Plans for Your Body · Blood sugar & insulin
The type 2 diabetes plan
Type 2 diabetes can go into remission. Start with your doctor.
The goal: For many people, type 2 diabetes can go into remission: HbA1c under 6.5% for three months without diabetes medication. The levers are lower insulin and less liver fat: cut refined carbs, eat in a window, fast, lift and walk. Step one is your doctor, because the medication has to come down as the numbers do.
The usual script: a pill, then two pills, then insulin, then more insulin. It treats the blood sugar and leaves the cause alone. This plan goes after the cause. It starts with a medication plan from your doctor, because lowering your sugar while still on full-dose drugs is how people end up on the floor.
- DoctorMedication plan before anything changes · how to spot and treat a low
- ChangeCut refined carbs · eating window · fasting · strength and walking
- RemissionHbA1c under 6.5%, three months off medication
Most treatment manages the sugar. This goes after what’s making it.
Not medical advice
Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.
02 Why it matters
More medication isn’t the same as getting better.
The default
Type 2 diabetes is treated as progressive: doses rise, drugs are added, and the disease is expected to win slowly. Insulin lowers blood sugar by pushing it into already-overloaded tissue, and tends to add weight while it does.
The evidence
In the DiRECT trial, 46% of people put their diabetes into remission at one year and 36% were still there at two, with diet alone. Remission tracked weight lost: 86% of those who lost 15 kg or more got there. Keeping it is harder: by five years, about a quarter of those in remission at two years were still there.
Knowing what drives the disease changes what you treat.
03 How it works
Too much sugar, stored in too little room.
Years of high insulin fill the liver and pancreas with fat. The liver stops listening to insulin and keeps releasing sugar; the pancreas struggles to keep up. Add more insulin from a syringe and the sugar has to go somewhere, usually into more fat. Empty the stores and, for many people, the system works again.
- Insulin resistance
- Cells are already full, so they resist taking in more. It’s a symptom of overload, not a shortage of insulin. One camp argues the high insulin comes first and drives the resistance, which would explain why adding more insulin rarely fixes it.
- Liver and pancreas fat
- Fat in the liver keeps it pumping out sugar overnight; fat in the pancreas blunts insulin release. Both fall with fasting and weight loss, often within weeks.
- Muscle
- Skeletal muscle is the biggest place glucose can go after a meal. Lose it and the sugar backs up into your blood; build it and you add room the liver and fat can’t offer.
- HbA1c
- Your three-month average. 6.5% or higher is diabetes. Remission means under 6.5%, measured at least three months after stopping glucose-lowering drugs.
- C-peptide
- Shows how much insulin your own pancreas still makes. Very low levels after many years make remission less likely, though better control usually isn’t.
- Time
- The shorter you’ve had diabetes, the better your odds. DiRECT enrolled people within six years of diagnosis. In Unwin’s eight years of practice data, people who started a lower-carb diet within a year of diagnosis did best by far. Later isn’t hopeless, just harder.
04 The steps
Doctor first. Then lower insulin. Then come off what you no longer need.
With your doctor · Before you change anything
Get a medication plan before you change what you eat.
- Medication reviewthe most important step
Insulin and sulfonylureas (like gliclazide) can drive blood sugar dangerously low once you cut carbs or fast. Doses usually need to come down before you start, not after. Only your doctor can set that.
- SGLT2 inhibitorse.g. empagliflozin, dapagliflozin
Combined with fasting or very low-carb eating, these can cause ketoacidosis even at normal blood sugar. Ask your doctor whether to pause them first.
- Blood pressure pillsmay need lowering too
Blood pressure often falls as insulin falls. Dizziness on standing is the sign. Tell your doctor.
- A monitoring planmeter or CGM, every day at first
Agree what readings mean “call me” and how often to check. Expect your doses to change more than once.
- Know a lowunder 4.0 mmol/L (72 mg/dL)
Shaky, sweaty, confused, heart racing. Take 15 g of fast sugar (juice, glucose tablets), recheck in 15 minutes, repeat if still low. Tell your doctor about every one.
Measure · Week 0
Know your starting point.
- HbA1cthe main number
Your diagnosis and your finish line.
