Type 2 Diabetes & Metabolic Health

The thread that connects these conditions

Most of what happens in metabolic health traces back to a single hormone: insulin.

Insulin has one main job, which is to move sugar out of your bloodstream and into your cells, where it can be used for energy. Every time you eat carbohydrates, your body releases insulin to handle the glucose that follows.

When that happens often enough, over enough years, your cells begin responding less to insulin’s signal. Your pancreas compensates by producing more of it. For a long time this works well enough that your blood sugar looks normal on a standard test, while your insulin levels climb quietly in the background. That can go on for a decade or more before anything shows up on a routine panel.

That state is called insulin resistance, and it does considerably more than raise blood sugar:

• It raises blood pressure. Elevated insulin signals your kidneys to hold on to sodium and water, which increases the volume of fluid your heart has to move.
• It raises triglycerides. Insulin tells your liver to convert excess carbohydrate into fat. Some of that fat goes into your bloodstream as triglycerides, and some accumulates in the liver itself.
• It makes weight loss feel impossible. When insulin is high, your body is in storage mode. Stored fat becomes much harder to access for energy, which is why eating less and moving more so often fails to work the way it is supposed to.

So blood sugar, blood pressure, triglycerides, and weight are not four unrelated numbers on a lab report. They are four windows onto the same underlying process.

This matters enormously for treatment. If you address each number separately, with a separate medication, you are managing four symptoms. If you address the insulin resistance underneath them, you have a real chance at treating what is actually driving them.

That is what our nutrition therapy is designed to do.

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Type 2 Diabetes

What type 2 diabetes is

Type 2 diabetes is diagnosed when blood sugar stays elevated over time, usually measured by an HbA1c of 6.5% or higher. HbA1c reflects your average blood sugar across roughly the previous three months, which makes it a more honest picture than any single reading.

But that elevated blood sugar is the measurement, not the disease. What is happening underneath is that your cells have become resistant to insulin and your pancreas can no longer produce enough to keep up. The sugar that should be moving into your cells stays circulating in your bloodstream instead, where over time it damages blood vessels, nerves, kidneys, and eyes.

Type 2 diabetes is frequently described as progressive, meaning it will inevitably worsen and require more medication as the years go on. That is a fair description of what usually happens under standard care. It is not a description of what has to happen. An eight-year study in UK primary care found that one in five people with type 2 diabetes were able to bring their blood sugar below the diabetic range and stop their diabetes medications entirely while following a low-carbohydrate approach.

Type 2 diabetes symptoms

Many people live with type 2 diabetes for years before noticing anything is wrong. When symptoms do appear, they usually come on gradually enough to be easy to explain away as stress, aging, or a busy season of life.

Common symptoms include:

• Increased thirst
• Needing to urinate more often, especially at night
• Fatigue, particularly in the hour or two after eating
• Blurred vision
• Cuts, sores, or infections that are slow to heal
• Frequent urinary tract or yeast infections
• Tingling, numbness, or burning in the hands or feet
• Increased hunger, sometimes shortly after a meal
• Unintended weight loss
• Darkened, velvety patches of skin, often on the neck, armpits, or groin

If several of these feel familiar, it is worth having your blood sugar checked, whether or not you already have a diagnosis.

What drives type 2 diabetes

Type 2 diabetes develops through several factors working together. Some you cannot change. The most important one, you can.

• Carbohydrate intake relative to your personal tolerance. Every carbohydrate you eat becomes glucose in your bloodstream and requires insulin to clear it. People vary widely in how much carbohydrate they can handle before this system starts to strain, and that tolerance tends to decrease with age and with years of exposure. This is the driver with the most immediate leverage, and the one that responds fastest to change.
• Visceral fat and fat stored in the liver. Fat that accumulates around the organs and inside the liver is metabolically active in a way that fat under the skin is not. It releases inflammatory signals and directly worsens insulin resistance, creating a loop where insulin resistance drives fat storage and fat storage deepens insulin resistance.
• Chronic inflammation. Low-grade systemic inflammation interferes with insulin signaling. This is one reason inflammatory markers like hs-CRP often move in the same direction as blood sugar.
• Sleep, stress, and physical activity. Poor sleep and chronic stress both raise cortisol, which raises blood sugar. Muscle is where most glucose gets used, so less muscle and less movement mean fewer places for sugar to go.
• Family history and genetics. Having a parent or sibling with type 2 diabetes meaningfully increases your risk. Genetics influence how quickly insulin resistance develops and how much carbohydrate you can tolerate, but they are not a sentence.
• Age and time. Insulin resistance builds slowly. Most people diagnosed at fifty have been developing the condition since their thirties.

