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Is diabetes curable?
Is there a cure for diabetes? I get this question all the time in my diabetes practice. Most of the time, the first reaction for somebody who was diagnosed with diabetes is to look up if there is an existing cure for the diabetes.
What is a cure?
So, let us talk about what “cure” means and how a cure is achievable. Cure means to heal or to restore normal health. From this definition, a cure for diabetes is possible. For example, if you ask the question “Is there a cure for ignorance”. then I would say the answer to that is yes. But, you have to ask questions to achieve the cure. There is no magic pill you can swallow and suddenly become wise and get cured of ignorance or illiteracy. You are reading this article because you are asking questions and you are not ignorant. If you are illiterate and asking for a cure I would say “you need to seek training through education and ask questions”. In that sense, if you do the right thing by correcting your lifestyle and/or take the right medications you can definitely cure diabetes. Sometimes all you need is the right diabetes coach and the right diabetes specialist who knows how to deal with and cure diabetes.
What is the definition of diabetes? What defines a cure for diabetes?
Diabetes is a disease state where a person’s insulin production is not adequate to meet the need. When this happens blood sugar starts to rise. Ultimate and long-term insulin production are genetically determined. So, someone who inherits certain high-risk genes from their family will be more likely to have diabetes. Nevertheless, when blood sugars remain elevated most of the time, physicians measure glucose control with a test called hemoglobin A1c. A1c is simply a representation of average blood sugars in the last 3 months. When hemoglobin A1c is above 5.7% it is called “prediabetes”. When it is about 6.5% it is called diabetes. One can say that if A1c goes below 5.7% for one or the other reason it can be considered “cured”. On the other hand, the word cure can be tricky since the recurrence or progression of diabetes is extremely common.
What causes diabetes?
Insulin production capacity is determined genetically. There is nothing you can do about that part. The demand, on the other hand, is body mass. The higher the body mass the higher the need for insulin. So, if you increase insulin production or reduce the body mass there will be no more diabetes. Let us make an analogy to understand this better. The definition of wealthy versus poor all depends on how much money you make and how much money you spend. You could be making $1 million a year and can still be in debt or go bankrupt because of uncontrolled expenses. On the other hand, you could be making 50,000 a year yet be very cautious about your spending which will lead to a significant amount of savings over time. So, the person making $1 million a year may end up with millions of dollars of debt and the person making 50,000 a year can accumulate millions of dollars by retirement time.
What does that have to do with diabetes? For example, even if you are not making a lot of insulin if you keep your body mass down you will probably never get diabetes. Also, if you already have diabetes and lose a significant amount of weight (which can change depending on the person and the duration of diabetes) you can be “cured” from diabetes. The most common example of a diabetes cure can be seen in gastric bypass surgery patients. Very soon after the surgery patients stop taking medications and literally become diabetes-free.
Since diabetes is a supply and demand disease, just because they are cured of diabetes at that time does not mean that diabetes will not come back. From a medical standpoint, we call that “remission”. For example, just because you had pneumonia, or a common cold and you are cured with antibiotics does not mean that you will not have another episode of pneumonia or common cold if you are under the same risk factors. So, managing the risk factors is the most important target in curing diabetes. The reason we were able to eradicate a lot of viral or bacterial infections is that we have implemented risk reduction measures in the entire population such as vaccines, hygiene, preservative agents in the water, etc.
Understanding the defects in the body that leads to diabetes puts you ahead of the game to beat the disease.
Moreover, addressing the defects that lead to diabetes during diabetes treatment, puts you at a significant advantage.
Defects in the body that lead to diabetes
One of the hardest parts of curing diabetes is that diabetes is not just insulin deficiency or insulin resistance. There are 8 well-defined defects in the body that lead to diabetes. Let us briefly talk about these defects as understanding these defects is very helpful in the path to a cure.
1. Defect in the pancreatic beta cells.
2. Defect in the pancreatic alpha cells.
3. Defect in fat cell glucose utilization and resistance to insulin.
4. Defect in the gut hormones.
5. Defect in the kidney’s glucose regulation.
6. Defect in the brain’s regulation of glucose and appetite.
7. Defect in muscle glucose uptake and resistance to insulin.
8. Defect in liver glucose metabolism.
1.Defect in the pancreatic beta cells:
Beta cells are the insulin-producing cells in the pancreas. Beta cells start to fail due to predetermined genetic weakness but also due to metabolic stress from excessive nutrition, fat cells and inflammation derived from excessive fat accumulation.
2.Defect in pancreatic alpha cells:
Normally when you eat, insulin response happens which inhibits alpha cells from producing glucagon. Glucagon is a hormone that rises blood sugar when needed. Typically, after eating this hormone goes down as there is no need to keep the blood sugar high. During fasting glucagon hormone goes high in order to keep the blood sugar at the normal level and prevent a low blood sugar while insulin is going down. Just like any other cell in the body, the cells also become resistant to the insulin. Not only that, but insulin production also deteriorates in patients with diabetes. The result is a paradoxical rise in glucagon which makes the blood sugars even higher than expected.
