Type 2 diabetes is steamrolling its way through the western world. A crowbar into the coherent running of your body, diabetes can continually run riot if left untreated.
Fortunately, unlike Type 1 (which is genetic), you can successfully reverse Type 2 diabetes with the correct intervention.
Type 2 Diabetes running riot
The rate of people with diabetes in UK has doubled in the last 20 years. From 1.9 million in 1998 to 3.9 million in 2018. In the last year alone this has risen by 100,000 (1). 90% of people diagnosed with Type 2 diabetes.
This figure is predicted to increase to 5.5 million by 2025. The diabetes organisation predicts 80-85% of the risk of getting type 2 diabetes is through being obese (2). They also anticipate 3 out of 5 cases can be prevented.
Rates in children getting type 2 diabetes are increasing compared to 10 years ago (3). 81% of children diagnosed were obese. It should also be noted that rates of childhood obesity have increased from year 6 onwards since 2010. This could suggest a lot more children are in the pre-diabetes stage already.
In terms of cost, a report in 2012 found type 2 diabetes cost the NHS £11 billion a year compared to £1.8 billion for type 1 diabetes. Two things to bear in mind; Type 2 diabetes is a lifestyle related condition and these figures were from 2012, so likely to have increased (4).
Put more clearly, the NHS spends nearly 11 times more money having to treat a lifestyle related condition (type 2 diabetes) than a genetic condition (type 1).
This means its hugely important if you have type 2 diabetes we look to create a strategy for reversing the condition.
What is meant by ‘reversing type 2 diabetes’
‘Reversing type 2 diabetes’ means a significant improvement in insulin sensitivity over a period of time. From a medical point of view this would reflect getting your HbA1c (average blood glucose levels) below 42 mmol/mol (6%) without the assistance of diabetes medication. This would be classed as being in remission (5).
A small caveat for the purpose of this article. In NO way will I suggest coming off your medication and you would ONLY look to come off them with the guidance of your GP.
How you get diabetes
Your body likes to run a tight ship. This means everything is regulated to work in equilibrium with everything else in the body. This is known as homeostasis. When one thing happens, it creates a reaction for the purpose of doing a job and bring order back to the system (that being your body’s functions).
In terms of diabetes, this relates to glucose, your blood sugar levels and insulin.
When you eat anything, it goes through a process of digestion and absorption. During this process your blood sugar levels will rise due to the increased levels of glucose now in the blood supply.
This will prompt a release of a hormone called insulin to be released from your pancreas. Contrary to popular belief this doesn’t just happen when you eat carbs (although you will see a sharp rise when you eat anything with simple sugars and little to no fibre, AKA sweets). Protein and dairy also spikes an insulin release.
The function of insulin is to transport glucose out of the blood and into cells, mainly liver, muscle and fat cells.
This causes blood sugar levels to drop back to normal and you to get on with your day. This is known as insulin sensitivity; Your blood sugar levels rise, insulin sorts it out.
What happens if insulin doesn’t turn up? Type 2 diabetes happens.
Imagine you have a bus company and its the only bus company in town. Its job is to transport kids to all the schools in the district. This runs smoothly until the bus company notices over the last couple of years the child population has increased dramatically.
Suddenly every bus is full. Now, the buses are so full some kids have to be left at the bus stop. Over the next couple of months, the amount of kids left at bus stops increases in numbers. There is no other way of getting to school so the left behind kids start causing mischief.
Now, the bus drivers are kicking off. Some refuse to turn up meaning less buses are going out, meaning less kids are being transported to school. After failed negotiations from the school to provide funding for more buses, the bus company decides to halt all buses meaning no kids are being transported to schools. Cue chaos.
This is type 2 diabetes.
Increased glucose in the blood over time causes the pancreas to get tired out from pumping insulin out regularly. In time, less insulin is released causing more glucose to be left in the blood. Eventually too much glucose is in the blood, resulting in a diagnosis of type 2 diabetes.
What happens if not treated effectively
The most common reason for hospital admissions related to diabetes, by far, is active foot disease which is where circulation to the lower limb is restricted resulting in longer healing times and, at the worst case, amputation.
Other factors that can result from type 2 diabetes include greater risk of heart disease, nerve damage and kidney damage.
In short, type 2 diabetes to your body is like a hurricane bellowing through a city; very little get unaffected.
How to reduce type 2 diabetes
If you’re £50K in debt, you don’t need me to tell you getting out of the red isn’t going to happen overnight. Reversing type 2 diabetes is the same.
You’ve hit a health roadblock, now’s time for action and it is going to require a systemised approach involving;
Psychology – Changing habits and how you identify with health
Nutrition – To lose body fat and improve insulin sensitivity
Movement – Exercise & everyday movement to improve blood glucose management
I will not cover psychology in this article as it is best to cover it in an article on its own covering identity and health.