You cannot change your genes or turn back the clock. But the amount of carbohydrate arriving in your bloodstream every day is something you have direct control over, and it is the lever that moves the fastest.

How Revero treats type 2 diabetes

Personalized nutrition therapy

We start with the intervention that has the most direct and immediate effect on blood sugar, which is what is on your plate.

Your care team builds a personalized low-carbohydrate, high-protein nutrition plan based on your labs, your medications, your conditions, and your goals. For type 2 diabetes, the plan focuses on removing the foods that drive blood sugar hardest: grains, sugar, and other concentrated carbohydrates. In their place you eat protein, healthy fats, and low-carbohydrate whole foods.

Two things about this are worth saying plainly, because they are the opposite of what most people have been told for decades.

We do not ask you to count calories, and we do not ask you to eat less. We change what you eat, not how much. Protein and fat are far more satiating than carbohydrate, and when blood sugar stops spiking and crashing, the hunger and cravings that make restrictive diets unbearable tend to settle down on their own. Most of our patients eat until they are full.

The plan is yours, and it can move. Your carbohydrate target and your food list are adjusted as your labs and daily biomarkers come in. If you are progressing well, your care team may reintroduce foods and widen the plan. If you want to push harder, or if you are struggling with compliance and need something more sustainable, we can adjust in either direction. This is a treatment plan, not a diet you either succeed or fail at.

The evidence base here is substantial. An umbrella review of randomized controlled trials found low-carbohydrate diets highly effective for weight loss, HbA1c reduction, and improvements in triglycerides and HDL cholesterol in people with obesity and type 2 diabetes. In a large Australian program of more than 500 patients, a low-carbohydrate approach lowered HbA1c and allowed many participants to reduce or discontinue diabetes medications, with more than half of those who started with high blood sugar dropping below the diabetes threshold.

The clinical care around it

Nutrition therapy is the engine, but it is not the whole program. Blood sugar responds to these changes quickly, sometimes within days, and that speed is exactly why this works best with a medical team watching.

• A licensed medical provider. You meet your provider by video before you begin, after your baseline labs are back. They review your full history, your current medications, and your goals, and they stay with you throughout the program. Revero has providers licensed across all 50 states.
• A smart glucose meter, included. You receive a bluetooth glucometer with unlimited test strips. Your readings sync automatically to the Revero app, so your provider and coach can see how your blood sugar is actually responding rather than asking you to recall it at a visit three months later.
• Medication management. Blood sugar can drop meaningfully once your nutrition changes. Some medications need adjusting right away to keep that safe. Your provider reviews everything you are taking before you start and continues adjusting as your numbers move. For many of our patients, that means coming off diabetes medications over time.
• Regular lab work. You complete baseline labs before you start and repeat them at three, six, and twelve months, with earlier testing if anything needs a closer look. Your panel includes HbA1c, fasting insulin, a full metabolic panel, a lipid panel, hs-CRP, vitamin D, thyroid function, and a complete blood count. Your provider reviews your cardiovascular markers with you individually and adjusts your plan based on what your results show.
• A dedicated health coach. Your coach is in touch daily, with particular attention during the first few weeks when your body is adapting. They help with the practical parts: what to actually cook, what to order at a restaurant, what to do after a hard day.

One note on scope: Revero treats type 2 diabetes. We are not able to treat type 1 diabetes, which is a different condition with different underlying causes.