- Fasting glucose, C-peptideask for both
C-peptide tells you how much insulin your pancreas still makes. HOMA-IR isn’t valid if you inject insulin, so skip it until you’re off.
- Continuous glucose monitortwo weeks
A small sensor on your arm for 14 days shows which meals spike you, how high, and for how long. Repeat every 4–6 months to see the trend. With diabetes, it’s also your early warning for lows as doses come down.
- Waist and weighttape and scale
In Lean and Taylor’s DiRECT trial, 86% of people who lost 15 kg or more were in remission at a year; of those who lost under 5 kg, only 7% were. Track the trend weekly, not daily.
Change the inputs · Months 1–6
Lower insulin every day, and fast to empty the stores.
- Sugar and refined carbscut hard
Sugar, sweet drinks, juice, white flour and most packaged snacks. The fastest lever on insulin, blood sugar and triglycerides. For type 2 diabetes, this is the fastest way to lower both your sugar and your medication needs. It’s also why the doses must come down first.
- Real foodprotein first
Build meals on protein, vegetables and natural fats: fish, meat, eggs, dairy, legumes, nuts. Protein and fibre keep you full and flatten glucose spikes.
- Eating windowdaily, e.g. noon to 8 pm
Eat inside a fixed window and not outside it. Fewer insulin spikes per day, fewer chances to overeat.
- 36-hour fastonce a week, only once your doctor has adjusted your medication
Dinner one day, then only water, black coffee or tea until breakfast two days later. A standard protocol in Dr. Fung’s clinic: long enough for insulin to fall and the body to draw on stored fat. A pinch of salt helps with headaches. Fung’s clinic often goes further, with 24-hour fasts three times a week, under supervision.
- Trainingstrength 2–3×/week, cardio 150+ min/week
Lift, and walk briskly or cycle most days. Muscle is where most of a meal’s glucose ends up, so more muscle means more room for it. Cardio makes that muscle more sensitive to insulin. A 10–15 minute walk after meals lowers the next few hours of blood sugar. Lifting matters as much: more muscle is more room to store glucose, so pair it with enough protein.
- Sleep7+ hours
One short night measurably worsens insulin sensitivity, blood sugar and appetite the next day. The cheapest part of the protocol, and the most skipped.
- Alcoholnone while fixing the numbers
It goes straight to the liver, raises triglycerides and adds to liver fat. Less is better; none is best while you’re fixing the numbers. With diabetes medication it also raises the risk of lows overnight.
Before you fast
Don’t do extended fasts if you’re on insulin or other diabetes medication, pregnant, breastfeeding, underweight, or have a history of eating disorders, unless your doctor approves.
Supplements · only with your doctor’s OK
Three with evidence. Your doctor needs to know about each.
- Psyllium husk~5 g, twice a day, with a full glass of water
A soluble fibre. Always with plenty of water: taken dry, it can choke or block. Taken before meals, it blunts the blood-sugar rise; the effect was largest in people with type 2 diabetes.
Find it on Amazon: Psyllium husk - Berberine500 mg, twice a day, with meals
A plant compound studied for blood sugar and lipids; about 1 g a day worked best in pooled trials. Stomach upset is common. It interacts with several medications, adds to the effect of diabetes drugs, and isn’t for pregnancy or breastfeeding. Pooled trials found lower fasting glucose and HbA1c. Because it adds to diabetes drugs, it can contribute to lows: your doctor needs to know.
Find it on Amazon: Berberine - Magnesium~300–400 mg a day of elemental magnesium, with food
Lowered blood pressure by about 2 mmHg in pooled trials, and modestly improved blood sugar in people with or at risk of diabetes. Small, but cheap and safe for most. Loose stools are the usual side effect. Avoid with kidney disease, and take it a few hours apart from thyroid pills, osteoporosis pills and some antibiotics. Modestly improved fasting glucose in people with diabetes.
Find it on Amazon: Magnesium
Remission · Months 3–12
Come off what you no longer need. Then prove it.
- Step downyour doctor leads
As your readings fall, your doctor reduces or stops medication, one step at a time. Never stop a drug yourself.
- The remission testHbA1c 3 months after the last drug
Under 6.5% at least three months after stopping glucose-lowering medication is remission, by the international definition.
