Can you reverse diabetes?

Diabetes (also known as diabetes mellitus) occurs when your blood sugar levels (sometimes called blood glucose) are too high. Blood glucose is the body’s primary source of energy. It’s absorbed from food and enters cells with the help of the hormone insulin, which the pancreas makes.

More than 34 million Americans have diabetes, and around 90%-95% of them have Type 2. It mostly affects people over the age of 45, but there is increasingly a higher incidence in children and young adults.

Is it possible to reverse diabetes?

It’s possible to reverse both prediabetes and Type 2 diabetes. Type 1 and gestational diabetes are not reversible; people with these conditions can only treat and manage them.

Most people with diabetes have insulin resistance, meaning their bodies don’t use insulin well and glucose then stays in their blood and doesn’t reach cells, eventually causing health problems. Other people with diabetes either don’t make enough insulin or make none at all. There are a few common forms of diabetes:

• Type 1 diabetes is when the body doesn’t make insulin. The immune system attacks and kills cells in the pancreas that create insulin. Healthcare providers usually diagnose this form of diabetes in young people, but it can develop at any age. Type 1 diabetes patients need to take insulin every day.
• Type 2 diabetes is when the body doesn’t make or use insulin well. It’s the most common form of diabetes. Although it can happen at any age, Type 2 diabetes most often develops in middle-aged and older adults.
• Gestational diabetes develops in pregnant women. It usually goes away after the baby is born but does raise the mother’s risk of having Type 2 diabetes later on. Diabetes during pregnancy is also sometimes Type 2 diabetes.

Healthcare providers also diagnose people with prediabetes. This is when blood glucose levels are higher than usual but not high enough to be diabetes. Prediabetes raises the risk of developing Type 2 diabetes and has many of the same causes.

RELATED: What are normal blood glucose levels?

What is the best way to reverse diabetes?

The first step in diabetes remission for those with prediabetes and Type 2 diabetes is blood glucose control. That’s done through medication if needed, eating healthy food, and losing extra weight to help the body respond more effectively to insulin. These actions can help reverse insulin resistance and prevent or delay Type 2 diabetes in people with prediabetes.

The Diabetes Prevention Program (DPP), an ongoing research study started in 1996 and funded by the National Institutes of Health, shows that people at a high risk of diabetes reduced their chance of developing the disease by losing 5%-7% of their starting weight. For someone who weighs 200 pounds, that’s 10 to 14 pounds. People who participated in the study lost weight by changing their diet and exercising more.

1. Dietary changes

The American Diabetes Association (ADA) and a panel of scientists, doctors, diabetes educators, and dietitians set out to find which healthy eating patterns work well for people with diabetes. They reviewed more than 600 research articles and found that no one diet works for everyone, but following a few guidelines can help people to manage the condition. In general, their report suggests people with diabetes eat plenty of non-starchy vegetables, whole grains, unprocessed foods, and less added sugar. 

For diabetes patients, the diet itself or food doesn’t matter; it’s more about portion control and longevity—whether you choose a low-carb diet, ketogenic diet, Mediterranean diet, or intermittent fasting.  “There’s no difference between one diet or another,” says Ghada Elshimy, MD, an endocrinologist with Augusta University Health. “The most important thing is to stick with one diet. And we tell patients they have to eat more vegetables, more protein, and fewer carbohydrates.”  

She recommends the diabetes plate method, which is also endorsed by the American Diabetes Association. It divides a dinner plate into three sections—half is for non-starchy vegetables, one-quarter is protein, and the final quarter is carbohydrates. Dr. Elshimy adds that diabetes patients should stick with 60 grams of carbohydrates per meal (the equivalent of one bagel), and the less complex, the better.  

RELATED: What exactly are carbohydrates?

2. Calorie restriction

What about eating a low-calorie diet? In a small study from 2011, researchers restricted people with Type 2 diabetes to just 600 calories a day for eight weeks. They found that the underlying signs of diabetes—insulin resistance and pancreas function—began to improve, signaling diabetes remission. Researchers noted, though, that more research is needed in a larger group of people. 

Similarly, other research shows that gastric bypass or bariatric surgery, which reduces the stomach’s size and limits calories, can reverse diabetes. In one study, researchers in Denmark studied just over 1,100 people with Type 2 diabetes who had gastric bypass surgery. One year after surgery, 74% no longer needed medications to lower blood sugar, while 27% saw their diabetes return after five years. 

A gastric bypass is an option for people with Type 2 diabetes or other serious weight-related health conditions like sleep apnea, high blood pressure, or high cholesterol with a body mass index (BMI) of 35 or higher. Those who have the surgery will still need to make significant lifestyle changes to lose and maintain their weight. Some patients have complications after surgery and may not be able to reverse their diabetes.

3. Exercise

Regular exercise and lowering body fat are critical in managing Type 2 diabetes and prediabetes. Physical activity increases the body’s cells insulin sensitivity so it works more effectively.

