Diabetes can essentially be divided into Type 1 and Type 2. Type 1 diabetes results from failure of the insulin producing pancreas and patients requires insulin to survive.
This blog refers only to type 2 diabetes. Type 2 diabetes is more complex. Most cases result from resistance to insulin, so patients with Type 2 diabetes may have normal levels of insulin but still be diabetic.
There are a number of factors that make you more likely to develop type 2 diabetes. Probably most important is carrying too much weight, particularly abdominal fat. But too much alcohol, smoking, lack of exercise, age, high blood pressure, polycystic ovarian syndrome and race all increase your risk. If you are of south Asian or afro-caribbean descent, you are at higher risk.
Patients with Type 2 diabetes may be treated with diet alone, diet and pills or diet and insulin or a combination of pills with insulin.
The problem with diabetes, is that apart from making you feel tired, lose weight and pass a lot of urine, the disease causes damage to nerves and blood vessels, resulting in a much increased risk of early heart disease, kidney disease, blindness, loss of sensation in the feet and amputation.
We know though, that good early control of diabetes with treatment, much reduces the risk of these ‘complications’.
What we did not know until recently, was that, it is possible to reverse diabetes and put people into remission. They are still diabetic but diabetics in remission. This has made us look very differently at the condition. From a condition with an inevitable progression to ever increasing medication and damage to organs, we can now offer the possibility of turning back the clock.
Diabetes UK have followed on from a landmark trial in Newcastle which showed that patients can reverse the process of diabetes with a very low calorie diet. They have funded the DiRECT trial.
The DiRECT trial results are not yet complete, but the first two years showed outstanding results with 45.6% of those starting the trial, in remission from diabetes at the end of twelve months and that, of these people, 70% remain in remission at two years. The trial combines a low-calorie, diet based, weight management plan delivered by a GP. Overall, 36% of those entering the trial were in remission at 2 years, a phenomenal result.
As a result of these findings, NHS England has agreed to fund a pilot scheme and NHS Scotland are already rolling out such programmes.
We know that bariatric weight loss surgery also results in remission in many cases as well as improving a number of other factors such as heart disease risk, arthritis and well being. Sadly, many CCGs will not currently fund such evidence based surgery.
The low calorie diet is challenging as it reduces intake to 850 calories a day. If you are thinking of trying this, do not do it in isolation, get dietary advice. Bear in mind, a sudden reduction in calorie intake may result in hypoglycaemic episodes in those taking insulin or sulphonyureas such as gliclazide. If your doctor is aware of your plan they can adjust your medication to compensate for the reduced calorie intake.
The magic figure for weight loss seems to be 15kg, although obviously it varies from person to person. Not everyone will achieve remission. But even those that do not achieve remission, such weight loss will result in reduced medication, better blood sugars and a reduced likelihood of complications.
Diabetes UK (https://www.diabetes.org.uk) is a terrific resource, providing a huge amount of information, recipes and advice.
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