How to use nutrition to reverse Type 2 diabetes
The first thing to point out is the idea you NEED to cut out carbs to sort out type 2 diabetes.
This is not true.
Whilst carbohydrates do digest into glucose, it is not the case your body can’t handle carbohydrates now it has type 2 diabetes.
For example, there has been studies where participants with T2D were given a diet consisting of up to 70% carbohydrates and achieved a greater reduction in both fasted blood glucose levels and post-prandial glucose levels (2 hours after eating), compared to a standard diet (6).
Carbohydrates are fine, you want to look to avoid processed carbohydrates featuring simple sugars due to the speed at which they are able to digest into glucose due mainly to the absence of fibre. Complex carbohydrates featuring fibre (potato, rice, quinoa) is fine.
The main factor you want to focus on is losing body fat and that requires 2 factors:
✔︎ Being in a calorie deficit
✔︎ Arranging your eating into your daily life so you can stick to it.
How you achieve the calorie deficit (low carb, high fat, low calorie, high protein, fasting) is entirely up to you and dependent on what you are more likely to stick to.
Losing Fat More Important Than Losing Weight
If you’ve ever been on a low carb diet, you may have marvelled at the speed of the initial weight loss. This is mainly due to water weight. When carbohydrate is stored, it is in the form of glycogen. For every gram of glycogen stored, 2 grams of water is also stored. When you go low carb you starve your glycogen stores, thus reducing water weight.
To help reverse T2D, losing water weight is not enough. Evidence suggests the most important component you need to reduce in order to reduce insulin resistance is visceral fat (7, 8). Visceral fat is the fat that accumulated around your internal organs, as opposed to subcutaneous fat which appears just below the skin, most noticeable around your abdominal & hips.
With that in mind, it is important to have multiple markers for assessing improvements other than just weighing scales. The 2 best ones I use with my clients is measuring the circumference of your hips and waist and also choosing one piece of clothing that is currently tight and you’d notice was baggy if you lost body fat.
A note on Very Low Calorie Diets (VLCD)
Very Low Calorie diets tend to range from 800-1200 calories daily. There has been ongoing evidence suggesting this can be used to bring T2D into remission (9). With Very Low Calorie diets it is common to be used in conjunction with support either in the form of a GP or support group due to it being potential difficult to stick to.
There is also evidence, like many diets, of regain due to metabolic adaptations (your body’s response to the loss of body fat) (10). This is why I say this process is psychological as well as physical and nutritional. I’m going to say this in bold in the hope it gets ingraved in your brain;
Treat the weight loss as a means to get your blood glucose stable & improve insulin sensitivity, NOT for aesthetic purposes. Once you have lost the weight, create a way of eating so you can MAINTAIN a weight while STABILISING glucose and insulin levels.
Exercise Your Way Out Of Diabetes
When you are looking to reverse T2D, you want to hit it from multiple angles. You’ve hooked it with nutrition, now you’re going to uppercut it with exercise.
The main benefit of exercise (aside from cardiovascular & stress reduction benefits) is its effect on blood glucose levels. However, the effect is only short term (less than 24 hours) so one trip to the gym on Monday and a light swim on Saturday isn’t going to cut it.
There doesn’t appear to be any difference in benefits between cardiovascular and resistance training (11) and High Intensity Interval training (HIIT) has also shown to increase insulin sensitivity & improve blood glucose control (12).
The main takeaway is to do exercise, do it regularly in the week and keep doing it with progressive improvements over time.
Having Type 2 Diabetes is not ideal and can lead to other health conditions that affect your whole body. However, it is predominantly a lifestyle related condition and as such changing your lifestyle can make massive improvements. Here is a 3 pronged approach to getting out of this mess;
1 Recognise your lifestyle has to change. This isn’t a half hearted “I’m going to lose weight for new year” situation you are in so you have to get your mindset on point. Part of that will be looking at what your other priorities in life (work, family, other commitments) are and how you can fit the nutritional and exercise changes into it.
2 Eat to lose body fat, not just weight. This means being in a calorie deficit and eating in a way that reduces insulin resistance and controls blood glucose. So, eliminate processed sugar & fat and focus on whole foods with fibre, good fat and a large dose of protein.
3. Exercise but also move more. It doesn’t matter if it is cardio or resistance exercise or both. Just do more of it and regularly in the week. Also look to move more during the day (known as Non-exercise activity Thermogenesis, or NEAT) to help aid weight loss.
This IS manageable. With a few changes you will be well on your way to making Type 2 diabetes an annoyance in the past.