Taming Diabetes

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Q: Is diabetes reversible? If so, at what stage? I was diagnosed with Type 2 diabetes about three years ago. I have been maintaining my weight, staying on the right diet, and exercise at least three to four times a week.

A: The quick answer is: Diabetes can be managed. However, once a person has a form of this disease, they always need to be vigilant in controlling their blood glucose levels. But if you have been diagnosed with Type 2 diabetes, your switch to a healthier lifestyle is providing you the opportunity to control this disease either with, or potentially without, diabetic medication.

Diabetes affects the way our bodies utilize the form of sugar in our blood known as glucose. In non-affected people, the pancreas usually makes the right amount of insulin to move the glucose obtained from food into the cells of our body for their growth and energy supply. In people with diabetes, the production of insulin by the pancreas may be affected, or the body's ability to use the insulin that is produced is impaired.

There are three main types of diabetes:

Type 1 occurs in five percent to 10 percent of all those affected with diabetes. It is considered an autoimmune disease in which the bodies' infection fighting system turns against the insulin producing cells in the pancreas, resulting in little or no insulin production. The reason this occurs is unknown. It most often begins during childhood and the young adult years, but can happen at any time in affected individuals. It is not reversible and requires medical treatment with insulin. Some individuals have received pancreas transplants or investigational procedures that have the potential to decrease or eliminate the need for insulin; however, they are not widely used alternatives.

Gestational diabetes affects approximately five percent of pregnant women. It is more common during the later stages of pregnancy and tends to correct after childbirth. However, within five to 10 years, those affected have a higher likelihood of developing Type 2 diabetes. The good news is that many of these cases can be prevented or delayed through regular exercise and weight control.

Type 2 is the most common form of diabetes. It is more likely to affect adults 45 and older, but can affect individuals of any age or ethnicity. Risk factors include:

Overweight
Inactivity
Family history of diabetes or gestational diabetes
Metabolic syndrome (high triglycerides, low HDL, obese with a large waist, high blood pressure, insulin resistance)
Prediabetes

Certain ethnicities have a higher rate of Type 2. These include African American, American Indian, Asian American, Hispanic American/Latino, Native Hawaiians and other Pacific Islanders.

Type 2 can be controlled as well as treated with lifestyle modifications (exercise, weight reduction, and healthier nutrition, among other efforts), or in combination with medication. It may even be prevented if identified during the early warning phase known as prediabetes.

The diagnosis of prediabetes is based upon a measurement of blood glucose after an eight-hour fast (impaired fasting glucose or IFG), or two hours after drinking a special beverage with added glucose (impaired glucose tolerance or IGT). A positive result to any one of these tests means there is an elevated level of glucose in the blood, but not yet high enough to be considered diabetes. This information is very important because if the high blood sugar is left unchecked, the affected person has a higher likelihood of developing Type 2 diabetes within 10 years of the prediabetes diagnosis. The good news is through weight reduction and regular exercise, Type 2 may be prevented, or at least delayed.

So even though glucose levels can get back to a "normal" range, it doesn’t mean the person is cured and their condition is reversed. What it does mean is that their diabetes is being managed and they are taking good care of themselves.

For further information, please visit the National Diabetes Education Program at www.cdc.gov/diabetes or the Office of Minority Health Resource Center at www.omhrc.gov.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)