By Helen Chow, ND, Dip Herb, UK-qualified Naturopath & Herbalist
Nutrition-Food Coach, Designer Realities Mind Coach
Originally published September 4, 2017. Reviewed & Updated September 29, 2026ed &
For years, being told you had type 2 diabetes sounded rather final.
You had diabetes. You would always have diabetes. You learned to manage it, took whatever medication was necessary, watched your blood sugar and tried not to think too much about what might happen twenty years down the road.
But the conversation has changed.
We now know that some people with type 2 diabetes can bring their blood sugar back below the diabetes range and keep it there without glucose-lowering medication.
There is a name for that. It is called remission.
And if you’ve recently been diagnosed with type 2 diabetes — or you’ve been living with it for a few years — that’s something worth knowing about. Not because I want to give you false hope.
Quite the opposite. I want you to understand what may actually be possible.
First, remission doesn’t mean “cured”
This distinction is important.
When type 2 diabetes goes into remission, your blood glucose has fallen below the diagnostic diabetes range and stayed there for at least three months without glucose-lowering medication.
In numbers, that generally means an HbA1c below:
48 mmol/mol — or 6.5%.
If you’ve been following this series, you’ll remember that we talked about HbA1c and blood sugar numbers and what they can tell you about what’s happening metabolically.
But remission isn’t the same thing as saying, “Wonderful, the diabetes has disappeared for ever.”
It can return. Blood sugar can rise again, particularly if the metabolic conditions that contributed to the diabetes return. That’s why I prefer the word remission rather than “reversal” or “cure”.
You’ve changed what your body is doing. You haven’t necessarily erased your susceptibility to type 2 diabetes.
And that’s actually quite an empowering distinction. Because it means there may be quite a lot you can influence.
So what has actually changed inside your body?
This is where things get interesting. Type 2 diabetes isn’t simply a case of “you ate too much sugar”. Long before glucose becomes obviously high, your body may already be struggling with insulin resistance.
Your pancreas produces insulin, but your tissues aren’t responding to it as efficiently as they should. So the pancreas compensates. It produces more.
For quite a while your blood glucose may still appear perfectly respectable even though insulin is working overtime behind the scenes.
Eventually, however, the system may no longer compensate adequately. Blood glucose rises. HbA1c rises.
And somewhere along the way you hear the words: “You have type 2 diabetes.”
But here’s the fascinating part: In some people, the process can move in the other direction.
Your liver and pancreas matter more than you might think
One of the most interesting pieces of diabetes research has looked at what happens to fat stored inside and around organs, particularly the liver and pancreas.
This isn’t simply about whether you look overweight. Your body has only so much capacity to safely store excess energy in ordinary fat tissue.
Once your own personal storage capacity is exceeded, fat may begin accumulating where you don’t particularly want it — including the liver. The liver becomes less responsive to insulin and can release too much glucose into your bloodstream.
Meanwhile, excess fat around the pancreas appears to be associated with impaired function of the beta cells that make insulin.
Researchers at Newcastle University have spent years investigating this.
And when sufficient weight was lost by people with relatively recent type 2 diabetes, liver fat could fall rapidly and pancreatic function could improve over time. In some people, normal glucose control returned.
That is one of the important biological explanations for remission.
“But… does that mean I have to lose 15 kilos?”
Not necessarily. You’ve probably seen the figure 15 kg — roughly 2 stone 5 pounds — mentioned in discussions about diabetes remission.
There’s a good reason for it. In the landmark DiRECT study, people who achieved greater weight loss had much higher rates of remission. Among those who lost 15 kg or more at one year, remission rates were particularly impressive.
But please don’t turn that into another magic number. Human beings don’t come out of a factory with identical metabolic settings.
One woman may develop type 2 diabetes at a much lower weight than another. That has led to the idea of a personal fat threshold. In other words, the important question may not simply be: “Am I obese?”
It may be: “Am I carrying more fat than my own body can safely store?”
And there is some fascinating research behind this.
A small study called ReTUNE looked at people with type 2 diabetes who weren’t classified as obese. Their average BMI was below 25. After losing roughly 6–10% of their body weight, many of them achieved remission too.
That’s rather important. It tells us that you cannot necessarily look at a woman and know what is happening metabolically inside her.
Weight loss after 50 needs to be smarter
This is where many conventional weight-loss conversations become far too simplistic.
If you’re 25, losing weight while sacrificing a little muscle may not immediately frighten you. However, if you’re 55, 65 or 70, you really don’t want to enthusiastically lose five kilos of “weight” without asking: “What exactly did I lose?”
