Two important points are made at the start of our conversation with Clair Naughton, a diabetes nurse specialist and regional development officer with Diabetes Ireland.
Number one; that putting diabetes into remission only refers to type 2 diabetes.
Number two; the correct term is “into remission” rather than “reversal” or “cure”.
“When we discuss diabetes remission it only applies to type 2 diabetes and pre-diabetes,” Clair says. “Historically type 2 diabetes was thought to be a life-long condition, but in recent years there has been studies looking at type 2 diabetes remission. It is now known that it is possible for some people to put type 2 diabetes into remission but each case is individual.”
Saying “reversal” wouldn’t be appropriate, she says. “That’s because it would imply that diabetes will go away permanently. With significant weight loss, type 2 diabetes may potentially go into remission but if people don’t maintain the weight loss, type 2 diabetes will return.”
Carrying excess weight, particularly around the abdomen, leads to insulin resistance
She points out that remission is only possible also if a person with type 2 diabetes is overweight.
“Twenty per cent of people with type 2 diabetes are not overweight. Some may even be underweight,” she says.
But how does losing a lot of weight – if you need to – help?
“Carrying excess weight, particularly around the abdomen, leads to insulin resistance, where the body’s insulin doesn’t work effectively,” she says. “By losing inches around the abdomen, it helps the body’s insulin work better. Exercise can also help control the glucose levels in the blood more effectively.”
After one year 46% of participants achieved remission of type 2 diabetes, after two years 36% of individuals remained in remission
The main body of research related to all this was first published in 2017 in the UK where the Diabetes Remission Clinical trial (DiRECT) took place, she says.
“Participants took part in an intensive programme for weight loss and weight-loss maintenance. After one year 46% of participants achieved remission of type 2 diabetes, after two years 36% of individuals remained in remission. The weight loss was significant however, averaging over 15kg per person.”
The findings show, however, that remission is more likely if the person hasn’t been diagnosed long.
“In the DiRECT study the average length of time participants had type 2 diabetes was three years.”
When it comes to overhauling lifestyle to put type 2 diabetes into remission the exercise recommendations for someone who is overweight are 60 minutes of moderate activity, five days a week.
“That’s the sum of all the exercise you do in a day – exercise that will leave you perspiring.”
She points out that the people in the DiRECT study were on a very low-calorie diet – using meal replacements – but were closely monitored during the period of weight loss.
Although she knows of some people who have followed very strict diets to put their type 2 diabetes into remission, Diabetes Ireland doesn’t advocate extreme diets like the ketogenic diet followed by our case study, Martin Marron.
“If someone (is overweight and) wants to follow a very low-calorie diet we would advise doing that with medical supervision. The UK study involved an intensive programme for weight loss where participants were on 800 calories a day, so they were off all food for several weeks and on sachet meal replacements.
Carbohydrates are needed for energy and heat and are part of a healthy diet. Yes, they are broken down into glucose in the body so that’s why portion size is key
“They then had a gradual solid food re-introduction but they were really supported. If someone goes on a restricted diet at home how do they go back to normality then? Also, if people do lose weight drastically they tend to put it on again and quite quickly. The more balanced approach is better.”
Cutting out carbohydrates completely isn’t something they would advise.
“Carbohydrates are needed for energy and heat and are part of a healthy diet. Yes, they are broken down into glucose in the body so that’s why portion size is key. We advise following the national healthy eating guidelines related to bread, pasta, cereal and potatoes for your age, gender and level of physical activity.”
The amount of fruit you eat is something to be careful about, she says. “Fruit contains natural sugar so it is broken down into sugar in the body so the advice for someone with type 2 diabetes is to eat one piece of fruit at a time, to a maximum of three pieces across the day. Treat foods should be limited to twice a week and to a small portion each time.
Prevalence of diabetes in Ireland
There is no register of how many people are living with diabetes in Ireland but it is estimated that the prevalence is 6.5% of the 20-79 age group in the population. That’s around 226,000 people.
The prevalence is 11.9% in the over 75 age group. Ten to 15% of this total have type 1 diabetes, an auto-immune condition that usually begins in childhood.
