Yes and no. More people could become un-diabetic than ever succeed in doing so. Other people really don’t stand a chance. Which are you?

Before going on, what does it mean to become un-diabetic? A simple answer would be to say that, without medication, your fasting blood sugar remains below 126 md/dL and your hemoglobin A1c (average blood sugar) remains in the normal range, and that you are able to eat normal foods.

Many people come close to this definition. Their blood sugars are well-controlled – as long as they watch their diet closely. This is then called diet-controlled diabetes mellitus.

A big problem with the definition is that the tendency towards diabetes remains for most people who achieve normal blood sugars through dieting.

A second problem is the underlying etiology of a person’s diabetes. For Type I diabetic patients, the pancreas no longer secretes insulin. Without insulin a Type I diabetic will die, usually within several days of not having insulin. Aside from a pancreas transplant, there is no way to make a Type I diabetic become un-diabetic at this time. Perhaps in the future stem cells may provide a cure – maybe there is a way to make a person grow a new pancreas. Fortunately, Type I diabetes is quite rare compared to Type II.

Type II diabetes is usually, but not always, related to weight. With higher body weight, the pancreas has to secrete more insulin, but in turn the body becomes resistant to the effects of insulin. Although the pancreas tries harder and harder to keep up with rising blood sugar levels, eventually it loses the battle and blood glucose levels exceed normal values. In most patients this condition persists for months to years before a person is diagnosed.

Who can become un-diabetic? The overweight patient who has had diabetes for a relatively short period of time is the best candidate. Taking medication will not make you un-diabetic, although it may return your blood sugar to normal levels. That does not mean you don’t have diabetes, however. Stop the medicine, and your sugar will likely rise.

Although there are occasional exceptions to this rule, the only way to become un-diabetic is to lose a significant amount of weight fairly early in the course of the disease. A person’s who has had Type II diabetes for a dozen years has probably surpassed the body’s ability to restore normal pancreatic function. The pancreas gets worn out, more and less, and just can’t keep up, like a failing heart.

However, early on in the process, if the body is retrained to use fewer calories, the diabetic process can be reversed. Usually at this stage fasting blood sugars are elevated, but still below 200 mg/dL. If a patient gets serious and loses a good amount of body weight – at least 10% – the process may be reversible. Some patients with higher blood sugars may also be able to become un-diabetic if they lose even more weight – say 50 to 100 pounds, depending on starting weight. Once the body is stabilized at the new, lower weight, the pancreas is again able to keep up with the body’s need for insulin.

Along the way your doctor will probably prescribe medication. It takes time to lose weight, and you don’t want to wait 6 to 12 months to begin medication. As your weight drops, the medication can be tapered.

If you are overweight and have been diagnosed with diabetes in the past several months (or perhaps up to even a few years ago) get serious and lose weight. For anyone in the pre-diabetic phase, the same advice holds true. Take action now before you are diagnosed with a disease that may haunt you the rest of your life.

Copyright 2010 Cynthia J. Koelker, MD

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