- Fat?
- Muscle?
- Water?
- Bone-supporting lean tissue?
Because after 50, muscle matters enormously. Muscle isn’t simply there to make your arms look toned.
- Muscle is metabolically active tissue.
- It helps dispose of glucose.
- It supports insulin sensitivity, mobility, balance, strength and your independence as you age.
So if your aim is better metabolic health — whether or not you ultimately achieve formal diabetes remission — I want you to lose fat without losing muscle, not simply make the number on the bathroom scales smaller.
This is not vanity weight loss. It’s metabolic restructuring.
Is there one “diabetes remission diet”?
No. And this is an area where people can become unnecessarily tribal. One person insists you must go very low carbohydrate. Another says Mediterranean. Another insists on fasting. Another tells you only a low-fat diet works.
The best-established clinical remission programme in Britain used a very-low-calorie total diet replacement for a period of time, followed by structured food reintroduction and long-term weight-maintenance support.
That doesn’t mean soups and shakes are the only way human metabolism can improve.
They’re a method of achieving substantial energy reduction and weight loss.
Research on lower-carbohydrate diets also shows that they can improve HbA1c, blood glucose, triglycerides and weight in people with type 2 diabetes, particularly in the shorter term.
Some people find reducing carbohydrates enormously helpful because it lowers the glucose load coming in and may make hunger easier to manage. Others do better using a different dietary structure.
For me, the interesting question isn’t: Which diet has the cleverest name?
It’s: Can you reduce the metabolic burden on your body, lose excess fat if you carry it, get sufficient protein and nutrients, preserve your muscle — and live this way long enough for it to matter?
That’s a much more useful conversation.
Exercise helps — but you can’t out-walk everything
Exercise deserves a place here too. When your muscles contract, they use glucose.
Regular movement can improve insulin sensitivity, help lower HbA1c, support cardiovascular health and make maintaining lost weight considerably easier.
And after 50, I particularly like the combination of:
- walking and ordinary daily movement
- some aerobic activity
- resistance or strength work
- enough protein to support the muscle you’re asking your body to keep.
But exercise by itself has not been shown to be a reliable way of putting type 2 diabetes into remission.
It is one part of the metabolic picture. An extremely useful part — especially when we’re also thinking about your next ten or twenty healthy years — but not the whole picture.
And what about medication?
Please don’t suddenly stop diabetes medication because you’ve read an article about remission. As your diet, weight and blood glucose change, your need for medication may change too. But that should be monitored. This is especially important if you’re taking insulin or medicines that can cause low blood sugar.
There is another important caution if you’re considering a very-low-carbohydrate or ketogenic diet.
Some people taking SGLT2 inhibitor drugs, such as dapagliflozin or empagliflozin, can have an increased risk of diabetic ketoacidosis when carbohydrate intake is sharply reduced.
So this is one of those occasions when “natural” and “medical” shouldn’t be sitting on opposite sides of the room refusing to speak to each other.
Use the information. Understand your metabolism. Then work intelligently with whoever is monitoring your diabetes.
What if you don’t achieve remission?
This matters enormously. Please don’t turn remission into another pass-or-fail health test.
Suppose
- your HbA1c falls beautifully.
- Suppose you lose visceral fat.
- Your blood pressure improves.
- Your waist becomes smaller.
- You become stronger.
- You need less medication.
- Your liver becomes healthier.
- Your triglycerides fall.
- You walk upstairs without becoming breathless.
- But technically, your HbA1c remains just inside the diabetes range.
Was all that work a failure? Of course not.
Health isn’t a certificate you either receive or don’t. Remission is an exciting possibility. Metabolic improvement is the bigger goal.
And every improvement you make changes the terrain you’re asking your body to live in.
Can remission last?
For some people, yes. But maintaining it is the harder part.
The original DiRECT trial showed that remission was achievable for a substantial number of participants after major weight loss.
The five-year follow-up gave us another piece of the story. Some people maintained remission for years. Others regained weight and their diabetes returned.
That doesn’t make the original remission meaningless. It tells us something very practical: The body responds to what we continue doing.
Losing weight once isn’t the finish line. Maintaining the metabolic changes is where the real work — and the real lifestyle — begins.
Which is why I’ve never been terribly interested in diets you survive for six weeks and then abandon. I want you building a way of living that still makes sense next year. And five years from now.
If you’re over 50, it’s not too late to improve your metabolism
Perhaps that’s the message I’d most like you to take away.