However, there are estimated to be over one million Irish people at risk of developing type 2 diabetes because they are overweight and don’t take enough exercise.
This has been shown by the Slán study 2007 and by the VHI Healthcare Screening project which tested 30,000 people for type 2 diabetes between 2009 and 2013. This found that 10% of those tested had confirmed pre-diabetes.
Risk factors for diabetes
Only two are modifiable.
Family history.Age.Sedentary.Overweight.Medication for blood pressure and medication.History of gestational diabetes. If someone puts their diabetes into remission, they should still get their bloods checked by their GP every Six months. Type 2 diabetes may return due to other risk factors such as the aging process and having diabetes in the family.
Healthy eating, regular physical activity, weight management is advised for everyone, whether you have diabetes or not.
Useful links
See hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/heal/healthy-eating-guidelines/Recommendations for physical activity – https://www.getirelandactive.ie/DiRECT study (UK Diabetes Remission Clinical Trial) – https://www.directclinicaltrial.org.uk/www.diabetes.ie Martin Marron is a 40-year-old father of three and part-time sheep farmer from Carrickmacross.
Diagnosed with type 2 diabetes in December 2017 the shock of the diagnosis and knowledge of his father’s struggle with this condition from the age of 50 drove him to research how he could put his diabetes into remission.
Martin Marron before his weight-loss journey.
He lost five and a half stone quickly, going from 21 stone to under 15 stone in just four months.
“I hadn’t been feeling well for a few months in 2017,” he says. “I had discomfort in my abdomen and was very thirsty and going to the toilet a lot. When the first test was done, where anything over a level of 48 mmol/l was a diagnosis, my level was 93 so it was very high. I was told I had type 2 diabetes and to come back in two weeks for another test, but in the meantime I watched YouTube videos day and night about how to put your diabetes into remission.
“I also rang the Diabetes Helpline for some support and information and they provided great support, helping to ‘steady the ship’ after the diagnosis, so to speak.
“At the two weeks test the levels had gone down to 74 which was still high so my doctor wanted me to start on medication but I said I wanted to give the ketogenic diet a try for a few months to see if it would make a difference.
“It is a low-carb diet where you don’t eat bread, pasta and spuds and you keep away from bad fats. It meant eating loads of green veg - real food, not sachets or food replacements or anything like that. I’d have the protein and veg and salads and some kinds of fruit, mostly berries. In the morning I had things like eggs, mushrooms, tomatoes and onions fried in olive oil. My wife, Michelle, would make normal dinner but I just wouldn’t eat the spuds. In the evening I’d have something like a chicken salad.”
Martin didn’t think the diet would work initially.
“That’s because I was always eating junk food, but while it was tough for those first two weeks I then stopped craving the foods I used to eat. “My energy levels went up as I lost weight and the farm saw a big difference because I was doing work that I had been putting off. I was eating three meals a day and wasn’t hungry but that said, it wasn’t easy.”
Martin’s three-month test reading was 27. The Haemoglobin A1c (HbA1c) blood test provides a three-month average of blood sugar levels to see if the person’s diabetes management plan is working.
Martin Marron on his 40th birthday, with his type 2 diabetes in remission.
“The diabetes had gone into remission. I was referred to a doctor in Dundalk hospital and they were all pretty interested in what I had done. It is important to think of it as your diabetes going into remission rather than it being reversed though, because it is not a cure, I’ve been told, although one doctor I met did use that word.”
Keeping the weight off isn’t easy however, he admits.“I let things slip for a while over Christmas and I was a bit shocked to see that I had put up a stone and a half but I’m back on track now. It is scary how quick the weight can go back on, but it is also fascinating to see how you can control your weight and feel better by eating healthily. When you are eating healthily you feel clean, good, but when you’re eating junk food you just feel like lying down afterwards.”
Martin says that he doesn’t tell people that he is cured.
“Once you have diabetes you always have it, I’m told, so I always have to be mindful that it could come back easily.”
Diabetes Ireland Helpline (01-842 8118) is open Monday to Friday, 9-5pm.
