But I thought…

11 09 2014

Since I have many new readers this semester, I thought I would do a little myth-busting this week. If you have heard something about diabetes that makes you scratch your head, or if you have questions in general,  please ask in the Comments and I will give it my best shot.

  1. Only old, fat people get diabetes. Based on the media’s portrayal of diabetes, I can understand why people think this. The reality is that age and obesity are linked to Type 2 Diabetes.  Type 1 Diabetes, however, strikes young children and young adults regardless of body stature and lifestyle. Actually, most T1Ds you meet are a healthy weight because exercise makes injected insulin work more effectively.
  2. Types 1 and 2 Diabetes are the same thing; they just strike at different ages. Big difference between these two types of diabetes. In Type 1, the body overproduces white blood cells in response to a virus and the extra wbc’s attack the pancreas and kill all the insulin-producing beta cells. In a matter of weeks or months, the pancreas is dead, no longer able to produce any insulin at all. Dead pancreas=insulin injections for life. In Type 2, the pancreas produces insulin and functions as it is supposed to; the body’s cells are the problem. The cells have been overworked for so long trying to process excess sugar that they get tired and become insulin resistant; in other words, the cells can’t use the insulin that is made. The pancreas senses the increasing amounts of sugar in the bloodstream due to the insulin resistance and produces even more insulin, all to no avail. Ultimately, the pancreas overworks itself producing more and more insulin until it finally just stops, leading to insulin-dependency. At this point, some would say individuals living with this progression of the disease are now Type 1, but there are big differences in how the two populations are treated medically.  For example, my father-in-law is an insulin dependent Type 2, but he doesn’t have to count carbs. My son, a Type 1, counts every single carb, every single meal, every single day. He’ll do that for the rest of his life.
  3. All forms of diabetes can be prevented. Nope. Nada. Wrong. T1D is an autoimmune disease. You get it because you are unlucky with genetics. You don’t get T1D because you are overweight or because you don’t exercise. Type 2 can often be prevented by adopting a healthy, active lifestyle…but genetics do play a role in Type 2 as well and sometimes even the healthiest individual will be unlucky enough to become Type 2 diabetic.
  4. T1D is reversible. I wish. But the unfortunate truth is that T1D is for life. There is no cure and you can’t get rid of it by maintaining a healthy lifestyle–though doing so will certainly help with managing blood glucose control. Type 2 isn’t often reversible either, unfortunately. When a person is diagnosed as pre-diabetic, they can prolong the onset of Type 2 Diabetes by eating a healthy diet and getting plenty of exercise, but they’ll have to exercise more and more as they age to maintain the same healthy blood glucose levels. At a certain point, you simply cannot exercise enough to prevent the inevitable.
  5. Diabetes is contagious/is a contagious blood disease. I actually had to correct a parent in my son’s class last year on this one. The class was having a pizza party, so my son had to check his blood sugar and inject insulin before eating the pizza. Another visiting parent flipped out because we did the finger prick in the classroom (in a private area away from the desks and other children). The parent was concerned that we had exposed her daughter and the other children to diabetes. She seemed to think diabetes was akin to HIV but worse because the “diabetes germs” could launch from a minuscule blood droplet into the air and be inhaled by her daughter. I put on my kid gloves and gave “mom” a little lesson in non-communicable diseases (6th grade health, anyone?). What really sucked is that the parent complained rather loudly before we had even gotten out the syringe to inject insulin, so the teacher asked us to go out in the hallway to administer the insulin. Ever tried to hold a test kit, syringe, and insulin AND administer an injection at the same time? We ended up having to put the test kit on the dirty floor. Now that sure is safer and cleaner, isn’t it? I lost a lot of respect for both the parent and the teacher that day.
  6. You cannot eat sweets if you have diabetes. Well, this is a toughy. Type 1’s can actually eat anything they want, but if it has carbs in it, complex or simple, they need to accompany the delectable with a healthy dose of insulin. That said, not all sweets are created equal. Candy that is pure sugar probably should be avoided simply because insulin processes sugar quickly, likely resulting in low blood sugar. Most T1Ds use sugary candy to treat lows. Sweets that contain protein (chocolate!) and a bit of fat are better choices for diabetes because they both slow the absorption of sugar into the bloodstream. Type 2’s need to be even more discriminating with their desserts because their cells and pancreas are already overworking to process sugars that naturally occur in foods (including vegetables), as well as the little bit of sugar the liver is constantly producing.
  7. Not eating carbs is the best way to treat diabetes. Wrong again. I am not a doctor or a dietician, but I know a little something about nutrition–by necessity, and NO ONE should eliminate carbohydrates all together. Besides, doing so would mean you could only eat meat. Blech! The ONLY healthy way for the body to convert food to energy is through consumption of carbs. One can/should certainly be selective about the kinds of carbs eaten, consuming carbs with low glycemic loads (ancient grains, legumes, and vegetables, for example), but cutting out carbs all together can be dangerous, especially for someone with Type 1, especially if that Type 1 is a child. If the body has no sugar to convert to energy, it uses fat. Dr. Atkins became famous for touting this as a good thing. However, the resulting ketoacidosis can kill. In addition, most foods that naturally contain carbs (fruits and vegetables) have essential vitamins and nutrients. There are multivitamins, but they contain only a fraction of the minerals your body needs daily.
  8. Diabetics have too much sugar in their blood; they don’t need to worry about hypoglycemia (low blood sugar). If a person with diabetes is on insulin, hypoglycemia is a very real concern. Determining how much insulin is needed to process carbs eaten at meals is based on trial and error. You try a ratio of insulin to carbs, and if your blood sugar is too high two hours later, you increase the ratio next time. And you keep making adjustments until your post-prandial (after meal) blood glucose is within range (usually 80-180 mg/dL). But wait! Just when you achieve that perfect ratio, other factors start influencing how well you process those carbs and insulin. While the common cold can make your blood sugar levels rise, exercise makes them drop.  Suddenly, the perfect dose is too little or too much. If the latter, you risk having a low, and lows can be dangerous, even fatal. On average, we adjust my son’s insulin ratio at least once a week, but most of the time, we are making multiple weekly adjustments. The doctors have told me not to expect my son’s blood glucose to level out until adulthood. Nice.
  9. Diabetes is a modern disease. Actually, Egyptian hieroglyphics attest to the existence and knowledge of diabetes. Egyptians used urine tasters to diagnose diabetes–if the urine tasted sweet, the individual was sent into isolation where he or she died.
  10. Diabetes is rare. We all know the incidence of Type 2 is increasing at an exponential rate, but did you know the incidence of Type 1 Diabetes has increased at a rate that far exceeds population growth? The number of diagnoses in the US, alone, increased by 23% in a ten year period between 1985 and 2004. This may seem insignificant, but when you consider that there has been a 20-25% increase every decade since the 1950s, the increase suggests we can expect more and more diagnoses in the future.
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