Experts recommend 20 minutes of moderate exercise a day—aerobic activity like jogging, cycling, or hiking, and resistance training such as lifting weights to build new muscle. People who aren’t very active or have health concerns should consult their healthcare provider before starting a new exercise program.

4. Medication

Medication could also play a role in delaying or reversing Type 2 diabetes. Some research shows that people with diabetes who take insulin immediately after a diabetes diagnosis have a better chance of living without it in the future and having fewer diabetes complications.

The DPP study found that taking metformin, a medicine healthcare providers prescribe to treat diabetes, may prevent people from developing the disease. And, two classes of Type 2 diabetes drugs that healthcare providers prescribe to improve blood sugar control—GLP-1 agonists and SGLT-2 inhibitors—can also lead to weight loss. Research shows that diabetes patients who take a GLP-1 medication could lose an average of three to five-and-a-half pounds. That number jumps to six to nine pounds with lifestyle changes in addition to diabetes medication.

There’s also medication to suppress appetite. Dr. Elshimy says the most effective drug for this purpose is Qsymia, and she only recommends it for Type 2 diabetes patients with a BMI of 27 or higher. Those who take this drug should only use it to supplement other lifestyle changes; they’ll also need to take it for the rest of their life to maintain weight loss results.

Besides medication, diet, and exercise, there are other lifestyle and medical factors to keep in mind when working toward diabetes reversal.

5. Sleep

Research suggests a link between sleep, metabolism, and obesity. A lack of sleep makes us more hungry, especially for foods high in calories and carbs. Scientists believe that sleep affects hormones in the body called ghrelin and leptin that regulate hunger. Another factor: a lack of sleep zaps our energy for physical activity. 

Most adults should get seven to nine hours of sleep a night and work toward better sleep habits like removing electronic devices from the bedroom and avoiding heavy meals two to three hours before bedtime.

6. Mental health

Having an illness can cause anxiety, sadness, and a loss of interest in previously enjoyable activities. People with diabetes are two to three times more likely to have depression than those without the condition, yet only 25% to 50% are diagnosed and treated. They’re also 20% more likely to have anxiety. 

Those who are trying to reverse their diabetes may also have these feelings if they don’t see anticipated results or have friend and family support.

7. Smoking

Smoking can be a cause of Type 2 diabetes, and in fact, smokers are 30%-40% more likely to develop it. They also have trouble controlling the disease and are at a higher risk for other serious health problems such as heart disease, poor circulation in the legs and feet, nerve damage, and eye disease.

8. Treating polycystic ovary syndrome (PCOS)

PCOS is a common cause of infertility and affects as many as 5 million U.S. women in their childbearing years. Women with the condition have trouble using insulin well, which raises their risk for Type 2 diabetes. More than half of women with PCOS also develop Type 2 diabetes by the time they reach age 40.

People with these health concerns should talk to their healthcare provider for help in treating them, which could also lead to a reversal of their diabetes.

How long does it take to reverse diabetes?

There’s no set timeframe for when people with Type 2 diabetes may start to see their hard work pay off. In general, diabetes experts say with medication and lifestyle changes, diabetes patients could notice a difference in three to six months. It may take one month to stabilize blood sugar (with or without medication), and then a couple of months or more for lifestyle changes to take effect. 

“With enough work and time, you can do it,” says Stephanie Redmond, Pharm.D., CDE, BC-ADM, co-founder of diabetesdoctor.com. “The longer you’ve had diabetes and the higher your sugars have been for a sustained time, the harder this might be.” Redmond adds that despite their best efforts, it may be impossible for some to become diabetes-free. “Your pancreas just can’t produce the insulin it needs. There’s no point in stressing or beating yourself up. Work with your healthcare provider on the best medication plan for you.”

An A1C test measures average blood sugar levels (hemoglobin a1c) over the previous two to three months. A hemoglobin A1C below 5.7% is normal, between 5.7 and 6.4% is a sign of prediabetes, and 6.5% or higher indicates diabetes. People managing their Type 2 diabetes should get an A1C test at least two times a year and more often if they change medications or have other health conditions.

People working to reverse diabetes may see a difference in their blood sugar right away and be tempted to go back to their old ways. “Don’t confuse this,” Redmond says. “If you stop eating sugar and carbs and exercising, you may have lower or normal blood sugars almost immediately. But, it may take much longer to reverse the damage that the pancreas has endured and start to cut through the body’s insulin resistance and inflammatory state.”

Reversed diabetes can return. People with diabetes already have a gene that makes them insulin resistant and susceptible to the disease. Reversing diabetes takes continuous effort over many months and maintaining changes for a lifetime.

Who can help me reverse diabetes?

People with diabetes should start with their primary care provider for guidance on reversing the condition and diabetes care. Their provider may refer them to a Diabetes Self-Management Education and Support (DSMES) service. A DSMES healthcare team includes diabetes educators such as doctors, nurses, dietitians, pharmacists, and other healthcare providers with special training and experience. The team helps diabetes patients to learn more about the condition and diabetes management.