Can I Put Diabetes Behind Me?
I was diagnosed with type 2 diabetes about 10 years ago. Through diet and exercise, I have lost 35 pounds and maintain an A1C around 5.7 percent or less. I've never been on medication, but I feel the need to check my blood glucose daily so as not to relapse. My current doctor says I now don't have diabetes. Can a former diabetic truly become nondiabetic? Sharon Yasui Carrell, Portland, Oregon
Belinda Childs, MN, ARNP, BC-ADM, CDE, responds:
You ask an interesting question that may not have one right answer. Another way to put your question is: Can type 2 diabetes be cured?
Let's start with what we know about type 2 diabetes. We know that the risk factors for type 2 include a family history of the disease, older age, being overweight, getting limited physical activity, having had a baby weighing over 9 pounds, and being of certain races and ethnicities, such as African American, Native American, Latino, or Asian. We know that type 2 diabetes in its early phase can be controlled by meal planning, weight loss, and increased exercise, and that these are the cornerstones of diabetes treatment.
Diabetes can be now diagnosed using the A1C (average blood glucose over two to three months), according to American Diabetes Association guidelines. If one has an A1C greater than 6.5 percent, the diagnosis is diabetes. If the A1C is from 5.7 to 6.4 percent, one is diagnosed with prediabetes, and action to prevent diabetes is recommended, including weight loss and increased physical activity. For most people with type 2 diabetes, the treatment goal is for the A1C to be 7 percent or less, although some people have higher or lower targets.
Most diabetes experts would say that you have controlled, if not cured, your type 2 diabetes through meal planning and exercise. But if you were to regain weight and decrease your physical activity, it is very likely that your blood glucose levels would rise again to their previous levels.
The one instance where type 2 diabetes often appears to go into remission is with gastric bypass weight-loss surgery. This surgery physically reconfigures the digestive tract in a way that may alter the so-called gut hormones. But gastric bypass is generally recommended only for people who are extremely overweight.
Type 2 diabetes is a result of genetic and environmental influences. We can alter our environmental influences, including what we eat and drink and how much physical activity we get. But we can't change our genetic makeup. And so once one has had type 2 diabetes, one will always have diabetes or at least be at risk for it.