YES! And here’s how:

First, let’s define what reversing diabetes actually means (also referred to as “diabetes remission”:

A true definition would be getting the HgA1C < 6.4%. (Prediabetes is defined as having an A1C of 5.7-6.3%, Type 2 Diabetes is diagnosed when A1C is 6.4% or greater).  However, some people would consider being able to control their blood sugars “medication-free” just as good.

Understanding what causes diabetes is the key to understanding how to reverse it. Type 2 Diabetes is related to excess weight gain (could be genetic or from eating too much sugar) which can cause fat accumulation in the liver and in the pancreas. This is what causes insulin resistance – meaning insulin doesn’t work as well as it should. 

WEIGHT LOSS

There is a lot of evidence that weight loss can reverse type 2 diabetes.  This means the obvious steps of exercising more as well as eating less carbs and sugar. Weight loss is the primary driver in diabetes reversal since this is critical to reducing the excess body fat that affects insulin function.

In a new study (https://www.thelancet.com/journals/landia/article/PIIS2213-8587(19)30068-3/fulltext), a weight management program provided by a dietitian or nurse showed the following diabetes reversal/remission rates based on amount of weight lost over 2 years:

No remission in 76 participants who gained weight

7% of 89 participants who maintained 0-5kg weight loss

34% of 56 participants with 5-10 kg loss

57% of 28 participants with 10-15 kg loss

86% of 36 participants who lost 15kg or more.

This shows how the more weight you lose, the higher the likelihood of reversing diabetes.

DIET

So how many carbs should you eat? This topic certainly seems up for debate. There are so many different diet recommendations from plant-based diets to ketogenic diets to intermittent fasting - and all claim to be the best one.  Remember, carbohydrates turn into sugar in the body.  The best idea is to start small – while its recommended to eat some carbs, almost EVERYONE benefits from cutting down on the amount of carbohydrates and sugars in our day (https://www.healthline.com/nutrition/good-carbs-bad-carbs#section7). A great place to start is by eliminating or cutting back on the “bad carbs” such as sugary drinks, fruit juices, white breads, pastries, cookies, cakes, ice cream, candies, chocolates, french fries, and potato chips.  Specifically, watch out for foods and beverages with fructose. What is cutting back? Trying eating only ½ of the amount of these carbs and sugars you would normally eat, for starters.

OTHER NATURAL THERAPIES

There are various herbs, vitamins, and minerals that act as natural insulin sensitizers. This means your insulin works better, and the pancreas doesn’t have to fight as hard to over-produce insulin as it tries to combat insulin resistance (which can cause the pancreas to “wear out” over time, worsening diabetes).  Cinnamon, Magnesium, Chromium, Banaba, and Milk Thistle can be helpful.  The key is looking for a supplement that will provide you with a high enough dose to see benefits, since most combination products only contain trace amounts.  Research supports the following daily doses for effects on insulin function and blood glucose levels:

• CINNAMON 500 mg
• BANABA 50 mg
• CHROMIUM PICOLINATE 1000 mcg
• MILK THISTLE (silymarin) 200 mg
• MAGNESIUM OXIDE 100 mg

One out of every three adults in America now has pre-diabetes.  Of these 84 million people with pre-diabetes, most of them don’t even know they have it - since there are often no signs or symptoms.  Without taking action, many people with pre-diabetes will develop type 2 diabetes within 5 years. Whether or not it progresses to type 2 diabetes, pre-diabetes makes you more likely to get heart disease or have a stroke. 

Look at this as a wake-up call that you’re on the path to diabetes… but it’s not too late to turn things around by taking action right away to lower these risks.  Pre-diabetes can usually be reversed.  Losing 5-10% of your body weight and doing 150 minutes of exercise a week (30 min/day) can lower your risk of developing type 2 diabetes by 58%.

WHAT CAUSES PRE-DIABETES & TYPE 2 DIABETES?

