Being too short to make the basketball team is a situation. It’s not a disease. Wearing high heels doesn’t help playing basketball.

Insulin doesn’t fix anything. It just forces excess energy into new storage space more quickly.

Complete recovery from type 2 diabetes is balancing energy intake, output and storage permanently without medication.

To learn more about programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

Defining Type 2 Diabetes

The World Health Organization describes diabetes as a chronic disease that occurs when the pancreas does not produce enough insulin or alternatively, when the body cannot effectively use the insulin it produces.

About 90% of people with diabetes around the world have type 2. It is recognized to be largely the result of excess body weight and physical inactivity.

It is not a disease. It is not ineffective use of insulin. It is the result of more energy than the body can use or store.

What causes excess body weight? Overeating. More energy consumed than can be used or quickly stored. Normal sites of quick storage are in skeletal muscle and liver. Slower storage occurs in subcutaneous fat tissue.

There is a normal range of storage capacity for excess energy. Just as there is a normal range of height for adult men and women. Type 2 diabetes very seldom occurs with low normal % body fat (<20% for males and <30% for females) along with high normal % skeletal muscle (>40% for males and >30% for females).

What has to be managed is energy intake in relation to energy output and sites of temporary energy storage.

Recovery From Type 2 Diabetes

Distinctions between reversal, successful treatment, remission, recovery and cure are confusing.

If type 2 diabetes is defined as high levels of blood sugar, lowering them could be called “reversal.” Normalizing those levels by lifestyle and medication could be “successful treatment.” If non-diabetes levels are attained and maintained without anti-diabetes drugs, that could be “remission.” If normal levels of blood sugar and a healthy balance between energy input, output and storage is regained without medication, then “recovery” seems more accurate.

If there never was anything wrong except overeating along with physical inactivity, then what was ever there to be cured? Possibly transplant of pancreas tissue replacing absent or defunct insulin-secreting cells could be called “cure.”

A consensus group of experts in diabetes met in 2009 to figure this all out. After much discussion, remission was defined as disappearance of the signs and symptoms of disease with no active anti-diabetes drug therapy or ongoing procedures for at least 1 year.

Disappearance of abnormal blood sugar values was defined as Fasting Blood Sugar < 100 mg/dL and HbA1c <5.7%.

Implicit in the statement is the possibility for recurrence of the disease. Therefore, the Expert Group recommended remission of less than 5 years’ duration be monitored by continued regular screening for microvascular complications. After 5 years with no history of a complication, screening could be reduced to schedules for individuals with no history of diabetes.

Position statement of experts in the UK meeting in March, 2019. This meeting was organized by the Association of British Clinical Diabetologists (ABCD) and the Primary Care Diabetes Society (PCDS). They proposed fasting blood sugar levels below the threshold currently used for diagnosis of type 2 diabetes (126 mg/dL) for at least 6 months without any anti-diabetes drug treatment.

Because the effects of an elevated A1C (>6.2%) can be damaging to microvascular function, the experts recommended continued screening for nerve, kidney, and eye damage for at least five years. Also recommended were frequent screenings for cardiovascular disease.

The Personal Fat Threshold with type 2 diabetes is similar in obese and non-obese individuals. Studies of insulin resistance in groups with type 2 diabetes or normal glucose tolerance show similar results for obese and non-obese subjects. The relative difference in insulin resistance is similar. Also, non-obese people reverse their diabetes after weight loss in the same proportions as obese people.

Reversal of type 2 diabetes apparently is associated with a reduction in pancreatic fat levels. Insulin resistance simply develops in relation to individual thresholds of tolerance for excess calorie intake. About 50% of individuals with type 2 diabetes tolerate greater accumulation of % body fat than non-obese individuals.

Recovery From Insulin Resistance

Change in body weight affects insulin resistance. Data from routine health checks show increased insulin resistance with increase in weight. As little as 4 or 5 pounds increase in 1 or 2 years increases insulin resistance enough to increase fasting blood sugar levels above 100 mg/dL. Decrease in weight reduces insulin resistance.

Body weight has little effect on responses to change. Increase and decrease in insulin resistance and fasting blood sugar values occurs with body weight in the normal healthy range as well as with overweight and obesity.

Weight reduction with exercise and calorie restriction improves insulin sensitivity. Studies in overweight men and women show favorable effects of each separately. Combined exercise and calorie restriction produce twice the increase insulin sensitivity with the same reductions in weight of either alone.

Benefits of reducing insulin resistance combined with improved secretion of insulin make calorie restriction and physical activity powerful mediators of recovery from type 2 diabetes.

