About Diabetes, Type 2:  Type 2 diabetes is characterized by "insulin resistance" as body cells do not respond appropriately when insulin is present. This is a more complex problem than type 1, but is sometimes easier to treat, since insulin is still produced, especially in the initial years. Type 2 may go unnoticed for years in a patient before diagnosis, since the symptoms are typically milder (no ketoacidosis) and can be sporadic. However, severe complications can result from unnoticed type 2 diabetes, including renal failure, and coronary artery disease. Type 2 diabetes was formerly known by a variety of partially misleading names, including "adult-onset diabetes", "obesity-related diabetes", "insulin-resistant diabetes", or "non-insulin-dependent diabetes" (NIDDM). It may be caused by a number of diseases, such as hemochromatosis and polycystic ovary syndrome, and can also be caused by certain types of medications (e.g. long-term steroid use). About 90-95% of all North American cases of diabetes are type 2, and about 20% of the population over the age of 65 is a type 2 diabetic. The fraction of type 2 diabetics in other parts of the world varies substantially, almost certainly for environmental and lifestyle reasons. There is also a strong inheritable genetic connection in type 2 diabetes: having relatives (especially first degree) with type 2 is a considerable risk factor for developing type 2 diabetes. The majority of patients with type 2 diabetes mellitus are obese - chronic obesity leads to increased insulin resistance that can develop into diabetes, most likely because adipose tissue is a (recently identified) source of chemical signals (hormones and cytokines).
Researcher Qizhi Tang, PhD, at the University of California, San Francisco, is studying the changes induced in beta cells by the shortage of oxygen and nutrients. Stem cell-derived islets have a low survival rate in the first few days after transplant due to the lack of adequate oxygen and nutrient supplies. However, the American Diabetes Association states, “Evidence suggests that beta cells can be trained to survive oxygen and nutrient shortages that they are exposed to before and after transplantation.”
Change in fasting plasma glucose (A), 2 h post-oral glucose tolerance test (B), and homeostasis model assessment (HOMA-B) insulin secretion (C) during the 16-year follow-up in the Whitehall II study. Of the 6,538 people studied, diabetes developed in 505. Time 0 was taken as the diagnosis of diabetes or as the end of follow-up for those remaining normoglycemic. Redrawn with permission from Tabák et al. (80).
Dr. Mona Morstein is a naturopathic physician with a medical practice focused in integrative diabetes treatment. Her clinic, Arizona Integrative Medical Solutions, is located in Tempe, Arizona, where she sees patients of all ages and genders for acute and chronic conditions. An expert on prediabetes and diabetes, she is a frequent lecturer at conferences and webinars, and is the founder and executive director of The Low Carb Diabetes Association. Dr. Morstein is also a member of the Arizona Diabetes Coalition. Visit her website lowcarbdiabetes.org
"You only need 10 percent of your beta cells to supply sufficient insulin," Roep said. He said there have been a couple of rare cases where a patient had typical type 1 diabetes but could go through long periods without insulin injections. "Insulin needs can be a moving target, and if you have a lifestyle change it's very plausible that you have a lesser need for insulin, and you can deal with [diabetes] with the beta cells you have," Roep said.
The accepted view has been that the β-cell dysfunction of established diabetes progresses inexorably (79,82,83), whereas insulin resistance can be modified at least to some extent. However, it is now clear that the β-cell defect, not solely hepatic insulin resistance, may be reversible by weight loss at least early in the course of type 2 diabetes (21,84). The low insulin sensitivity of muscle tissue does not change materially either during the onset of diabetes or during subsequent reversal. Overall, the information on the inhibitory effects of excess fat on β-cell function and apoptosis permits a new understanding of the etiology and time course of type 2 diabetes.
What’s critical is not necessarily the cutoff itself, but where someone falls within the ranges listed above. The level of risk of developing type 2 diabetes is closely related to A1c or FPG at diagnosis. Those in the higher ranges (A1c closer to 6.4%, FPG closer to 125 mg/dl) are much more likely to progress to type 2 diabetes, whereas those at lower ranges (A1c closer to 5.7%, FPG closer to 100 mg/dl) are relatively more likely to revert back to normal glucose levels or stay within the prediabetes range. Age of diagnosis and the level of insulin production still occurring at diagnosis also impact the chances of reverting to normoglycemia (normal blood sugar levels).

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Q. I have Type 2 diabetes, and I currently take 1,000 milligrams (mg) of metformin twice a day, 5 mg of Onglyza (saxagliptin) once a day, and 5 mg of glipizide once a day. Does it matter when I take the Onglyza and the glipizide? I used to take them both at breakfast, but I thought I might get better blood-glucose-lowering coverage if I took one of them with lunch and one with dinner.
The diet was strict: three litres of water a day, three 200-calorie food supplements (soups and shakes) and 200 calories of green vegetables. Thanks to my doctor's dietary guidance, and running three times a week, I had already lost a stone. Yet my glucose levels were still above 6mmol/L (millimols per litre), the upper limit for a healthy person without diabetes. According to Taylor, I had to lose a sixth of my pre-diagnosis bodyweight.
