Frequently Asked Questions
Type 2 diabetes is a medical condition where the body cannot make enough insulin or does not use the insulin it makes very well. Insulin is a hormone that helps control the amount of glucose, or sugar, circulating in your blood. When insulin is not sufficient or ineffective, blood glucose rises too high and stays circulating too long in the bloodstream.
Risks for type 2 diabetes include genetics and family history, metabolic syndrome, excess abdominal body fat, obesity, and a diet with high amounts of sugar or foods that rapidly digest to sugar. By the time you are diagnosed with type 2 diabetes, the underlying process of ineffective insulin and rising blood glucose has likely been going on silently for years.
Excess glucose in the blood can damage delicate blood vessels and nerves. When insulin is ineffective, it also prevents your muscles and tissues from taking up enough glucose for energy. Complications from diabetes includes damage to the eyes, feet, heart, kidneys and other organs. Annually, type 2 diabetes impacts an estimated 5.7 million Canadians and its rates have been steadily increasing.
Common symptoms of type 2 diabetes often develop gradually and can be subtle at first. Many people don’t realize they diabetes it until it’s diagnosed during routine tests. Here are some of the most frequent signs and symptoms:
Frequent urination
Excessive thirst
Increased hunger despite frequent eating
Fatigue, lack of energy, lethargy
Abdominal obesity, “apple shape”
Blurred vision
Slow-healing cuts or sores
Frequent infections
Tingling, numbness, or pain in hands or feet (neuropathy)
Darkened skin in the neck, armpits, or groin (a condition called acanthosis nigricans)
Skin tags
Itchy skin
Here are the four most common ways to test for type 2 diabetes:
Fasting blood glucose: blood is taken first thing in the morning after fasting; a result greater than 7.0 mmol/L indicates diabetes.
Random blood glucose: blood is drawn at any time, regardless of when you have last eaten; a result of 11 mmol/L or higher indicates diabetes.
Hemoglobin A1C: Also called an HbA1c or A1C, this blood test measures your average blood glucose over three months by measuring how much glucose has stuck to your red blood cells; a result of 6.5% or higher indicates probable type 2 diabetes.
Oral glucose tolerance test: two hours after drinking a very sweet drink, your blood is tested; a result of 11 mmol/L or higher indicates diabetes.
Type 2 diabetes remission means that you have normal blood sugar levels for three months as measured by your HbA1C blood test without taking any diabetes medications. It is called remission and not cure because type 2 diabetes can come back, especially if you eat foods with a lot of sugar or refined carbohydrates that rapidly digest to sugar.
While more research is needed, it is clear that people with type 2 diabetes who start with greater pancreatic function, prior to lifestyle changes or interventions like bariatric surgery or GLP-1 RA medications, are more likely to achieve remission.
It is also known that remission is more likely if lifestyle changes are made within six years of your type 2 diabetes diagnosis. However, individual case reports have documented that some people have achieved remission as much as 25 years after being diagnosed with type 2 diabetes, even when taking multiple medications, such as injectable insulin.
Studies have shown that significant and sustained weight loss — for example, in the range of 10 kg (about 22 pounds)— can be a contributing factor to remission maintenance. However, even without weight loss, if you can reduce your blood glucose levels by consistently consuming less sugar, or foods that digest to sugar, you may be able to achieve and maintain remission.
However, even if remission is not achieved or maintained, any change in diet that reduces the amount of glucose coming into the blood, or lifestyle change that increases the body's ability to store or use the glucose, can be beneficial. These changes can still help with the reduction of medications and decrease diabetes complications, while improving health, blood sugar levels, and overall wellness even if remission is not achieved.
If you are taking any medication that lowers your glucose, you must speak with your doctor first before changing your diet. Your dosages may have to be lowered or discontinued. If you change your diet without changing your medication, your blood glucose may fall too low, which is a potentially dangerous condition called hypoglycemia.
Also, if you are pregnant or breastfeeding, please speak to your doctor before changing your diet.