3.Defect in fat cell glucose utilization and resistance to insulin:
Every person is born with a fixed amount of fat cells. Fat cells do not increase in number. They only go up in size. Unfortunately, there is limited space in those fat cells. When excessive amounts of fat are packed in those cells, it creates an inflammatory reaction. As a result, most patients with insulin resistance feel tired and fatigued due to the inflammatory reaction in the body. That is why we call obesity an inflammatory disease state. The same inflammation also puts stress on the beta cells and alpha cells in the pancreas. On the other hand, due to limited space available in fat cells, excessive fatty acids start circulating in the blood causing insulin resistance in multiple organs.
4.Defect in the gut hormones:
There are gut hormones called “incretins”. These hormones are the basic communication between the intestinal system and the beta cells in the pancreas. Basically, when you eat, these hormones signal the pancreas to make the insulin. In patients with diabetes, cells producing incretins are also defective. As a result, insulin is not produced enough after consuming a meal.
5.Defect in the kidney’s glucose regulation:
Normally kidneys reabsorb all the glucose that is filtered from the blood in order to save energy. When blood sugars go above 180 mg/dL, kidneys start to excrete the glucose in the urine. Kidneys also contribute to glucose production in the body. When the kidney is resistant to insulin, glucose production increases. Moreover, the threshold to excrete glucose goes above 220 mg/dL instead of 180 mg/dL making it more difficult to keep blood sugar under control.
6.Defect in the brain’s regulation of glucose and appetite:
In healthy individuals’ the brain can detect excessive fat and excessive nutrition and reduces the appetite. Unfortunately, due to chronic and repetitive override of these signals, leads to failure of appetite-suppressing mechanisms that lead to chronic hunger and lack of satiety.
7.Defect in muscle glucose uptake and resistance to insulin:
Due to excessive fatty acid circulation causing insulin resistance in the muscle cells, the glucose uptake in the muscle slows down. This leads to a lack of glucose inside the muscle creating fatigue and yet leaving the glucose out in the bloodstream.
8.Defect in liver glucose metabolism:
A similar process of insulin resistance affects the liver. The liver is at the largest organ that stores glucose and releases it when necessary. The only way of communication between the body and the liver for glucose metabolism is insulin. When there is resistance in the liver there is a constant excretion of glucose that is not stoppable which leads to excessive glucose in the bloodstream giving during a fasting state. That is the main reason for many patients with diabetes to wake up with high blood sugars although they have not have eaten for more than 10 hours.
Now since we have reviewed all the pathological mechanisms that lead to diabetes, we can understand the magnitude of the problem and why it is difficult to cure diabetes especially later on. It is a lot easier to “cure” diabetes in the early stages. All you need is a diabetes care plan which can turn into diabetes “cure” plan. Most importantly diagnosing diabetes at the prediabetes stage is extremely important. It is very important to obtain the opinion of a diabetes specialist such as an endocrinologist early on. If you make significant lifestyle changes and embrace daily exercise and avoid processed foods and heavy starches that will lead to weight loss and more than likely you will never have diabetes. It is easier said than done right? Believe me, we know.
How to achieve success?
A diabetes coach who is assigned to you will definitely be your best friend on your journey. And if you do have diabetes, you can still reverse it by reducing the demand which is your body’s insulin resistance that is due to excessive body fat. Monitoring is extremely important. Nowadays, thanks to the technology that is remote glucose monitoring systems where you do not have to manually enter any information and your diabetes doctor can still see what is going on with your glucose levels and your overall health.
If on the other hand, you are genetically very susceptible to diabetes due to lack of insulin production, you may develop diabetes even without significant obesity. When the problem is in your genes, it is a more difficult task to reverse diabetes. It is considered an organ failure just like kidney failure or liver failure. In most cases, patients with kidney or liver failure seek transplantation. Pancreas transplantation is not common. That is because pancreatic transplants do not survive as long as liver and kidney transplants. Treatment of pancreatic failure (diabetes) also is a lot easier than for example kidney failure in which dialysis a few times a week will be necessary. Today with the right tools diabetes is not a deadly disease anymore. If it is not curable for some individuals, it is still very manageable and controllable. A dedicated diabetes care team with a specific diabetes care plan will get you the results you need.
The bottom line, even if there is not an absolute cure, remission or recovery from diabetes is completely possible. This way you do not have to suffer the consequences of diabetes. Make sure you have a diabetes specialist or endocrinologist as well as diabetes coach on your side guiding you to the right path to help you cure or control your diabetes. Remember, you are not alone and diabetes is beatable.
Ahmet Ergin, MD, CDE, ECNU
Endocrinologist and Founder of SugarMDs.