A case study
Mrs X, 50 years old, weighed 93 kilos and was 153 cms tall. Her BMI or Body Mass Index was 39.9 kg/m2. Body mass index (BMI), a measurement which compares weight and height, defines people as overweight (pre-obese) if their BMI is between 25 and 30 kg/m2 and obese when it is greater than 30 kg/m2.
Mrs X was categorised as having morbid obesity. She has recently been diagnosed to have Type 2 Diabetes. Her three-month blood glucose average test result (glycosylated hemoglobin or HbA1c) is
7.2 per cent. Her fasting blood sugar is 140 mg/dL. She does not exercise and her lifestyle is sedentary. She loves to eat sweets, rice-based dishes and non- vegetarian food. Both her parents have Diabetes. Her son has an unhealthy life style and is obese.Brimming with anxiety, she asked, “Doctor, can I reverse my Diabetes diagnosis?”
Remission or reversal
It is important to first clarify a common misconception. Type 2 Diabetes remission is a better term than Type 2 Diabetes reversal. When the term Diabetes reversal is used, it means that the Diabetes is resolved for lifetime, irrespective of the individual’s situation. This expectation is incorrect rendering the term inaccurate.
The term Diabetes remission denotes that Diabetes is resolved as long as the person continues to stick with the lifestyle that he followed to resolve the same. Once he reverts back to his previous condition, Diabetes recurs. Diabetes remission is possible and is commonly seen in several motivated patients.
Defining Diabetes remission
People with Type 2 Diabetes should be considered to be in remission when the glycosylated hemoglobin or HbA1C test result is less than 6.5 per cent without consuming any anti-diabetic medication in the preceding 3-months. Remission of Diabetes is achieved through several methods like:
. Consuming a correct diet
. Daily exercise
. Correct medications
. Undergoing bariatric surgery
Irrespective of the method followed, the key is to lose weight. Remission is directly proportional to the weight loss. In other words, more the weight loss, faster is the remission. The longer the patient continues to maintain the weight loss, the longer is the remission. If the patient regains the weight, Diabetes recurs.
The good news is that some cases of Type 2 Diabetes can definitely reverse with improvement in diet and exercise pattern. The pathophysiology of Type 2 Diabetes is largely influenced by family history of Diabetes and life-style which includes diet, exercise and stress.
Science behind remission
Type 2 Diabetes in obese people is a result of consumption of excess calories. The extra calories get converted in to fat and deposited in various organs of the body of importance like liver and pancreas.
Carbohydrate in the food is broken down into glucose which is utilised for energy. Excess glucose gets converted into glycogen and deposited in the liver. With the help of insulin, it also gets converted into fatty acid, circulated to different parts of the body and deposited as fat in adipose tissue.
When calorie consumption exceeds utilization then the excess calories cause fatty acid flux. If the fat cells cannot expand rapidly enough to store this increasing fatty acid flow, then the excess released fatty acids begin to accumulate in other tissues such as the liver and skeletal muscles. This begins the process of lipotoxicity (fatty acid induced toxicity) which increases insulin resistance. Insulin resistance occurs when cells in your muscles, fat, and liver don’t respond well to insulin and can’t use glucose from your blood for energy. To compensate for it, pancreas makes more insulin. Over time, blood glucose levels rise.
Excess deposition of fat in the liver causes fatty liver disease which is one of the risk factors for Type 2 Diabetes and its progression. Fatty liver disease worsens insulin resistance which is the primary reason why Type 2 Diabetes occurs. So the primary aim to facilitate Type 2 Diabetes remission is to reduce this fat by losing weight.