If you are taking other prescription medications, such as for blood pressure or cholesterol, there is less concern about interference with the diet and medications. However, dosages may need to be changed based on weight loss or a reduction in blood pressure. It is good to let your doctor know you are adopting a lower-carbohydrate way of eating.
To get your health provider’s support to help you achieve remission and manage your prescription medications, personalize our downloadable letter and take it to your medical appointment.
Type 2 diabetes remission is possible when you help your pancreas and liver function more effectively and you reduce your body's need to handle a lot of glucose coming in through the food you consume.
Research suggests type 2 diabetes arises when too much body fat is in the abdomen, especially in the liver and pancreas. When you have excess fat in these two organs, called visceral fat, you reduce your capacity to store excess energy and the organs don’t work well, increasing the risk of diabetes. When you lose this excess visceral fat, you improve your body’s ability to store excess energy and regulate your blood sugar levels. When you consume less sugar, or high carbohydrate foods that rapidly digest to sugar, you body has less need to store it or use it, also reducing your circulating blood glucose.
Insulin resistance happens when the body's cells—especially in the muscles, fat, and liver—stop responding effectively to insulin. Insulin is the hormone that is pulsed out by the pancreas in the response to glucose (sugar) in the blood. Insulin helps glucose enter cells from the bloodstream. Insulin is like a key in a lock, opening up a channel in the cell wall to allow glucose to enter into the cell to be converted to energy or stored as fat. When the cell becomes too full with excess energy, it ignores insulin’s signal and refuses to open up the channel to take in more energy. This is called insulin resistance.
When cells become resistant, the pancreas makes more insulin to compensate. Higher insulin (hyperinsulinemia) will cause fat to be stored in the liver and pancreas and in the abdomen. Over time, this can eventually lead to elevated blood sugar, because the cells’ refusal to take in glucose keeps the glucose circulating in the blood.
Insulin resistance often develops silently over many years and is closely linked to belly fat, lack of physical activity, poor sleep, chronic stress, and a high-carbohydrate, highly processed diet. Insulin resistance is a key driver of type 2 diabetes, pre-diabetes, and other metabolic conditions like fatty liver and high blood pressure.
Lowering insulin levels, reversing insulin resistance, and becoming more insulin sensitive is a key action to burn more body fat and to put type 2 diabetes into remission. Lowering the need for the pancreas to pulse out insulin helps reverse insulin resistance and helps address the root cause of rising blood sugar levels.
Currently, research evidence shows that type 2 diabetes may be put into remission by four different ways:
Eating a low carbohydrate or a ketogenic (very low carb) diet
Eating a low calorie diet
Intermittent fasting
Surgical (bariatric surgery) and medical management (GLP-1 receptor agonists)
Why do these methods work? Each method helps you lose excess body fat, especially from around your abdomen, giving you more space to store excess energy. Each way also helps you improve your blood glucose levels by reducing the amount of sugar you consume and/or the need to store excess energy.
You can read more about each of these methods in the free downloadable ebooklet. The ebooklet and this site puts the focus on 1, 2, and 3 by changing what and how you eat. That's because you can easily do the first three methods at home.
However, if you lose weight by having bariatric surgery or by using GLP-1 RA drugs like Ozempic, you will still have to change the way you eat to support long term remission. The resources in this website and the ebooklet can help support successful lifestyle changes to assist with successful surgery or medication options.
It is not only losing body fat and consuming fewer foods that digest to glucose that helps with remission. Paying attention to these other lifestyle factors can help, too:
Get a good night’s sleep: Poor sleep can raise your blood glucose levels, increase stress hormones, and contribute to weight gain and metabolic dysfunctions. Restorative sleep gives you more physical, mental and emotional energy and helps your metabolism work better. Prioritize getting a good sleep by following the rules of good sleep hygiene. These include going to bed and getting up at the same time every day, sleeping in a cool dark room with minimal distractions, limiting caffeine during the day, and curtailing screen time an hour before sleep. Google “good sleep hygiene” for more tips and advice.