What our patients see

Among Revero patients with type 2 diabetes, after three months in the program:

• HbA1c improved from 7.65% to 6.57% on average, a reduction of more than a full point¹
• Fasting blood glucose improved from 158.5 to 140 mg/dL, an 11.7% reduction¹
• Fasting insulin fell 19.3% among patients with elevated insulin at baseline, and 30.9% among those who started with the highest levels¹

In a survey of more than 11,000 people following a low-carb high-protein diet, 79% of those taking medications reported reducing or eliminating them.² In an independent Harvard Medical School affiliated study, 98% of participants with diabetes or insulin resistance reported that their condition resolved or improved, and 84% of those taking oral diabetes medications discontinued them.³

Prediabetes

What prediabetes is

Prediabetes is diagnosed when blood sugar is higher than normal but not yet high enough to be called diabetes, typically an HbA1c between 5.7% and 6.4%.

The name is a little misleading. "Pre" suggests nothing has happened yet, when in fact the underlying process has usually been building for years. By the time blood sugar drifts into this range, insulin resistance is often well established and insulin levels have already been elevated for a long time.

Here is the more encouraging way to read that same fact: prediabetes is the point where this responds most readily. Your pancreas is still keeping up. You likely have fewer years of accumulated damage and fewer medications to unwind. The same changes that take months to move an established diabetic HbA1c often move a prediabetic one considerably faster.

More than one in three American adults has prediabetes, and the CDC estimates that the great majority do not know it.

Prediabetes symptoms

Prediabetes is usually silent. Most people have no symptoms at all, which is why it so often goes undetected until a routine blood test or until it has progressed to type 2 diabetes.

When there are signs, they tend to be the kind of thing people live with for years without connecting them to blood sugar:

• Fatigue or a noticeable energy crash after meals
• Strong cravings for carbohydrates or sugar, particularly in the afternoon
• Difficulty losing weight, especially around the midsection
• Hunger returning soon after eating
• Skin tags, or darkened patches of skin on the neck or in skin folds
• Elevated fasting insulin or triglycerides on a lab panel, even when glucose looks fine

You do not need a formal diagnosis to work with us. If you suspect your metabolic health is heading in the wrong direction, we can run the labs and find out.

What drives prediabetes

The drivers are the same as those behind type 2 diabetes, because it is the same process at an earlier stage: carbohydrate intake beyond your personal tolerance, visceral fat, chronic inflammation, poor sleep, chronic stress, low muscle mass, and family history.

The difference is one of degree rather than kind. In prediabetes your pancreas is still compensating successfully. It is producing extra insulin and, for now, that extra insulin is enough to keep glucose close to normal. Type 2 diabetes is what happens when that compensation finally falls behind.

This is also why a standard fasting glucose test can miss the problem for years. Glucose is the last thing to break. Fasting insulin, which we measure at baseline and at every follow-up, tends to show what is happening much earlier.

How Revero treats prediabetes

The approach is the same, and it is usually simpler.

Your care team builds a personalized low-carbohydrate, high-protein plan calibrated to your labs and your goals. Because insulin resistance is generally less entrenched at this stage, many people find they can achieve normal blood sugar without needing an especially restrictive carbohydrate target, and they can eventually reintroduce a wider range of foods while holding their results.

You still get the full clinical program: a licensed medical provider, baseline and follow-up labs including fasting insulin and a lipid panel, daily biomarker tracking in the app, and a health coach in touch daily. If you are already taking medication for blood pressure or cholesterol, your provider manages that alongside everything else.

Most people with prediabetes are not on diabetes medication yet, which means there is nothing to taper and no medication risk to manage. It is the cleanest possible starting point.

A two-year study focused on normalizing blood sugar in people with prediabetes found that a very low carbohydrate intervention delivered with ongoing remote clinical support produced sustained improvements in HbA1c and weight, with the majority of participants no longer meeting the criteria for prediabetes.

High Blood Pressure (Primary Hypertension)

What high blood pressure is

Blood pressure is the force your blood exerts against your artery walls. It is considered elevated at 130/80 mmHg or above, though the threshold your provider treats to will depend on your age, your other conditions, and your overall cardiovascular risk.

"Primary" hypertension, sometimes called essential hypertension, simply means there is no single identifiable cause such as a kidney or hormonal disorder. It accounts for the large majority of cases. In practice, being told you have primary hypertension often means being told that your blood pressure is high, that nobody knows exactly why, and that you should take a pill for the rest of your life.

We think there is more to say than that.

