In Type 1 diabetes, the pancreas produces little to no insulin, while in Type 2 diabetes, the body stops responding to insulin properly. In both types, elevated blood sugar can damage our bodies, leading to heart disease, kidney problems, nerve issues and even blindness.
Weight loss — even 5 to 10 percent — can improve blood sugar levels and lessen the need for medications for Type 2 diabetes. More radical lifestyle changes — overhauling your diet and exercising more — and weight-loss (bariatric) surgery can lower weight and lead to reversal of Type 2 diabetes for some people.
Type 1 diabetes, which is caused by an autoimmune response against part of the pancreas, cannot be reversed — though scientists are working on a cure.
Millions of Americans have diabetes but haven’t yet been diagnosed. A one-minute CDC risk tool can help you determine whether you should seek such testing or you can ask your doctor about testing. Common tests either check your blood sugar directly (blood glucose) or measure an average of your blood sugar level over the past two to three months (hemoglobin A1c).
Testing may show that you have diabetes or prediabetes. Prediabetes means you have higher blood sugar than normal, but not yet high enough for a diabetes diagnosis. You should think of it as the yellow in a traffic light: There is a significant risk of it progressing to diabetes without changes to your lifestyle.
Diagnosis is an ‘all hands on deck’ moment
Anytime one of my patients is diagnosed with diabetes, I consider it an “all hands on deck” moment. Not just for our clinical team, but also for the patient and their family. That’s because the first few weeks after a diagnosis are critical for establishing new patterns, from dietary habits to keeping blood sugar logs to managing medications.
Medications for Type 2 diabetes help your body use insulin better or rid your body of extra glucose. Most come in pill form (for example, metformin), though insulin and injectable medicines are also prescribed, particularly if the blood sugar is very high. It may take some time for you and your doctor to find the best medicines to treat your diabetes — and most patients continue taking them for life.
A number of new medicines for diabetes have come on the market in recent years. Some such as glucagon-like peptide 1-based therapies (such as semaglutide, liraglutide and tirzepatide) lower blood sugar but also slow digestion and help with weight loss.
If you already have diabetes, it’s worth speaking with your doctor to make sure you are on the best combination of medicines. And it’s always worth asking: “How might I safely get off one or two of these drugs?” Posing that question could be the first step toward reversing your diabetes.
Type 2 diabetes can sometimes be reversed without medications
We know that Type 2 diabetes can be reversed. A study in the United Kingdom, known as the Diabetes Remission Clinical Trial (DiRECT), showed that patients could reduce blood sugar below diabetic levels — with about a third of patients sustaining that control for at least two years, without medication.
Study participants had to be committed; initially, all diabetes drugs were stopped and meals were replaced with a strict 800-calories-a-day diet that was mostly healthy shakes. Then real food was gradually reintroduced, and patients were supported by dietitians, nurses, and tailored workbooks to maintain their weight loss.
If this sounds intense to you — it is. But so is injecting yourself with insulin every day! To me, the most important lesson of the DiRECT trial is how important it is to find a nutritional plan that you can stick with for the long haul.
Anyone who has tried to lose weight knows the toughest part is keeping it off. My advice is to think about what nutritional changes you can sustain over years, not weeks.
A Mediterranean diet has perhaps the strongest long-term scientific evidence supporting its use in Type 2 diabetes. Plant-based and vegetarian diets have also been shown to be effective for the prevention and treatment of Type 2 diabetes. Low-carbohydrate (including “keto”) diets and intermittent fasting have less scientific support but work for some — those options should be discussed with a nutritionist or doctor.
Managing diabetes is its own prevention
My father has had Type 2 diabetes for over 30 years, but he has been able to control it and hasn’t had to start insulin. He is unlikely to reverse his diabetes at this point, but there are still immense benefits to managing the disease well.
We focus on the “ABCs of diabetes”: his A1c, or average blood sugar, which we keep below 7; his blood pressure; and his cholesterol.
Keeping blood sugar at or near the goal level helps protect the eyes, kidneys and nerves. And keeping blood pressure and cholesterol levels under control reduces the risk of heart attacks and strokes.
My father is on medicines for each of the ABC, but we always look for opportunities to pare back on his pills through better eating and more exercise.
Prevention is even better than reversal
I have a strong family history of Type 2 diabetes — along with my father, each of my four grandparents also suffered from it. The deck may be stacked against some of us in this way, but we can take steps to reduce our risk of developing diabetes.
Eating more fruits and vegetables and less meats, sweets and refined grains (such as white bread and pasta) is important. It’s a myth that people concerned about diabetes should avoid fruit; eating whole fruit (rather than juices or processed fruit) is a good source of fiber, vitamins and minerals.
Sugary drinks such as soda and juice should be rare indulgences, as should ultra-processed foods such as starchy snacks, chips and crackers, and packaged food such as energy bars. If you’re not sure whether something is ultra-processed, check the ingredients list: More is not better! Shifting to whole grains, like switching from white rice to brown rice, also helps.
Personally, I am vegetarian and started a version of intermittent fasting a few years ago, whereby I eat only between the hours of noon and 9 p.m. each day. I find it’s easier for me to stick to time-based cutoffs, and they have helped me reduce unhealthy snacking.
Physical activity also matters for how our body processes sugar. Hitting the gym is great, but walking, gardening and dancing all count. If you have fun while you’re exercising, it feels like less of a chore, and you’re more likely to keep doing it. Some studies show that combining strength training with aerobic exercise lowers diabetes risk more than either alone.
The National Diabetes Prevention Program, which is offered by many organizations such as the YMCAs across the country, has been scientifically proven to help people adopt healthful habits for nutrition and exercise. Depending on your age, weight and test results, your doctor may also consider some medications — such as metformin or semaglutide — to help stave off diabetes.
The benefits of preventing diabetes are remarkable. Studies estimate that a diagnosis of diabetes at age 40 reduces life expectancy by six years. An ounce of prevention is worth a pound of cure — and a few birthdays, too.
Meet the doctor: Dave A. Chokshi (@davechokshi) is a primary care internist at Bellevue Hospital and clinical professor at NYU. He previously served as the 43rd health commissioner of New York City.
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