- Stay thereyearly HbA1c
Remission lasts as long as the habits do. In DiRECT’s five-year follow-up, regaining weight was the usual way people fell out of remission. Keep the window and the training, and keep weighing in.
- If the numbers won’t moveyour doctor
Take the before-and-after numbers to your doctor. Whether you need medication is their call. Needing it isn’t failure. If you can’t come off everything, lower doses and better numbers are still a win.
05 The rules
Short list. No exceptions.
Choose
- A medication plan from your doctor before you start
- Protein and vegetables at every meal
- A fixed eating window, and fasting your doctor has cleared
- A walk after meals, and strength training 2–3 times a week
Avoid
- Cutting carbs or fasting on full-dose insulin or sulfonylureas
- Sugar, sweet drinks, juice and white flour
- Stopping any medication on your own
- Ignoring a low. Treat it, then tell your doctor
Non-negotiables
- Your doctor adjusts medication. You don’t.
- Check your blood sugar as often as your doctor says, especially in the first weeks.
- Know the signs of a low and carry fast sugar.
- Remission means HbA1c under 6.5% off medication for three months. Until then, it’s progress.
06 Checkpoints
What to track, and what remission looks like.
Your doctor sets your targets. These are the standard thresholds.
| What | Target | How and when |
|---|---|---|
| HbA1c | <6.5% off medication for 3+ months = remission | Every 3 months while changing doses, then yearly. |
| Fasting glucose | <7.0 mmol/L (126 mg/dL), heading under 6.1 (110) | Morning meter reading or CGM. |
| CGM readings | Mostly 3.9–10.0 mmol/L (70–180 mg/dL), no lows | Two weeks at a time, more often while doses change. |
| Medication | Fewer drugs, lower doses | Keep a list with dates. Your doctor makes every change. |
| Weight and waist | Down, and staying down | Weekly. Waist under half your height is the long-term goal. |
| Lows | None | Every reading under 4.0 mmol/L (72 mg/dL) goes to your doctor. |
Converted values are rounded. Your doctor’s targets win over this table.
07 Where experts disagree
Where the experts don’t agree.
Remission is no longer a fringe idea: the major diabetes societies have agreed on a definition. The arguments are about how to get there, and who can.
Is it the carbs, or the weight?
Insulin first: Fung, Unwin
High insulin from constant eating and refined carbs drives the disease. Fasting and carb restriction lower insulin directly, and blood sugar can improve before much weight comes off. In Unwin’s NHS practice, a lower-carb diet put about one in five of all his patients with type 2 diabetes into drug-free remission.
Weight first: Taylor, Lean
Fat in the liver and pancreas is the driver. Lose enough, by any diet, and remission often follows; DiRECT used a low-calorie formula diet, not carb restriction, and remission rose with every extra kilogram lost.
Our read They agree on the target: empty the liver and pancreas. Low-carb eating and fasting are among the easiest ways to do it. Pick what you’ll sustain.
Is remission realistic after years on insulin?
Yes, often: Fung
Case reports from his clinic show people on high-dose insulin coming off it within weeks of supervised fasting.
Be careful: Lean, Taylor
Case reports aren’t trials. DiRECT excluded people on insulin and those diagnosed more than six years earlier, so its numbers don’t apply to them.
Our read The earlier, the better your odds. After years on insulin, full remission is less certain, but lower doses and better numbers are very achievable, with your doctor.
Remission, reversal, or cure?
“Reversal”: low-carb advocates
The disease is reversible, so call it that.
“Remission”: the consensus panel
Blood sugar can rise again if the causes return, so “remission” is the honest word, and “cure” is out.
Our read Remission. It’s accurate, it’s what doctors recognise, and it reminds you the habits are the treatment.
08 Limits
What this plan won’t fix.
A worn-out pancreas
After many years, some people’s pancreas makes too little insulin to manage alone. They may always need some medication. Less of it is still worth winning.
Damage already done
Remission lowers future risk, but existing eye, nerve and kidney damage needs its own care. Keep your eye exams and foot checks.
It can come back
Regain the weight, go back to the old diet, and the numbers follow. Remission is maintained, not achieved once.