The body breaks down carbohydrates from the food you eat into glucose (sugar).  The hormone insulin, made by the pancreas, is responsible for moving glucose from the bloodstream into the cells of your body for energy. In Pre-diabetes and type 2 diabetes, cells gradually become less sensitive to insulin and the pancreas cannot produce enough insulin to compensate (i.e. INSULIN RESISTANCE SYNDROME).  As a result, glucose builds up in the blood. Having pre-diabetes means your blood sugar levels are higher than normal—but not high enough to be diagnosed as diabetes.

It’s a combination of genetics and lifestyle that are proposed to be the culprit for this insulin resistance syndrome. If you are eating more carbs, sugar, and fructose than the body can handle – this sugar gets converted into fat that starts to clog the liver (contributing to fatty liver disease) and the pancreas (so it can no longer make as much insulin to bring blood sugars down). However, we understand there is also a genetic component to this disease that may make you more likely than someone else to develop diabetes, even if they have the same lifestyle as you.  Because of this, you will sometimes see “thin” people that still develop diabetes – although it is more likely that this person has LADA (latent autoimmune diabetes of adult onset).

AM I AT RISK FOR PRE-DIABETES?

Across the general US population, around 40% of people are expected to develop type 2 diabetes in their lifetime. Anyone can get pre-diabetes or type 2 diabetes, but some important risk factors besides genetics, age, weight, and lifestyle are:

• Being overweight – specifically abdominal fat – is the #1 RISK FACTOR
• Large waist size (Men with waists larger than 40 inches and for women with waists larger than 35 inches may be at increased risk).
• Eating processed foods, sugary foods and drinking sugar-sweetened beverages.
• Age over 45 years old
• Family history (for example - parents or siblings with type 2 diabetes)
• Race - African-Americans, Hispanics, Native Americans, Asian-Americans and Pacific Islanders
• Gestational diabetes or if you gave birth to a baby who weighed more than 9 pounds
• Polycystic ovary syndrome (PCOS)
• Sleep issues, obstructive sleep apnea, or people who work changing shifts or night shifts
• Darkened skin on certain parts of the body (neck, armpits, elbows, knees and knuckles)

Now even some at home genetic testing kits, specifically 23& Me, offer testing to identify certain genes that may increase your likelihood of developing Type 2 Diabetes.

The CDC and American Diabetes Association offer a test to identify if you are at risk for pre-diabetes and type 2 diabetes. Click here to take the test: https://www.cdc.gov/prediabetes/takethetest/

HOW DO I KNOW IF I HAVE PRE-DIABETES?

Blood Sugar Levels

If you think you have prediabetes or may be at risk, its best to talk with your doctor about having a Hemoglobin A1C drawn. This will tell what your blood sugars have been “averaging” for the past 3 months. Another option is to purchase a glucometer online or at the drug store and test blood sugars first thing in the morning before eating (fasting) and 2 hours after eating a typical meal.

A fasting blood sugar level from 100 to 125 mg/dL is considered prediabetes. A fasting blood sugar level > 126 mg/dL or a 2 hour after meal sugar > 200 mg/dL indicates type 2 diabetes.

Signs & Symptoms

Since sugar levels are not significantly elevated in pre-diabetes, there are usually no symptoms until full blown “diabetes” has developed.  However, when sugar levels in the blood stream are elevated – common symptoms that may be an indicated that pre-diabetes is progressing into type 2 diabetes are:

• Fatigue, tiredness (since glucose isn’t being used for energy properly)
• Increased thirst
• Frequent urination
• Blurred vision

I HAVE PRE-DIABETES, NOW WHAT DO I DO?

The primary treatment for pre-diabetes is the same as what you do to prevent or reverse diabetes: lose weight, exercise, and eat a healthy diet.  A diet high in vegetables, nuts, whole grains and olive oil is associated with a lower risk of pre-diabetes.  Additionally, physical activity helps you control your weight, uses up glucose as energy and makes your cells more sensitive to insulin.  It is possible to reverse pre-diabetes by making these lifestyle changes.

