How much weight do you need to lose to reverse prediabetes?
Many people with prediabetes need to take action now—if they don’t, they could develop type 2 diabetes within five years, according to the CDC.
Weight loss is a key strategy to reverse prediabetes, but it’s important to know that not everyone needs to lose a massive amount of weight. Often only minor changes in dietary intake and minimal weight loss, together with more physical activity, will help chase diabetes away.
The CDC’s national Diabetes Prevention Program (DPP), which includes an ongoing Outcomes Study, has shown that people with prediabetes who lost a modest amount of weight—5 to 7% (4.5 – 6.5 kg for a person weighing 90kg, for example)—with the help of a structured lifestyle-change program cut their risk of developing type 2 diabetes by 58%.
The key is to start with simple interventions at home and expand on them over time, especially when these lifestyle changes are aimed at children. The interventions might include pursuing more physical activity as a family or trying different-colored foods on the dinner plate. Managing stress, which can be a roadblock, is also important.
What if lifestyle changes don’t lead to weight loss?
If adults and children have difficulty changing lifestyle habits themselves, there are options, including a variety of types of weight-loss surgery (which in itself has been shown to reverse type 2 diabetes) and medications.
Some doctors prescribe metformin, a front-line medication for type 2 diabetes, “off-label” for prediabetes (meaning doctors prescribe it for a condition even though the Food and Drug Administration [FDA] hasn’t specifically approved it for that condition). Studies have shown the drug metformin can decrease the risk of progression to type 2 diabetes, although to a lesser degree than lifestyle changes.
What kind of exercise is best for people with diabetes?
The most important thing is incorporating any exercise in your regular routine. Ideally, that exercise will include a combination of aerobic activity and strength training to maximize weight loss and also reduce insulin resistance.
A lot of the glucose going into cells goes into muscles, muscles that are active and working can take in glucose more easily, and that helps lower your blood sugar. Active muscles are also less prone to insulin resistance.
Benefits of exercise
Exercise, which can include all types of physical activity and moving more, has lots of benefits for your overall health. And it’s also a way to manage your type 2 diabetes.
Moving more can:
- help your body use insulin better
- lower your blood sugar levels, also known as HBA1c levels
- help you maintain weight loss
- lower your risk of diabetes-related complications
- Exercise for type 2 diabetes remission
Moving more can help you lower your blood sugar levels long term. This is because when your muscles move, they use up sugar – also known as glucose – in the blood, bringing your blood sugar levels down.
But there’s no evidence that exercise alone can lower blood sugar levels enough to put type 2 diabetes into remission. It’s changes to your diet that you eat that are proven to do that.
Exercise still plays a vital role though. A combination of changes to diet and exercise has helped people put their type 2 diabetes into remission. It’s also helped people maintain their weight loss, which is important for staying in remission.
So, moving more can help whether you’re working towards remission, trying to stay in it, or just want to improve your blood sugar levels long-term.
How much exercise should I do for type 2 diabetes remission?
How much exercise you should do when you’re trying to go into type 2 diabetes remission depends on:
- how much exercise you currently do
- what diet you’re following
- if you take medication to manage your diabetes.
A study that had people aim for 10,000 steps a day and at least 2 1/2 hours of moderate exercise a week — along with cutting 500-750 calories a day and following a specific insulin and medication routine — saw more than half of them reach near-normal blood sugar without medication. Some were able to keep those levels long-term, too.
If you’re taking insulin or medications that can cause hypos (low blood sugar levels) like sulphonylureas, it’s especially important you speak to your healthcare team. This is because moving more can affect your blood sugar levels in different ways.
Some people find that their blood sugar levels go up during, or immediately after, exercise. Others find that moving more lowers their levels during and up to 24 hours after exercise.
Effects of weight loss
The strongest evidence we have at the moment suggests that type 2 diabetes is mainly put into remission by weight loss. Remission is more likely if you lose weight as soon as possible after your diabetes diagnosis. However, we do know of people who have put their diabetes into remission decades after diagnosis.
The strongest research we have – from a study called DiRECT – shows that the best chance that people living with overweight and obesity have of putting their type 2 diabetes into remission is to lose around 15kg of weight quickly and safely. But not everyone has that amount of weight to lose. Around 10% of people with type 2 diabetes have a BMI that isn’t in the overweight or obesity category.
Another research, called the ReTUNE study, aimed to see if weight loss could also help people with lower body weights to go into remission. Twenty people with type 2 diabetes and BMIs in, or just above, the healthy range took part in ReTUNE.
They went on a low-calorie weight loss programme with support from a medical team. The findings showed this helped some people with body weights that weren’t in the obese or underweight category to lose fat from inside their liver and pancreas and go into type 2 diabetes remission. This is because the liver and pancreas are organs that help control your blood sugar levels.
We need more studies with bigger groups to confirm ReTUNE’s results. But this research gives us hope that one day we will be able to support everyone with type 2 diabetes to go into remission.
It could be unsafe to lose weight if your BMI is in the underweight category. People who have a BMI of 18.5 or under are classed as underweight and may be under nourished.
It could also be unsafe to lose weight if your BMI is in the healthy category. A healthy weight range is a BMI of 18.5-24.9.
Losing too much weight can put your BMI into the underweight category. This can lead to health problems like a weakened immune system – meaning you’re more likely to pick up infections. It could also affect the density – or strength – of your bones too, making you more likely to break a bone if you fall.
How is stress related to diabetes?
Stress may be linked to diabetes simply because it leads to other unhealthy behaviors, such as stress eating and getting inadequate sleep and exercise.
Stress might activate the hormone epinephrine (adrenaline)—the fight or flight hormone—which can also raise blood sugar levels. This makes biological sense. If you’re faced with a bear, you want blood sugar in your muscles so you can run fast. However, most people experience a chronic variety of stress. They don’t need a blood sugar spike to evade danger. Their biggest threat is perpetually elevated blood sugar levels.
Conclusion:
It’s not a life failing to have diabetes. It’s not like you did anything wrong. Part of it is genetics and part of it is living in a Western society. It’s not your fault that you’re programmed to get all the calories you can and that you currently live in a calorically abundant society.
The bottom line: It’s the weight loss that really matters. Exercise can help you get there, but expect to change your diet as well and manage stress.
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