Insulin Resistance – Understanding and Overcoming Metabolic Syndrome

Type 2 diabetes has long been considered a progressive, irreversible disease marked by steady loss of insulin secretion over time. But an improved understanding of the underlying pathophysiology shows that it is actually reversible in many cases through intentional weight loss.

Insulin Resistance and Diabetes: What You Need to Know

Numerous studies now show remission of diabetes is achievable through interventions like bariatric surgery, very low-carb diets, intermittent fasting or simply losing weight through calorie restriction: Intermittent fasting and calorie restriction were used to reverse diabetes for decades before medicines like insulin were discovered. Losing just 10-15% of body weight can reverse diabetes in up to 50% of patients with early disease.

For many people living with type 2 diabetes, the condition is a lifelong sentence that requires perpetual medication and lifestyle management. But emerging research reveals that for some, full diabetes remission may be possible through bariatric surgery procedures like gastric bypass and sleeve gastrectomy.

How Bariatric Surgery Induces Diabetes Remission

Bariatric surgery works to induce diabetes remission in several key ways:

• Reduced Stomach Volume – By reducing the size of the stomach, less food is required to feel full. This supports weight loss and metabolic improvements.
• Hormone Changes – Levels of gut hormones, like GLP-1 and PYY, rise after surgery, stimulating insulin production and improving blood sugar control.
• Calorie Restriction – The anatomical changes significantly reduce how many calories can be consumed, forcing the body to pull from fat stores.
• Weight Loss – Losing excess fat, especially around the midsection, directly improves insulin resistance and metabolic function.
• Improved Insulin Sensitivity – With weight loss and hormone changes, cells become more sensitive to insulin, allowing better blood sugar regulation.

Remission Rates with Bariatric Surgery

Multiple studies demonstrate bariatric surgery can lead to full diabetes remission, especially when performed soon after diagnosis. Remission rates include:

• Up to 80% remission with gastric bypass.
• Remission in over 60% of patients after sleeve gastrectomy.
• More than 90% saw diabetes resolution after biliopancreatic diversion surgery.
• Remission is less likely with longer diabetes duration and worse glycemic control.

Sustaining Diabetes Remission Long-Term

While bariatric surgery can induce remission, lifestyle factors determine long-term success. Steps for sustaining remission include:

• Maintaining weight loss and metabolic improvements.
• Continuing diabetes medications initially until blood sugars normalize.
• Adhering to dietary recommendations for optimal nutrition.
• Getting regular exercise to support insulin sensitivity.
• Working closely with your bariatric surgery team for follow-up and support.

For eligible patients committed to making lasting lifestyle changes, bariatric surgery may provide a second chance at being free of diabetes. But maintenance of a healthy weight and metabolic profile are key to experiencing long-lasting benefits.

Insulin Resistance and Diabetes: What You Need to Know

The traditional view was that diabetes progresses due to declining function of insulin-secreting pancreatic beta cells (“pancreatic burnout”). However, newer research shows this beta cell dysfunction is reversible – it is not caused by permanent damage or scarring.

Rather, excess fat deposition in the pancreas temporarily impairs insulin secretion. Along with fatty pancreas, type 2 diabetes involves a “twin cycle” of excess liver fat as well. Both are caused by chronic hyperinsulinemia from factors like overeating, sedentary lifestyles and consumption of refined carbohydrates.

Reversing Diabetes by Addressing Insulin Resistance

In essence, type 2 diabetes is a reversible metabolic disorder driven by excess ectopic fat deposition in liver and pancreas. It is not an inexorably progressive beta cell disease.

Recognizing diabetes as potentially reversible opens up new treatment approaches focused on lowering insulin levels and body fat through lifestyle measures. Medications have a role, but diet, exercise and fasting can often successfully put type 2 diabetes into remission without need for increasing medications over time.

This paradigm shift to viewing diabetes as reversible represents a major advance in our understanding. Along with dispelling pessimism about progression, it empowers patients and clinicians to positively impact the disease through lifestyle changes targeting root causes of hyperinsulinemia and excess body fat.