Manage stress: Stress is an essential feature of life, but too much stress that is not released can make it much harder to keep blood glucose under control. Stress increases hormones in your body that may directly increase glucose levels. When stressed, the body prepares for fight or flight by making sure enough glucose or energy is available for quick movement. Feeling stressed can also interfere with a good night’s sleep. Stress reduction such as meditation, yoga, and doing relaxing activities can help.
Get regular, enjoyable movement: When muscles move, they use up glucose circulating in the blood. The more you move, the more glucose your muscles will take out of the blood. Additionally, the more muscle you have, the more you are able to use the circulating glucose. So get moving and use, or build, your muscles. While some people enjoy going to the gym or lifting weights, any movement and anything that sustains or builds muscles is great. What is the best physical activity? The one you enjoy doing regularly! Something as easy as a 15 minute walk after a meal has been shown to immediately reduce blood glucose.
In general, you should eat whole, minimally processed foods and avoid sugary foods or ultra-processed foods (foods in packages with long ingredient labels.)
Prioritize protein at every meal either from animal sources (meat, poultry, fish, seafood, dairy) or plant sources (tofu, tempeh, beans and legumes.) Eat plenty of vegetables, especially leafy greens, cruciferous vegetables, or colorful above ground vegetables, and consume low sugar fruit like berries. Drink unsweetened beverages like water, sparkling water, black tea or coffee.
Avoid foods that have added sugar or that are made with refined carbohydrates that digest rapidly to sugar. Eliminate sweet beverages, fruit juice, and reduce or eliminate ultra-processed foods.
The free downloadable e-booklet has more detailed information. Additionally, you will find more information in the following hand outs:
Where are the hidden sources of sugar?
There will be times when it is hard to follow the common principles of eating for remission (focusing on a whole foods, minimally processed diet that prioritizes protein and vegetables and is low in sugar, refined carbohydrates and ultra-processed foods.) Here are some of the common situations that can make it more difficult and how to plan for that challenge. Do any of them apply to your life?:
Tempting food in the house: Clear out your fridge, freezer and pantry of tempting foods like chips, cookies, crackers, ice cream and don’t bring them into the house. If family brings in such food, ask them to hide it or not eat it in front of you.
Tempting food in your daily activities: Do you have to walk by a bakery or donut shop every day on the way to work? See if you can change your route or plan to avoid the lure.
Snacking traps: Sudden hunger can sabotage plans. Have in your fridge hard boiled eggs, pre-washed and cut up vegetables like celery and sweet peppers with a yogurt or cream cheese dip. Out on the road, choose roasted nuts, no-sugar jerky, or cheese strings. Have a packet of roasted almonds in your car or purse.
Dining out: When you are not in control of the food, plan for the following situations:
Buffets: Fill the plate with simple proteins, vegetables and salad. Skip the rice, potatoes, pasta and deep-fried items. Steer clear of the dessert except the cheese.
Fast food restaurants: Order the burger or breakfast sandwich without the bun; get salad instead of fries.
Higher end restaurants: If possible, look at the menu online before you go to plan your order. Try to go for simple grilled or roasted protein (fish, meat, tofu), veggies and salad.
Friends’ parties: If appropriate, ask if you can bring a dish to share. At a cocktail party go for the charcuterie, cheese or crudité plate. At a dinner party you can ask for reduced portions of starches or decide to eat what you are served and get back on track the next day.
Work-related conundrums: Are pizza or sandwiches common working lunches? Just eat the top off pizza or the insides of sandwiches. Or bring your own food from home. Does a colleague keep a dish of candies on her desk? Keep a dish of nuts on yours. Does shift work prevent easy access to food. Try to plan ahead and stock your fridge with healthy options and bring food from home.
Travel: Business travel and vacations can be one of the hardest challenges. Use the tips above for eating out or snacking or decide to get back on track after the trip.
Grief and loss: One of the hardest times to eat well is during times of great stress or loss. If friends and family want to support you by bringing food, you can ask for specific remission-friendly dishes, freeze plates of cakes and cookies or give them away. Or get back on track when you can.
Assess for sugar addiction: If changing your diet is unrelentingly difficult, check our online resources for food addiction or sugar addiction.