For a substantial number of people, elevated blood pressure is not a mystery. It is a downstream consequence of insulin resistance. When insulin is chronically high, it signals the kidneys to retain sodium and water rather than excrete them. More fluid in a fixed system means more pressure. Elevated insulin also affects the sympathetic nervous system and the flexibility of blood vessel walls, both of which push in the same direction.

This is why blood pressure so often improves alongside blood sugar, and why it can improve quite quickly. When insulin falls, the kidneys begin releasing the sodium and water they have been holding, sometimes within the first week or two.

High blood pressure symptoms

High blood pressure is often called the silent condition, and for good reason. Most people have no symptoms at all, sometimes for years, while pressure quietly damages arteries, kidneys, eyes, and the heart.

When symptoms do occur, they are usually a sign that pressure has become quite high:

• Headaches, particularly in the morning
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Vision changes
• Nosebleeds
• Blood in the urine
• Pounding sensation in the chest, neck, or ears

Because you cannot feel it, the only way to know is to measure it. If you have not had your blood pressure checked in the last year, please do, whether or not you work with us.

What drives high blood pressure

• Elevated insulin and sodium retention. The mechanism described above. This is the driver most often overlooked, and it is the one our program targets directly.
• Excess weight, particularly around the midsection. Visceral fat contributes both mechanically and hormonally to higher pressure.
• Inflammation and blood vessel stiffness. Healthy arteries expand and contract to buffer each heartbeat. Chronic inflammation reduces that flexibility, so the same volume of blood produces higher pressure.
• Alcohol. Regular drinking raises blood pressure in a fairly direct, dose-dependent way, and reducing it is one of the more reliable non-pharmaceutical levers available.
• Sleep apnea and poor sleep. Interrupted breathing at night raises overnight blood pressure and is strongly associated with hypertension that resists treatment.
• Chronic stress. Sustained cortisol elevation raises both blood sugar and blood pressure.
• Family history, age, and kidney function. Real contributors, though less modifiable than the others.

You may have been told the main thing to do is cut salt. Sodium does matter, but for many people the more consequential question is what is telling their kidneys to hold on to sodium in the first place. That signal is largely insulin.

How Revero treats high blood pressure

Your personalized nutrition plan reduces the carbohydrate load that keeps insulin elevated. As insulin comes down, the sodium and water retention it was driving tends to come down with it. Because we also remove processed foods, sodium intake typically falls as a natural consequence rather than as a separate thing you have to police.

On the clinical side, if you have hypertension you receive a bluetooth blood pressure monitor as part of the program. Your readings sync automatically to the Revero app and are reviewed daily. Blood pressure can fall quickly on this approach, and blood pressure medications sometimes need adjusting to prevent it from dropping too far. Your provider watches your daily readings and manages that with you.

Patients in a UK primary care practice following a low-carbohydrate approach saw lasting improvements in blood pressure, weight, and cholesterol, and many were able to reduce or stop their blood pressure medications.

Among Revero patients with hypertension, average blood pressure improved from 141.6/84.2 mmHg to 126.1/76.0 mmHg after three months, a 10.9% reduction in systolic and 9.7% in diastolic pressure.¹ In the Harvard Medical School affiliated study, 93% of participants with hypertension reported that their condition resolved or improved.³

High Triglycerides (Hypertriglyceridemia)

What high triglycerides are

Triglycerides are the main form in which fat travels through your bloodstream and is stored in your body. They show up on a standard lipid panel alongside your cholesterol numbers, and they are considered elevated above 150 mg/dL, high above 200, and very high above 500.

Of everything on a lipid panel, triglycerides are the marker most directly and most rapidly responsive to what you eat. And somewhat counterintuitively, the food that raises them is not primarily dietary fat. It is carbohydrate.

When you consume more carbohydrate than your body can immediately use or store as glycogen, your liver converts the excess into fat through a process called de novo lipogenesis. Those newly created fats are packaged and released into the bloodstream as triglycerides. Fructose, found in sugar, high fructose corn syrup, and fruit juice, is handled almost entirely by the liver and is particularly efficient at driving this process.

This is why high triglycerides so rarely appear alone. They usually travel with elevated blood sugar, low HDL cholesterol, extra weight around the middle, and often fat accumulating in the liver itself. They are one of the clearest signals that insulin resistance is present, sometimes appearing on a lab panel years before blood sugar does.

