Can I Be Cured Of Diabetes?

Ask Theresa is a weekly advice column by Theresa Link. A Virta Health Coach since 2015 and a loyal follower of the ketogenic lifestyle, Theresa is a Registered Dietitian who is an expert in living a metabolically-healthy life. 

At Virta, our business is reversing type 2 diabetes. But once your A1c is under the diabetes threshold, does that mean your diabetes is gone? The answer to this is surprisingly complicated. Buckle up as we explore this meaty question in this week’s installment of Ask Theresa.

❓Question:

Theresa,

I've dropped 145 lbs since December 2023 and I'm within about 40 lbs of my goal. I've also dropped my A1c to 5.1, and I’m off all diabetes meds. My question is – do I still have diabetes? Is my diabetes gone forever or could it come back? 

Sincerely,
Perplexed

👩🏻‍💻 Theresa:‍

Dear Perplexed,

You’ve absolutely crushed it on Virta! You’ve really kicked diabetes in the knees, and you should be incredibly proud of how far you’ve come. Thanks for asking this question. Although it doesn't have a clear answer (that’s true of most of my columns, right?) we can still get to the bottom of it.

Let’s explore.

‍Do I Still Have Diabetes?

‍You’ve smashed diabetes, kicked it out of the park. You’re no longer shackled by multiple medications; you don’t have to stick your finger a million times a day; you don’t have to live with the heavy burden that perhaps you won’t be there for your loved ones, or that you might share the same fate of those whose diabetes has stolen their vitality. You’ve freed yourself. You get to do the things you love with the people you love.

At Virta, we're applauding your success and shouting from the rooftops with pure glee! You are the reason we do what we do.‍

Am I Cured?‍

Skeptics in the medical community didn’t believe diabetes could be reversed (some still don’t), but we have the evidence to prove that it can with our ground-breaking results. That said, at this time there is no cure. So how can a condition be reversed but not cured?

From a medical standpoint, to cure type 2 diabetes it would mean that the disease has completely resolved and no further medical intervention is needed. Think of it like a bacterial sinus infection: your snot has been green for three weeks and you’ve broken your Neti pot from overuse. You go to the doctor, they give you antibiotics, and the drugs kill your infection. There is no more bacteria. You don’t need any further medical treatment for the sinus infection. You’ve been cured. 

Type 2 diabetes doesn’t work this way. Type 2 diabetes is the result of insulin resistance, and insulin resistance improves dramatically in response to reducing dietary carbohydrates. Reversal occurs when you’ve eliminated the hallmark symptoms of type 2 diabetes to the point where you’re able to maintain healthy blood sugars (A1c below 6.5% for at least 3 months) without the need for most diabetes medications. Significant reduction of dietary carbohydrates to the point of achieving nutritional ketosis can accomplish this, although the process takes longer for some than others. ‍

Will my diabetes come back?‍

Only if you return to your old habits. Since there’s no cure, there’s always the possibility that your blood sugars could go back up, your weight could increase, and you could need to go back on medication. But again, only if you return to your old habits. And if that happens, you would unravel the success you've made. In other words, yes – your diabetes could come back, but you have the power to prevent that. The great news is that you can keep diabetes at bay as long as you sustain the lifestyle changes that helped you to achieve reversal in the first place:

1. Maintain your carbohydrate intake below your personal carbohydrate tolerance
2. Explore different ways to prepare foods to keep things fresh (and avoid a food rut)
3. Stay vigilant about preparing ahead, particularly for major changes to your routine like trips and holidays
3. Continue to prioritize optimal sleep and stress levels (as best as you can)
3. Have a support system to help keep you aligned on your goals
4. Update your “why” over time to ensure you keep evolving in your health journey

In summary, no – you no longer have the high blood sugars that are the definition of diabetes, but you do still have the tendency toward insulin resistance and type 2 diabetes. And yes, it’s possible your diabetes can return if you don’t maintain your healthy lifestyle changes. But long term diabetes reversal is possible as long as you truly commit to the daily habits that got you here. 

The power of reversal is in your hands!

‍