A multipart question/case study: A 72-year-old male with diabetes, on insulin, no oral diabetic meds. C-peptide 2.8. After four to six weeks on a Paleo-type reset, able to keep blood sugars in the normal range without insulin. Five months later, still off insulin. Latest A1c 5.7, down from 7.7. I thought Chris had mentioned type 2 diabetes as not often reversible in contrast to prediabetes, but we have seen many insulin patients like this with similar improvements as long as C-peptide is normal. On a separate note, the patient is still losing weight and still pretty low carbohydrate. He would like to increase muscle mass and strength, but tends towards blood sugar spikes if carb loading with exercise or going to moderate carb in general. I’m kind of between a rock and a hard place with the carb situation with him and other thin diabetics.

Dr. Amy Nett:  Yeah, I think we do see type 2 diabetes being reversible. I’m not certain which context that was in because there’s potentially some degree of progression beyond the point at which your beta cells aren’t functioning, but I think as long as you have adequate residual function, type 2 diabetes can be reversible, but not always, largely depending on the degree of progression. Again, I don’t know exactly what that context was, so I can’t be too certain, but I would say, no, we do see reversal of type 2 diabetes, and that’s fantastic that you got a 72-year-old to change his diet like that and make those improvements. That’s really awesome.

I hear you, and that could be a good place, actually, to refer someone to work with Laura or Kelsey or another dietitian because there is a lot of fine-tuning here, and I don’t know that there’s a one-size-fits-all answer here. If he’s trying to put on weight and he can’t do low carb, I would definitely look at fat intake because I do have some pretty athletic patients who are doing low-carbohydrate diets and still have a lot of weight on them. I don’t think that you necessarily need to be moderate or high carbohydrate in order to put on weight, strength, and muscle mass. It might be worth having the patient talk with a dietitian a little bit more specifically, and I would also wonder if the patient is using a glucometer. The first thing I would probably do before I refer out—unless someone wants to work with a dietitian—is have them use a glucometer and really get a good sense of what the upper limit of their carbohydrate intake can be. Also make sure carbohydrates are eaten in a complete meal where you have fat and protein.

Experiment with that one a little bit more. Try a glucometer and let us know how that works out.