Two important points are made at the start of our conversation with Clair Naughton, a diabetes nurse specialist and regional development officer with Diabetes Ireland.
Number one; that putting diabetes into remission only refers to type 2 diabetes.
Number two; the correct term is “into remission” rather than “reversal” or “cure”.
“When we discuss diabetes remission it only applies to type 2 diabetes and pre-diabetes,” Clair says. “Historically type 2 diabetes was thought to be a life-long condition, but in recent years there has been studies looking at type 2 diabetes remission. It is now known that it is possible for some people to put type 2 diabetes into remission but each case is individual.”
Saying “reversal” wouldn’t be appropriate, she says. “That’s because it would imply that diabetes will go away permanently. With significant weight loss, type 2 diabetes may potentially go into remission but if people don’t maintain the weight loss, type 2 diabetes will return.”
Carrying excess weight, particularly around the abdomen, leads to insulin resistance
She points out that remission is only possible also if a person with type 2 diabetes is overweight.
“Twenty per cent of people with type 2 diabetes are not overweight. Some may even be underweight,” she says.
But how does losing a lot of weight – if you need to – help?
“Carrying excess weight, particularly around the abdomen, leads to insulin resistance, where the body’s insulin doesn’t work effectively,” she says. “By losing inches around the abdomen, it helps the body’s insulin work better. Exercise can also help control the glucose levels in the blood more effectively.”
After one year 46% of participants achieved remission of type 2 diabetes, after two years 36% of individuals remained in remission
The main body of research related to all this was first published in 2017 in the UK where the Diabetes Remission Clinical trial (DiRECT) took place, she says.
“Participants took part in an intensive programme for weight loss and weight-loss maintenance. After one year 46% of participants achieved remission of type 2 diabetes, after two years 36% of individuals remained in remission. The weight loss was significant however, averaging over 15kg per person.”
The findings show, however, that remission is more likely if the person hasn’t been diagnosed long.
“In the DiRECT study the average length of time participants had type 2 diabetes was three years.”
When it comes to overhauling lifestyle to put type 2 diabetes into remission the exercise recommendations for someone who is overweight are 60 minutes of moderate activity, five days a week.
“That’s the sum of all the exercise you do in a day – exercise that will leave you perspiring.”
She points out that the people in the DiRECT study were on a very low-calorie diet – using meal replacements – but were closely monitored during the period of weight loss.
Although she knows of some people who have followed very strict diets to put their type 2 diabetes into remission, Diabetes Ireland doesn’t advocate extreme diets like the ketogenic diet followed by our case study, Martin Marron.
“If someone (is overweight and) wants to follow a very low-calorie diet we would advise doing that with medical supervision. The UK study involved an intensive programme for weight loss where participants were on 800 calories a day, so they were off all food for several weeks and on sachet meal replacements.
Carbohydrates are needed for energy and heat and are part of a healthy diet. Yes, they are broken down into glucose in the body so that’s why portion size is key
“They then had a gradual solid food re-introduction but they were really supported. If someone goes on a restricted diet at home how do they go back to normality then? Also, if people do lose weight drastically they tend to put it on again and quite quickly. The more balanced approach is better.”
Cutting out carbohydrates completely isn’t something they would advise.
“Carbohydrates are needed for energy and heat and are part of a healthy diet. Yes, they are broken down into glucose in the body so that’s why portion size is key. We advise following the national healthy eating guidelines related to bread, pasta, cereal and potatoes for your age, gender and level of physical activity.”
The amount of fruit you eat is something to be careful about, she says. “Fruit contains natural sugar so it is broken down into sugar in the body so the advice for someone with type 2 diabetes is to eat one piece of fruit at a time, to a maximum of three pieces across the day. Treat foods should be limited to twice a week and to a small portion each time.
Prevalence of diabetes in Ireland
There is no register of how many people are living with diabetes in Ireland but it is estimated that the prevalence is 6.5% of the 20-79 age group in the population. That’s around 226,000 people.
The prevalence is 11.9% in the over 75 age group. Ten to 15% of this total have type 1 diabetes, an auto-immune condition that usually begins in childhood.
