Type2 Diabetes Mellitus

Type2 Diabetes Mellitus Type2 Diabetes Mellitus

What is type2 diabetes?

Type2 diabetes is a form of diabetes that occurs due to problems which are present at birth, but these problems manifest later on in life as we grow older. In scientific parlance, we use the term polygenic inheritance for this condition. Some aspects of our lifestyle like a very poor diet and total lack of exercise can worsen diabetes or trigger diabetes at an earlier age than would be expected due to our genetic issues.

Can a young person get type2 diabetes?

How early you get type two diabetes depends on the complement of genes that you inherit. If you have a parent who has had diabetes early on in life, the chances are very high that you may also get diabetes when you are younger. Diabetes tends to get triggered in the presence of a poor lifestyle on top of unfavorable genes. There is a popular misconception that diabetes results only due to poor lifestyle choices that a person has made and the person himself or herself is responsible for their diabetes.This is not true. In fact 90% of diabetes happens due to changes in the genes and some diabetes happens due to epigenetic changes or changes that happened to your genes after your conception that is either in utero life or later on when you grow older.

 

In India as a practicing Endocrinologist, we see a lot of patients with type2 diabetes who are young. Type2 diabetes does occur much earlier in the Asian population than the people in the west. This does not mean that type2 diabetes is more difficult to manage in the Indian population. What this means is that early recognition and appropriate treatment will make sure that the optimal outcomes are achieved for a patient who has to deal with diabetes lifelong.

Can type2 diabetes be reversed or cured ?

Firstly it’s important to realize that the terms cure and reversal are slightly different from each other. By Cure we imply that the disease goes away completely and never comes back. If we cure diabetes you should then not get diabetes till you are 70 to 80 years of age which will be your normal lifespan.  On the other hand, reversal refers to the fact that the progression of diabetes has been stopped. So your metabolism, which was abnormal to the extent that the blood glucose was high for months- but by changing your lifestyle and with exercise and diet you have somehow arrested the progression of diabetes.

This also means that if you do not continue following the same lifestyle modification the reversal can eventually progress. As doctors and scientists we use a different term than these two terms which are popularly used. We use the term called remission. 

What is remission from type2 diabetes?

Remission is defined as not having diabetes for six months or more. We should prove that diabetes has not been there by measuring HbA1c which is a widely accepted and standardized method of evaluating increases in blood glucose. 

Can there be long-term remission From Type2 diabetes?

We get asked this question on a daily basis by my patients. The answer to this is complex. The answer is complex because type2 diabetes itself is a complex disease. One person’s diabetes is not like another person‘s diabetes. Just because a person receives a diagnosis of type2 diabetes does not mean that he will have the same prognosis as any other person with type2 diabetes. Therefore, the prognosis of type2 diabetes is vastly different and variable between individuals. What is generally observed is that if you have a family member with type2 diabetes, the progression of type2 diabetes in your family member may be largely similar to the progression of type2 diabetes in you. Some patients  with type2 diabetes have long-term remission. For example patients with type2 diabetes who undergo bariatrics surgery-tend to have long-term remission from Type2 diabetes. Some researchers have shown that a very low calorie diet and massive weight loss triggered by this very low calorie diet can in fact put the diabetes back into remission for many years even after the said diet is stopped. 

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