Is Type 2 Diabetes Reversible? We Asked the Experts
Take a look around your neighborhood, office, or supermarket. You can't tell by looking, but if your environment matches the country's average, a full 1 in 10 of the people you see has been diagnosed with diabetes, according to the latest data from the U.S. Centers for Disease Control and Prevention (CDC). Upwards of 90 percent of those have type 2 diabetes. (Here's a refresher about the differences between type 1 and type 2 from our pals at EatingWell.)
"Type 2 diabetes, also referred to as 'insulin-resistant diabetes,' usually takes years to develop," says Diana Licalzi, MS, RD, the co-founder of Reversing T2D in Boulder, Colo. "So to understand the process of how this condition progresses from prediabetes to type 2 diabetes, it's important to understand how insulin normally works in our body."
When we eat carbohydrates, one of the three major macronutrients along with protein and fat, they're broken down into glucose — our body and brain's preferred energy source. Once glucose enters the bloodstream, our pancreas receives a message to release a hormone called insulin. Insulin acts like a key, opening "locks," or channels, on the surface of our cells. Once the channels open, glucose can funnel out of the bloodstream and into our cells, and our cells can then utilize this glucose for energy or store it for later use.
As time progresses, some bodies are home to cells that stop responding to insulin. The pancreas hustles as much as possible to keep pace and pump out more insulin, but in time, it can get overwhelmed.
So, who is at-risk for type 2 diabetes, and its precursor stage, prediabetes?
"There is a well-established link between dietary patterns and type 2 diabetes. The Standard American Diet, which is high in meat and processed foods, can lead to insulin resistance," Licalzi says, referring to that condition in which cells are not able to respond adequately to insulin. "Insulin resistance develops when lipids, or fats, are deposited in cells that aren't typically meant to hold fat."
This can include liver and muscle cells, she explains, where those misplaced lipids begin to interfere with insulin signaling. If insulin can't do its job, then glucose can't get into our cells and lingers in our blood. Hence, the term "high blood sugar."
If all remains equal in the individual's lifestyle, insulin resistance worsens over time and blood glucose levels continue to rise. To diagnose prediabetes and type 2 diabetes, doctors use two measures.
- Fasting blood sugar
- Prediabetes: 100 to 125 mg/dL
- Type 2: 126 mg/dL or higher
- HbA1c, a long-term measure of blood glucose
- Prediabetes: 5.7 to 6.4 percent
- Type 2: 6.5 percent or higher
"In short, a person's level of glucose in their blood determines whether they have prediabetes or type 2 diabetes," Licalzi says.
Is It Possible to Reverse Prediabetes or Type 2 Diabetes?
"It is certainly possible for someone to improve blood sugar enough through positive lifestyle interventions that it can revert to a normal range. However, the reasons that blood glucose was elevated still exist, such as genetic predisposition and damage to the beta cells of the pancreas that produce insulin," Harris-Pincus says.
So "remission" might be a better term, since there may be some lingering internal challenges in terms of genetics and within the pancreas.
Earlier this year, diabetes experts at the American Diabetes Association (ADA), the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK came to the consensus that people with type 2 diabetes are considered in "remission" after they reach an A1c of less than 6.5 percent for three months or more after stopping medications.
The possibility of remission depends on a few factors, licalzi says, including:
- How insulin resistant a person is by the time they are diagnosed
- How well their pancreas is working
- How aggressive they are with their dietary and lifestyle changes.
"In order to start reversing pre- or type 2 diabetes, a person needs to first tackle insulin resistance. Research demonstrates insulin resistance can be reversed through lifestyle changes, including weight loss, adopting more of a plant-based diet, and incorporating exercise," Licalzi says.
At her practice, she has coached people with A1Cs in the 10 percent range to a level well within the normal range, around 5.7 percent, in as little as 10 weeks. Adopting more of a whole-food, plant-based diet was key, she says. (Psst... Our guide for how to switch to a plant-based diet can help you get started.)
