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Can Diabetes Be Reversed?

My brother has had type 2 diabetes for 10 years and insists that there's nothing to be done for it but take his medication. I don't agree, but have no real medical basis for this belief. Can diabetes be reversed?

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Diabetes is a disease in which the body is unable to produce enough insulin, isn't able to use the insulin it produces, or both. Regular exercise, weight loss, and good blood sugar control can improve the body's ability to produce and use insulin. Though the person would still have diabetes, these changes can look like a reversal of the disease.
People with type 2 diabetes have a decreased sensitivity to insulin (also called insulin resistance). Insulin is needed to take sugar (glucose) out of the blood and put it into the body's cells to be turned into energy. Insulin resistance means that the cells ignore the insulin and more sugar stays in the blood for a longer time.
One of the things that can cause insulin resistance is the amount of fat circulating in the bloodstream and stored in the cell. This is one of the reasons why losing weight (and losing fat from the cells) can help with blood sugar control. With less fat, the cells can become more sensitive to the insulin. This allows sugar to enter the cell and lowers sugar in the blood.
Obesity can also cause constant low-level inflammation, which leads to insulin resistance. Regular exercise helps to make cells more sensitive to the insulin that is available, so with regular exercise and weight loss, medications may be able to be reduced or even eliminated in some people with diabetes.
If high blood sugar is not controlled over a long period, it decreases the body's ability to produce insulin. This is sometimes called "glucose toxicity." Bringing blood sugar down to a normal or near-normal range and keeping it there may reverse this glucose toxicity. More insulin is then produced, and blood sugar is more easily controlled.
There is some evidence that gastric bypass surgery can improve or even reverse diabetes, though long-term studies are not available to see if this is a permanent reversal or if diabetes comes back over time. People who lost weight after gastric bypass and then gain it back sometimes also begin having high blood sugar again.
For more information on this topic, see the question on gastric bypass surgery. Diabetes is considered a chronic condition; however, regular exercise, maintaining a healthy weight, and keeping blood sugar near normal can make it easier to control.
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