Understanding Diabetes: Can It be Reversed? Who Can Get It? Is there a Special Diet for Those Who Have it?

Understanding how to effectively live with diabetes and manage it to maintain a normal life is paramount for anyone affected by this prevalent condition. Diabetes mellitus can impact individuals of all ages.

There are several forms of diabetes; however, the primary types include: Type 2 diabetes, the most common, affecting up to 85% of individuals with the condition; Type 1 diabetes, which predominantly occurs in children and young adults; and gestational (pregnancy-associated) diabetes. A combination of treatment strategies can enable effective management of the condition, promoting a healthy life and reducing the risk of complications.

Below are important points to note about diabetes.

What is diabetes and how does it present?

Diabetes is a metabolic disorder characterized by elevated blood sugar levels. In Type 1 diabetes, this elevation occurs when the pancreas does not produce sufficient insulin. In Type 2 diabetes, the condition is marked by insulin resistance, where the body does not respond appropriately to insulin, a vital hormone that regulates blood sugar.

Can diabetes be cured or reversed?
Diabetes is a long-term condition that requires ongoing monitoring and treatment, whether through lifestyle modifications alone or in combination with medications, oral or injectables, as needed. In some cases, particularly among individuals with Type 2 diabetes who have a shorter disease duration, minimal complications, and good glycemic control with minimal medications, the condition may be effectively controlled without the need for ongoing pharmacotherapy. Weight loss achieved through lifestyle changes, medications, or weight-loss surgery has been associated with an increased likelihood of remission.

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However, it is important to recognize that remission does not constitute a cure, as diabetes can recur if lifestyle modifications are not rigorously maintained. Lifelong monitoring and regular follow-up with healthcare teams remain essential, even in the absence of medication.

Do I need to be on medication?

Medication requirements vary from person to person. Depending on the degree of glycemic control, some patients may need long-term medication, while others can manage their condition by carefully monitoring their diet and blood sugar levels. In certain cases, higher doses of medication may be necessary in the initial stages, with the possibility of gradual reduction as blood sugar levels stabilize. Any modification in medication should be conducted only under the guidance of a healthcare professional.

Is there a special diet for a person living with diabetes?

Nutritional needs for those aiming to prevent or control diabetes are highly individualized, taking into account factors such as body weight, weight loss goals, diabetes-related complications, glycemic control, blood pressure, cholesterol levels, personal and cultural preferences, health literacy, access to nutritious foods, willingness to change behaviours, and any barriers to change (ADA, 2024). Ideally, every individual living with diabetes should consult a dietician for personalized dietary advice.

• Carbohydrates: Limit intake to high-fibre, minimally processed sources such as non-starchy vegetables, fruits, legumes, and whole grains (e.g., whole wheat, oats, brown rice, barley, and quinoa). Opt for dairy products with minimal added sugars, and replace sugar-sweetened beverages, including fruit juices. with water or low-calorie alternatives.
• Fats: Adopt a dietary pattern similar to the Mediterranean diet, which is rich in monounsaturated (MUFA) and polyunsaturated (PUFA) fats. Use oils such as olive, canola, peanut, and avocado (MUFA) or corn, safflower, and soybean oils (PUFA). Include sources of PUFA like walnuts, sunflower seeds, and fatty fish (e.g., salmon, mackerel, herring, trout), while avoiding saturated fats found in red meat, dairy products, and certain tropical oils like coconut and palm oils.
• Proteins: Include both plant-based and animal-based proteins. Plant sources encompass legumes, lentils, tofu, soybeans, green peas, nuts (almonds, cashews, hazelnuts, Brazil nuts, macadamia, peanuts, pecans, walnuts), and seeds (sunflower, pumpkin, or linseed). Recommended animal proteins include skinless poultry, low-fat beef, fish, eggs, and reduced-fat dairy products such as low-fat yogurt and cheese.

Does having obesity predispose me to diabetes?

Overweight and obesity are well-established risk factors for Type 2 diabetes. The risk is particularly heightened when excess weight is concentrated around the abdomen, as visceral fat surrounding the internal organs is closely associated with insulin resistance.

Is a diet high in protein good for a person living with diabetes?
For individuals with diabetes, the emphasis should be on maintaining a balanced overall dietary pattern rather than focusing solely on specific foods. A healthy diet must include appropriate amounts of proteins, carbohydrates, and fats, as all three are essential for proper bodily function.

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Research indicates that an excessive intake of high-fat animal protein may contribute to insulin resistance, a key factor in the development of diabetes.

What are the risk factors for developing diabetes?

Approximately 90 percent of diabetes cases are classified as Type 2. The risk of developing diabetes increases with age, a family history of the disease, and in individuals of African or Asian descent.

Additional risk factors include a history of high blood pressure, overweight or obesity, cigarette smoking, the use of certain medications (such as steroids or antiretroviral drugs for HIV), elevated cholesterol levels, and polycystic ovarian syndrome in females.

Are there complications associated with diabetes?
Individuals with diabetes face an increased risk of developing several serious health complications. These include cardiovascular diseases (such as heart attacks, stroke, and reduced blood flow to the limbs leading to possible amputations), blindness, kidney failure, neuropathy (manifesting as numbness, tingling, burning, or pins and needles sensations), sexual dysfunction, and frequent infections of the urinary, genital, or respiratory systems. Additionally, diabetes is associated with sleep disturbances, non-alcoholic fatty liver disease, and a higher incidence of depression and anxiety. Maintaining blood glucose levels, body weight, blood pressure, and cholesterol near normal levels is critical in delaying or preventing these complications.

This article was written by Dr Sairabanu Sokwalla, Consultant Physician and Endocrinologist at Aga Khan University Hospital Nairobi. 

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