Can Type 2 or Type 1 diabetes be not only reversed, but cured? Can beta cells start producing enough insulin? Can the liver store glucose better, and can body cells learn to handle glucose more efficiently?
We always hear that diabetes is incurable, and so far it has been. But people are trying. Diabetes affects so many organs; we’ll have to investigate them one at a time. This week we’ll look at beta cells in the pancreas.
If you have Type 1 or 2 diabetes or prediabetes, you have damaged beta cells. So you don’t have enough insulin, and what you have may not be released when it’s needed. If the cells were healed, diabetes would pretty much go away. But is this possible, and how could it be done?
In Type 1 diabetes, cells from the immune system attack and destroy beta cells. Type 1.5 diabetes or LADA (latent autoimmune diabetes of adults) probably involves a similar process.
So restoring beta cells in Type 1 or 1.5 will probably require changing the immune system. Reducing the need for insulin by eating a healthy diet helps, but I don’t know of any Type 1s or people with LADA who recovered normal beta cell function by diet alone.
Many are looking at surgically replacing beta cells. Hundreds of experimental “islet cell transplants” have been done. But the results aren’t great. This approach will only work if we could also “turn off” whatever process is killing beta cells in the first place. But there’s a lot of money in it, so I’m sure the research will continue.
Research is going on into drugs that might stop the immune system’s attack. A drug called teplizumab is being studied and shows promise. But as a person with an immune disease of my own, I’m pretty sure this progress will be slow. The immune system is not well understood yet.
Beta cells in Type 2
People with Type 2, however, recover beta cell function all the time. A study done in Seattle found that beta cells subjected to high glucose levels (about 288 mg/dl in a test tube) lost function rapidly. But when switched to a low-glucose environment (about 15 mg/dl), most of them recovered normal insulin production.
The longer the cells had stayed in the sugary solution, the longer it took them to recover. The researchers said that the damage might be irreversible after too much time in the glucose bath. They couldn’t say how long that time would be.
In 2011, a widely-reported British study found that beta cells recovered in a couple of weeks in most (not all) people eating 600 calories a day. Most of these people had been diagnosed with Type 2 fairly recently.
A study of African-Americans with extremely high glucose (559 mg/dl, on average) was done in Brooklyn and published in 2001. Eleven of 26 people recovered beta cell function, stopped their medicines, and had near-normal A1C results after a few months. The improvement lasted for the year and a half of follow up.
Subjects had been treated with insulin or a sulfonylurea drug, and coached on diet change. The drugs are not known to heal beta cells, so it must have been the normal blood glucose levels that did it. Their beta cells had been taken out of the glucose bath.
However, 15 of 26 people continued to require drugs. Researchers said there was “no significant difference in age, sex, plasma glucose at presentation…, body-mass index, magnitude of weight change or pharmacological agents used for treatment between the two groups.” So we don’t know why some healed and some didn’t. I’m guessing the non-responders had had undiagnosed Type 2 for a longer time.
In 2009, researchers in Pittsburgh led by Dr. Andrew Stewart found that, in humans, the proteins cdk-6 and cyclin D1 caused beta cells to regenerate after they had been destroyed by diabetes. Cdk-6 is not easily measurable in rodents (where most of the research is done), so it had not been previously studied.
Dr. Stewart’s team wrote that drugs based on these proteins might stimulate beta cells growth in humans, which could put diabetes into permanent remission.
The idea of “resting” beta cells is often discussed. An article in Diabetologia in 2008 said the simplest way to rest beta cells was by reducing demand for insulin. The authors suggested this could be done with metformin, glitazone drugs, or insulin. They report on a study that showed “bedtime administration of NPH insulin resulted in significant improvements in [insulin function] in response to glucose.” However, they go on to say that no studies have yet confirmed that any of these drugs actually cause beta cells to grow back.
Healing beta cells without drugs
Can improved diet, stress reduction, and/or exercise heal beta cells? If “resting” them is important, eating fewer carbohydrates should give them a chance to recover.
Another way to take pressure off beta cells is by lowering insulin resistance. According to Charles Burant, MD,
All you have to do is [increase] your insulin sensitivity just a small amount…and you can remarkably decrease the amount of insulin secretion that you need to maintain normal blood glucose levels. So what we need to do is get…[people’s] insulin sensitivity improved so that their beta cells don’t have to work so hard.
The herbal medicine site Green Med Info lists black cumin seeds, vitamin D, berberine, bitter melon, curcumin, chard extract, and more as helping beta cells grow and heal, although mostly in rodent studies.
To me, it seems keeping glucose down is the key to regenerating beta cells. But the longer they’ve been damaged, the longer they’ll take to come back. “Longer” could stretch into “never” in the worst cases.
But most people can do it eventually. The pancreas is only one organ involved in diabetes, though. Next week, we’ll look at the liver.