How finding out that you could reverse Type 2 Diabetes completely changed my career….

I (Mary-Anne) worked as a nurse practitioner in General Practice for many years, and towards the end of my career, inherited looking after patients with Type 2 Diabetes (DM).

This was not a popular slot in the practice as it was a depressing disease both for patients and the practitioner.

Numbers were soaring and we were beginning to realise that the diagnosis of DM was the end point of metabolic problems that may have started years before. 

There were also obvious links with the growing problem of obesity.

Management at the time was all about the aggressive use of medications to keep blood sugars under control to avoid complications. Historically DM had been considered a mild disease of the elderly, but suddenly patients were getting younger and this meant they had a much greater chance of developing complications in their lifetime.

We were told to emphasise the nature of these complications and treat them much more aggressively. This was frightening for patients who in many ways felt they were partly responsible for their diagnosis and they were also given very little hope of any improvement without medication. 

There was very little attention paid to lifestyle change as we thought people knew how to be healthy and it wasn't for us to judge people’s lifestyles. 

There was general dietary advice based on low fat and emphasis on having carbohydrates at each meal. This was also the time when there was advice about eating little and often to keep your blood sugar level and of course once on medications this became more of an issue. 

In fact, I noticed that patients soon began to eat to keep up with the blood sugar-lowering effects of their medications, and this made them put on more weight.

My patients told me that the medications often seemed to make them hungrier too, and I became more curious about the risks and benefits of this strategy. 

We were lowering blood sugars on the medications but these often needed increasing fairly rapidly and in fact, patients were warned they would be on insulin within 2 years. This was really frightening for many and disempowering.

In addition to that, we were making it much harder for them to lose weight and they were often very hungry and very efficient fat stores. 

It was believed at the time that these patients had a malfunctioning pancreas that was not producing enough insulin. This was a logical conclusion as we knew that insulin lowered blood sugars.  But - what we did not know was that in fact most of these patients were overproducing insulin but their cells had become less sensitive to the effects. 

Understanding insulin resistance changed everything and this is what led eventually to a change in practice and the beginning of much more interest in lifestyle and how changing the quality of food and adding more activity could really make a difference in this disease. 

This was also the beginning of making patients feel more hopeful and that there were things they could do to alter the course of this disease. 

It was an exciting time for both patients and those practitioners who were interested in looking at things differently.

I always say my patients taught me everything, and in so many ways this is true. At about this time a patient with DM came for her annual review.  She had lost weight and taken herself off her medications as she felt she no longer needed them, and her blood results confirmed that she had reversed her DM. 

For me, this was the confirmation that this could be done, and I was beginning to understand that there was much more to lifestyle changes than we had ever believed.

I began to use a 3 month window after diagnosis to really work with my patients on lifestyle measures. The added bonus was repeating their bloods at this point to show the improvements that were possible. This was a great time to do this and it began to empower patients and myself to look at this disease very differently.

I used food diaries twinned with blood sugar meters to give my patients live feedback on what certain foods were doing to their blood sugars and how regular meals of a quality mix of macronutrients without snacks could help to stop the abnormal blood sugar surges and resulting insulin surges that were driving their appetites and their problems with weight management. 

Once seen this was difficult to unsee! 

At about this time, Professor Taylor a researcher at Newcastle University published a very small study showing that it was possible to reverse type 2 diabetes with a low carbohydrate-restricted calorie diet, and this was the pre-runner of the much larger DiRECT study which is ongoing but has some really exciting interim results.

This is the beginning of a new chapter for the treatment of DM.

Medications will always be useful, but lifestyle turns out to be the real star when it comes to chronic metabolic disease.

This changed my whole career and I have retrained as a health coach and love working in an area filled with hope and tools to manage chronic disease that I never would have thought was possible.