Thursday, November 19, 2009

Snit Post

Ok, I am probably getting PMS early, but I want to respond to an idea I see bouncing around on the internet-- that diabetes is a choice, and that if diabetics just get their acts together and do right things, they can cure their disease.

Here goes:

"Facing a diagnosis of type 2 diabetes, many people immediately ask, ‘Is there a diabetes cure?’ Unfortunately, the answer is no.

"Once you have it, you have it," says R. Paul Robertson, M.D., president, Medicine and Science, of the American Diabetes Association, and professor of medicine and pharmacology at the University of Washington, Seattle. "You can make it go into remission, but it will always be there because it is a disease linked to your genetics. You can't cure type 2 diabetes because you can't make that gene go away.” But you can make significant strides against the disease, often to the point of quitting medication.

Type 2 Diabetes: Diet and Exercise Can Feel Like a Diabetes Cure

Most people end up with type 2 diabetes for two reasons. Their body has become resistant to insulin because they are overweight or obese. And their pancreas is unable to produce enough insulin to overcome that resistance.

Diet and exercise are considered essential to treating diabetes. In fact, many people who eat right and work out every day respond so well it feels like a diabetes cure, especially if they lose a significant amount of weight and their blood sugar levels remain stable.

Unfortunately, by the time diabetes has progressed far enough to be diagnosed, the pancreas often has been damaged by the strain put on it. Many cells in the organ have ceased producing insulin altogether, and there's no way to reverse the damage. That means if the patient slacks off on diet and exercise, the diabetes will return as strong as ever.

The good news: If you catch diabetes early enough, you can prevent further damage to your pancreas. That makes diet and exercise very important, and maintaining an ideal body weight crucial. In fact, some people can control their blood sugar levels through diet and exercise alone, without having to resort to medicine."


Please believe I am not trying to belittle the critical importance of good diet and exercise. Or the importance of terrorizing your offspring into maintaining a normal weight if diabetes runs in your family :P But it is a genetic problem. You can have a normal BMI and still get diabetes. You can weigh 400 pounds and not get it. It seems terribly important to me we not forward this idea that Type 2s are somehow choosing to be diabetic. It's just not true and it adds stigma to what is already a very difficult diagnosis.

My 145 pound uncle has what used to be called "high blood sugar". My 115 pound grandmother had it. My dad, unsurprisingly, has type 2. When I was a teen with a BMI of 19, I used to faint if I didn't eat right-- hypoglycemia is a precursor to Type 2. There is some evidence that insulin resistance comes first, and the extra weight comes after-- because your body is crying out for the sugar that is circulating in the blood stream rather than gaining admission to the cells.

You take some poor soul who is always hungry, craving carbs, overweight, with a pancreas worn out from years of trying to compensate. That person becomes diabetic. Then you tell him, Gosh, why are you choosing to be diabetic? In what way is that helpful?

12 comments:

  1. Seems like a legitimate complaint to me -- not a snit! My grandfather was diabetic and was very, very careful with his diet and exercise. I was overweight as a teen (he died when I was 19) and he once took me aside and said that he didn't want to see me go down that same path. So far, I'm not diabetic, but I know that I need to be in a healthier place if I want to escape my genetic heritage as I age.

    ReplyDelete
  2. I'm with you. I don't see where that is a choice at all.

    ReplyDelete
  3. Probably one of the best posts I've read in a while. Thank you.

    ReplyDelete
  4. Well said. My husband has been diagnosed diabetic for the last two years, starting at age 54. He has never been overweight. I have been significantly overweight for 30 years and my blood sugar is under a 100, even after a high-sugar binge. He wakes up in the morning at 135, and I'm still under 100. I'm sure I don't have the gene, and I'm sure he does.

    ReplyDelete
  5. I don't know if I have the gene or not. My mother has diabetes. I work really hard to keep my weight off and eat healthy as I know food and exercise are really medication to help prevent or slow the progression of diseases like diabetes.

    ReplyDelete
  6. I apologize in advance for a terribly long comment.

    I am going to have to disagree with you a little. Before I do though, I will say that I do believe there are certain people who do not have a choice in the matter. That being said, I think there are certain people who do. For example, if someone does very, very foolish things like I did for years, they are inviting diabetes into their lives. While there is a genetic component, I don't think we are seeing the rampant increase in juvenile type II diabetes solely from genetics. (yes, I know juvenile diabetes is type I, I am talking about juveniles who get type II.) I believe that poor diets are a very large contributing factor.