A new study suggests that the type of exercise you do matters.  If you do BOTH aerobic (cardio) and resistance (strength training, light weight lifting) this would be better than doing only cardio or only resistance exercise.  Pre-diabetes patients who did resistance training combined with aerobic workouts for 24 months had a 74% reduced risk of developing type 2 diabetes. (https://onlinelibrary.wiley.com/doi/full/10.1002/dmrr.3143)

Click here to find a Diabetes Prevention Program in your area: https://nccd.cdc.gov/DDT_DPRP/Programs.aspx

Other Treatment Considerations

PRESCRIPTION MEDICATIONS

Diabetes medicines are not as effective as diet and exercise. However, your doctor might prescribe medicine if you are at high risk for diabetes and have other medical problems. These could include obesity, a high triglyceride level, a low HDL cholesterol level, or high blood pressure.

STRESS MANAGEMENT TECHNIQUES

Stress itself can cause high blood sugars – whether its physical or emotional. Try yoga, meditation, or deep breathing exercises to help in periods of stress.

HERBAL, VITAMIN & MINERAL THERAPIES

Certain natural therapies (link to Early Defense product description) have clinical research supporting their use in type 2 diabetes prevention.  For example, 100 mg/day increase in dietary magnesium intake is associated with a 15% risk reduction for developing type 2 diabetes.  Increasing blood vitamin D levels reduced the risk of developing diabetes by approximately 70-81%. 

Having a good A1C doesn’t always mean your blood sugars are “well controlled.” For example, what about the patient who has an A1C of 6.4% but who’s blood sugars vary from 50 to 300 mg/dL throughout the day.  Regardless of their A1C, these wide fluctuations puts them at risk for passing out from low blood sugars and damage from high blood sugars. The A1C tells us what blood sugars have been averaging over the past 3 months, but does not tell the story of what happens day to day. Finger pokes of blood sugar readings with a glucometer may give us more insight into what’s happening during the day, but not in between readings. If your blood sugar in the morning is 120 mg/dL – was it just coming down from 250 mg/dL? Was it just coming up from a low blood sugar of 60 mg/dL? Or has it been steady at 120 mg/dL all night long?  Certainly the 120 mg/dL reading alone doesn’t tell the full story.

This is where continuous glucose monitoring has emerged as an extremely beneficial option for diabetes patients. Continuous Glucose Monitors (CGMs) have been around for a while now, but more often used in patients with type 1 diabetes. Today, there are plenty of great options for people with Type 2 diabetes to also use and learn from these monitoring devices!

What is a CGMs?

Continuous glucose monitors have sensors placed with a small needle under the skin either on the arm or abdomen that reads glucose levels (the size of a small “cat whisker”). The sensors, ranging in size from a penny to a stack of two quarters, are held in place with adhesives. The sensor is worn in place for 7-14 days at a time before being changed. There is even a sensor that is implantable by your doctor (http://www.senseonics.com/) for 3 months.  The sensor measures blood sugars 24/7 and transmits their blood sugar readings via Bluetooth to a handheld receiver or directly to a smartphone app. The display will tell you at any time 1) what your blood sugar currently is, 2) what direction it is trending, and 3) what blood sugars have been over the last 8+ hours.

BENEFITS OF CGMs

• ALARMS: When glucose levels are too high or too low, you can receive notifications to take steps, such as drinking some juice to prevent a low blood sugar. For example, wouldn’t you like to know if your blood sugar was 80 mg/dL and dropping? Or 200 mg/dL and continuing to increase? It would help give you guidance on what to do to keep blood sugars in range.
• LOWER A1C WITHOUT MORE MEDICATION: Studies have shown that simply wearing a CGM can lower your A1C through helping you understand your blood sugars better. Better control with less medications and no side effects!
• LEARN ABOUT FOOD & ACTIVITY: Seeing blood sugars continuously can give insight into how certain foods or exercises may affect your blood sugars (since everyone is different!) Some people see strength training can INCREASE blood sugars whereas cardio exercise can DECREASE blood sugars.  
• No more painful finger sticks! The FreeStyle Libre (https://freestylelibre.myehcs.com/?gclid=EAIaIQobChMIs4f7tOiL4QIVviCtBh3ARQkYEAAYASAAEgIV_PD_BwE) or Dexcom G5/G6 (https://www.dexcom.com/) are both accurate and approved by the FDA to replace finger pokes from blood glucose monitors.

