Once A Diabetic, Always a Diabetic?

I’ve been diagnosed for exactly one year now and I’m still so confused on allot of the diabetic issues. Right now I know of two people who were very overweight (over 400 lbs) who had high blood pressure, and diabetes and other assorted medical conditons. These two people have both had bariatric surgery and each has lost almost 200 lb. Supposedly these people are being told that they no longer have diabetes. How can this be?? These people do not know each other and have different doctors and had their surgeries in different hospitals.They are no longer taking high blood pressure meds or diabetes meds. I don’t know about any other meds they were taking that they are now not taking. I went to a diabetic convention here in Indy about a month ago and I sure didn’t understand or get the impression that you could become un-diabetic. Help you guys!! I need some info here… Confused Gerry in Indy.

I would say "cured" is incorrect, though the word has been used way too often, even in medical circles, if -- as we've been told -- a diagnosis of diabetes can not exist without at least 50% beta cell death (some circles say 80%). While a drop in weight reduces insulin needs (potentially to the point that the body is able to produce it in sufficient quantities), this does not account for the whole picture.

A confounding issue (in both the lay ("confusing") and medical ("interfering") senses) is that fat produces hormone-like substances that interfere with the body's ability to use insulin. If there is little or no beta cell death, and one gets consistently- and unhealthily- high blood glucose readings, fructosamine, A1c, etc., then it is possible that what the medical profession is calling "diabetes" is instead a side effect of obesity -- in which case, removing the fat tissue (through drastic weight loss) removes the symptoms, and with there being no underlying beta cell death, the original diagnosis of "diabetes" would appear to have been false.

Now, there are a few other confounding issues in here (both medically and in lay terms).

  • Medical folk are finding that certain forms of bariatric surgery cause the balance of hormones to shift to improve insulin sensitivity. If the complete hormonal balance is off, and is permanently corrected by surgery, then perhaps the word "cure" may not be so entirely out-there.
  • Persistent hyperglycemia over long periods of time can by itself cause beta cell death, so it is possible that even after bariatric surgery and significant weight loss, a person may have functional diabetes which (because of their previous weight) may be called "Type 2".
  • Insulin resistance causes beta cells to overproduce insulin, which may cause someone who is now more sensitive to insulin (or less resistant to it) to have blood glucose numbers which are closer to normal, or even consistently hypoglycemic. It is believed that this overproduction causes beta cells to "wear out early", resulting in (another?) form of "Type 2" diabetes.

All of these are issues which make the idea of a "Type 2 cure" very confusing.

thanks for the info–I was wondering if what you stated was possible–that they are’nt “true diabetics” with a poorly functioning pancreas–they are and can be hyperglycemic because of high weight and high sugar/carb intake. When they lose significant weight they maybe no longer can be hyperglycemic. As you said very confusing. The more info I find out about this disease the better off I think I can be to deal with it. I look at information as tools in my fight for good health. Thanks again. Gerry

At the recent ADA Scientific Sessions, speakers were quite positive about the immediate blood glucose-lowering effects of bariatric surgery. Even before the patients lose the excess weight, their blood glucose drops to “non-diabetic” levels. This may be because food bypasses a certain portion of the stomach or intestine and this somehow affects some of the gut hormones that are involved with processing food (and eventually, glucose entering the blood stream). Still, we don’t have much data of the effects of such surgeries over time when it comes to diabetes.

And, bariatric surgery is expensive, tends to be reserved for the morbidly obese as a “last-chance” therapy, and brings a whole bunch of after-surgery lifestyle changes; low-fat diets, very small meals, surgery complications, etc., etc. Still, it is apparent in medical circles that researchers are very interested in studying bariatric surgery and diabetes. I would expect more data in the next few years.

Of course, there are issues other than blood glucose when it comes to type 2. Blood pressure and blood lipids (cholesterol, triglycerides) must also be kept under control. Weight loss, whether through diet and exercise or through surgery, may help with these issues, too.

As tmana writes, type 2 is a very complex condition. Usually two things are present: increasing insulin resistance and decreasing insulin production. During the 10-15 years leading up to the diagnosis of type 2 diabetes (as defined by fasting blood glucose of over 126 mg/dl), the body churns out more insulin (to fight the insulin resistance and the increasing blood glucose levels). But this peak eventually drops and insulin production declines. The insulin resistance remains. Both fasting blood glucose levels and after-meal levels continue to climb (with after-meal levels typically 20-50 mg/dls higher than fasting readings). Insulin resistance eventually more or less plateaus, but insulin production (and also the production of another gut hormone, incretin) continue to decline through the years.

So it would be really interesting to know if bariatric surgery helps lower blood glucose levels in someone who has lost a large amount of beta cell function (insulin production).