Mostly be kind to yourself. Every day is a new day. There is no shame in having to go back on medication. Remission can be achieved more than once. Try again!
Since being in remission enables blood glucose levels to stay in a healthy range, it is assumed this will prevent the many complications of having too high blood sugar over time. Being in remission also helps to keep blood pressure and cholesterol down, and reduces inflammation.
Having blood glucose, blood pressure, blood lipids, and inflammation levels all in a healthy range is usually linked to a lower risk of complications, such as serious problems with the eyes, feet, or heart. So, remission is likely to do the same.
The information on this website will still be useful to you, too. You may be able to reverse your prediabetes symptoms and improve your blood pressure and reverse your metabolic syndrome. By doing this you will prevent future type 2 diabetes all together.
It is still important to talk to your health care provider about your interest in trying one of these approaches, especially if you are taking medications.
Please visit our sister site: https://www.reversingprediabetes.ca for more information about prediabetes
What you measure and track is up to you and how you respond to information. Your health care provider will also track some key measurements such as your HbA1C.
Some people finding tracking weight, blood glucose, and food to be stressful. That stress interferes with their motivation, enjoyment of lifestyle changes, and progress. Others love to track health measures and chart their progress; they find it keeps them focused and motivated. Which one are you?
If you like to track your progress, here are some measures to track:
Starting weight; and then weekly, or daily, weigh-ins
Starting waist measurement; then weekly waist measurements
Starting HbA1C with your doctor; then note it every 3 months from your medical visits
Starting blood pressure, then get a home BP machine, or routinely check it at a local pharmacy, to note regular updates
Food diary – noting what and when you ate every day
Tracking blood glucose (see next question.)
If you want to track your blood glucose (aka bloodsugar) there are two ways you can do it:
Purchase a glucometer kit and blood glucose test strips You will find these for sale behind the counter at most pharmacies. They come with instructions about how to use them in the package. In general, however, a blood glucose kit comes with a small battery-powered meter, lancets (a sterile, disposable small sharp needle) and a spring-loaded lancet device that help puncture the skin of a finger tip. To test your blood you will wash and dry your hands, prick your finger with a sterile lancet loaded in the pen-like lancet device, and put a drop of blood on a test strip inserted into the metre. Here are some common times to test your blood: Fasting blood glucose: test it first thing in the morning, before you have eaten or drunk anything. Pre-meal: before eating a meal, test to see your baseline level blood sugar level. Post meal (post prandial): check your blood 1 hour and then 2 hours after eating to see how high it goes. The results of these tests will be compared to blood sugar charts to determine how well you body (and insulin) is now regulating your blood sugar.
Purchase a Continuous Glucose Monitor (CGM): You will find the sensors behind the pharmacy counter. CGMs are more expensive than glucometer kits, but give you more in depth information. In general, you will place the sensor on the back of your arm. Then you download an app on your smartphone that links to the sensor. For 14 days, the sensor will give you real time readings, 24 hours a day, of your blood sugar. Here is a more in-depth article that explains the pros and cons of CGMs and how to use them.
In general, if you are able to continue to consume a low sugar diet and maintain weight loss, you will keep in remission. However, sometimes due to genetics or other factors beyond your control, the pancreatic function continues to decline and blood glucose levels rise again.
The return of high stress, poor sleep or sedentary behavior can also increase blood sugar.
If blood glucose rises again, it helps to have a plan for recurrence, such as re-committing yourself to a lower sugar way of eating and adding in more physical activity.
Download our e-booklet, which goes into more detail about most of these FAQs. You can also watch or listen to our podcast “At the Helm”. Also read some of the patient testimonials for some of the common struggles, and solutions, that others found to achieve and stay in remission.
Visit the website of the Institute for Personalized Therapeutic Nutrition (IPTN). There you will find some of the following resources for health professionals, including:
A quick start guide for health professionals
Our CME-Accredited training program Foundations in Therapeutic Nutrition
Join our Community of Practice of other health professionals supporting patients using therapeutic nutrition and other lifestyle changes to achieve remission.
Go here to view our curated list of studies & research