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Will a person with Type 2 diabetes under control end up with the need for insulin?

This is one of a series of articles answering questions in this POST: 108 Most Asked Questions For Drugstore Marketing Activities

As you may have read, Type 2 diabetes is a progressive disease. Will you require insulin? That all depends on individual factors that includes, among many other factors, weight, exercise, genetics, hormones and beta-cells, those cells that produce insulin in your pancreas. Research shows that managing your diabetes early in the disease process can have big payoffs in later years. Joining a support group for people with diabetes can be helpful in keeping you going in your health quest. Following up with your health care team regularly and keeping abreast on the new developments in diabetes management can also benefit you.

Answered by Andrea Dunn, RD, LD, CDE: Andrea Dunn is a registered dietitian and certified diabetes educator with the Center for Human Nutrition.

—-By Dr.  Andrea Dunn, RD, LD, CDE

Not necessarily, but sometimes it can, especially if obese (which often is seen in type 2 diabetics and further lowers one’s sensitivity to insulin) and having had diabetes for a long time, yes. And then there are those with Latent autoimmune diabetes of adults (LADA) who don’t fit the “regular” type 2 profile being not overweight, these people will be needing insulin soon. Some think of those initially diagnosed as type 2 diabetes, around 5 – 10% in fact have unrecognized/undiagnosed LADA.

In obese type 2 diabetes losing lots of weight > 10kg can sometimes reverse one’s diabetes if one is able to hold their weight down afterwards.

Professor Robert Taylor of Newcastle in 2011 published a paper in Diabetologica Reversal of type 2 diabetes: normalisation of beta cell function in association with decreased pancreas and liver triacylglycerol in which he reversed type 2 diabetes is 11 quite obese patients having had diabetes for no longer than 5 years, not on insulin (so their pancreas hadn’t been “worn out” yet) by putting them on a grueling 600 kCal/day diet for 8 weeks, so they lost a mean of 15 kg of weight (±20% of body weight) and both their liver and pancreas lost the fat= triglycerides (that made these organs not function properly = dysfunction) as shown on serial abdominal MRI, know that after a 3 months follow-up 3 out of the 11 again became diabetic again after resuming a more normal diet. However, there are reports that in people doing it at home if very well motivated so losing 15 kg it can work see Population response to information on reversibility of Type 2 diabetes.
A new study by Professor Taylor’s group published in Diabetes Care of May 2016 Very Low-Calorie Diet and 6 Months of Weight Stability in Type 2 Diabetes: Pathophysiological Changes in Responders and Nonresponders seems to show that losing a bit less (10 kg) weight could be effective too, up to 6 months after the strict diet, even in those having had diabetes for 10 years, some who perviously were on insulin, AS LONG AS THEY KEEP THEIR WEIGHT DOWN: 12 (later 1 person reversed his diabetes too making a total of 13) out of 30 participant were free of diabetes after 6 months. Also see Reverse your diabetes – and you can stay diabetes-free long-term

—-By Dr. Liang-Hai Sie, Retired general internist, former intensive care physician

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