HOW TO GET A CGMs

Talk with your healthcare provider or pharmacist about options that would be best for you. Often times it will come down to cost of the product and coverage through insurance.   CGM is now covered by Medicare for patients with type 2 diabetes who are on multiple injections of insulin daily. Also, many commercial insurance companies will cover a CGM for type 2 diabetes.  If this is not covered by insurance, the least expensive option at this time is the FreeStyle Libre scan system.  Cash pricing is generally <$100/month for the system – which can be less expensive than glucose meter test strip supplies.

DEXCOM G6	FREESTYLE LIBRE

The scientific world used to believe that a varied, healthful diet would provide all the vitamins and minerals we need. But recent surveys show that most American diets fall short of satisfying the minimum daily requirements for several vitamins and minerals.  The majority of U.S. adults—68%—take dietary supplements  (http://www.crnusa.org/CRN-consumersurvey-archives/2015/). Therefore, it’s imperative to understand what to look for when picking a supplement.

#1 SAFETY  

• QUALITY: Look for certification seals including cGMP, Made in the USA, and FDA registered facility.  This means the manufacturer is adherent to cGMP (current Good Manufacturing Practices) which assures the identity, strength, quality, and purity of drug products. This helps ensure you are not getting mis-branded or adulterated ingredients, and that you can expect to know what ingredients are actually in the product.

• INTERACTIONS WITH MEDICATIONS & HEALTH CONDITIONS: Before you add a supplement or vitamin to your routine, always discuss it with your doctor or pharmacist. Dietary supplements may interact with your medications or pose risks if you have certain medical problems or are going to have surgery. Some supplements, such as St. John’s Wort and Golden seal should be avoided if you take prescription drugs.

#2 DOES IT ACTUALLY WORK?

• PROPER DOSAGE: The key to whether or not a supplement will work is truly in the dose! Under-dosing renders the supplement ineffective while over-dosing may cause problems. Determining the proper dosage should be based on data from research studies on what has been demonstrated to actually provide benefit. Many supplement companies include many different ingredients at doses much too low to work – it’s about quality and dose of each ingredient, not quantity!

• BACKED BY CLINICAL STUDIES: Your healthcare provider may have professional access to clinical studies, but you can also search for legitimate research studies yourself here: https://www.ncbi.nlm.nih.gov/pmc/ . Use the search tab to type in the name of the ingredient and disease or symptom you are trying to investigate.  Take note on the number of patients in the study and patient characteristics to help you decide if it is a good study or not, and applicable to what you are using it for.  These studies can give guidance on what benefits or side effects to expect, and what doses to use.  

• NOT ALL FORMS ARE THE SAME: Look for formulations that are easier for the body to use and absorb, another name for this is “bioavailability”. For example, Vitamin D supplements come as either Vitamin D2 (inactive form) or Vitamin D3 (active form) – which the body doesn’t have to convert since its already active. Magnesium, also, has many different salt forms – some have higher amounts of elemental magnesium and some are absorbed better than others (https://www.algaecal.com/expert-insights/magnesium-oxide-delivers-more-magnesium-with-far-fewer-pills/).

#3 I’VE DECIDED TO TAKE A SUPPLEMENT, NOW WHAT?

