In Type 1 diabetes, the pancreas produces little to no insulin, while in Type 2 diabetes, the body stops responding to insulin properly. In both cases, high blood sugar can damage our bodies, leading to heart disease, kidney problems, nerve issues and even blindness.
Losing weight — even 5 to 10 percent — can improve blood sugar levels and reduce the need for medications for Type 2 diabetes. More radical lifestyle changes — overhauling your diet and exercising more — and weight loss (bariatric) surgery can reduce weight and lead to the reversal of Type 2 diabetes for some people.
Type 1 diabetes, caused by an autoimmune response against part of the pancreas, cannot be reversed – although scientists working in a remedy.
Millions of Americans have diabetes but are undiagnosed. One minute CDC risk tool can help you determine whether you should seek such a test or you can ask your doctor about the test. Common tests can either check your blood sugar directly (blood glucose) or measure the average of your blood sugar levels over the past two to three months (hemoglobin A1c).
The test may show that you have diabetes or prediabetes. Prediabetes means you have higher blood sugar than normal, but not enough for a diagnosis of diabetes. You should think of it as a yellow traffic light: There is a high risk of developing diabetes without changes in your lifestyle.
Diagnosis is an ‘all hands on deck’ moment
Anytime one of my patients is diagnosed with diabetes, I consider it an “all hands on deck” moment. Not only for our clinical team, but also for the patient and their family. That’s because the first few weeks after diagnosis are critical for establishing new patterns, from eating habits to keeping blood sugar records to managing medications.
Medicines for Type 2 diabetes help your body use insulin more efficiently or rid your body of excess glucose. Most are in pill form (for example, metformin), although insulin and injectable drugs are also prescribed, especially if blood sugar is very high. It may take some time for you and your doctor to find the best medications to treat your diabetes — and most patients continue to take them for life.
A number of new drugs for diabetes have come on the market in recent years. Some glucagon-like peptide 1-based therapies (such as semaglutide, liraglutide and tirzepatide) lower blood sugar but also slow digestion and help with weight loss.
If you already have diabetes, it’s worth talking to your doctor to make sure you’re on the best combination of medications. And it’s always worth asking: “How can I safely get off one or two of these drugs?” Asking that question may be the first step toward reversing your diabetes.
Type 2 diabetes can sometimes be reversed without medication
We know that Type 2 diabetes can be reversed. A study in the United Kingdom, known as the Diabetes Remission Clinical Trial (DiRECT), Shown patients can reduce blood sugar below diabetic levels — with about a third of patients maintaining that control for at least two years, without medication.
Study participants had to commit; at first, all diabetes medications were stopped and meals were replaced with a strict 800-calories-a-day diet of mostly healthy shakes. Real food is then gradually reintroduced, and patients are supported by dietitians, nurses, and tailored workbooks to maintain their weight loss.
If this seems extreme to you – it is. But so does injecting yourself with insulin every day! For me, the most important lesson of trying DiRECT is how important it is to find a nutritional plan that you can stick with long term.
Anyone who has tried to lose weight knows that the hardest part is keeping it off. My advice is to think about what nutritional changes you can sustain over years, not weeks.
A Mediterranean diet is probably the strongest long-term scientific evidence supporting its use in Type 2 diabetes. Plant based and vegetarian diets have also been shown to be effective for the prevention and treatment of Type 2 diabetes. Low-carbohydrate (including “keto”) diets and intermittent fasting have less scientific support but work for some – those options should be discussed with a nutritionist or doctor.
Diabetes management is its own prevention
My father has had Type 2 diabetes for over 30 years, but he has managed it and never had to start insulin. He is unlikely to reverse his diabetes at this point, but there are still tremendous benefits to properly managing the disease.
We focus on “ABCs of diabetes”: his A1c, or average blood sugar, which we keep below 7; his blood pressure; and his cholesterol.
Keeping blood sugar at or near the goal level helps protect the eyes, kidneys and nerves. And keeping blood pressure and cholesterol under control reduces the risk of heart attacks and strokes.
My father uses medications for each of the ABC’s, but we always look for opportunities to offset his pills by eating better and exercising more.
Prevention is better than reversal
I have a strong family history of Type 2 diabetes — along with my father, each of my four grandparents also suffered from it. The deck may be stacked against some of us this way, but we can take steps to reduce our risk of developing diabetes.
Eating more fruits and vegetables and less meat, sweets and refined grains (such as white bread and pasta) is important. It’s a myth that people worried about diabetes should avoid fruit; eating whole fruit (rather than juices or processed fruit) is a good source of fiber, vitamins and minerals.
Sugary drinks like soda and juice should be a rare indulgence, as should ultra-processed foods like starchy snacks, chips and crackers, and packaged foods like energy bars. If you’re not sure if something is ultra-processed, check the ingredients list: More is not better! Switching to whole grains, such as switching from white rice to brown rice, also helps.
Personally, I’m vegetarian and started a version of intermittent fasting a few years ago, where I only eat between the hours of noon and 9 pm each day. I find it easier for me to stick to time-based cutoffs, and they’ve helped me cut back on unhealthy snacking.
Physical activity is also important for how our body processes sugar. Hitting the gym is great, but walking, gardening and dancing are important. If you’re having fun while you exercise, it won’t seem like much of a chore, and you’ll be more likely to keep doing it. Some studies show that combining strength training with aerobic exercise reduces diabetes risk more than either alone.
The National Diabetes Prevention Program, offered by many organizations such as YMCAs across the country, has been scientifically proven to help people adopt healthy habits for nutrition and exercise. Depending on your age, weight and test results, your doctor may also consider certain medications – such as metformin or semaglutide – to help prevent diabetes.
The benefits of preventing diabetes are remarkable. Learning estimate that a diagnosis of diabetes at age 40 reduces life expectancy by six years. An ounce of prevention is worth a pound of cure — and a few birthdays, too.
Meet the doctor: Dave A. Chokshi (@davechokshi) is a primary care internist at Bellevue Hospital and clinical professor at NYU. He previously served as New York City’s 43rd health commissioner.
