So wait...can you get over diabetes or can't you?

I thought there wasn’t a cure for diabetes - that is, once you have it, you have it. However, today I read this:

“He used to have type II diabetes but no longer.”

So, can you “lose” diabetes?

Milder cases of diabetes II can be controlled by diet alone.
Some cases are caused purely by obesity or pregnancy.

Type I or “juvenile” diabetes probably can’t be controlled by diet alone, and is a condition that does not go away. My mother had it (although it did not manifest until she was in her early 30’s) and lived with it for over 45 years. Even though she was careful, there were a lot of side effects over time.

Supposedly, and I say supposedly, there are two types of diabetes. Early onset, called Diabetes I, in which people are insulin dependent because the Beta Cells of their pancreas have gone south, and late onset type, called Diabetes type II, in which there is actual insulin resistance by the cells.

Actually there are even other variants of this disease.

My point is however that even though they have been given the same name by the medical profession, they are totally different biological mal-functions.

What they do have in common is that in both, if left unchecked, glucose will accumulate in the blood and reach harmful levels. Glucose at high levels will cause organ damage.

I’ve heard that a side effect of gastric bypass surgery is that it ‘cures’ diabetes.

Type I diabetes definitely cannot be controlled by diet alone. It is an autoimmune disorder in which the body’s immune system attacks the beta cells in the pancreas, destroying your ability to produce insulin. Type I diabetics must take insulin daily in order to survive.

Type II diabetes is different in that the body is still producing insulin, but the cells are no longer responding to it as they should. (I.e., they become insulin-resistant.) Generally speaking, no, this cannot be cured. Most of the time when you see someone say their type 2 diabetes has been “cured”, what they really mean is that they no longer need to take medications to control their blood sugar. But if they started eating a high-sugar diet or reversed the other lifestyle changes that allowed them to discontinue medication, they would again see a problem with high blood sugar.

That said, it does look like in some cases where people have had gastric bypass surgery, their diabetes is genuinely gone, i.e. they can eat a high-sugar diet (at least in the short-term) and see no ill effects on their blood sugar. I’m not an expert and I’m not really sure what the deal is with this but there have been at least a few studies indicating that this is a real effect.

As runner pat said, some cases of diabetes are cause by obesity, and once the obesity is dealt with, they are controlled (‘go away’). And since gastric bypass surgery is mostly done on morbidly obese patients, to control their obesity, it will also help control diabetes.

When a patient of mine meets the criteria for a diagnosis of Type II Diabetes Mellitus, and then through diet, exercise, and weight loss (to name the 3 most common non-medication modalities) gets his blood sugars so well controlled that he no longer meets the criteria for a DM II diagnosis, I tell him he’s a diabetic whose disease is now under excellent control, and continuing such tight control bodes well for his future.

I do not tell him he’s ‘cured’ of his diabetes. I do not believe that he is ‘cured’. The metabolic abnormality that caused him to have insulin resistance and abnormal glucose levels is still waiting there, only it is presently in abeyance due to changed physiology. Gain the weight, stop the exercise, and glucose levels will most likely rise outside of the normal range once again.

Then there is gestational diabetes which my daughter suffered. Baby born, blood glucose returns to normal. She was told, however, to control her weight (she is mildly overweight) since she has a 50% chance of developing type II later on. Especially so since her father has it. I am well-controlled by metformin and have lost about 30 pounds in the six years since my diagnosis. Currently, my glucose in 5.7 mmoles/liter (about 102 mg/dl) and my A1C is 5.8%, both high but not in the diabetic range.

Although obesity (esp abdominal obesity) and type II diabetes are connected, there is something more about obesity surgery that makes it control diabetes. The surgeries bring blood sugar levels into normal range within days, and people have barely lost any weight by then. And even when done on people who aren’t obese but have type II diabetes the surgeries still bring blood sugar under control. Plus people who start out as super-obese who get the surgery are usually still obese (but less obese) down the road, but their blood sugar is under control. So it isn’t the weight loss that is causing it.

I don’t know tons about it, but I think obesity surgery works because it changes the endocrine system more than the weight loss when it comes to diabetes control.

This is basically my experience from the patient side. When I was first diagnosed and later became asymptomatic, my doctor explained that I no longer met the criteria for diagnosis and was now what was called a “well-controlled diabetic.”

