Reversing Diabetes

This is not going to be fancy. Just a post that was on the facebook group that I felt should be here for prosperity.

There was a post the other day in the facebook group Common Sense Keto that was deleted and it was talking about reversing diabetes and eating chocolate and how that affected glucose levels.

This post is an explanation of the physiology behind this.

What causes Type 2 diabetesThere are different theories on this but the only one that even makes plausible sense to me is Personal Fat Threshold (PFT).Short story is that everyone has a genetic capacity to store energy as fat and once that level is reached, the cells are full and can no longer take in more energy with the level of insulin that the pancreas is putting out.
To get more detailed with the actual process we need to look at energy storage and management in the human body.

Glucose is essential but also dangerous to have in high levels in the blood. The body manages this tightly using insulin. When glucose levels are high insulin rises and puts it away. It first goes to liver and muscle and is stored as glycogen. Glycogen is just long chains of glucose essentially. We can store 500g roughly.

so long as we don’t exceed that 500g we will never have high blood sugar and there can never be T2D.

If we do exceed this amount the body needs to deal with it in another way and since energy is valuable for survival it is never wasted. The body converts it to fat via a process known as de novo lipogenesis (DNL). This simply means creation of new fat. This fat is then packed away into fat cells for later use.

At this point we are still perfectly fine and could live this way forever with no chance of T2D so long as we don’t consume more energy in a day than we use. This is where calories in vs calories out is 100% accurate. If you have full glycogen and you convert all carbs you eat to fat plus you eat a lot of fat you are going to accumulate alot of fat but as long as you use enough energy to empty out the fat you accumulate each day there will be no diabetes.

Now the problem is most people do not empty out glycogen and they certainly don’t empty out all the fat the accumulate each day on a SAD diet. Once the fat cells reach their limit, that is when diabetes starts.

The pancreas will start making more insulin to force the glucose out of the blood. it does this because insulin causes fat cells to grow which allows them to take in more fat which allows the glucose to be cleared from the blood again.

The problem here is that the increased demand on the pancreas also causes it to die. The cells that make insulin actually start to die off. If insulin is prescribed and given this can save the cells somewhat by taking off the pressure. The more you push the limits of storage the more insulin is needed.

Can you reverse Type 2 diabetes?

That depends. We have to separate T2D from insulin resistance (IR).
T2D is a chronic issue with blood glucose management while insulin resistance is the inability to clear glucose as a result of the cells not responding to insulin. Very different things.

Insulin resistance is actually not pathological by nature. It happens all the time and for good reason. It can become pathological if not dealt with soon enough but it can always be reversed and pretty easily.

T2D is totally reversible unless you have done too much damage to the pancreas. If you have left it untreated for too long or too poorly managed then the insulin producing beta cells die off and you can no longer produce enough insulin to properly manage glucose levels and this is when it is not reversible.

Now how do we reverse it these things?

All that is required to reverse insulin resistance is to empty glycogen stores. If these are empty then you have at least partially reversed insulin resistance. The reversal will be limited to 500g worth of glucose but for those first 500g you are not going to be insulin resistant and can absolutely have a high carb meal and see normal blood glucose levels.

The problem with this is that it is very temporary and does not empty out as fast as it fills. Once the body gets some glycogen it will hold onto it. It will preferentially run gluconeogenesis and make glucose over using the glycogen so once you have that glycogen it can take days to empty out.
To really reverse insulin resistance you have to empty out fat cells. You have to lose weight. Once you have emptied fat cells you have reversed insulin resistance for the most part. There will be lots of room to get glucose out of the blood.

For some people, depending on how long they have been in the IR state, they might still have some higher than normal glucose levels for some time until the body re adapts to not having to operate from a place of chronic IR. The longer you spend with empty glycogen and unfilled fat cells the better your glucose responses will get.

So in closing, if you have been keto for any amount of time you will have empty glycogen. If you have lost weight you will have lots of room to get glucose out of blood and you will have reversed T2D and insulin resistance so long as you have not permanently damaged your pancreas.
You have cured it in essence. Until you refill your glycogen stores and fill your fat cells back up again.

Anyone on keto will be able to eat one meal, even a few days of carbs and see normal glucose response times. Because you have empty glycogen.
This does not mean you are able to do this long term. it just means that still have empty glycogen and have not yet filled it up. When you do, and you will, you will start gaining weight again. When you gain enough weight you will again, be insulin resistant and will again be diabetic.

There is really no “cure” to T2D because it is not really a “disease” unless you have killed your pancreas. It is just a state where the body is at max storage capacity for energy at which point it starts becoming a disease.
You can reverse it and restart it many times over. Until yo have killed your pancreas then it is a disease and reversal is impossible.