There are books and articles by the dozens that state just that, “reversing or curing diabetes.” My take on it is that if a person is insulin resistant due to weight, then they can get rid of their diabetic symptoms and issues with diet, exercise and weight loss, however, not all T2 diabetics are insulin resistant or even over-weight, so the terms “reverse” or “cure” are misleading for T2 diabetes. To me it is like shrinking a tumor, it is still there, just smaller and maybe unnoticeable to the person carrying it. I know many people who can control with diet and exercise and who have lost weight and have no more diabetes issues. Is that a cure? I guess in a sense, but I bet if they gained the weight back the symptoms would come back also…
I don’t think so. I’m very clear that it DOES get harder and harder to control as you get older. For the reason you state. Drug management unfortunately is going to be a part of our life at some point or at all points. But I just really feel that the use of drugs should not be our ONLY strategy. That it is only one tool in our toolbox and we all can reduce the amount that we need. Plus the worst thing that could happen from trying is you eat healthier and exercise.
Maybe we just see it differently. I’m not trying to demotivate people, the opposite in fact. Just giving up, eating whatever you want, and just covering the load with more insulin feels wrong to me. Not that your saying that, but I know lots of people who feel that way. But needing meds is not a failure to me. Not even trying makes me feel like I have no control over my disease and my own body.
Excellent - got discussion rolling.
I must disagree, Insulin resistance from my perspective is not issue of weight. That is misleading. My take and experience is that dailiy high levels of glucose force body to use insulin resistance to stop its own insulin letting in any more glucose to cells already saturated.
Every day from my liver massive dumps I would see maximum insulin resistance on my body to where even 40 units of 75/25 was like sticking into dead post for two hours.
Go walk and burn off excess till BG drops and gets back to 140 and under and insulin became proactive again.
I was doing this every day till mrtformin used to squelch liver.
from my perspective, I finally got my mess under control and stopped further damage. That’s as best as it gets.
I asked many people about my data and what was happening and nobody had a rational explanation and how to proceed.
What I saw and recorded clearly shows there is another aspect to this problem not yet codified nor understood.
The huge explosion of cases of this type of diabetes is begging the question.
And my work was done after 26 years stalled out the other way and in last 4 struggling to document and cleanup.
we have had enough sophistry and WAG and now time to devolve this bugger better,
This is not a blame game issue, we have an issue here not getting corrected in any menaingful wave and it seams that lap band and other surgerys suggest that hauling back what body can cosume as well as ensuring receptors later in small intestine can properly signal.
This is not diet is everything game and or carbs control as medical shorcomings unfixed can overwhelm any meaningful glucose control;.
I don’t think I got the point across to you.
A person who still makes a meaningful amount of insulin is like a short-sighted person. They can get spectacles to help them so see. This is analogous to improving insulin sensitivity. This is the early stage T2.
But a person who makes very little or no insulin is like a person who is blind. Spectacles are not going to help! This is the late stage T2.
Chris:
Dead on target.
When one ages, systems degenerate and organs all do at different rates.
When young and mostly working - I use term carbs control( rather than all the implications word diet has) and strong hearty exercise suggests one health should be OK.
As system ages, drugs will be required to keep organs in line and not swamping out glucose control.
WIthout careful use of metformin I was on my way out the door at high speed with everything rotting.
Now I can see good numbers, kidney’s stable, eye issues abd rot stopped. Lungs healthier.
Thank god medical science is going after the hormones like glp-1 and gpp5 and hopefully will end up with tool kit of
medicines to control aging and degeneration effects.
As I said - this is NOT blame game. Many of us ( not the 35 percent of population that eat anything it wants in any volume and not rot out) are stuck with systems optimized for an earlier time. Today’s agriculture and science have so enhanced volume, production and quality-manufacturing of the grains and related carbs at same time computers, cars, electronic games and wide screen tv has removed a big load of the energy burn.