• TAKE IT CONSISTENTLY: In order to decide if a new supplement regimen is working or not, it’s important to take it consistently as directed on the bottle (i.e. every day – not just occasionally).  If you have not noticed any benefit or change in symptoms within 3 months of consistently taking something, consider stopping the supplement and discussing alternative options with your provider.

With the astronomical and rising cost of prescription medications, the most common complaint I get from both patients and providers are “I can’t afford my medications!” This often creates a huge barrier for you to get the right medications to keep your sugars under control. Additionally, doctors are limited on what they can recommend based on formularies and affordability, instead of what is the best therapy for a patient.  Unfortunately, our healthcare system spends much more on treating the complications from uncontrolled diabetes than we actually do on the medications to treat it.  Here are my 10 BEST tips to help you with affordability of your diabetes medications.

• GENERICS

Most of us know that generic medication is less expensive than brand name medications. This means the original drug company’s’ patent has expired and the medication is able to be made by multiple manufacturers - which drives the price down for you. The problem is, the diabetes medications that are available as a generic are very few:

• Metformin
• Glipizide, Glimepiride, Glyburide
• Pioglitazone (Actos®)
• Acarbose
• Alogliptin (Nesina®) – this drug works in the same way as Januvia®, Onglyza®, & Tradjenta® which only come as Brand Name, so this may be a less expensive alternative to those therapies

This is why when you ask your pharmacist or doctor, “Isn’t there a cheaper drug?” The answer usually is no.

If you are paying more than $15/month for Metformin & Glipizide/Glimepiride/Glyburide medications... you shouldn’t be.  Metformin (depending on the formulation) & Glipizide/Glimepiride/Glyburide medications should be available on any major pharmacy $4 generic drug list without insurance.  Walmart also offers pioglitazone for only $9/month. YHere is a link to find participating stores and prices:

https://www.needymeds.org/DiscountDrugProgram.taf?_function=National_list

• METFORMIN

There are different kinds of Metformin formulations – Metformin immediate release, Metformin extended release (ER), and Metformin ER osmotic release.  The extended release versions are often used to help relieve stomach upset and diarrhea.  There are price differences in doses and formulations.  For example, Metformin ER osmotic release 1000 mg tablets can be 50 times more expensive than Metformin ER 500 mg tablets. You can always check with your pharmacist to find out if there is a less expensive version of Metformin than what you are taking.

• SPLITTING PILLS

There generally isn’t much difference between strengths of pills.  As examples, cash priving of Invokana 100 mg is about the same as Invokana 300 mg tablet per tablet and Januvia 50 mg is about the same as Januvia 100 mg per tablet. So (depending on your needs) it may make the most sense talking with your provider about prescribing the highest dose and then cutting the pills in half every day. This can get you the most bang for your buck! I find value in this option for patients who pay cash, have a high deductible, or who use Medicare Part D.

• COM

GoodRx offers coupons and discounts on hundreds of prescription drugs – but its utility truly is only in generic medications.  The discount is not significant enough to make brand name medications affordable and they usually remain hundreds of dollars per month.  Therefore, for brand name medications – you are much better off using a copay card directly from the manufacturer (see next tip below). Also, you cannot use both a GoodRx coupon and your insurance – again, making this not very useful in the diabetes realm. 

Where GoodRx can be useful is in getting cash pricing of medications between local pharmacies to try to find the most competitive price.

• DRUG MANUFACTURER COPAY CARDS

Pay attention if you have commercial insurance – especially a high deductible!! You cannot use these if you have any government insurance (like Medicare, Medicaid, or Military).

In order to use copay cards, the prescription must be run through your insurance first. Therefore it’s best to first find out what is covered on your insurance plan’s formulary, and then find the copay card that offers the largest discount. You can do this by calling your insurance company or referring to their formulary book that they usually mail you at the beginning of each calendar year. I also refer to this website tool:

https://lookup.decisionresourcesgroup.com/

This is also helpful when it comes time to pick the best insurance plan for you the following year!