High triglycerides symptoms

Elevated triglycerides typically cause no symptoms whatsoever. Most people find out from a routine lipid panel.

At very high levels, generally above 500 mg/dL, they carry a real risk of acute pancreatitis, which is a medical emergency causing severe abdominal pain, nausea, and vomiting. Some people with genetically driven extreme elevations develop small yellowish fatty deposits under the skin.

Because there is nothing to feel, testing is the only way to know. A standard lipid panel measures triglycerides, and we include one in every patient’s baseline labs and at every follow-up.

What drives high triglycerides

• Carbohydrate intake, especially sugar and refined carbohydrate. The primary dietary driver, through the liver conversion process described above.
• Fructose specifically. Sugar, high fructose corn syrup, fruit juice, and honey are metabolized almost entirely in the liver and are unusually effective at raising triglycerides.
• Alcohol. Alcohol is processed in the liver and directly promotes triglyceride production. For some people it is the single largest contributor.
• Insulin resistance. Insulin normally helps clear triglycerides from the blood. When that signaling is impaired, they clear more slowly and accumulate.
• Excess weight and visceral fat. Both raise triglyceride production and reduce clearance.
• Certain medications and conditions. Untreated hypothyroidism, kidney disease, and some medications can raise triglycerides independently, which is why we test thyroid function and kidney markers at baseline.
• Genetics. A minority of people have inherited disorders of fat metabolism that produce very high triglycerides regardless of diet. These need specific medical management, and your provider will identify this from your labs and history.

How Revero treats high triglycerides

This is the condition where the dietary lever is cleanest and works fastest. Removing sugar, refined carbohydrate, and alcohol addresses the primary inputs directly, and triglycerides typically respond within weeks rather than months.

Your personalized plan removes the foods that drive triglyceride production and replaces them with protein and whole foods. Because triglycerides are so responsive, they are often one of the first markers where patients see a dramatic change on a follow-up panel, which is genuinely motivating at a point in the program where blood sugar and weight may still be moving more slowly.

In a direct comparison, patients following a low-carbohydrate diet lost nearly twice as much weight as those on a low-fat diet, lowered their triglycerides more, and raised their HDL cholesterol. An umbrella review of randomized trials confirmed improvements in triglycerides and HDL across studies of low-carbohydrate approaches.

Among Revero patients with elevated triglycerides at baseline, average fasting triglycerides improved from 222 to 164 mg/dL after three months, a 26.1% reduction.¹ Patients who entered with elevated liver enzymes also saw improvement, with AST falling 14.2% and ALT 15.0%, which is consistent with reduced fat accumulation in the liver.¹

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What if I am taking a GLP-1?

GLP-1 medications like semaglutide and tirzepatide work, and we are not here to tell you otherwise. If they have helped you, that is a good thing.

You do not need to stop taking one to start with us. Many of our patients begin the program while still on a GLP-1, and their provider manages it alongside everything else.

What we offer is a different mechanism, and for many people, a different endpoint. GLP-1 medications reduce appetite pharmacologically for as long as you keep taking them. Our nutrition therapy works on the underlying insulin resistance, and one of its most consistently reported effects is that hunger and cravings decrease on their own. In our survey of more than 11,000 people following a low-carb high-protein diet, 91% reported improvement in cravings and hunger.

That matters practically for two reasons. GLP-1s are expensive, and appetite and weight commonly return when people stop taking them. If your goal is to eventually not need the medication, an approach that changes the underlying metabolic picture gives you somewhere to land.

If coming off a GLP-1 is something you want, your Revero provider can build a plan for it and monitor you through the transition. If it is not, that is completely fine too. We will work with you either way.

Results

Across all conditions, after three months in the Revero program:

• 25% reduction in hs-CRP, a marker of systemic inflammation¹
• 5.4% reduction in BMI among patients with obesity¹
• Meaningful improvements in quality of life, with the largest gains among patients who entered the program with the greatest health burden¹

On the experience of care itself, Revero patients give an average rating of 9.8 out of 10 for care and ongoing support, and 9 out of 10 would recommend Revero to a friend or colleague. 90% of our patients say they feel confident sustaining their nutrition therapy long term, which matters more than any single lab value, because none of this works if you cannot keep doing it.