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Type 2

Type 2 Remission: How I Got Here and How I’ll Stay Here

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Michael writes about how he used two main strategies – intermittent fasting and walking after meals ­– to put his type 2 diabetes into remission.

There’s that word again. Remission. The dream word of people with type 2 diabetes. But is it only a dream? Not for me. As a person with type 2, it did come true. Or to be more accurate, I made it come true. It didn’t just happen. Since I achieved remission many people have asked me, “How did you do it?” and, “How are you staying in remission?”

Well, first of all, I did have help. If you read my article on the power of CGM, you will know that I don’t think I could have achieved remission without the aid of such amazing and important technology. But just having a continuous glucose monitor (CGM) isn’t the whole picture. You still have to make the commitment to using that panorama of information in ways that help you to achieve your goals in your diabetes management.

For me that meant setting goals for diet and exercise; I was also determined to do it without the aid of any medication. As a nurse, I did have a good deal of knowledge about nutrition and exercise, but not really in relation to diabetes.

First, I think that it was possible for me to achieve remission for several reasons:

1. This is a big one: I only had diabetes for about three to four months. At the time that I was diagnosed with type 2 diabetes, I was being treated for high cholesterol, so I was having labs drawn every three to four months. My most recent fasting blood sugar, from four months earlier, was 109 mg/dl. That was the first time I ever had a fasting blood glucose level over 100. Neither I nor my doctor really paid any attention to it. But four months later, after I had been experiencing symptoms (extreme thirst, peeing eight to ten times each day), my fasting blood sugar turned out to be 305 mg/dl! And even more alarming was my A1C of 10.5%. Previously it had been 5.9%.

Because of the short time I was actually living with diabetes, my pancreas was still working pretty well, and probably hadn’t lost a significant number of beta cells (which make insulin). So, that meant my chances of remission were relatively high. This gave me hope and motivation to do whatever it would take to bring my blood sugars back down.

2. As mentioned, I am a nurse. And although I see people with diabetes in surgery all the time, I was not actively involved in their diabetes management, so I was not up-to-date. But I did have the advantage of understanding diabetes and knowing the basics of what to do for it. Knowledge is power!

3. I have done every diet and exercise routine on earth! I was actually a certified aerobics instructor back in the 1980s. I had a good grasp of nutrition and a lot of experience with things like Atkins, Keto, and Mediterranean diet. Mmmm-hmmm! Been there, done that! Like, a hundred times! And I knew that any or all of them worked for me, for one reason: low carbs. AND - exercise!!

So, armed with knowledge and huge motivation, I set out! At first, my primary care provider (PCP) was reluctant to let me do this without medication, since my blood sugar was in the 300s. Those kinds of numbers, in some cases, would actually be treated with insulin. Or at least an oral medication like metformin. But again, because of the short duration of my diabetes, he agreed to give me two weeks without meds to see what I could do. This was a personal decision – and not for everyone. For many, medication can be extremely helpful – especially GLP-1 agonists and SGLT-2 inhibitors, which have been shown to help lower blood sugar and improve the health of your heart and kidneys.

AND most importantly – my doctor agreed to put me on a CGM. A nurse friend of mine told me about this amazing technology when I was first diagnosed, and you can read that story here. To be honest, I did not realize what a life-saving tool the CGM would turn out to be, but it really was.

Trying out CGM

After I got the CGM (a FreeStyle Libre, to be specific), I read all about it, then applied it (that was a breeze, and completely painless). In an hour, it was calibrated and I started scanning it at least once an hour just to see what numbers I was getting. I did do at least one finger stick a day for about a week, as I was just a bit leery of this new technology, and did not completely trust it at first. But after a few days of getting accurate and completely consistent results, I was sold. After that I only checked with a finger stick if the reading seemed off, as in very low or very high.

The true beauty of it became clear after a week or so: I realized it was like having a compass or GPS for blood sugar at hand ANY time I needed it. Twenty-four hours a day. Some of the new sensors check your blood sugar once every five minutes! That’s the equivalent of 288 finger sticks a day. Can you imagine how much information that is? It means that you can not only check your blood sugar at any point in time, but you can also watch it go up and down in real time, in response to whatever you do: eat, take meds, not take meds, sleep, exercise… It informs you of your every move and how that affects your blood sugar, even while you’re sleeping – this has significantly reduced my fear of night time hypoglycemia (low blood sugar). Some of the systems, like the Dexcom 6, have alarms that can be set to tell you when your blood sugar is getting low or is likely to get dangerously low.

Experimenting with diet: intermittent fasting

I used this blood sugar information to do things like test out different foods. Could I eat my favorite food, pho? Let’s try! Knowing the CGM would show me exactly how different foods affected my blood sugar allowed me to experiment with my diet. It gave me the confidence to try out something I considered radical: intermittent fasting. I did a lot of reading about what intermittent fasting is and how to do it safely, and with the safety belt of the CGM, I decided to try it out.