    Now, with regards to whether diabetes can be cured or not, I really do not know. I have said I am cured from diabetes, however, if I went back to eating my old way again, I am sure I would be right back where I began. That being said, I suppose I am not cured, but with a fsb of 85, I sure feel that way. Just to give a little background, some of which is on my blog, and some isn't. I was diagnosed with diabetes several years ago. I straightened my eating out and my doc took me off of my meds. Even after going back to bad eating, my blood sugar remained borderline for several years. I was never formally diagnosed again, but I know I had slipped into full blown diabetes because of the signs. I would not appear to be diabetic to anyone now, although I know I have to always be careful or I will be back there again. In fact, I may go back whether I am careful or not, but I am going to fight it tooth and nail.

    I am not meaning to take away from your points, as I think overall they are legitimate, but I strongly disagree that no one has a role in whether they get diabetes or not. While that may be true for some, there are certainly some who are inviting it into their lives. Yes, they may be predisposed, but that doesn't mean they would become a diabetic without their bad eating habits.

    All that being said, no one should have to be verbally belittled because they are diabetic, especially when looking at a person from the outside doesn't tell you whether they are truly predisposed to getting diabetes and they really had little if anything to do with that, or whether they have encouraged the onset of diabetes through extremely bad eating habits.

    Of course, this is all my opinion as I am certainly no expert, and I only have my own case study and reading I have done to use as evidence.

    ReplyDelete
  7. I think you make a very good point, Steve, which is there is a strong lifestyle component to Type 2 diabetes. I don't think that's really in dispute. You certainly have done great with it. I'm not sure we could say your diabetes or my getting-awful-close is cured so much as controlled (because the underlying problem is not correctable, just the manifestations.) I just want to make the point that you can be within normal parameters in terms of diet and size and still get Type 2. To say my 115 pound, professional dancer Grandma abused her body is just not true. And you can abuse yourself terribly and bear no (outward) signs. I think type 2 is a really unfortunate marker for deciding how well someone has or hasn't taken care of themselves. It really just says more about whether or not they have the gene than anything else.

    ReplyDelete
  8. Found your blog from Casa Hice, great post. I have known a few people that it runs in their families and unfortunately they developed it despite living their entire lives with a good diet and weight.

    ReplyDelete
  9. I agree - neither of us, especially me, can call ourselves "cured", although I use that term some now. I do realize it is lurking in the background. I also agree that there are people, like your father and grandmother (I would go so far as to say you too) who did not ask for this. On the other hand, there are people like me who did.

    Good, thought-provoking post.

    ReplyDelete
  10. Ugh. Ugh ugh ugh ugh ughhhhhhhhhhh!!!!!! Snit! I'm snitting away with you! I've seen stuff like this. It twists my panties in the worst way, and I feel like it's the equivalent of people being told they can cure their cancer by having a "positive outlook." YES there is an emotional component, but that pink ribbon brigade that Barbara Ehrenreich writes about so eloquently can be so oppressive.
    And YES there is a very STRONG health-and-lifestyle component to diabetes, but I do not believe that the disease is based 100% on what people do and eat. AND I think that it is never truly "cured" although one's high BG levels can be said to be in long-term remission.

    I just hate and I mean HATE the self-righteous attitude. Ugh.

    ReplyDelete
  11. Found this post over on Foodie's blog, and wish I'd read it before replying to the original. There are a lot of people, it seems, who don't fit the "profile" and are really ticked that they still got diabetes.

    Regarding the premise, shortly after diagnosis, I found Jenny Ruhl's excellent "You did NOT Eat Your Way to Diabetes!" post (http://www.phlaunt.com/diabetes/14046739.php) and it did help me get the guilt out of the way so that I could focus on taking the best care of myself possible. My lifestyle (sedentary, eating lots of not-so-good food along with the healthy stuff) hastened my development of type 2, no doubt in my mind, but I have to wonder how much of that could be considered "choice" when the symptoms of high blood sugar (hunger, tiredness, mental fuzziness) robbed me of the mental clarity and the energy to get myself on track. I think diagnosis provided the necessary "shock," as well as ensured I got the help I needed to take better care of myself.

    ReplyDelete
  12. @ Foodie and Pubsgal, thanks for your contributions. So much of my eating in the past has been an effort to feel better-- not emotionally, but physically better. Unfortunately I came of age right during the low-fat, high-carb regime. I could play a game called "Spot the diabetic" and I don't think anybody could pick out you or Foodie or me or Steve. Because we have this condition, we have to respect our bodies-- not really a bad thing, as Foodie has pointed out. But to say that we have the condition because we're stubborn and self-indulgent just kind of blows me out of the water. Ok, snit concluded!

    ReplyDelete