Resting Heart Rate and Insulin Resistance

Insulin resistance correlates strongly with resting heart rate. Because heart rate is controlled by the autonomic nervous system it’s possible that the brain is stimulating insulin secretion. It’s also possible that insulin is stimulating the nervous system.

The relation between resting heart rate and insulin resistance has been studied in 137 young men and women in the UK. Resting heart rate was measured after 30 minutes lying down in a quiet room. Insulin resistance was measured using measurements of insulin in blood samples following intravenous injection of sugar (225 mg of glucose per pound of body weight).

The level of insulin in blood following injection of sugar indicates the resistance of skeletal muscle and liver to quickly clear the blood of sugar. As shown in the Figure, those individuals with the lowest resting heart rates had the least insulin response following injection of sugar.

High overnight heart rate measured by other investigators has shown a strong association with the insulin resistance syndrome.

Successful Maintenance Of Recovery

The Look AHEAD study randomly assigned 5,143 overweight/obese subjects to education and intensive coaching to promote weight loss through decreased calorie intake and increased physical activity. Intensive intervention resulted in an 8.6% weight loss the first year and nearly 5% at 4 years. Those subjects who reduced weight more than 10% the first year were the most successful in maintaining weight loss during 4 years of follow-up.

The National Weight Control Registry is an ongoing, observational study of individuals who have achieved long-term success in weight loss maintenance. Individuals are eligible to join the program if they have maintained a weight loss of at least 30 pounds for at least 1 year.

The general conclusion from the study so far is that restricting calorie intake and increasing exercise are essential to success. No particular diet or exercise routine stands out as particularly effective over all other programs.

The majority of successful individuals follow 3 health practices.

High levels of physical activity. The average amount of time spent in moderate and strenuous exercise is approximately 60 minutes per day. Substantially more than the 150 minutes per week recommended by health and fitness experts.

Food intake low in total calories. Most report meals and snacks low in fat and high in carbohydrates.

Regular self-monitoring of weight.

Those who maintain a weight loss for 2 to 5 years have the best chances of long-term success.

Strategy For Long-term Recovery From Type 2 Diabetes

Establish the best possible baseline recovery state.

Schedule regular medical review.

Meal plan you can follow forever.

Exercise Routine you can follow forever.

Sleep 7 to 9 hours every night.

Don’t Smoke Tobacco.

Self-monitor.

Summary

Type 2 diabetes is the result of overeating. More energy consumed than can be used or quickly stored. Normal sites of quick storage are in skeletal muscle and liver. Slower storage occurs in subcutaneous fat tissue.

There is a normal range of storage capacity for excess energy. Just as there is a normal range of height for adult men and women.

What has to be managed is energy intake in relation to energy output and sites of temporary energy storage.

Remission of type 2 diabetes has been defined as disappearance of the signs and symptoms of disease with no active anti-diabetes drug therapy or ongoing procedures for at least 1 year.

Normal blood sugar values have been defined as Fasting Blood Sugar < 100 mg/dL and HbA1c <5.7%.

Weight reduction with exercise and calorie restriction improves insulin sensitivity.

Insulin resistance correlates strongly with resting heart rate.

Success in recovery follows 3 health practices.
•High levels of physical activity.
•Food intake low in total calories.
•Regular self-monitoring of weight.

Let us help you recover good health and maintain recovery with good health practices.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com

Removing fat from muscle and liver decreases insulin resistance. Removing fat from pancreas increases secretion of insulin.

Both strenuous exercise training and severe calorie restriction remove fat from muscle, liver and pancreas. Improved insulin secretion and decreased insulin resistance maintain remission and prevent return of glucose intolerance.

Let us help you get that good start.

To learn more about programs Herd Healthcare offers, our website is:
www.herdhealthcare.com

Reversing Type 2 Diabetes

Diabetes mellitus creates a level of sugar and fat in the blood that is more than is healthy. The increased level causes damage to organs during the short term and disabling chronic diseases during the long term. Clearing sugar and fat from the blood involves using sugar and fat for energy needed immediately and storing the extra in muscles, liver and fat until it’s needed. Insulin secreted from the pancreas aids the transfer of sugar from blood into organs needing it for energy.

Type 1 diabetes is caused by failure of the pancreas to secrete insulin such that organs don’t get enough sugar to function. Consequently, fat and protein build up in the blood to supply energy for vital functions of the brain, muscles and other organs. Effects of excess fat and protein coupled with lack of sugar for brain, nerve and muscles eventually are fatal.

Type 2 diabetes is caused by lack of room to store sugar and fat in muscles and liver. Storing sugar and fat in fat tissue and extracellular spaces requires much more insulin than transfer into cells of muscle and liver. Consequently, more insulin is secreted by the pancreas but it’s often not enough to clear sugar and fat to safe levels in the blood.