- Your body is not frozen in its current state.
- Insulin sensitivity can improve.
- Liver fat can change.
- Visceral fat can change.
- Muscle can be built.
- Blood glucose can improve.
- Medication requirements can sometimes change.
And yes, for some people with type 2 diabetes, remission is possible. However, there are no guarantees.
The longer diabetes has been present and the more beta-cell function has been lost, the harder remission may be to achieve.
But please don’t translate “not guaranteed“ into “nothing I do matters.” Those are two completely different statements.
At Health Sifu, this is the way I want us to approach metabolic health after 50. Not chasing perfection. Not punishing ourselves for what happened during the last twenty years.
And certainly not spending the next twenty years believing your future is already decided. This is really what I mean when I talk about building your next twenty healthy years — protecting your metabolism, your muscle, your independence and the life you still want to live.
Instead:
- Understand what’s happening.
- Change what you can change.
- Build muscle.
- Lose harmful excess fat where appropriate.
- Eat in a way your metabolism handles well.
- Move your body.
- Watch your numbers.
- And keep making smarter choices!!!
A Health Sifu Note
If there’s one thing I want you to take away from this article, it is this: A diagnosis of type 2 diabetes does not mean your future is already written.
Remission may be possible for some people. For others, the win may be better blood sugar, less medication, lower visceral fat, improved strength, a healthier liver, more energy and a much stronger metabolic foundation.
All of those matter.
You don’t need to chase perfection. You need to understand what your body is asking for, make the changes that matter most, and keep moving in the right direction.
After 50, I’m far more interested in helping you build a body that will carry you well into your next twenty years than in chasing a number on the bathroom scales.
Health Sifu
Make Smarter Choices.
Consciously. Deliberately.
Scientific References & Further Reading
International consensus definition of type 2 diabetes remission — American Diabetes Association, European Association for the Study of Diabetes, Diabetes UK and others. The consensus defines remission as HbA1c below 6.5% (48 mmol/mol) for at least three months without usual glucose-lowering pharmacotherapy and stresses that continued monitoring remains necessary.
Read the consensus report
Diabetes UK — What is type 2 diabetes remission? A clear patient-friendly explanation of remission, why it isn’t considered a cure, and why routine diabetes checks should continue.
Read Diabetes UK’s remission guide
DiRECT five-year follow-up — The Lancet Diabetes & Endocrinology, 2024. At five years, 11 of 85 extension participants were in remission; among participants who had been in remission at year two and were followed to year five, 26% remained in remission. Sustained weight loss remained central to maintaining remission.
Read the DiRECT five-year study
NHS Type 2 Diabetes Path to Remission Programme. NHS England now offers an intensive weight-management remission programme to eligible people with relatively recently diagnosed type 2 diabetes. Early programme data found remission in 32% of participants with the required follow-up measurements, alongside average weight loss of almost 16 kg.
Explore the NHS remission programme
ReTUNE study — type 2 diabetes in people of normal BMI. This small mechanistic study found remission in 14 of 20 participants after weight loss, supporting the concept that an individual’s personal fat threshold may matter more than BMI alone.
Read the ReTUNE research
Newcastle University — liver fat, pancreatic fat and the mechanisms of remission. Newcastle researchers describe evidence that substantial weight loss can reduce liver and pancreatic fat and allow insulin production and glucose regulation to improve in some people with relatively recent type 2 diabetes.
Explore the Newcastle diabetes research
Low-carbohydrate diets and diabetes remission — BMJ systematic review and meta-analysis. Low-carbohydrate diets produced better short-term glucose, weight and triglyceride outcomes than comparison diets in several trials, although remission advantages were less certain at 12 months and long-term adherence remains important.
Read the BMJ review
Exercise and type 2 diabetes remission — Diabetes UK. Exercise improves insulin sensitivity, glucose control and weight maintenance, but current evidence does not show that exercise alone reliably produces remission.
Read about exercise and remission
Muscle and healthy ageing with diabetes — ADA Standards of Care 2026. Current guidance emphasises adequate protein and resistance, weight-bearing and aerobic activity, particularly for older adults losing weight, to help preserve lean mass and physical function.
Read the 2026 older-adult diabetes guidance
Low carbohydrate diets and diabetes medication safety — Diabetes UK. People using insulin, sulphonylureas or SGLT2 inhibitors may require medication review when substantially reducing carbohydrates; SGLT2 inhibitors require particular caution because of ketoacidosis risk.
Read the Diabetes UK low-carb guidance
Leave a Reply