When a diabetic no longer needs medication and has normal blood sugars \u2013 do we call it remission or do we call it a cure?<\/p>\n
Assume for a moment that you’re a diabetic.\u00a0 Your fasting blood sugar is 214.\u00a0 Your hemoglobin A1c \u2013 the component of hemoglobin to which glucose is bound \u2013 is an unhealthy 7.9.\u00a0 You are taking nine pills per day in an effort to control your blood sugar, but it does not seem to be working.\u00a0 This means you are a poorly controlled type 2 diabetic, and your risk of experiencing the deadly effects of unchecked diabetes \u2013 heart attacks, strokes, dementia, blindness, kidney failure, loss of sensation in your extremities and amputations \u2013 is significantly elevated.<\/p>\n
Now, let’s consider a different scenario.<\/p>\n
You are a patient at Longevity Medical Clinic. Since we started treating your type 2 diabetes, we have restored your hormone balance to that of a 25-year-old.\u00a0 Your immune system is more robust and competent than it has been in decades.\u00a0 Your body fat has dropped from 30% to 15%.\u00a0 You are lean, strong, and fitter than you were in high school.\u00a0 You eat a near ideal diet and workout regularly 3 to 5 times per week.\u00a0 Your fasting blood sugar is now 85, and your hemoglobin A1c is a healthy 5.3.\u00a0 You are maintaining these great blood sugar levels and yet are taking no diabetic medications whatsoever. The big question: what do we call you?\u00a0 Are you in remission, or are you cured?<\/p>\n
This is the current state of debate in medicine.\u00a0 A large percentage of type 2 diabetics still make perfectly adequate amounts of insulin.\u00a0 The problem is that they have developed significant insulin resistance.\u00a0 If we correct the insulin resistance, their diabetes will essentially disappear.\u00a0 There are at least two ways to accomplish this.\u00a0 The first, called bariatric surgery, is more invasive and brings higher risk; nevertheless, this surgery will correct insulin resistance in about 85% of surgery patients.\u00a0 The less risky path to overcoming insulin resistance, combining aggressive hormonal treatments with significant lifestyle changes, can potentially eliminate symptoms of diabetes in roughly 70% of people.<\/p>\n
In 2009, the International Consensus Committee decided that it was probably most appropriate to refer to a diabetic whose robust good health has been restored as \u201cin remission\u201d \u2013 not \u201ccured.\u201d\u00a0 Their reasoning is that most people will eventually return to the old lifestyle that caused the disease in the first place, creating a high probability that they will once more become diabetic.\u00a0 This reasoning makes sense, based on the behavior of all too many people. But this same committee admitted that the \u201cremission\u201d versus \u201ccure\u201d debate is mostly a matter of opinion, not really based on objective science.<\/p>\n
My view is simple. Instead of resting on opinion, preferences, or social and political pressures, I prefer to use the term \u201ccure.\u201d If a person has normal blood sugar and normal insulin levels and is not taking any diabetes medications, I am hard pressed to consider them a diabetic.\u00a0 But at the same time, I certainly agree that any patient who returns to the lifestyle that caused the diabetes in the first place will almost certainly cause it to recur. Let me give you an analogy from my own experience. Several years ago when I was skiing (in my usual less than cautious manner), I took a nasty fall and broke my left hip.\u00a0 Today, other than some bony callus at the site of healing, and some scarring on the bone, I have no current evidence of a fractured hip.\u00a0 I run, I jump, I leap and cavort, and I also continue to ski in a less than cautious manner!\u00a0 That means I am certainly at risk of fracturing my hip a second time.\u00a0 Am I cured, or am I in remission? I would say that my hip fracture has been cured, but using the reasoning of the medical community my fracture would be in remission, since my lifestyle might cause me to break my hip again at some time in the future. Sounds like silly reasoning, doesn\u2019t it?<\/p>\n
To sum up: the vast majority of people with type 2 diabetes make plenty of insulin.\u00a0 Their blood sugar is high because they have developed severe insulin resistance.\u00a0 We know how to correct insulin resistance and to restore patients to health.\u00a0 The big question that we are now arguing about is not so much whether it can be done, but what we should call it when we have done it.\u00a0 Some people seem outraged when we suggest that some type 2 diabetics can be cured.\u00a0 I sincerely don’t want to upset them, so if they prefer, they can substitute the words “in remission” for cured.\u00a0 I frankly don’t care what we call it.\u00a0 What I do care about is helping those people with high blood sugars, high insulin, and a high risk of devastating consequences to overcome their problems and lead a longer, healthier life. That\u2019s what we\u2019re working to do every day at Longevity Medical Clinic.<\/p>\n
Source: When a diabetic no longer needs medication and has normal blood sugars \u2013 do we call it remission or do we call it a cure? Assume for a moment that you’re a diabetic.\u00a0 Your fasting blood sugar is 214.\u00a0 Your … Continue reading
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