Diabetes Basics

When Remission Is Better Than a Cure for Diabetes

If we had a cure for diabetes, we would be so happy.

No more needles or pills! We wouldn’t have to consider how every tasty morsel we put in our mouths would raise our blood sugar or remember to exercise even when we would rather sit on our easy chairs. We wouldn’t have to do regular fingersticks, despair over our A1C levels, or moan about our BMI. We could relax.


Graphic courtesy of Ginger Viera

When Dr. Frederick Banting isolated insulin in 1922, the world hailed him for discovering the cure for diabetes, awarding him and Professor J.J.R. Macloud the 1923 Nobel Prize in Medicine.  Life saving for anyone with type 1 diabetes, insulin certainly is, but we all now know that it is no cure.

Ever since then, people with diabetes have longed for a cure. And the diabetes organizations are glad to oblige. “Just give us your money and we will cure it for you in another 10 years,” is the message we keep hearing. “The Tour de Cure” is perhaps our biggest annual event.

If and when a cure for diabetes finally arrives, I will be delighted for all those people with type 1 diabetes who will be able to lead a normal life. I would also cheer for all those people with uncontrolled type 2 diabetes who could avoid the awful complications that they otherwise face.

I could finally retire, and now at age 79 I think I deserve a rest. But if I considered myself cured, my good health would probably suffer.

Because I have type 2 diabetes, I know that I have to pay close attention to what and how much I eat, how much I weigh, and how much physical activity I get. Because I indeed make sure that I regularly perform these three key tasks, I don’t need to take any diabetes drugs, don’t have any complications of diabetes, and have reduced my A1C from 14.4 to 5.4 and my BMI from 39.1 to 19.5. I have done this since 2007 by following a very low-carb diet.

Consequently, I always say that my diabetes is in remission. It’s not cured.

“Since you’ve been successfully managing diabetes for so long,” my friend Jon wrote me in a letter last month, “how do you know you aren’t basically cured of it? That is, the carbs/grains aren’t good for anyone, but maybe you’re at least already back to the standard/non-diabetes level of reaction to them.”

In my letter back to Jon I thanked him for giving me the idea for this article. Then I looked into what diabetes researchers say about remission and cure. The best resource that I’ve found is the report of a consensus group that met in June 2009 to discuss these issues.

The full-text of this report is “How Do We Define Cure of Diabetes?” It appeared in the November 2009 issue of Diabetes Care.

“Some would say the definitions are too conservative,” the corresponding author, M. Sue Kirkman, M.D., told me. Dr. Kirkman, now professor of medicine at the University of North Carolina, was the senior vice-president for medical affairs and community information at the American Diabetes Association when the consensus group published its report. “But I recall the group wanted to err on the side of not giving people false hope or allowing ‘miracle cure’ claims to be based on our work.”

The group’s key finding is that “for a chronic illness such as diabetes, it may be more accurate to use the term remission than cure.” A cure, they wrote, is defined medically as a restoration to good health. Remission is “abatement or disappearance of the signs and symptoms of disease.” It also means, the report continues, having normal blood sugar levels without diabetes drugs or surgical therapy.

Only after we die can we be considered cured, because “if cure means remission that lasts for a lifetime, then by definition a patient could never be considered cured while still alive.” I doubt if we will know then either.

I still hope for most people with diabetes that we will have a cure for diabetes in my lifetime. If you have type 1 diabetes or uncontrolled type 2, I would rejoice with you.

But I am happy right now to be in remission, and I hope that all of us who manage our type 2 diabetes realize that a cure isn’t as good for us as remission. We don’t have anything to gain by acting as if we are cured and have a lot to lose.

This article is based on an earlier version of my article published by HealthCentral.

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  • ruslim April 26, 2015 at 8:16 pm

    Dear David, thank you for your kind advise ,

    With regards ,

    Ruslim

  • ruslim April 15, 2015 at 1:35 am

    Dear David ,

    May I know your frequency of testing blood sugar ( fasting or randomized) and hb1ac? Because some people some times are “racing” like how low the blood sugar in order to give them comfortable level. My personal believe this only marker as part of indication of general health. The holistic measurement should not put on the marker, but to our empowerment in controlling our health. need your advise on this …

    thanks and regards,

    Ruslim

    • David Mendosa April 15, 2015 at 8:22 am

      Dear Ruslim,

      Sure. I make sure to test my A1C on the first day of each month and have been doing that for years. But I don’t have a regular schedule for fingerstick testing. That’s because with my very low-carb diet my level varies only a few points before and after eating and I already know from previous testing of the different foods that I eat how much they will affect my level.

      With metta,
      David

  • ruslim April 1, 2015 at 1:36 am

    Dear David ,

    I found this article or chart is suitable for to manage diabetes . http://www.dietdoctor.com/four-simple-steps-healthier-leaner-life

    God bless you always …. cheers

    Ruslim

    • David Mendosa April 1, 2015 at 10:37 am

      Dear Ruslim,

      Thanks for sharing this great link! As always, Dr. Eenfeldt makes a whole lot of sense (as do the comments on this post by Dr. Jason Fung). I think that my success in managing my diabetes is because I do all four of the things Dr. Eenfeldt says to.

      Best regards,
      David

  • ruslim March 4, 2015 at 8:17 pm

    Dear David , thank you , and to be honest I learn a lot from your website. God bless you always … Cheers

    Ruslim

  • ruslim March 3, 2015 at 2:38 am

    Dear David , Thank you for this inspiring articles. I am Type 2 Diabetic since January 2012 and able to controlled my diabetes since June 2014 without any drugs ( my last Hb1ac is 5.4 ) and able to reverse my health (my BMI is 21 from 28 and lost around 20 kg) . And I am grateful with my condition and “remission” will always give me awareness to taking care of my health especially in relation with my blood sugar.
    Thanks a lot ….

    Ruslim
    Jakarta – Indonesia

    • David Mendosa March 3, 2015 at 8:22 am

      Dear Ruslim,

      I think that the fact that your diabetes is in remission just three years after your diagnosis is absolutely remarkable! Many congratulations to you. By contrast, I am a very slow learner: I learned in February 1994 that I had type 2 diabetes and was not able to bring my A1C level down to 5.4 until almost six years later. But my level is still 5.4, which is considered to be the level of diabetes remission.

      With metta,
      David