Diabetes Remission - can you live a normal life again?

                           

 Over the past few weeks I have personally experienced friends and relatives that have been affected by the complications of diabetes mellitus (DM). One was a relative that succumb to the disease and died after many years of living with the disease and enduring many of the disease’s complications. This post as with so many other communications on DM is written as an informational tool so that persons may investigate the topic and communicate with their healthcare provider about management of the disease as it relates to them.

Diabetes is a very serious disease that is directly and indirectly linked to many serious medical conditions such as heart disease and kidney failure. DM can be controlled however. With the proper medications and lifestyle changes the disease’s progression and its complications can be slowed and even prevented. The lifestyle changes (rigorous diet control and consistent exercise) are at the center of care and not achieved by many because of their demanding nature. In all most all cases the lifestyle changes that are required are permanent, nevertheless the need for lifestyle modifications cannot be overstated.  It has been recently recognized that under certain circumstances the disease progression can be slowed or stop and medication may not be needed for long periods and in some cases indefinitely if the disease is identified and treated early. In the late 1990’s it was reported that following a hyperglycemic (high blood sugar) crisis persons that were treated with intensive insulin therapy - in a hospital - and were subsequently placed on low doses of oral medication (sulfonylurea) a subsequent crisis was prevented for several years.¹   In this study all the patients maintained lifestyle modifications of diet and exercise following the initial treatment. And approximately ten years later several studies cited remission (a temporary cure of a disease or condition) and the elimination of the need for medications altogether while markers of DM: blood sugar, insulin levels, and A₁C normalized (without medications) following the initial treatment of the crisis ^{2, 3}. All the studies integrated lifestyle modifications (diet and exercise) following resolution of the crisis so there was no free ride for those that achieved remission. And all patients continued the lifestyle modifications to maintain medication liberation. In those studies (where intense insulin therapy was used) the blood sugar control was supervised directly by a medical professional (most studies were performed in a hospital). So this is not a treatment strategy that can be attempted without medical supervision. Nevertheless, there may be a silver lining to the dark cloud of diabetes. Intensive therapy in the early stages of the disease may induce remission for years if lifestyle modifications are maintained. And if medications are needed following a crisis blood sugar levels may be controlled by the use of low dose oral medications (without the need for insulin). Lifestyle modification however, remains the backbone of care, and all care plans should be developed in conjunction with and under the supervision of a medical professional.

1-  Diabetes Care 1997 April 20(4): 479-83

2 - Diabetes Med. 2001 Jan; 18(1): 10-6

3 - Lancet 2008 May 24; 371 (9626): 1753:60