R M Cullen MD MSc MFM BA DipStats DipProfEthics

Reversal of Type 2 diabetes and pre-diabetes

"Add years to your life and life to your years"

All forms of diabetes can be seen as a problem of supply and demand. The pancreas cannot produce (supply) the amount of insulin required (demand) by the rest of the body.

Type 2 diabetes is the end result of years of excess Beta cell mortality. Beta cells are found in the pancreas and they are the only cells which produce insulin. Human bodies are made up of many, many cells and each of those cells uses glucose for energy. Insulin is required to move glucose from the blood into cells.

In the normal course of events, some cells divide to produce two daughter cells, and others die. In people with type 2 diabetes and pre-diabetes more Beta cells die than divide. This is what I mean by excess Beta cell mortality.

The remaining Beta cells are unable to produce insulin in sufficient quantities quickly enough to maintain the blood sugar level in the normal range. The result is persistent elevation of serum glucose for at least part of each day. At high levels glucose is toxic to small blood vessels, and this blood vessel damage is the cause of the complications of diabetes (which include heart disease, stroke, blindness, kidney failure, and lower limb amputation)

You might not have heard type 2 diabetes described in this way before. Type 2 diabetes is most commonly talked about as the result of insufficient insulin or the body's inability to utilise insulin well. This is true, but a different starting point, a different looking glass. It leads to discussions about control rather than reversal.

There is no question that pre-diabetes can often be reversed. Nor is there any question that type 2 diabetes can sometimes be reversed. My practice is focussed on reversal not control.

My approach focusses on both sides of the problem. We try to reduce the body's requirement for insulin and at the same time try to improve the health of Beta cells so that the supply of insulin increases.

References

My diabetes reversal practice rests on the claim that type 2 diabetes is the result of years of excessive Beta cell death, more often than not triggered by the development of insulin resistance. In the paragraphs below I state the key claims.

Fatter young people have a greater Beta cell mass than lean young people

For some years at least, an increase in the number of fat storage cells stimulates Beta cells, and their mass increases (more Beta cells rather than bigger cells). This finding is not controversial. Here is a link to a 2013 study. Obese non-diabetic adults have some 50% more Beta cells than lean adults. The pdf can be seen here

Type 2 diabetes results from asking too much of a decreasing number of Beta cells

Non-controversial. This is the standard conventional understanding.

Type 2 diabetes is often reversed by gastric bypass surgery

This is old news. Twenty years old. The interesting thing is that the return to normal blood sugar levels occurs in the few days following surgery, before any significant weight loss. The question is what is the mechanism? For a long time it was thought that the fall in blood glucose levels was the result of various hormones that were released in response to a full stomach no longer being released. The Newcastle group have shown that the sudden dramatic drop in food intake may be the reason for the fall in blood glucose levels.

Type 2 diabetes can be reversed by a short duration very low calorie diet

This is uncontroversial. The Newcastle group have shown this. To find out more google "diabetes reversal newcastle". The question now is whether this can be done in primary care (general practice). A major study to investigate this is currently underway in the UK.