@thecryptofiend your posts are always intelligently written yet comprehensive.
So doc, I mean @thecryptofiend.. is there a certain diabetes type where a person gets overweight and they just work out , reduce weight , change their diet and in a few weeks they're free from insulin? I've seen a tv series of such in here and it's amazing. Unfortunately, it seem to just work on obese ones.
In type 2 diabetes you can reduce the severity with diet and exercise but it is rare to completely get rid of it. The only thing that can cure it is gastric bypass surgery - it is still not understood why.
@thecryptofiend A few years back, I remember having this discussion with Dr Day, an endocrinologist who has done some ground breaking research and whom I believe to be the author of the study you're thinking about.
What I recall most was the discussion on options because I was looking at prediabetes myself.
He explained that the reason bariatric surgery is effective at all is the restriction in food uptake, which results in a reduction of fat and the reduction in fat decreases insulin resistance.
The loss of weight from gastric bypass is literally a starvation effect. But for type 2 diabetics gastric bypass is ill advised due to slower wound healing times. However lapbands which are far less invasive, have been used with good success on morbidly obese patients who are also type 2 diabetic. I wish I had a citation, I'm going from memory here.
A lot of heavy fat makes you insulin resistant. Remove the fat, and you remove the insulin resistance. Ergo eat a solid diet and get plenty of exercise, but if you're looking at heart failure each time you exercise, then a lapband can be used to get your weight down low enough you can move around without having a heart attack.
The other advantage to lapbands besides being less invasive is that they can be adjusted and even removed if necessary.
Dr Day's website
https://intermountainhealthcare.org/locations/utah-valley-hospital/medical-services/diabetes-care/diabetes-resources/
More info on lapbands...
https://en.wikipedia.org/wiki/Adjustable_gastric_band
That's what I thought too but it has been refuted by studies.
The normalisation of blood glucose has been noted to occur as soon as 48-72 hours post surgery and at most within a week. This goes against the previous belief that it was a weight loss effect.
I don't currently have Athens access to see the full article but this paper from the July 2013 issue of Science suggests a possible mechanism:
http://science.sciencemag.org/content/341/6144/406
One further mechanism that I have heard suggested is the alteration of gut microbiota:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3652229/
That's interesting. Thanks for the follow up. I hadn't looked at this since 2008 or so. So you have any info on the refutation studies? I work at a hospital and am in a position to let people who are making these recommendations know about the info.
Perhaps refuted is a bit strong of a word for me to use! I think there is growing evidence that it is related to other factors than overall weight loss but that probably contributes too.
It's hard because I don't have academic access to journals right now as you know most of them are behind expensive paywalls! I think the best people to ask would be your endocrinologist colleagues - they can do a Medline search or if the hospital has a good library with a librarian they can do it for them to look for the latest reviews.
The other good source of information is bariatric surgeons they tend to be up to date with the latest research - that is how I found out about this information myself initially and I've read various supporting articles on Medscape etc.
Further in discussions I have had with my own endocrinologist who works directly as part of the bariatric team he is definitely of the opinion that weight loss is not the main cause of resolution. I might ask him for more information at my next appointment.
Actually I just found this article which suggests there may still be some controversy over it although it is from 2013:
http://care.diabetesjournals.org/content/36/Supplement_2/S287
Here is one from Nature Reviews but it is behind a paywall and the abstract doesn't really say much:
http://www.nature.com/nrendo/journal/v9/n10/full/nrendo.2013.159.html
I see, thanks doc @thecryptofiend. One of my friends have it, she's 65 and skinny and going on a diet won't work. She does move a lot and walk much so she actually has not much of a problem with it - just that she's always hungry and thirsty :)
Is she seeing a doctor about it? It sounds like she has poor control and the symptoms you are describing are consistent with high blood glucose levels. The fact that she is skinny may indicate that she may have type 1 or a mix of the two - I would suggest she gets a full assessment from an edocrinologist/diabetic specialist.
@thecryptofiend yes, she always has a blood sugar check up or something like that .
I think if she is still having symptoms like you describe she needs more intensive treatment.