Type 2 Diabetes Remission is a Reality

ObesityObesity is a condition in which excess body fat is accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and increased health problems. When you eat more calories than you can burn off, you gain weight. How you eat, your activity level and other things affect how your body uses calories and whether you gain weight. If your family members are obese, you may have inherited a tendency to gain weight.Your family also plays an important role in forming eating and lifestyle habits which can lead to obesity.Obesity is a serious medical problem and is responsible for many serious health conditions such as Diabetes, high blood pressure, heart disease, knee and back pain, infertility and even life-threatening diseases like cancer. The best part is that obesity is a preventable disease. If addressed in time, it is possible not only to reduce excessive body weight but also to better manage any other health condition associated with obesity.Defining Diabetes remissionPeople with Type 2 Diabetes should be considered to be in remission when the glycosylated haemoglobin 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 dietDaily exerciseCorrect medicationsUndergoing bariatric surgeryIrrespective 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 remissionType 2 Diabetes in obese people is a result of consumption of excess calories. The extra calories get converted into 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 on 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.SustainabilityInsulin is an anabolic hormone and causes a fat storing state. Type 2 Diabetes is characterised by insulin resistance and increased insulin production. Irrespective of the diet followed, weight loss secondary to calorie deficit causes decreased insulin production because of increased insulin sensitivity. This improves the cardio- metabolic status of the individual. The key is to maintain the weight loss to maintain Type 2 Diabetes remission. So following a diet which can be continued in the long term is ideal..Daily physical activityDiet helps to lose weight and exercise helps improve blood glucose control besides keeping the person fit. People with Type 2 Diabetes are able to produce insulin but insulin is not as sensitive because of excess abdominal fat. Hence a greater amount of insulin is needed to lower blood glucose levels.While exercising, blood glucose level decreases as it is utilised without the help of insulin. Abdominal fat also decreases thereby increasing insulin sensitivity. Thus exercise acts in multiple ways to improve blood glucose control. Weight loss can be maintained both by continuing with the diet and by exercising regularly.Recommendations for good blood glucose control are:a daily brisk walk for about 45 to 60 minutes, five times a weekstrength training exercise twice a week like lifting weights or resistance training exercise using bandsTo concludeI think the important thing to convey is people are individuals and so there is no one weight i.e. an ideal weight. Even body mass index is misleading and if a person has Type 2 Diabetes they are too heavy for their own body. Don't compare yourself with others. Ascertain if you have become too heavy especially around the waist. The only measurement you should take is the measurement around the waist. Especially for women, I have often had my patients say to me that after pregnancy, regaining waist size is impossible. This is just not true. It is certainly true that hip size will not go back to pre-pregnancy measurement but it is possible to reduce your waist size. It is possible and occurs mainly through recognising that the food has to be cut back and eaten at an appropriate time.It is important to understand that the answer is a resounding yes to all three questions - Is it difficult? Is it challenging? Is it possible? It is also worthwhile and rewarding.