BUT. And this is a BIG but. Fasting is NOT for everyone. Especially anyone taking insulin, unless you are REALLY an expert at managing your insulin. And even then NOT without talking to your healthcare professional first, and preferably also to a diabetes care and education specialist (DCES). Obviously, not eating can seriously affect your blood sugar, and if you are taking meds and/or insulin and don’t change your dosages accordingly, there could be life-threatening consequences.

I had already been on a low-carb/keto-like diet for several weeks, which gave me a kick-start. However, intermittent fasting (16 hours of fasting, and later on 24 hours of fasting at a time) took me to the next level, and brought my blood sugars down under 180 mg/dl in a week. It decreased my appetite, after about two weeks. My cravings for sugar and carbs disappeared. My one meal of the day, between 5pm and 7pm, was a delicious, nutritious meal of foods like roasted veggies (cauliflower, broccoli, asparagus, yams) and lean proteins like chicken, pork loin, and fish, with occasional small servings of fruit for dessert (usually low-sugar fruits like blueberries, blackberries, raspberries and strawberries) with a dollop of whipped cream.

More and more research has emerged in recent years showing that carbohydrates, and NOT fat, are what’s driving the epidemic of obesity in this country. And that obesity is directly related to high insulin resistance, which leads to type 2 diabetes. Healthy fats, like olive oil and avocado oil, have been shown to be beneficial to your health - when consumed in moderation, of course. Adam Brown recalls in his brilliant book, “Bright Spots and Landmines,” how his doctor told him to eat as many carbs as he wanted - so long as he covered them with insulin! I’ve heard stories even today of people who are still told by their healthcare team to eat at least 65% of their diet in carbs. Unbelievable. That’s not to say you can’t have any carbs, but you have to pick and choose, and always in moderation. And again, the CGM allowed me to see exactly which carbs I could eat without huge rises in blood sugar.

Walking to lower blood sugars

So what about exercise? Surprisingly, I did not go crazy, with four-hour fanatical workouts. You might not believe this, but all I did was walk. Seriously. In my diabetes education class, the educator talked about that fact that even a short amount of moderate exercise causes your muscles to absorb glucose, and that the effect can last for hours. Everyone was skeptical, but she made us all promise to walk at least 15 minutes after each meal. And not a punishing, sweat-crazed walking pace. Just a moderate pace. And guess what: every single person that did it reported that their blood sugars came down significantly. And stayed there.

With the advantage of a CGM, I saw at least a 40-60 point drop consistently, with just 15-20 minutes of walking. If I upped it a bit and walked 30 minutes, sometimes it came down even 80 points or more. I also made myself walk shortly after eating, before the dreaded post-meal crash, where all you want to do is lie down. Granted, it was a challenge sometimes, but I never once felt anything but refreshed and energized. And that is SUCH a great way to feel after you eat.

Now, I have upped my game with exercise, because I would like to lose another 20 pounds. So, I’ve added resistance, both with free weights and through an exercise class that uses various types of resistance in a circuit. But I also still walk after every meal, even if it’s only ten minutes. It really makes a difference.

What’s that? Oh. There’s 15 feet of snow outside and there’s a blizzard? There are many things you can do inside your house that can get you moving, even just walking around the house. If you have stairs, and can manage them, that’s even better. No? Do chair exercises. Just sit and stand, sit and stand. Can’t stand? Do simple leg and arm raises. Anything that uses your muscles can help. Pull out those old Jane Fonda exercise videos. Or Richard Simmons. OK, I’m dating myself, but seriously, any activity is helpful in lowering your blood sugar.

Now what?

So, how am I keeping my diabetes in remission? That is very simple. Diet and exercise. I know you’ve heard that many times, but it really does work. I am continuing with intermittent fasting and sticking to a low-carb, permanent way of eating. I check my blood sugar once every couple of weeks, just to see where I am. I know that if I go back to my old ways, there is every chance the diabetes will return. That little reminder stays in the back of my mind, but it does not rule me.

I recently went to Japan for two and half weeks. By then, my fasting blood sugar had settled below 100 consistently. My A1C was down to 5.2% in four months. I was off the CGM. I was worried about how my blood sugar would do with all the rice in the Japanese diet; I had not eaten rice for almost three months. So, to test whether I really was in remission, with agreement from my PCP, I decided to eat what I wanted (in moderation, of course) and see what happened. I stuck to eating only when I was hungry (I did not intentionally fast), and only until I was just barely feeling full. I also walked an average of six miles a day in Japan. You have to walk everywhere over there, and up and down a lot of stairs. When I got home, I still had one FreeStyle Libre CGM left, so I put it on. And guess what? No change. I was still under 100 mg/dl fasting, and my mealtime blood sugars were not going over about 160 mg/dl.

I hope my story of remission will give some people hope of, at the very least, improving their quality of life. And it’s all very simple: watch what you eat, be active to the best of your ability, be consistent, and most of all, be good to yourself!

This article is part of a series on time in range. 
The diaTribe Foundation, in concert with the Time in Range Coalition, is committed to helping people with diabetes and their caregivers understand time in range to maximize patients' health. Learn more about the Time in Range Coalition here.