However, there are estimated to be over one million Irish people at risk of developing type 2 diabetes because they are overweight and don’t take enough exercise.
This has been shown by the Slán study 2007 and by the VHI Healthcare Screening project which tested 30,000 people for type 2 diabetes between 2009 and 2013. This found that 10% of those tested had confirmed pre-diabetes.
Risk factors for diabetes
Only two are modifiable.
Family history.Age.Sedentary.Overweight.Medication for blood pressure and medication.History of gestational diabetes. If someone puts their diabetes into remission, they should still get their bloods checked by their GP every Six months. Type 2 diabetes may return due to other risk factors such as the aging process and having diabetes in the family.
Healthy eating, regular physical activity, weight management is advised for everyone, whether you have diabetes or not.
Useful links
See hse.ie/eng/about/who/healthwellbeing/our-priority-programmes/heal/healthy-eating-guidelines/Recommendations for physical activity – https://www.getirelandactive.ie/DiRECT study (UK Diabetes Remission Clinical Trial) – https://www.directclinicaltrial.org.uk/www.diabetes.ie Martin Marron is a 40-year-old father of three and part-time sheep farmer from Carrickmacross.
Diagnosed with type 2 diabetes in December 2017 the shock of the diagnosis and knowledge of his father’s struggle with this condition from the age of 50 drove him to research how he could put his diabetes into remission.
Martin Marron before his weight-loss journey.
He lost five and a half stone quickly, going from 21 stone to under 15 stone in just four months.
“I hadn’t been feeling well for a few months in 2017,” he says. “I had discomfort in my abdomen and was very thirsty and going to the toilet a lot. When the first test was done, where anything over a level of 48 mmol/l was a diagnosis, my level was 93 so it was very high. I was told I had type 2 diabetes and to come back in two weeks for another test, but in the meantime I watched YouTube videos day and night about how to put your diabetes into remission.
“I also rang the Diabetes Helpline for some support and information and they provided great support, helping to ‘steady the ship’ after the diagnosis, so to speak.
“At the two weeks test the levels had gone down to 74 which was still high so my doctor wanted me to start on medication but I said I wanted to give the ketogenic diet a try for a few months to see if it would make a difference.
“It is a low-carb diet where you don’t eat bread, pasta and spuds and you keep away from bad fats. It meant eating loads of green veg - real food, not sachets or food replacements or anything like that. I’d have the protein and veg and salads and some kinds of fruit, mostly berries. In the morning I had things like eggs, mushrooms, tomatoes and onions fried in olive oil. My wife, Michelle, would make normal dinner but I just wouldn’t eat the spuds. In the evening I’d have something like a chicken salad.”
Martin didn’t think the diet would work initially.
“That’s because I was always eating junk food, but while it was tough for those first two weeks I then stopped craving the foods I used to eat. “My energy levels went up as I lost weight and the farm saw a big difference because I was doing work that I had been putting off. I was eating three meals a day and wasn’t hungry but that said, it wasn’t easy.”
Martin’s three-month test reading was 27. The Haemoglobin A1c (HbA1c) blood test provides a three-month average of blood sugar levels to see if the person’s diabetes management plan is working.
Martin Marron on his 40th birthday, with his type 2 diabetes in remission.
“The diabetes had gone into remission. I was referred to a doctor in Dundalk hospital and they were all pretty interested in what I had done. It is important to think of it as your diabetes going into remission rather than it being reversed though, because it is not a cure, I’ve been told, although one doctor I met did use that word.”
Keeping the weight off isn’t easy however, he admits.“I let things slip for a while over Christmas and I was a bit shocked to see that I had put up a stone and a half but I’m back on track now. It is scary how quick the weight can go back on, but it is also fascinating to see how you can control your weight and feel better by eating healthily. When you are eating healthily you feel clean, good, but when you’re eating junk food you just feel like lying down afterwards.”
Martin says that he doesn’t tell people that he is cured.
“Once you have diabetes you always have it, I’m told, so I always have to be mindful that it could come back easily.”
Diabetes Ireland Helpline (01-842 8118) is open Monday to Friday, 9-5pm.
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