Unfortunately we basically eat all the foods of our childhood and portions needed for a growing body that today for the old gene bodies needs carbs scaled back. That is not fault of one’s fork/plate/knife activities but in end to keep mess down carefull sizing and consideration is needed. Just watch the CGMS after eating.
I am not trying to demotivate anybody. I can still eat all the good foods but I most carefully watch size and volume of the bread, pasta, flours, rice, corn and all the high energy snack food so as not to blast my body.
On the getting fat side, I was at point even on 1200 calorie diet that could not lose weight. Ended up at 330 pounds.
Once dam liver told to sit down and shut up, finally got BG control and weight loss now down to 260 and I keep driving. Arguments over weight and blame are insensitive, useless and in end prove little other than your genes are cooperating in body to help store excess glucose floating around.
as much as I have issues with dexcom, I have found CGMS invaluable getting feedback on eating habits and digestion times and glucose generated as well as liver leaks.
thank you for writing.
Thank you for writing.
I believe you are missing something:
If you have little or no insulin left, taking starlix/insulin doses before meals is easy and straightforward.
If uou have this background body insulin in there and being ignored - ok dose handling same.
If the previously ignored body made insulin is now working, stratagies of adding pills insulin dose before eating runs risk of supper low from added starlix/ insulin dose on top of pancreas bolus.
For me since I really did not need huge boost of insulin; it was wiser to add after eating meal and weight til cgms showed gut output up and add the extra shot. No super lows and working nice.
The bigger point is that none of this is discussed or hinted at and how to manage. Who is being short sighted?
and BTW, I needed small boost and liquid insulin was way better answer than the big hammer approach of starlix /glyburide pills.
This just proves my point that the whole aspect of the issues in "type 2 " has not really been fully explored, it relies too much on type 1 data and science and nor is there really any in depth info to the complexity. Both complications are equally deadly and serious and Type 2 training and knowledge needs a superior upgrade rather than being stuck on weight, diet without a gestalht whole. There are two many non diabetics driving this stuff who have never lived this crap - good intentions aside.
I am going to side with Jim here. Nobody is saying that meds = failure. What Jim seems to be saying is that his pancreas has always produced insulin… even now after over 30 years! His problem is that his liver dumps sugar and he has insulin resistance. It sounds like he was prescribed a sulphonylurea ( gluberide) to tackle this problem. So…even though his body was unable to effectively use the insulin that he was producing, he was given a drug which squeezed the cells to produce more of that same insulin so his body became overwhelmed with this insulin and his liver had to dump more sugar. His sugars began to spike and all of this led to continuous weight gain and terrible complications.(When you are insulin resistant and have too much insulin floating around, you can eat virtually nothing for months and still gain weight.)
I hope I am understanding you correctly Jim…I think I can relate …even if this is not Jim’s experience… it is certainly mine. The difference is that I did not go through this for so many years. Once I stopped the sulphonylurea, I immediately lost the excess weight. I am now on a low dose Metformin and once again I am managing fine.
I do not believe that ALL Type 2s lose pancreatic function. This IS NOT DENIAL it IS SELF-PRESERVATION! Type 2s are not routinely tested to see if their pancreas is functioning or not. A small gain in A1C is enough to cause docs?endos to ramp up the pills. This can be DEVASTATING in the short term for those who are actually suffering from an autoimmune attack. It can be JUST AS DEVASTATING over the longterm for those who are are already producing insulin which their body cannot effectively use.
Jim is right. The cause of high blood sugars needs to be investigated in every human being. If something has caused the pancreas to stop producing insulin then…insulin needs to be provided. If an infection, another med or a temporary health problem has contributed to the problem then the problem needs to be corrected and proper treatment provided until all is well. Just because one has been labelled as diabetic should not mean that one does not have the right to a proper diagnosis. Just assuming that the disease has or has not progressed is an inadequate response.