"While weight is not the only factor in prediabetes and diabetes, if someone has overweight or obesity, a small but significant weight loss of about 5 to 7 percent of their body weight can greatly improve blood sugar," Harris-Pincus adds. "If someone weighs 200 pounds, that's 10 pounds to likely see a benefit."
And in related promising news, emerging research has shown that pancreatic function can actually improve and even be restored in some individuals when weight loss is achieved. (And maintained — that latter detail is vital to keeping any of the benefits.)
7 Dietitian Tips to Help Reach Remission for Prediabetes or Type 2 Diabetes
"Achieving remission of type 2 diabetes may not be possible for everyone. It depends on how long you have been living with diabetes and several other factors. Every body is different and each situation is unique. Since A1C tests measure blood sugar over two to three months, testing more often won't allow you to see major changes," Harris-Pincus says.
If you've been diagnosed with prediabetes or type 2 diabetes by your doctor, consider these next steps to increase the chances of remission.
1. Meet with a dietitian. Most health insurance policies cover visits to a registered dietitian for diabetes counseling, Harris-Pincus says. "Teaming up with a nutrition expert will help you customize a plan to initiate impactful diet and lifestyle changes to improve your blood sugar and overall health," she explains.
2. Time it right. "Eating more of your calories earlier in the day has been shown to improve blood sugar and insulin levels," Harris-Pincus explains. That's because most bodies tend to process carbohydrates better earlier in the day compared to later in the evening. Try to make breakfast or lunch your largest meal of the day, then end with a smaller dinner.
3. Eat the right kind of carbs. Carbs are not off limits! Instead of thinking about restricting carbohydrates severely (a la the keto diet), replace refined and processed carbs with healthier ones, including whole grains, legumes, fruit, vegetables, nuts, and seeds. "These foods are full of fiber and other important nutrients, and have little to no saturated fat," Licalzi says. "Populations where people live the longest and have the lowest incidence of disease, the Blue Zones, all eat diets primarily made up of these healthy carbohydrates."
4. Aim for fewer added sugars. This is one thing you definitely do want to limit. "Minimize sources of added sugar, especially those found in processed food and sweetened drinks. These types of sugar can significantly raise blood sugar and don't provide beneficial essential nutrients your body needs," Harris-Pincus says. Yes, this also includes honey, maple syrup, agave, and coconut sugar — and anything else that does not exist naturally in fruit, veggies, and plain dairy products like milk and unsweetened Greek yogurt. (Here are 10 delicious and filling snack ideas to add to your no-sugar-added diet.)
5. Trade meat for plant proteins. To reduce the saturated fat in your diet while also increasing your fiber intake (fiber is one thing only 1 in 20 Americans consume enough of daily), swap animal-based proteins like red and processed meats for more plant-based proteins, such as beans, lentils, and tofu. "Excess intake of saturated fat directly affects insulin's action and can lead to insulin resistance," Licalzi adds.
6. Balance your plate. With a little planning, you can minimize the increase in post-meal glucose by fueling up with a combination of lean protein, quality carbohydrates and healthy fats at each meal and snack. "Try to fill half of your plate with non starchy veggies, one-quarter with a whole grain complex carb like a sweet potato, quinoa, beans or whole grain pasta and one-quarter with a lean protein that's approximately 4 ounces," Harris-Pincus says.
7. Get moving. It's not just about when and what you eat. "Exercise stimulates our muscles to take up glucose in the bloodstream and helps us maintain a healthy body weight," Licalzi explains. Aim to incorporate physical activity into your daily agenda, "not just for blood sugar lowering purposes, but for overall physical and mental health as well. Find something that brings you joy that you can stick with long term," Harris-Pincus says, like walking, gardening, biking, or yoga. Our sister brand SHAPE has tips for how to get started with a fitness routine in the first place, plus how to get back on track after you've taken some time off.