Diabetes explained Diabetes is a progressive condition in which blood sugar levels rise in abnormal proportions. When food is eaten, the carbohydrates are processed and sugar is released into the blood. This leads to a temporary rise in blood sugar levels. .Dr Roy Taylor answers the imminent question that every person with Diabetes carries in his or her mind and attempts to explain the role of calories in blood sugar managementThe pancreas releases the hormone insulin which processes the sugar in the blood, thereby bringing the blood sugar levels to a normal range. Blood sugar levels vary throughout the day according to the fasting and post-meal states. A person is diagnosed with Diabetes when his or her body fails to process the blood sugar either due to insulin deficiency or due to insulin impairment. Type 1 Diabetes is an autoimmune condition where the beta cells in the pancreas fail to produce any insulin. This leads to an absolute deficiency of insulin. This condition is also known as juvenile Diabetes as it is commonly observed in children and adolescents. People with Type 1 Diabetes require insulin injections to manage their blood sugar levels. A person is diagnosed with Type 2 Diabetes if there is little production of insulin in the body or the produced insulin is incapable of processing the sugar in the blood. People with Type 2 Diabetes are often prescribed oral anti-diabetic drugs along with diet, exercise for weight loss and lifestyle modifications to manage their blood sugar levels.Type 1 Diabetes (where there is a near-complete deficiency of insulin) is not reversible with diet. There are a few more genetic types of Diabetes that are difficult to reverse with diet apart from the most common type of Diabetes i.e. Type 2 Diabetes. The good news is that some cases of Type 2 Diabetes can be reversed with improvement in diet and exercise patterns. The pathophysiology of Type 2 Diabetes is largely influenced by family history of Diabetes and lifestyle which includes diet, exercise and stress. Type 2 Diabetes in obese people is a result of chronic consumption of excess calories which get converted into fat and deposited in various organs of the body - of importance here are the liver and pancreas. It was earlier believed that these changes are not reversible. But recent research studies suggest that it is possible to reverse these changes with calorie restriction and remit Type 2 Diabetes at least in selected patients. The research is in its early phase but it is a very pleasant ray of hope for people with Type 2 Diabetes who otherwise have to depend on medications for life.Low-calorie diet explainedEnergy restricted diets are mainly of two types - low-calorie diets and very low-calorie diets. A typical low-calorie diet provides 1000-1200 KcaVday and a very low-calorie diet provides lesser than 600 kcaVday, usually in form of a liquid diet. Both these diets must be administered in association with proper diet counselling and underclose medical supervision. Even if restricted in energy, the diet must be balanced to cover all the nutritional needs to avoid deficiencies of any essential nutrients.Energy restriction and reversal of DiabetesDiabetes is thought to be a result of a positive energy balance i.e. consuming more than what you need which results in obesity and deposition of fat and loss of function of important organs of the body (mainly liver and pancreas) resulting in diabetes. So scientifically speaking, a negative energy balance i.e. consuming less than what you need, should result in the utilization of deposited fat and improvement in the function of these organs. Large scale studies are getting conducted on this new way of managing diabetes using a very low-calorie diet and less dependence on medications. Research has shown that even low-calorie diets are equally effective compared to very low-calorie diets and are also more flexible, easy to administer and less expensive.In a very scientific way, a state of negative energy balance is created to have the potential to reverse the basic cause of Type 2 Diabetes. With calorie restriction, few people not only achieve normal bloodglucose levels and weight loss but also have an improvement in the parameters suggesting an increase in pancreatic insulin secretion and reduced insulin resistance.The DiRECT Studyglucose levels and weight loss but also have an improvement in the parameters suggesting an increase in pancreatic insulin secretion and reduced insulin resistance.The DiRECT Study participants between the ages of 20 to 65 with Type 2 Diabetes. The BMI levels of the participants were between 27 to 45 kglm2 (overweight to obese). The participants were divided into control and intervention groups. The control group was prescribed standard practices of Diabetes care along with a normal diet. The intervention group was prescribed a low-calorie meal plan of 850 calories a day for 3 to 5 months. Mer 5 months, calorie intake was slowly increased and counselling was done to aid the subjects to maintain their weight loss regime. Mer 12 months, the group was prescribed standard practices of Diabetes care and were taken off their diabetic and hypertension medications.The outcomesThe outcomes showed that in the first 12 months, nearly 45 per cent of people in the intervention group had experienced weight loss of 12 kg or more. More than 46 per cent of people were diagnosed with HbAlc levels below 6.5. This indicated that their Diabetes was reversed. This helped people in the intervention group get off their Diabetes medication. In the control group, only 4 per cent of people could manage to achieve the targeted HbAlc levels of 6.5. As opposed to the intervention group, only 18 per cent in the control group could lower their diabetes medication use.One of the biggest challenges witnessed in any weight loss program is maintaining the state of weight loss for a long time. At 24 months, only 36 per cent of people in the intervention group could remain in a state of remission. People who could not continue with weight loss experienced a relapse in their blood sugar management. People in the control group (those on a standard diet and care plan) were found to have high HbA 1c and develop health complications such as heart disease, heart attack, toe amputation and weight-related cancer (colon, bladder, kidney and prostate) in 24 months.These results show that people with Type 2 Diabetes should be counselled about the complications of Diabetes and how relapse in weight loss could impact their health in the long term. Thus, weight management is of utmost importance not only for achieving a normal HbA 1c but also to ensure a complication-free body. The study has also found that on the way to weight loss and maintenance, several social and psychological barriers such as boredom, stress, lack of social support, travel and dissatisfaction with outcomes may push to relapse. Some of the factors that could help people stay motivated towards weight loss are avoidance, distraction, drinking water at regular intervals and inclusion of friends, family and peers. To avoid relapse, it is recommended to switch to a stable diet in moderation with calories. This helps achieve a stable weight along with the fulfilment of dietary needs.To avoid any pitfalls in remission, the diagnosis of the correct type of Diabetes is highly important. Incorrect diagnosis may push people to further worsen their condition. Also, beta-cell resilience defines the success or failure of the weight loss program. It is advised to consult your endocrinologist, diabetes educator and dietician to understand Type 2 Diabetes and how it could be better managed with diet.