I have read frightening accounts of DKA experiences on this site. Why must one wait to go DKA before someone will provide the proper tests? Why must one suffer years of complications like Jim did before finding an adequate treatment?
I KNOW it’s a puzzle! I KNOW it’s complicated! It just seems unfair that so many are denied a simple (and apparently inexpensive) test!
Hope I didn’t misunderstand you Jim. This is what I believe right now.
Joanne
But what about the non-auto-immune, non-insulin-resistant, non-MODY, non-idiopathic Type 1 types? They don’t fall into either side of your “bright line”. But they’re out there. I don’t see a bright line as much as a lot of blurring on the edges if you aren’t dealing with a “definition”, but looking at the clinical reality. The garbage-can diagnosis of Type 2 is really not adequate for a lot of people.
If you look at the actual numbers, 85-90% of new-onset correctly diagnosed Type 1s are antibody positive (5-10% of the total diabetes population). 100% of the LADAs (also Type 1) are antibody positive, by definition, and are two to three times more common than the correctly diagnosed Type 1s. Doing the math, 3% or less of Type 1 diabetes is non-autoimmune. I would say there certainly is a bright line between autoimmune diabetes and insulin-resistant diabetes–again, different genetics, triggers, treatments, potential cures. Entirely different diseases. I am in total agreement with you regarding Type 2 diabetes–it is a throw-a-bunch-of-diseases-in-a-bucket diagnosis and really, really, complex–and not getting the attention it deserves (people are tossed in the bucket without looking at the disease process).
Peetie/Joanne:
Thanks for detailed comments and analysis. From my perspectiev this class of fracas’s are a curse to the victim and Doctor alike. Our battle field medical systems whereby Doctors need to see as many patients as possible per day and make fast best guess just flies in the face of what is needed for this disease.
,Extensive testing and supervisory equipment needed to monitor body to catch sufficient data to draw decent assessment of problem is usually only available in hospitals at $100K per month. It is really better today but can be pricy and we now have CGMS, at home A1C tests and better finger stick machines with at least now some have targeted strips for human glucose and not the trick crap of the trick sugars.
Otherwise the human body has no warning lights or gauges like our cars to provide warning
of individual system failures or exceeding operating points - average glucose supply exceeding system capability.
oh well, we can hope as science really marches on. The grief comes from having to walk down all the blind alleys and edge cases to catch the base operation and key operation effects and how to correct degredation and component failure.
thank you
You have captured the essence.
OK, there is something confusing here. I’m assuming that only 85-90% of new onset Type 1’s are antibody positive because they are diagnosed as Type 1 because they present as youngsters in DKA? So why do LADAs need to be 100% antibody positive? What if an adult experiences gradual onset, and because of mistreatment goes into DKA, but is still antibody-negative (and NOT black or Asian)? Why can children be antibody negative and still Type 1, when adults cannot?
Hi Natalie: I am referring to studies on Type 1s where antibody testing has actually been performed, no speculation. In “classic” new-onset Type 1, 85-90% are antibody positive based on testing. LADA is by definition antibody-positive: it is latent autoimmune diabetes in adults.
Natalie and Melitta: This may be a little off topic but I just wanted to check with you two. What do you think of the Joslin Medalist studies? Is it possible that some T1s regenerate cells only to have them attacked once again? Do you think they are getting close to finding out how to switch off /slow down the autoimmune attack? Do you think they are getting close to discovering the protective factor that prevents complications in all types?
Hi Lila: I have read your posts on other threads. Were you able to get the C-peptide test? It’s great that you are getting the correct treatment right now but beware…a change in doctors could mean a change in treatment based solely on an incorrect diagnosis. I hope you are able to get the tests. 
Joanne
Judith: Your post about cats reminded me of thoughts I’ve had myself. While I have had many cats, none have had diabetes. I did have 2 with “fatty liver” syndrome. They would stop eating, lose too much weight and would have to be hand fed for awhile before they could eat on their own again.
