Remission, not reversal

The prevalence of Type 2 Diabetes is rising steeply in the paediatric population. The only way to improve quality of life is to slow down its progression through optimal management, writes Dr Rajeshwari Janakiraman

Diabetes is a chronic, progressive condition with higher than normal blood sugar levels. Patients with diabetes may have reduced or no production of insulin or their insulin doesn’t work well (insulin resistance.) Insulin is a hormone that is necessary for managing blood sugar levels. The condition with no insulin secretion is known as Type 1 Diabetes. In other patients, although the insulin level is normal, the body cannot recognise its presence. Such patients are said to suffer from Type 2 Diabetes. The exact cause of both types of diabetes remains unknown. Researchers believe that Type 1 Diabetes may be due to an autoimmune condition in which the immune cells destroy the insulin-secreting cells, leaving the body deprived of insulin. Type 2 Diabetes, on the other hand, may be due to unhealthy practices, such as physical inactivity, obesity, sedentary lifestyle, and poor eating habits.

There is a rising trend of diabetes in children, possibly due to the increased prevalence of obesity or excessive weight. 85% of the children with Type 2 Diabetes are obese or overweight. The obesity prevalence in India is around 3.6 to 11.7% and is rising. Over 1.1 million patients between the ages of 14 and 19 years are living with diabetes globally. Covid restrictions in mobility have further increased the prevalence of obesity and diabetes.

Remission vs reversal

American Diabetes Association recommends using the term ‘diabetes remission’ instead of ‘diabetes reversal’. Clinicians and patients commonly use them interchangeably. However, there is a difference between the two. Reversal means that the disease is completely cured and will not return. Remission implies that the disease would be dormant as long as the patients maintain certain conditions. For instance, if there is diabetes remission through weight loss, it is crucial to maintain an optimum weight to avoid recurrence of diabetes.

There is no remission for Type 1 Diabetes as there is an insulin deficiency, and the child has to take medical treatment to fulfil the need. However, in children with Type 2 Diabetes, there are high chances of remission, especially in the initial stage of the disease, when the body is making adjustments for high blood sugar levels. Early diagnosis of the disease is challenging as the disease progresses without the patient experiencing any symptoms.

Identifying early symptoms

Early diagnosis of diabetes offers several advantages. It increases the chances of remission, provides more management options, and reduces the risk of complications. Some of the most common symptoms of diabetes are:

Weakness and fatigue

Increased urination frequency,
especially at night

Weight loss without any known reason

Vision problems, including blurred vision

Increased thirst

Sores, ulcers, and wounds that are slow-healing

Numbness and tingling sensation in feet and hands

Recurrent infections

Extreme hunger

Irritability

If the parents notice any of the above symptoms in their child, they should consult a paediatrician.

Achieving remission

Several measures may help the child in diabetes remission. Some of them are:

An active life: Maintaining an active lifestyle helps improve the blood sugar level and reduces insulin resistance. Firstly, reduce the screen time from television mobiles or computer to less than 30 mins a day (other than online class time). Parents must engage their children in activities that keep them energetic and involve exercises at least 1-2 hours a day. It may be best to take the child for some sports activity or even jogging in the park. Routine vigorous exercise may help in diabetes remission.

Healthy diet: Diet plays a crucial role in managing blood sugar levels and diabetes remission. Parents should keep their children away from cakes, pastries, sugar candies, packed juices, and aerated drinks. Their diet should have a low glycemic index and contain fresh fruits and vegetables, complex carbohydrates, whole grains, healthy fats, and lean proteins.

Weight loss: Obesity or excessive weight is a significant risk factor for Type 2 Diabetes. In diabetes remission, it is not only about losing weight but also about maintaining it. It is where most patients fail to result in the re-reversal of diabetes. Obese diabetic patients losing around 5 to 7% weight may help in diabetes remission.

Motivation and persistence: High level of motivation and enthusiasm is a prerequisite for diabetes remission. It takes a lot for routine exercise, strict diet control, and losing weight. Parents should motivate their children and explain to them about a healthy lifestyle in diabetes management. They should also
exercise and be an example to children. Parents may also take the help of counsellors or diabetes educators to instil confidence in the child.

Incorporating health in routine: Diabetes remission is a long-term process and requires continuous efforts. Parents must also include healthy practices in the family. Minimise or avoid eating junk or street food, identify healthy food options, and avoid storing processed foods in the refrigerator.

Management through technology: Several mobile apps are available to inform you about the calories you lose and the number of steps you walk. Evidence suggests that bariatric surgery results in Type 2 Diabetes remission in 95–100% of adolescents with diabetes.

(The author is a consultant endocrinologist.)