I have compiled below categories of brand name diabetes medications, based on how they work. The medications within the table are generally interchangeable so it may make sense to switch to an alternative medication within the same class if it saves you money.

SGLT2 inhibitors (the pills that cause you to urinate out extra sugar)

GLP1 receptor agonists (non-insulin injections that help your body use its own insulin better and slows how food moves through your stomach)

DPP4 inhibitors (pills that can help lower sugars)

Long Acting Insulin

Meal Time Insulin

• FREE TRIAL VOUCHERS

Unlike copay cards, anyone can use these whether or not you have insurance, or even if you have Medicare or Medicaid, since it is not run through insurance at all.   These are usually 30 day offers to try the medication for free.   These are not advertised online, so the best option is to ask your doctor if they have them for the medications you take.  The exception is medications from AstraZeneca – Farxiga and Bydureon both have 30-day free trial offers here: www.azmedcoupons.com (*make sure you click the Free trial and not the Savings card!)

These medications have 30-day free trial vouchers available that may be available from your doctor:

• Invokana
• Farxiga
• Jardiance (14 day free-trial only)
• Humalog
• Trulicity
• Bydureon

This isn’t a long-term solution, but certainly buys you time to try a medication and know if it’s going to work before paying for it.

• PATIENT ASSISTANCE PROGRAMS

Whether you have commercial insurance, Medicare insurance, or no insurance – if you are struggling financially with paying for your medications you may qualify for FREE medication from the drug company.  The income requirements and out-of-pocket spend vary based on the company.  You will need to provide documentation for your income for all of them except Sanofi.  If you are a Medicare patient, some of these programs will require that you have tried to apply for Medicare Low Income Subsidy. (i.e. “Extra Help) – see below for guidance on this. Keep in mind, these must be renewed annually.

• MEDICARE LOW INCOME SUBSIDY

If you have Medicare and are considering patient assistance programs due to financial hardship, this is undoubtedly your best option to try first.  You may be able to get extra help to pay for the monthly premiums, annual deductibles, and co-payments related to the Medicare Prescription Drug program. This extends to ALL of your medications (not just diabetes) and does not have to be renewed each year like the patient assistance programs do. I would only attempt to do this online. Calling can take hours. If you aren’t computer savvy – find someone to help you (even someone at your doctor’s office)!

Go here to apply: https://secure.ssa.gov/i1020/start and click “Apply Now” at the bottom of the page.  You will need to have your income and asset information handy.  It takes only about 5 minutes to complete.

• INSULIN SAVINGS

First, check out my tips on copay cards and patient assistance programs. If those don’t work for you – there are still other options.  Lilly now has a hotline available for you to call, 1-833-808-1234, which is designed to help you figure out how to afford your insulin.  Sanofi also offers non-insurance pricing about 1/3 of the total cash price ($99/vial, $149/pen pack) for Lantus, Toujeo, and Ademlog at this website: https://www.admelog.com/insulins-valyou-savings-program.

Still too expensive? There are “cheaper” insulins, although most clinicians will argue they aren’t as good.  This is because the time they take to work can be different, which can pose challenges for efficacy and safety.  WALMART pharmacy offers Novolin Relion N (long-acting) and Novolin Relion R (meal time short-acting insulin) for $24.88 per vial (1,000 units per vial).   Ask your provider about substituting your insulins for these.

If you use insulin through an insulin pump and have Medicare – this insulin CAN be run through Medicare Part B (not Part D) so it is not subject to the Donut Hole and should be covered almost at 100%.... which is a SIGNIFICANT cost savings! The tricky part is finding a pharmacy contracted with Medicare Part B.  Usually the large chain pharmacies (WalMart, Walgreens, CVS/Target) will offer this, but small independent pharmacies do not.  Note, this also applies to diabetes testing supplies! Ask your pharmacy to run them against your “red, white, and blue” Part B card.

• SAMPLES

Some doctors’ offices are still given samples of medications from the drug company reps. All you have to do is ask if they have any available!