Type 2 diabetes can be reversed. Several studies have now demonstrated this. Here’s how to measure type 2 diabetes remission with paired glucose tests — and how to spot a relapse early.
10-Year Reversibility Window: Clinical research highlights that the capacity for pancreatic beta cells to recover normal insulin production after fat loss remains possible for up to 10 years after the onset of the condition. Findings on this extended window were detailed in studies from Newcastle University Press and published in professional journals like Diabetes Care. For why acting within that window matters, see reversing type 2 diabetes — don’t put it off.
Clinically, however, one does not speak of a cure but of remission: normal blood glucose values without glucose-lowering medication. The distinction is material: a cure would be final, remission is not. The predisposition remains, and with it the possibility that type 2 diabetes returns.
Remission is achieved primarily through weight loss. Maintaining it requires a lasting change in lifestyle: fewer calories, fewer refined carbohydrates, altered meal times, avoidance of snacks and late meals, and more physical activity are just some of the strategies that can be employed.
Two questions generally remain unanswered:
- How can I measure my progress towards type 2 diabetes remission?
- How do I maintain type 2 diabetes remission — and catch a relapse early?
How can I measure my progress towards type 2 diabetes remission?
Paired glucose tests measure your progress toward type 2 diabetes remission
In paired measurements you determine blood glucose immediately before a meal and two hours after a meal. What is informative is not the individual values, but the difference between the two measurements. The goal is to reduce the difference between the two values. The difference describes how your body reacts to a particular meal.
- If you are making progress toward remission, insulin production increases and insulin sensitivity improves. This causes your blood glucose to fall by the 2 hour mark.
- If you are not making progress, the second reading at 2 hours will still be high and you will need to make further changes.
For target ranges before and after breakfast, see what your blood glucose should be before breakfast and 2 hours after.
Fasting blood glucose
Fasting blood glucose is another indicator of your progress.
- Run a blood glucose test before breakfast, ideally at least 8 hours after eating.
- In a fasted state your body produces needed glucose by converting stored glycogen. Glucose will rise and insulin should be produced to control the rise.
- If your fasting blood glucose level is high then there is not enough insulin being produced or the cells around the body are not responding to the glucose — insulin resistance. Insulin resistance occurs when cells in your muscles, fat, and liver fail to respond effectively to insulin, preventing the body from efficiently moving glucose out of the blood.
Three signs of progress toward remission of type 2 diabetes
1. The two-hour rise becomes smaller. A meal that six weeks previously produced a rise of 4.5 mmol/L now produces a rise of 2.8 mmol/L. This is the earliest recognisable sign.
2. The fasting value falls. It responds more slowly to lifestyle changes, but is the more dependable parameter.
3. The two-hour value itself falls into the normal range. Not only does the difference become smaller — the absolute value two hours after the meal also returns to ranges regarded as normal. The two can occur separately: a smaller rise from a high starting value does not yet mean a normal two-hour value.
For orientation, not as an individual treatment target: In diagnostics, a value below 7.8 mmol/l two hours after a defined glucose quantity counts as normal. Values from 7.8 to 11.0 mmol/L correspond to impaired glucose tolerance, values above 11.1 mmol/L indicate diabetes. Fasting values below 5.55 mmol/l are considered normal. Your individual target values are established with your doctor.
How do I maintain type 2 diabetes remission?
Once your diabetes is in remission, the key to maintaining it is to prevent fat build up in the liver and pancreas. This cannot be detected by measuring your body weight alone.
Why body weight alone gives no early warning, but blood glucose can
What is decisive for blood glucose is not body weight, but the fat content of the liver and pancreas. The Counterpoint study describes the relationship as follows: weight loss reduces the fat in the liver which then reduces the fat in the pancreas which restores the function of insulin producing beta cells, and in consequence improves glucose values. For a practical home-monitoring approach, see type 2 diabetes reversal monitoring at home.
Three consequences follow from this:
- A generally valid “safe” weight does not exist. Every person has an individual, partly genetically determined personal fat threshold. The same weight gain may be decisive in one person and inconsequential in another.
- Liver fat changes more quickly than body weight. In the Counterpoint study, hepatic glucose production normalised within seven days of beginning calorie restriction, that is, long before any appreciable weight loss. The reverse case proceeds correspondingly: a calorie-rich period leads to the deposition of liver fat before weight changes measurably.
- Not every deterioration is weight-related. A higher intake of refined carbohydrates raises postprandial values immediately, even at unchanged weight.
In a relapse, the changes almost always follow the same sequence: first the liver fat content rises, then the after-meal values rise, then the fasting value — and the HbA1c last. With annual HbA1c determination, this development may therefore remain unnoticed for up to ten months, and body weight need not have changed noticeably in that time.
Body weight remains a useful parameter. As an early indicator, however, blood glucose measurement is the appropriate one. Achieving remission is not a cure and therefore it is important to monitor your blood glucose and at the first signs of a deterioration, act. This makes maintenance far more likely than relying on yearly or twice yearly check ups. Preventing undiagnosed disease progression has considerable benefits. For how often to test when you are on tablets, see how often someone with type 2 diabetes should check blood glucose.
What to look for in a blood glucose meter for remission tracking
Bulky test kits with multiple components and test steps are inconvenient and often end up in a drawer. An all-in-one meter that does not use test strips can make paired before-and-after meal testing easier to stick with.
Check the meter allows results to be labelled before meal or after meal. This is done with a symbol, typically an apple for before meal and apple core for after meal. These symbols then travel to the app with each result allowing analysis and reports that contain this useful information. Check the meter comes with an app and has wireless built in so you don’t need to find a cable.
Key points: type 2 diabetes remission
- Track progress with paired glucose tests — before a meal and two hours after. The useful signal is the difference between the two readings, not either value alone.
- Three early signs of progress: a smaller two-hour rise, a falling fasting value, and a two-hour reading that moves into the normal range.
- Body weight alone is a poor early warning. Liver and pancreas fat drive relapse and can increase before body weight.
- Monitor regularly and act early at the first signs of deterioration — don’t wait for an annual check-up. A meter with before/after-meal markers and an app makes paired testing easier to sustain.