Is it possible to reverse type 2 diabetes?

Once you have type 2 diabetes, is it possible to reverse it? I am a bit of a foodie and was diagnosed with it last year. I would do anything not to have it hanging over me.
J Frinton, by email

A Dr DAN RUTHERFORD WRITES:

Most people with type 2 diabetes are overweight and their high blood glucose is due to two main factors. One is a drop in the ability of their pancreas gland to produce insulin (which lowers blood glucose), and the other is that the tissues of the body become “resistant” to the effect of insulin, so their blood glucose goes up.

Losing weight improves blood glucose levels in type 2 diabetes and is a central part of the treatment. In some people, especially those who have not been diabetic for long and who have been successful at getting rid of excess weight, one does sometimes see the need for diabetes medication disappear. Regular exercise boosts this potential reversibility. This seems to be due to a partial recovery of the insulin-producing power of the pancreas combined with a drop in “insulin resistance”. Although some people who do this remain diabetes-free, this is mainly dependent on them not putting excess weight back on.

One of the reasons that type 2 diabetes is usually not reversible, which is also one of the great challenges of this disease, is that by the time most people are diagnosed, they have actually been diabetic for several years and have already lost half or more of the insulin-producing cells from their pancreas. Type 1 diabetes, where no insulin is produced by the pancreas, is not reversible and always needs regular insulin injections.

A SARA STANNER WRITES:

Some people with type 2 diabetes (usually those diagnosed relatively recently) who have lost large amounts of weight following surgery or a very low-calorie diet have achieved normal blood glucose levels and no longer need treatment. However, whether this “reversal” is permanent depends on many factors, including their genetic susceptibility to the condition and their ability to maintain a healthy weight and lifestyle.

But don’t let this put you off making important changes to your diet and lifestyle, as these will help to control your blood glucose levels. For example, one study of 2,500 adults with type 2 diabetes showed that those who lost weight within 18 months after diagnosis were up to twice as likely to achieve their blood pressure and blood glucose targets as those who didn’t lose weight. This will influence the risk of diabetes-related complications such as heart disease, blindness and nerve and kidney damage in later life.

If you are trying to lose weight, a structured weight-loss programme or slimming group can help with support and motivation. Eating regular small meals rather than lots of snacks is usually the best approach – it will help to control your appetite, as well as your blood glucose levels.

But dietary advice for people with diabetes is the same as general healthy-eating advice – a balanced diet that is low in saturated fat, added sugar and salt and high in fibre, vegetables and fruit. Although you don’t need to eat a sugar-free diet, cutting down on high-sugar drinks and snacks will also help weight loss, as will watching your alcohol intake.

A TONY GALLAGHER WRITES:

“Reversing” may not be the most prudent verb to employ, but certainly sufferers can make improvements to the symptoms with this form of diabetes.

A healthy lifestyle is important for both adults and children, especially because obesity may be a risk factor for childhood type 2 diabetes.

While exercise alone is no panacea, it certainly helps improve symptoms. The recommended intensity of aerobic-type exercise should be around 60-70 per cent of maximum heart rate (runsweet.com/HeartRate.html). At this level, prolonged exercise will be possible with a subsequent fall in blood glucose after about 20 to 30 minutes and a further reduction after 40 minutes. Diabetic retinopathy, which causes damage to the eyes, means you should avoid exercises that significantly raise your heart rate and blood pressure.

If you have the diabetic symptom of impaired sensation in your feet it is probably best to stay clear of exercises which are hard on them, like running and tennis. If you feel faint or dizzy, stop exercising and have some orange juice or glucose tablets. Always drink fluids prior to, during and post exercise as this will raise your blood sugar levels.

A well-known athlete who was diagnosed with diabetes was Sir Steven Redgrave, the rower. It didn’t stop him turning in some mighty impressive performances!

Q Workout woes

I’m male, aged 50. I have been a gym-goer (cardio and weights mostly, about five times a week) for about 20 years. In the past few weeks I’ve had to stop my workout halfway through because of overwhelming nausea and dizziness. I’m not doing anything differently in my routine, and I stay hydrated.

A DR DAN RUTHERFORD WRITES:

The appearance of effort-related symptoms in a middle-aged person inevitably makes the cardiovascular system the first place to look for a reason. Perhaps your blood pressure is too high and swinging further on exercise. Maybe it is angina, i.e. the symptoms that arise from narrowed heart arteries.

You might have had a recent viral illness that has affected your heart muscle, or maybe these symptoms are an indicator that something else is wrong, such as anaemia. Clearly your body is sending out a message and this needs to be heeded. I would advise you to back right off on your exercise until you have seen your GP and had a good overhaul.

A SARA STANNER WRITES:

The nausea and dizziness you are experiencing while working out could be the result of a number of problems. Ear infections can affect your balance and make you feel sick when exercising and some medications can make you feel dizzy and nauseous during exercise.

But these symptoms can also result from strenuous exercise causing the heart to work too hard. When you’re exercising intensely, your heart may not be able to circulate blood as fast as your body needs it. This results in less blood going to the brain, causing dizziness. Water will rehydrate you, but sports drinks containing electrolytes and carbohydrates are also appropriate.

Another common cause of the symptoms you describe is hypoglycaemia. This is a condition where the blood glucose (sugar) level is too low and occurs when your body’s blood sugar is used up too quickly, glucose is released into the blood stream too slowly, or too much insulin is released into the bloodstream. Hypoglycaemia is common in people who have diabetes, but it can happen to non-diabetics if not enough fuel is consumed prior to exercise, causing you to run out of vital glucose stores (glycogen) in your muscles.

Exercising in the mornings without eating anything or not much at all increases the risk of developing hypoglycaemia. Eating a small carbohydrate-rich meal or snack 30-60 minutes before exercise can help prevent it. Low-GI foods are good (whole-grain cereal and bread, dried fruits) but if your workout lasts longer than an hour, you may also need to top up your carbohydrate supply during exercise, by drinking a sports drink for both glucose and fluid. You also need to make sure your body recovers adequately. Timing is key for recovery, because the highest rates of muscle glycogen storage occur in the first few hours after exercise. Eating some carbohydrate immediately after training will help the muscles start recovery and ensure you replenish your glycogen stores for your next workout.

SORE THROATS

About 15 years ago, I was having three or four debilitating sore throats a year. An ENT consultant could find nothing which would cause it, so I was left to my own devices.

I deduced that the reason could have been snoring with my mouth open, drying up my mouth and saliva. The obvious solution was to put a piece of 1in tape vertically over my mouth, tight enough to deter snoring, but loose enough to breathe through my mouth in an emergency. Since then I have had two or three sore throats.

The medical profession are not interested, I imagine because my simple, cheap solution doesn’t require hard-won expertise.

However, I have learnt that a professor of orthodontics at Guy’s Hospital used to advise all his patients to do it, because it retains saliva, which protects teeth and gums.

Ray Marsh, by email