Other drugs are on the horizon as well, as scientists work to improve the variety of medications to treat type 2 diabetes. Frequently physicians will prescribe one type of oral medication and discover it isn't really helping to control blood glucose that much. In the past, this would have meant that the patient would likely be put on insulin. Now, physicians can try another type of medication to see if it helps correct problems. Physicians often notice that a particular medication works well for a period of time and then begins to work less well for a patient. Now they can mix and match medications that work on different aspects of the diabetes problem to see if that will improve blood glucose control.

It was the same endorsement the first Diabetes Surgery Summit, also organized by Cummings in 2007, had made, but the landscape had changed since then. In addition to more accumulated research, this time, their stance was backed by over 50 international professional organizations, including the American Diabetes Association. And while other medical societies and organizations had long backed surgery as an option for diabetes, the DSS-II guidelines are the first meant to guide clinical practice.
Over the last century, advancements in new treatments aided by the remarkable developments in computer technology have helped many people better manage the disease, but achieving optimal glucose control remains an unattainable goal for the vast majority of those with diabetes, and particularly among young people. Despite patients' best attempts, managing diabetes remains a challenging, daily balancing act that requires constant vigilance. That's because insulin therapy cannot ideally mimic the exquisite biological function of a healthy pancreas. And that's why the Diabetes Research Institute and Foundation remain passionately committed to achieving this singular goal. Learn more about our progress toward a cure and the steps we are taking to turn our vision into reality.
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It is important to note that these herbs and spices are intended to support blood sugar maintenance and are not meant to replace diabetes/hyperglycemic medications. Research does show benefits to incorporating these herbs and spices, so enjoy incorporating them daily into your favorite recipes for a boost of flavor and blood sugar-lowering benefit.
Thiazolidenediones can increase risk of heart failure and should not be used in patients with symptoms of heart failure. Liver enzymes should be checked regularly with use. Other side effects include weight gain, fatigue, swelling of the legs or ankles, increased risk for fractures in female patients. Avandia may have a potential increased risk for heart attack.
Steve Vincent, 58, from Southampton, England, was diagnosed with type 2 in December 2010. He was told there was no known cure and he had an increased risk of heart attack, stroke, blindness and limb loss. He had a BMI of 29, weighed 93kg and showed an HbA1c of 10.7%. In summer 2011 he read the reversal story and went on a daily 600 calories green vegetable diet and three litres of water, for two months. At the end he was and remains diabetes-free. In December 2012 he told me: "All my blood test levels are within the normal range, and my cholesterol and blood pressure levels are now normal." When he came off the diet he weighed just 72kg, although he has put on weight since then as he admits he has not been eating as healthily as he might, but his BMI remains at a healthy 24, and his HbA1c level is 5.5%.
But early last year, routine finger-prick tests showed his blood-sugar levels were normal, so doctors advised him to stop his insulin injections, Darkes said. Now, his doctors have told him they're 80 percent sure he's cured, the Northampton Chronicle and Echo reported. If true, this would mean Darkes could be the first person ever to naturally experience complete remission of type 1 diabetes. [27 Oddest Medical Cases]
A substantial proportion of people who experience type 2 diabetes remission after gastric bypass eventually have relapse of the disease down the road. I feel the best study of this was done by my co-author on CROSSROADS, David Arterburn. In a study of nearly 5,000 patients with diabetes who underwent [gastric bypass surgery] and were followed retrospectively for 13 years, about 70% experienced diabetes remission. Among these, about 1/3 eventually relapsed, but it’s important to note that the median disease-free interval was 8.3 years.
Gupta says that with her patients, “we typically emphasize cutting out processed food and sugary drinks to begin with, and exercise recommendations include 150 minutes of moderate-intensity cardiovascular exercise per week, and two to three days per week of strength training, which is consistent with exercise guidelines from the Centers for Disease Control and Prevention.” The American Diabetes Association recommends replacing high-fat, high-sugar, high-salt foods with a mix of fiber, protein, fruits, and vegetables to keep blood sugar levels steady.
Despite these encouraging results, Vulksan cautions that it's too early for diabetic patients to rely on ginseng. Herbs sold in this country are not standardized, he says, so it's difficult to know for certain what you're buying and impossible to ensure consistent dosages. Besides, his study looked only at American ginseng, and he's not certain the results would hold true for the seven other varieties. What's more, researchers haven't conclusively identified ginseng's active ingredients.
Although the promises are big, these technologies are still far from the market. First, clinical trials will have to show they do work. Then, the price could be steep, as cell therapy precedents for other applications, such as oncology, come with price tags that reach the six figures and are finding difficulties to get reimbursed. Considering that compared to cancer, diabetes is not an immediately life-threatening disease, health insurers in some countries might be reluctant to cover the treatment.
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