Diabetes Remission   (July 10, 2011)

I received the following e-mail question:

Just had my doctor's appointment and had some great results (excuse my bragging).  I lost 23 pounds, my blood glucose was 101, and my A1C went from 6.5 to 6.3. My blood pressure was 117/74, cholesterol was 119, HDL=47, LDL=52, and triglycerides was 102 (down from 243). Guess this all proves that a diabetic diet is good for a person!  My question: Does that mean I went from type 2 diabetes to "pre-diabetic" -- or is it once a diabetic always a diabetic?

My reply:

First of all, my congratulations on getting your diabetes under excellent control! But notice I said diabetes -- you've still got type 2 diabetes (T2D); you're no longer in the category of "pre-diabetes." I think the term "pre-diabetes" is best reserved to describe a stage you went through in the past, and now that you've got the diagnosis of diabetes, the diabetes diagnosis will stay stuck to you. 

Actually, I think that the diabetes community should use a word to describe your situation that's commonly used in other medical disorders: you seem to be in what I would call a diabetes remission. Remission has been defined as "the state of absence of disease activity in patients with a chronic illness, with the possibility of return of disease activity" -- and that is a situation that can and does occur with diabetes. You can expect the return of hyperglycemia if you goof off on your meal plan and exercise program, or if you have the misfortune to have any acute illness with accompanying increased stress, or if, over time, your pancreas' ability to make sufficient insulin eventually deteriorates due to the effects of aging. In any of these circumstances, your diabetes will resurface, and you will come out of your remission.

By the way, although you have T2D, where remissions are fairly frequent, a similar situation can also occur early in the course of type 1 diabetes (T1D). In recently-diagnosed T1D, especially when aggressively treated with an intensive insulin program, blood glucose levels may return to normal and smaller and smaller doses of insulin are needed to maintain the normal glucose levels (sometimes no insulin is needed, although experts frequently advise maintaining a small dose). In this case T1D could be described as having either a partial or complete remission, but the term "diabetes honeymoon" is usually used instead of the term "remission." Typically, the honeymoon in T1D lasts several months, and then disappears, never to return.

If you have normal A1C and normal blood sugar levels, as well as other other lab tests, you could be described as having either of two situations, depending upon whether you are taking diabetes medications:

If you are taking diabetes medications, and all your lab parameters are normal, you would ordinarily be described as having your diabetes under excellent control. The fact that medications are needed to control the "disease activity" means that I personally wouldn't use the term "remission" in this situation.

On the other hand, if you are not taking any diabetes medications and all your lab parameters are normal, you are in remission.

Congratulations. Stay on your meal plan, stay active, and hopefully you'll have a remission of long duration.