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Preventing and Reversing Diabetes

Preventing and Reversing Diabetes

Decades of research have found that two things matter most when it comes to stopping diabetes in its tracks: losing weight (even a small loss can have a big impact)—or maintaining a healthy weight if you’re already there—and regular physical activity. Together these two can prevent type 2 diabetes from happening in the first place and reverse it if you’re prediabetic or even diabetic, in some cases.

Obesity can trigger the condition because excess fat seems to interfere with the body’s metabolism and can lead to insulin resistance—the inability of the body to use the insulin it produces. Studies have shown, too, that physical activity can improve and even reverse diabetes by helping glucose be more efficiently used by cells; this is because exercise can improve insulin sensitivity. Muscle tissue also uses glucose better than fat does, which is why building and using muscle through regular exercise helps to keep blood sugar on an even keel.

Even if you’ve already been diagnosed with diabetes, it’s definitely not too late to turn things around. Weight loss (or maintenance) and exercise still matter a lot, and you may need medication to help the pancreas produce more insulin and prevent the complications of glucose build-up.

The Diabetes Prevention Program (DPP), a large clinical trial funded by the National Institutes of Health, looked specifically at what works best to stop or prevent diabetes in people at risk for developing the disease. The DPP came away with several findings: most important, that intensive lifestyle changes, especially weight loss and regular exercise, reduced the development of type 2 diabetes by 58%. By comparison, the study found that metformin, often the first diabetes drug given, says Dr. Ro, lowered diabetes risk by just 31%.

Here are some guidelines that will help lower your risk of developing type 2 diabetes or prediabetes, or keep your blood sugar in check if you’ve already been diagnosed (bonus: they’ll also keep your weight down):

DIET & EXERCISE

“We can’t blame any particular food for triggering diabetes, but the easy availability of processed and convenience foods and the access to refined carbohydrates [such as crackers, breads, cookies, candy and pasta] has led to an excess intake of calories, fat and sugar. And that’s leading to the weight gain and the prevalence of obesity,” says Rodriguez-Brindicci, adding that these foods are not bad in themselves, but the amounts in which many of us eat them is a problem. “That, added to the decrease in levels of physical activity, is definitely leading to the rise in type 2 diabetes.”

Dani Rodriguez-Brindicci, MS, RD, recommends working with a nutritionist or diabetes educator to find realistic ways to modify your diet “and develop a meal plan that works best for you.” It’s also worth taking a hard look at the beverages you’re drinking; many contain sugar that can drive up glucose. Sugary sodas and coffee drinks are obvious offenders, but sports and energy drinks, juices and smoothies are often just as bad.

When it comes to exercise, the DPP found that being moderately active for 150 minutes a week was enough, combined with a low-calorie, low-fat diet, to drop diabetes risk significantly. That equates to just 30 minutes per day, five days per week, of an activity like brisk walking. And if you can work out longer or more vigorously, that’s even better.

MEDICATION

While metformin is often the first choice for newly diagnosed type 2 diabetics and some prediabetics, there are many medications that can be used to treat type 2 diabetes, says Dr. Ro. Some improve the body’s sensitivity to insulin; others promote insulin secretion from the pancreas; and still, others slow the body’s metabolism of carbohydrates.

“The choice of medication depends on the patient and how bad their diabetes is,” Dr. Ro says. “Some will need insulin right away because blood sugars are so high and oral medications will not be enough to achieve adequate control.”

Insulin therapy is necessary, she adds, if the pancreas isn’t able to produce enough insulin or if existing kidney or liver problems prevent someone from using oral medications safely.

While insulin has typically been given through injections or a pump device, the Food and Drug Administration recently approved Afrezza, a fast-acting form that’s inhaled. Over the past few years, Dr. Ro says there have been major breakthroughs in the treatment of diabetes, including new classes of medications called GLP-1 agonists and SGLT-2 antagonists that not only control blood sugar but are effective in promoting weight loss.

“Every patient with diabetes should receive an individualized treatment regimen based on their specific needs,” stresses Dr. Ro. “You should talk with your doctor to see which medications would best help control your diabetes.”

BARIATRIC (WEIGHT LOSS) SURGERY

Surgery can be an important tool for those who are both very overweight and have type 2 diabetes. Weight-loss surgery (technically known as bariatric surgery) has a lot of benefits, but there’s one that’s probably not so well-known.

“There’s a secondary but significant impact on diabetes from the surgical procedure: hormonal changes that improve insulin resistance,” says Aileen Takahashi, MD, medical director of bariatric surgery at Torrance Memorial. “In order to be a candidate for surgery, besides meeting all the medical criteria, the person has to accept that they must change their habits after the surgery is over. That means they must exercise regularly, and they have to improve their eating habits. If they don’t, then they won’t be successful with the weight loss, and the surgery is just a waste.”

But if a patient can make these changes, adds Dr. Takahashi, they’re likely to make an excellent candidate for a successful surgery. “What I tell the patients is that exercise and eating properly are the ways to lose the weight. Surgery can help control your appetite, and then when you do eat you’re satisfied with less. So if you have that help, then it’s easier to stay on track with proper eating habits.”

There are several kinds of bariatric surgery, and three of these procedures are performed by surgeons at Torrance Memorial: gastric bypass surgery, a less-invasive procedure called the gastric sleeve and gastric band surgery. Dr. Takahashi says to reverse type 2 diabetes, the best choices are gastric bypass or sleeve gastrectomy because these are metabolic operations, meaning they change hormonal levels that relate to glucose metabolism. (The gastric band, on the other hand, doesn’t lead to hormonal changes, so if you want to reverse type 2 diabetes and you choose gastric band surgery, weight loss becomes crucial.)

Prior to surgery, Dr. Takahashi says patients must attend pre-surgery classes at the hospital and support groups where they learn about different types of bariatric surgery and how to keep off weight long-term through better eating habits and physical activity.

“These are all-important to improve health and will lead to overall better glucose control,” says Dr. Takahashi. (See “Which Weight-Loss Surgery Is Right for You?” on page 38 for more on the types of bariatric surgery performed at Torrance Memorial.)

Even if improving your blood sugar and getting your type 2 diabetes under control is the main reason you choose to have bariatric surgery, the operation can offer other big health benefits. If the extra weight is kept off, your risk of cardiovascular disease will drop, and the surgery can ease symptoms of incontinence, joint and back pain, sleep apnea and reflux disease—and may even lower the risk of cancers that have been linked to excess weight, such as breast cancer.