The usual cause for type 2 diabetes is adding more sugar and fat into the blood, day after day, until levels rise above what can be cleared into muscles and liver. The excess is transferred into fat tissue and into the extracellular spaces of muscles, liver and pancreas.

A normal healthy person transfers sugar, protein and fat from a meal that is not needed immediately into muscles and liver.

Insulin resistance. When the cells of muscles and liver are filled and there’s no more room, the extra nutrient is stored somewhere else. Clearance is slower and requires more insulin. That’s called insulin resistance.

Reduction of insulin secretion. Buildup of sugar and fat that doesn’t clear completely between meals and overnight causes the pancreas to secrete more insulin. When more insulin is increased in the blood, sugar and fat gets stored as fat in muscles, liver and pancreas. Extra fat stored in the pancreas blocks it from secreting enough insulin. Reduction of insulin secretion causes even less sugar and fat to be cleared from the blood.

Increased insulin sensitivity. Physical work by muscle increases its needs for energy such that it increases the amounts of sugar and fat that it clears. Increased requirements for energy, day after day, increases the amounts of sugar and fat it clears even when it’s resting. That’s called increased insulin sensitivity.

Aerobic exercise training. Muscle that works using energy beyond the sugar and fat it has stored, increases its clearance of fat and sugar from the blood while it’s working. Blood vessels dilate and circulation of blood increases the amounts of sugar and fat delivered. It also increases the amount of oxygen delivered while working. Work can be performed for minutes or even hours without stopping. This type of work is called aerobic exercise training.

Resistance exercise training. Muscle that is forced to work beyond amounts of energy immediately available stimulates its fibers to increase in strength. The duration it can continue working is limited by the amounts of energy it has stored. Between bouts of work, it stimulates its fibers to increase in bulk and store more energy. This type of work is called resistance exercise training.

Reversal of type 2 diabetes. Exercise that increases the amounts of energy muscle requires for its work increases daily requirements for calories in food and drink. When total requirements for energy exceed energy in the total calories consumed, stores of excess fat in muscle, liver and pancreas are depleted. When excess fat is depleted from these organs, levels of sugar and fat in the blood return to normal healthy levels between meals and overnight. That’s called reversal of type 2 diabetes.

Remission of Type 2 Diabetes

Remission means reducing concentrations of sugar and fat in the blood to normal healthy levels. These would be levels that are not associated with organ damage or disabling chronic diseases.

Investigators in the DiRECT diabetes remission trial defined remission as having an A1c <6.5% and discontinuing all diabetes medications for at least 2 months.

Investigators in the Look AHEAD intensive lifestyle intervention trial defined remission as having A1c <5.7%, fasting blood glucose <100 mg/dL and discontinuing all diabetes medications for at least 1 year.

Scientific opinion is that extra fat deposited in the liver due to weight gain, causes fat accumulation in the pancreas and impairs its production of insulin. The objective proposed is to reduce excess fat in the liver and pancreas.

DiRECT Diabetes Remission Trial

The DiRECT trial was done in primary care practices in the UK. Investigators recruited 298 individuals aged 20–65 years, with less than 6 years’ duration of type 2 diabetes, BMI 27–45, and not receiving insulin. Approximately 25% of the patients in private practices who qualified agreed to participate.

Subjects were divided into Control Group and Intervention Group with 149 subjects in each group.

The intervention consisted of withdrawal of antidiabetes and antihypertensive drugs, total diet replacement (825–853 kcal per day formula diet for 12–20 weeks), stepped food reintroduction (2–8 weeks), and then structured support for weight-loss maintenance.

The first Figure shows that the average body weight for all subjects was about 200 lb. During the first 4 months, average body weight for subjects in the Intervention Group fell to about 175 lb. During the next 20 months, their average body weight increased to about 185 lb.

Subjects in the Control Group remained little changed at about 200 lb.

The first Figure below shows that during Year 1, 24% of the subjects in the Intervention Group reduced body weight more than 30 lb. During Year 2, 9% of those subjects had reduced weight more than 30 lb.

The second Figure below shows that during Year 1, 45% of those subjects had achieved remission. Those subjects had been in remission for at least 2 months. During Year 2, 35% were in Remission. Most of those 53 subjects had been in remission for at least 1 year.

The next Figure shows that the % Achieving Remission was strictly proportional to the Amount of Weight Reduction. Approximately 70% of those who lost more than 30 lb achieved Remission that held for about 2 Years.

In the whole Study Population, including those in the Control Group, 64% of those subjects who maintained at least 20 lb weight loss achieved Remission.

More than 35% of subjects in the DiRECT Trial achieved Remission. However, 75% of the total eligible population rejected the opportunity to participate. The % of eligible patients in private practice who participated and achieved Remission was less than 5%.