Alas, that didn’t last long and now I’m just a regular old type II diabetic again. :frowning:

A contestant on the most recent 1 person “Biggest Loser” had the experience of his weight loss allowing him to drastically reduce his medicine regimine.

One explanation I heard for Type II (Insulin Resistance) is that the cells forget what to do with insulin, when a person apparently has high sugar intake, so has high insulin levels, but all the cells are already full of glycogen (long-term high-sugar diet) and rarely depleted (limited exercise). The cells apparently learn to ignore the chemical message of insulin since they cannot store any more glycogen.

The article went on to talk about the 30-second workout to prevent diabetes. (Seriously) Basically the researchers had at-risk test subjects pedal as hard as they possibly could on a bicycle for 30 seconds several times a week. Their research showed that this depleted the thighs of glycogen, and the thighs were the biggest muscle mass in the body. They showed that if the cells needed to use insulin to replenish their stored energy on a regular basis, then the body never developed insulin resistance. Naturally, 30 seconds did not do anything for muscle tone, lung function, heart strength, etc. - but it did keep type II diabetes at bay.

Of course, as others point out above, if you alter your lifestyle to use the carbs you produce and restrict your diet so there is not an excess, you may control diabetes - but once the body learns to ignore the insulin signal to some degree it does not appear to unlearn.

I don’t understand the reasoning here. Diabetes mellitus is defined by its one direct symptom: hyperglycemia. The various types are defined by how that occurs. None of them are defined by a specific chemical imbalance.

Just because someone has something that can cause a disease doesn’t mean they have the disease. If it did, every person who had a cold virus would have a cold. Or, a more commonly known distinction: people who are HIV positive would be considered to already have AIDS.

Under that reasoning, people with type II diabetes who measured their glucose and found the level was normal would be “cured” - even if later in the day, it might no longer be normal. Not everyone who gets fat will have their blood sugar go out of whack, but people with type II diabetes will.

Importantly, people who are HIV-positive do not necessarily have AIDS yet - that’s a whole different set of diagnostic criteria and generally takes many years after becoming infected to progress to - and they may also have unmeasurably low levels of the HIV virus in their systems per standard tests. This, also, does not mean they no longer are infected by HIV.

Probably the applicable term for controlled diabetics might be remission, in that the disease is not active but may return, like in the case of many forms of cancer. Many cancers aren’t so much cured as put into remission, where no active cancer cells are found, but it may well come back.

In the "ex-"diabetics’ case, however, they should continue the “treatment” of watching diet and weight, or else they will indeed see the disease return.

Being a type II who controls with diet and exercise, I oft times will say I am completely normal except for being allergic to carbohydrates. (sugar is sugar is sugar is sugar)


DM in that circumstance is diagnosed by hyperglycemia. That is but one way to diagnose it. But diagnosis is not definition. Oh, maybe in inaccurate dictionaries it is, but not in the scientific community.

DM II is defined as a derangement of metabolism where there is insulin resistance. This manifests most frequently as elevated glucose. Even if the glucose is well controlled by diet and weight loss or other modalities, the metabolic abnormality which predisposes towards the insulin resistance is still there. Hence so is the DM II.

That’s quite simplified, and DM II is much more complex than that, but it’s a pretty accurate approximation of the situation.

And I see Ferret Herder has elaborated very accurately on the difference between HIV and AIDS.

I hope so! and my internist says so. At least if you accept “remission” as cured. It is important, since the doctor won’t have to report you as diabetic to insurance companies etc. if you can get your HbA1c number back to normal for at least a year. Of course one’s prior history is still available and other institutions can draw their own conclusions, but two sucessive normal tests are supposed to mean one is no longer diabetic. Of course one can still slide back into the condition, but since diabetes for many is a progression, it is possible to stay on on the right side of the scale for a long time. When your ability to create insulin shuts down completely, as far as I know there is no restarting it.

Question: is it better to control insulin via diet alone, presumably an extreme low-carb diet, or to eat a more balanced diet + use insulin?

The goal is to achieve adequate control of your blood sugar levels. It’s better to meet that goal with a healthy, balanced diet and exercise. If one fails to do that, one may need to move on to a variety of medication, usually starting with pills. If control is still not adequate after appropriate oral medications and lifestyle modification, insulin should be considered.

If one needs to literally deprive themselves of essential nutrients to get adequate blood sugar control, then dietary therapy needs to be supplemented with medications added.