Question
Why are so many people with Type 2 diabetes told to lose weight? Can weight loss “cure” Type 2 diabetes?
Answer
To answer those questions requires a very simplified version of how insulin works.
Think of the cells in our bodies cells as a locked room and think of the blood glucose as the “workers” trying to get in the room to do their jobs of creating energy. Now think of insulin as the “key” that lets those workers into the room. People in the early stages of Type 2 diabetes often produce plenty of “keys” (insulin) to allow all the “workers” (glucose) into the room, but their “locks” are “jammed up” by excess body fat, lack of exercise, medications, smoking, genetic history, or some combination of all the above! In this case, we want to try to unstick the locks as much as we can, so that the keys will work. There are some things we can’t change, like our history or our genetics , but we can potentially change a person’s body fat/fat distribution, amount of muscle mass they have, their exercise routine, whether or not they smoke, and what medications he/she is on. To get back to the “weight” question, however—basically if a person with Type 2 diabetes loses extra body fat (and hopefully gains some muscle), they can potentially “unstick” some of those locks and allow the insulin to do its job of removing the glucose from the blood and allowing it into the cells. It doesn’t have to be a huge weight loss either—even just 5-10% weight loss from the current weight can make a difference in blood sugar control for some folks.
As far as a “cure” is concerned, following a diet and exercise plan that results in weight loss might help someone control the blood sugar so that they don’t need medication or insulin. But since you have to follow that carbohydrate controlled diet FOR THE REST OF YOUR LIFE, most people would not consider that a “cure.” People who have had weight loss surgery that resulted in a rapid weight loss sometimes claim their diabetes was cured as they no longer needed medication or insulin; however, you still have to follow a strict diet to keep the weight (and the high blood sugars) from returning. So, it appears weight loss surgery “manages” diabetes instead of “cures” it.
Also keep in mind that not everyone with Type 2 diabetes is overweight or obese, and that telling everyone with Type 2 that weight loss will automatically lead to removal of medication or insulin is misleading. When bringing up weight loss, you also want to remember that many people who are overweight or obese know they are overweight, and are pretty aware of the risks of such. Many of them have tried different diets, are aware of their need to cut back, etc, but they don’t change their diet for a variety of reasons—lack of financial resources to obtain healthy food and physical disabilities that hinder cooking at home are among them. Keep in mind that trying to shame someone into losing weight will usually backfire on you. Telling them to achieve a weight they have never achieved in their life doesn’t help either. It helps first to find out what the person’s weight loss goals (if any) are, and what they might need to actually achieve those goals, instead of just telling them to lose weight.
And there is currently no “cure” for Type 1 diabetes, although there are some people who have received a pancreas transplant, an expensive and still risky procedure. There is also some pretty interesting research into an artificial pancreases and stem cell research that also looks promising and a lot closer to be on the market than when I was writing these tips last year. Many type 1s are also to manage their insulin doses more closely with the use of insulin pumps and continuous glucose monitors (CGMs) to get a more physiologic dose of insulin.
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