disappears on its own after delivery. If it doesn't go away, you will need to treat and manage the condition long-term, but you can work with your doctor to attempt remission as well.
Patients who undergo bariatric surgery--weight loss surgery-- also have a good chance of successful remission. Bariatric surgery is known to induce type 2 diabetes remission in up to 95 percent of patients. Because bariatric surgery creates weight loss, the body’s fat storage is decreased and has a better chance of absorbing sugar into the cells – resulting in more energy and decreased blood glucose levels. It also reduces the amount and type of medication needed and improves other related health issues like sleep apnea and joint pain.
Q: What steps should you take if you're seeking remission?
A: Committing to a very healthy lifestyle and maintaining a healthy weight is key. You should ensure you are eating nutritious foods and avoiding things like refined sugar, gluten and alcohol. Opt for high fiber foods with a low glycemic load, including vegetables, nuts, avocados, organic meat, fish and eggs. Exercise will also help reduce body fat. You should generally exercise for at least 150 minutes a week. This lifestyle, coupled with appropriate medication, will help you on the road to remission. Keep in mind, you should always consult a doctor before creating or attempting any kind of remission plan.
Q: Because there is a possibility of remission, does this mean that you don't have to be as concerned about developing type 2 diabetes or prediabetes?
A: Actually, quite the opposite is true. The possibility of reversal should motivate you to be more vigilant of the condition and do all you can to prevent it. You should develop diabetes goals based on your overall health. Even if you are genetically predisposed, being proactive can help lessen some of the more uncomfortable symptoms and long-term complications.
In fact, being proactive is the most important piece of advice I can give when speaking about prevention and management. Being familiar with your own risk factors, educating yourself and having periodic medical checkups will have a huge impact on the progression of the condition.
Whether or not you are able to achieve remission for your type 2 diabetes, I encourage you to find and stick to a treatment plan that will give you the best possible results. Take charge of your health, and explore your options with your doctor.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.