The plan treats the cause. It can’t undo every year the cause had.
09 Resources
Worth your time.
The Diabetes Code
Fung’s case for treating type 2 diabetes with diet and fasting rather than ever more insulin.
Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin
Three patients, 70+ units of insulin a day, off insulin within weeks. Short and readable; three case reports, not a trial.
5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT)
The honest long view: remission is possible and lasting for some, and weight regain is what usually ends it. Open access.
Low-carbohydrate diets for adults with diabetes
Diabetes Canada’s position, including adjusting insulin and sulfonylureas first.
What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss
What a lower-carb approach looked like in a real NHS practice. Observational, not a trial, but practical and open access.
10 Questions
Questions, answered plainly.
Can type 2 diabetes be reversed?
It can go into remission: HbA1c under 6.5% at least three months after stopping diabetes medication. In the DiRECT trial, 46% of participants got there at one year and 36% were still there at two; by five years it was 13%. It isn’t guaranteed and it isn’t a cure, but better numbers on less medication are worth having either way.
Can I fast if I’m on insulin?
Only with your doctor adjusting your insulin first. Fasting on a normal insulin dose can cause dangerous lows. Fung’s clinic fasts patients on insulin, under close supervision.
How long does remission take?
Blood sugar often improves within days to weeks, and medication can come down quickly. Proving remission takes at least three months after the last drug is stopped.
What is a good blood sugar for someone with diabetes?
Your doctor sets your targets. Common goals are fasting 4–7 mmol/L (72–126 mg/dL) and HbA1c of 7% or lower while on medication; remission is under 6.5% off medication.
Do I have to stay low-carb forever?
You have to keep doing whatever got you there. Most people can loosen up a little once in remission, and your retests will tell you how much.
11 Sources
Where this comes from.
Experts drawn on
- Jason Fung, MD — Nephrologist, Toronto. Author of The Diabetes Code; his clinic uses supervised fasting for type 2 diabetes.
- Roy Taylor, MD — Professor of medicine and metabolism, Newcastle University. Co-led the DiRECT remission trial; showed liver and pancreas fat fall as remission begins.
- Mike Lean, MD — Professor of human nutrition, University of Glasgow. Co-led the DiRECT remission trial and its five-year follow-up.
- David Unwin, MBBS — GP, Norwood Surgery, Southport, England. Has used a lower-carb approach in routine NHS practice since 2013 and published the results.
- Matthew Riddle, MD — Endocrinologist, Oregon Health & Science University. Led the international consensus on defining remission.
Sources
- Consensus report: definition and interpretation of remission in type 2 diabetes. Diabetes Care / Diabetologia (ADA, EASD, Endocrine Society, Diabetes UK), 2021.
- Primary care-led weight management for remission of type 2 diabetes (DiRECT). The Lancet, 2018.
- Weight loss can put type 2 diabetes into remission for at least two years (DiRECT two-year results). University of Glasgow, 2019.
- Therapeutic use of intermittent fasting for people with type 2 diabetes as an alternative to insulin. BMJ Case Reports, 2018.
- Low-carbohydrate diets for adults with diabetes. Diabetes Canada.
- Definition, classification and diagnosis of diabetes, prediabetes and metabolic syndrome. Diabetes Canada Clinical Practice Guidelines.
- Psyllium fiber improves glycemic control proportional to loss of glycemic control: a meta-analysis. American Journal of Clinical Nutrition, 2015.
- Effect of berberine on cardiovascular risk factors: systematic review and dose-response meta-analysis. Frontiers in Nutrition, 2022.
- Oral magnesium supplementation for treating glucose metabolism parameters in people with or at risk of diabetes: a systematic review and meta-analysis of double-blind randomized controlled trials. Nutrients, 2021.
- 5-year follow-up of the randomised Diabetes Remission Clinical Trial (DiRECT) of continued support for weight loss maintenance in the UK. The Lancet Diabetes & Endocrinology, 2024.
- What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss. BMJ Nutrition, Prevention & Health, 2023.
Not medical advice
Discuss everything here with a medical doctor before acting on it — supplements included. Your doctor has your bloodwork and history. We have neither.