I realized that I had had the same experience when young. I’d forget to eat … studying for exams… working overtime etc. and then would find that I just couldn’t eat and would have to force myself to eat in order to slow down the rapid weight loss. My grandmother was certain that it was the beginning of diabetes (my grandfather was Type 2) and she would go to great lengths to make certain that I started to eat again. My last episode was at age 40…ten years before diagnosis.
I wonder… perhaps observing our furry friends is not so off-base?
Actually, I think the 85-90% number is from a sampling ofT1s of mixed vintage, not newly diagnosed. And if it is actually true that LADAs are T1s, then they would have similar antibody positive rates as T1s. And this is confusing the questions of what patients are actually T1 or LADA and how they have been diagnosed. We know how much misdiagnosis goes on.
Some of the confusion about “Curing” and “Reversing” diabetes comes about through a confusion about what diabetes exactly is. Is it the symptom of abnormal glucose levels or is it the underlying defect? That is the key question. Can you restore normal glucose levels? Yes. I think many of use would agree on that. If you cut your hand and blood is dripping out, can you stop the blood flow? Yes, wrap it tightly in a bandage. See, no blood!!! OMG, I’m cured.
Well that is totally bogus, but in fact that is what we hear. Think about the Diabetes Prevention Program (DPP). They took a large population of people who test positive for pre-diabetic blood sugars (what I consider diabetes). Then they studied the effect exercise and diet and amazing wonder of wonders, their blood sugars improved. So what did they find? That by the end of the study (3 yrs), people who exercised and followed a diet were found to have less blood sugar abnormalities than those who just sat on the couch and watched TV. Did the study look at how many people eventually were diagnosed? No. Did the study look at how many people still suffered from underlying diabetes? No.
So instead, we get headlines that the DPP study showed you could “Prevent” diabetes. Totally bogus. The study did not show prevention, it showed you could Fix glucose abnormalities for some patients with exercise and diet. It didn’t show you could Delay diabetes and it certainly did not show you could Prevent diabetes.
So, while we might get frustrated at people who claim cures and reversal, we must understand, these people are naive and uninformed. Have pity on them, but also realize that this ignorance is so pervasive that even in the so called professionals involved in the DPP could not figure it out.
bsc, you took the words right out of my mouth. Why should the antibody-positive rate be different in classical T1 vs. LADAs, except that, as Melitta said, autoimmunity is part of the DEFINITION of LADA. Maybe it’s time for the definition of LADA to be modified, if some people are being treated inappropriately because of the antibody requirement.
But that brings another question: WHY are some T1’s antibody negative? Is there something ELSE going on?
So far as I have read, there IS beta-cell regeneration in T1’s. However, the autoimmune attack is ever at the ready, so they are destroyed almost as soon as they’re made. However, just like in a chemical reaction, there is an equilibrium point, and many (or most, according to Dr. Bernstein) do have a detectable C-peptide, although they don’t produce enough insulin to keep them alive. But even a small insulin production may well make control easier.
But as far as prevention of complications in ANY PWD, there are a lot of factors that go into that. Glycemic control is indubitably important, but there may also be genetic and other hormonal factors at work that they don’t yet know enough about. That’s one of the reasons for the careful medical workup they’re doing on the Medalists.
About slowing down or even stopping the autoimmune attack, it IS being researched, but I don’t think they’re anywhere close to having something ready to test in humans. If I were wrong about that, I’d be pleasantly surprised!
My only quibble with your blog is that I would use the word “remission” instead of “reversal”. While reversal may not mean cure to you, it DOES to many people. Whereas remission is sort of like the way it’s used in cancer – you may appear to be free of the disease at the moment, but it CAN come back, and you need to be vigilant about it.
I congratulate you on the steps you have taken – you had the wisdom to make major, difficult changes in your life, and I am confident that they will pay off. May you live to see your dear daughter grow into a strong, competent woman who will bring a whole new dimension into your life!