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).
For over a decade, Cummings and others have tried to reframe the very concept of bariatric surgery (they prefer “metabolic surgery”). Their work has shown these procedures just don’t change how much food the stomach can fit; they trigger a cascade of metabolic and bodily changes, many of which help people with type 2 diabetes naturally get their blood sugar under control. Some changes even start happening before a patient loses weight, such as higher levels of peptide production in the gut that seem to restore a patient’s sensitivity to insulin.
Type 2 diabetes has long been known to progress despite glucose-lowering treatment, with 50% of individuals requiring insulin therapy within 10 years (1). This seemingly inexorable deterioration in control has been interpreted to mean that the condition is treatable but not curable. Clinical guidelines recognize this deterioration with algorithms of sequential addition of therapies. Insulin resistance and β-cell dysfunction are known to be the major pathophysiologic factors driving type 2 diabetes; however, these factors come into play with very different time courses. Insulin resistance in muscle is the earliest detectable abnormality of type 2 diabetes (2). In contrast, changes in insulin secretion determine both the onset of hyperglycemia and the progression toward insulin therapy (3,4). The etiology of each of these two major factors appears to be distinct. Insulin resistance may be caused by an insulin signaling defect (5), glucose transporter defect (6), or lipotoxicity (7), and β-cell dysfunction is postulated to be caused by amyloid deposition in the islets (8), oxidative stress (9), excess fatty acid (10), or lack of incretin effect (11). The demonstration of reversibility of type 2 diabetes offers the opportunity to evaluate the time sequence of pathophysiologic events during return to normal glucose metabolism and, hence, to unraveling the etiology.
“For me it’s a personal challenge – going from being completely 100% sedentary to climbing the highest mountain in Africa. One thing I’ve learnt on this journey is that I’m capable of so much more than I ever thought possible – and this is just another way of proving that to myself. It’s also a way of showing people with diabetes that there is always greatness within you; that you have the power to change your diagnosis and your destiny one step at a time.”
Diabetes education is very important for any diabetic or a person who has a diabetic at home. The education helps an individual to know more about this dreadful disease. Once educated, the individual can control diabetes in a better manner. Administering insulin, medications, and understanding emergency situations like hypoglycemic attacks, etc. are major points of diabetes education. It also includes the diet a diabetic should avoid and have. Diabetes education is very essential for each and every diabetic and individual who has someone close living with diabetes.
These findings present a hopeful option not just for improved management of the condition, but a potential cure. One that doesn’t rely on expensive medications or invasive surgery, but instead, on improved diet and lifestyle — which could also be beneficial in managing and preventing a number of other chronic conditions which are affected by weight. As Taylor told The Guardian, “The weight loss goals provided by this programme [sic] are achievable for many people. The big challenge is long-term avoidance of weight re-gain.”
Diabetes is a disease characterized by a person’s inability to process carbohydrates, a condition that if untreated can lead to often-catastrophic health consequences: lethargy, diminished eyesight, heart attacks, strokes, blindness and a loss of circulation in the feet that could lead to amputation. The Centers for Disease Control and Prevention estimate that in 2014, about 29 million Americans – almost 1 in 10 – had diabetes.
Curcumin. The compound curcumin, which is found in the spice tumeric, has been shown to both boost blood sugar control and help prevent the disease. In a nine-month study of 240 adults with pre-diabetes, those who took curcumin capsules (which are available over-the-counter) completely avoided developing diabetes while a sixth of patients in the placebo group did.
During this 8-week study, β-cell function was tested by a gold standard method that used a stepped glucose infusion with subsequent arginine bolus (21). In type 2 diabetes, the glucose-induced initial rapid peak of insulin secretion (the first phase insulin response) typically is absent. This was confirmed at baseline in the study, but the first phase response increased gradually over 8 weeks of a very-low-calorie diet to become indistinguishable from that of age- and weight-matched nondiabetic control subjects. The maximum insulin response, as elicited by arginine bolus during hyperglycemia, also normalized. Pancreas fat content decreased gradually during the study period to become the same as that in the control group, a time course matching that of the increase in both first phase and total insulin secretion (Fig. 3). Fat content in the islets was not directly measured, although it is known that islets take up fat avidly (24) and that islet fat content closely reflects total pancreatic fat content in animal models (25). Although a cause-and-effect relationship between raised intraorgan fat levels and metabolic effect has not yet been proven, the time course data following the dietary intervention study are highly suggestive of a causal link (21).
“Diabetes type 1 is very different from your standard disease. Insulin requirements vary greatly from one day to another and there is no way patients can know what they need,” Roman Hovorka, Professor at the University of Cambridge, explained to me during an interview. His research group is working on the development of an algorithm that can accurately predict insulin requirements for a specific patient at any moment.
What can people with prediabetes do to avoid the progression from prediabetes to type 2 diabetes? The most important action people diagnosed with prediabetes can take is to focus on living a healthy lifestyle. This includes making healthy food choices, controlling portions, and increasing physical activity. Regarding weight control, research shows losing 5-7% (often about 10–20 lbs.) from your initial body weight and keeping off as much of that weight over time as possible is critical to lowering the risk of type 2 diabetes. This task is of course easier said than done, but sustained weight loss over time can be key to improving health and delaying or preventing the onset of type 2 diabetes.
That is the goal of Imcyse, a French company running a clinical trial with an immunotherapy designed to stop type 1 diabetes. Patients that have been diagnosed within the last 6 months, who still retain some insulin-producing cells, are given a treatment designed to make the immune system destroy the specific immune cells that are attacking insulin-producing cells. Results are expected later this year and will reveal whether the treatment has the potential to become a cure.
Another non-insulin injection for people with diabetes is exenatide (Byetta). This medication, originally derived from a compound found in the saliva of the Gila monster, triggers insulin release from the pancreas when blood glucose levels rise. Exenatide is meant to be used along with oral diabetes drugs. It is dosed twice daily and should be injected within an hour of the morning and evening meals. Recently, the FDA warned that exenatide may increase the risk of severe even fatal pancreatitis (inflammation of the pancreas) and that the drug should be discontinued and not restarted if signs and symptoms of pancreatitis develop (severe abdominal pain, for example). It is not for use in people with type 1 diabetes.
Trick (most important): Go for longer periods of time without eating (yes, yes, fasting). Consume water only for days or weeks at a time. Your fat will literally dissolve away, and with it your type 2 diabetes and other ailments. The definitive book here is Dr. Joel Fuhrman’s book, Fasting and Eating for Health: A Medical Doctor’s Program for Conquering Disease. I highly recommend it; if you’re skeptical, read the 200+ testimonial comments on Amazon. I and at least 20 of my friends have tried fasts lasting days to weeks. It works, and it is amazing.