Look AHEAD Intensive Lifestyle Intervention

The Look Ahead clinical study was done in 16 centers throughout the U.S. Investigators recruited 5,145 men and women aged 46–76 years with type 2 diabetes and BMI >25. Approximately 20% were taking insulin at baseline.

The objectives of the intervention were to achieve a mean loss >7% of initial weight and to increase physical activity to >175 minutes a week.

Half of the subjects were randomly assigned to Intensive Lifestyle Intervention with group and individual counseling every week in the first year and twice each month during 2nd to 4th years. Intensive Intervention consisted of instruction in nutrition and physical activity and social support.

Subjects in the Control Group were offered 3 group sessions each year.

The Figure shows total body weights of subjects in the Intensive Intervention Group at the end of Year 1 and after the end of Year 8.

At the end of Year 1, 93% had reduced weight at least -5%, 68% had reduced weight at least -5%, 38% had reduced weight at least -10% and 16% had reduced weight at least -15%.

By the end of Year 8, 74% had reduced weight at least -5%, 50% had reduced weight at least -5%, 27% had reduced weight at least -10% and 11% had reduced weight at least -15%.

As shown in the Figure, the subjects with the greatest success in retaining reduction in weight were those who reduced the most. Almost all of those who lost less than -5% weight during the first year, regained most of what they had lost. Those who lost at least -15% weight during the first year were all successful in retaining weight reductions of at least -10%.

Remission of diabetes during Year 1 was achieved by 11.5% of subjects in the Intensive Intervention Group and by 7.3% at the end of Year 4. Continuous, sustained remission for 4 years was achieved by 3.5%.

Average physical activity reported at baseline by all subjects expended approximately 860 kcal per week. That represented approximately 15 min per day of moderate intensity exercise.

Energy expended by subjects in the Intensive Intervention Group more than doubled in Year 1. Duration of moderate exercise was increased to about 40 minutes per day. However, intensity and duration decreased during the next 7 years. During Year 8, energy expended on physical activity was 1,472 kcal per week during exercise sessions lasting about 30 minutes per day.

Subjects who did not lose weight or actually gained weight did not increase their physical activity during the study.

In addition, subjects who were successful in reducing weight measured their weight more often than subjects who did not lose weight. Approximately half of the subjects who lost weight measured their weight daily. Only approximately one quarter of the subjects who did not lose weight measured weight daily.

Exercise Training And Reduction Of Fat In Liver And Pancreas

Hepatic fat content is reduced by aerobic and resistance exercise training. Results of several clinical trials have demonstrated that exercise reduces fat content of the liver. In skeletal muscle, exercise reduces insulin resistance and decreases the excess sugar and fat delivered to the liver. In the liver, exercise increases metabolism and removal of fat from blood and liver.

Exercise is proven to be good treatment to improve fatty liver disease.

Pancreatic fat content and glucose tolerance respond to exercise training. Fat content of the pancreas can be measured by magnetic resonance spectroscopy.

Studies of men and women in Finland have demonstrated reductions in pancreatic fat content of normal, healthy men and fat content in the pancreas of men and women with type 2 diabetes.

Two weeks of exercise training decreased fat content in all subjects and improved both insulin-stimulated glucose and fatty acid uptake.

On Physical Examination, Maximum Waist Circumference is the most sensitive indicator of excess fat in liver and pancreas. It also is the most sensitive indicator of insulin sensitivity.

Effects of exercise on fat in liver and pancreas can be assessed by sequential measurements of maximum waist circumference.

Summary

The combination of Calorie Restriction and Exercise Training reverses diabetes all the way to complete remission.

Scientific opinion is that extra fat deposited in the liver is due to weight gain.
That weight gain causes fat accumulation in the pancreas and impairs its production of insulin.

The most success is achieved by substantial restriction of calories and vigorous daily exercise that get started right away.

Both strenuous exercise training and substantial calorie restriction remove fat from muscle, liver and pancreas. Improved insulin secretion and decreased insulin resistance maintain remission and prevent return of glucose intolerance.

Age by itself does not decrease energy requirements. As long as intensity and duration of daily exercise continue, requirements for daily calorie intake stay the same.

Maintaining remission of type 2 diabetes requires good health practice that continues indefinitely. That includes restraining calorie intake and enhancing energy output.

What’s essential is:
•Moderate intensity and duration of daily exercise,
•Adequate intake of protein, fiber and healthy fat,
•Avoidance of sugar, excess sodium and unhealthy fat.

Life is more enjoyable limiting excess calories and keeping active than having to consume less and exercise more.

We are pleased to share our blog articles with you, and we are always interested to hear from our readers. Our website address is: www.herdhealthcare.com