Thursday, January 20, 2011

Heated Debate: Does Diabetes Ever "Go Away"?

I subscribe to feeds/email updates on several blogs that I regularly follow.  On Tuesday, I received one from "Keeper of the Home, Naturally Inspired Living for the Christian Homemaker" with a post from a guest blogger entitled "What is 'Real' Health?"  Although the basic tenants of the author's message were good (eating and living healthier to achieve better health), I took issue with her including diabetes on her "Signs of Not So Good Health" in the article.  It was not the fact that she was suggesting that a better lifestyle would make you healthier that angered me (in fact, I agree 100% on that one); rather, it was her argument that losing weight and improving diet & exercise habits would make Type 2 diabetes go away. 

Here is my response:
I have Type 1 Diabetes. It is not because I'm "unhealthy"; I'm not overweight, I eat right, and I take care of myself. Type 1 Diabetes is an autoimmune disease caused by a genetic predisposition paired with an environmental trigger...Not bad health. Unless by bad health you mean an entirely unpreventable genetic predisposition coupled with a similarly inexorable environmental factor. To suggest otherwise is to further reinforce the notion that these diseases are the person’s fault and that a change in diet is going to make them go away. Becoming and staying as healthy as possible isn't going to make Diabetes of any kind "go away". It may become more controllable and something that doesn't require as much daily disruption, but once you’re diagnosed with it, it's always going to be a serious health concern that requires attention. To suggest otherwise is simply irresponsible. There are already too many people that ignore their Diabetes to the further detriment of their health; too many “miracle cures” that encourage people to stray away from the proper management of their disease.
Therefore, to include Diabetes on your "Signs of Not So Good Health" is to misinform the general public and further reinforce the common misconception that all Diabetes is caused by poor health habits, such as eating too many sweets. This gives some people without diabetes a superiority complex that causes them to make people with Diabetes feel like it is THEIR FAULT they developed the disease. It’s so important to point out that you have to have the gene to get Diabetes--you could be 500 lbs and not leave the couch all day, but if you don’t have the gene, you’ll never develop the disease. Yes, the incidence of Type 2 Diabetes is on the rise, and some cases are preventable, especially in those who are overweight or obese. Being diagnosed with Prediabetes in particular allows the person an opportunity to become healthy and prevent the development of Type 2 Diabetes.
Don’t get me wrong, I’m all for being/becoming as healthy as possible; since being diagnosed with Type 1 Diabetes, I’ve become the healthiest I’ve ever been. Being diagnosed with a chronic illness is a major motivation to take care of yourself as well as possible. HOWEVER, as I’ve already stated, it’s horribly detrimental to misinform both the people affected by these diseases and those who are not because it makes life harder for those of us who have to deal with the day to day challenges that these diseases entail. It’s not something you can “overcome;” it’s only something you can manage as a part of living well. I don't doubt your intentions are good, and the overall message is great, but in the future, please, please, PLEASE review the current medical literature before making claims of this nature, especially since there are many who will take your word as scientific fact.
I received this reply from the "Keeper of the Home" site admin/main blogger:
@Ashley, I think that Kate was probably referring more to Type 2 diabetes, which develops later in life. Type 1 diabetes is certainly a serious illness that needs to be properly treated. I do think it's important to mention that it can be managed in many cases through dietary and lifestyle changes, as it sounds like you yourself have done. :)
To which I responded:, I agree that she is most likely referring to Type 2 rather than Type 1 Diabetes. However, it would have been helpful for her to mention this, as the two Types are very different in their causes and treatment!
I have been making dietary and lifestyle changes, but this only helps to some extent--eventually, most people with Diabetes (of either type) will need insulin to properly control their BG numbers (according to my CDE and the classes I've taken), which in turn prevents complications. And after all, isn't that the most important thing?
I elected to make this switch early on, while I'm still in the "honeymoon" phase of Type 1 (when your body still makes some insulin and numbers are easier to control). I started with diet & exercise, then moved on to Janumet (sitagliptin/metformin) when my numbers were inexplicably high. This was around the time we found that I had slow-onset Type 1 rather than Type 2 Diabetes. My numbers kept rising, so I chose to start insulin therapy recently. I think the end result (lower BG numbers and less risk of complications) is much more important than the form of treatment, be it diet & exercise, oral meds, or insulin. It's also important to point out that the failure of any of these treatments (not including insulin, of course) does not mean the patient is being noncompliant or not making healthy lifestyle choices; sometimes, the current treatment simply isn't enough to properly control the disease. This may seem like a minor distinction, but trust me, when you already feel like it's somehow your "fault" you developed this disease, it means the world to know that some things are truly beyond your control and sometimes will not respond to the changes you're making, however positive.
Again, I agree that dietary and lifestyle changes are very important not only to disease management, but to overall health...But again, this disease usually requires much more than that to be properly managed! =)

From the post's writer:
@Ashley, Yes, I was talking about Type 2. And it's critical to understand that MANY of these cases CAN be completely managed or eliminated. There are plenty of people I've talked to who have! Drew Carey would be the most famous and recent example....
The thing is, in type 2, it's primarily about insulin resistance, often due to obesity. If you can lose weight and get your adrenal glands on track, and your hormones working properly, your body will not be resistant to insulin any longer. This is not true in type 1; but it is true in type 2. Many, many people CAN make changes to be healthier! And many have.
I am also not intending to "blame" anyone for their health; in most cases, diseases developed because there was a lot we did not know. Most people believe they are doing their best because they only have so much information. Doctors often don't tell people the right stuff. Such as, eat lots of grains, fake sugars, and not too much fat! That's a recipe to get sick, but it's what doctors tell you. So it is not anyone's FAULT, I am just saying that regardless of where you are, you can feel good again, you can have hope.

And finally, my reply to that piece of information:, Managed, yes. Eliminated, no. Even if, as you suggest, insulin resistance is decreased through weight loss, it doesn’t change the fact that you have diabetes. Your pancreas produces less insulin over time, so even if weight loss fixes the problem in the present, your blood glucose numbers will likely rise again in the future and require attention again. Insulin resistance does not “disappear” in these cases; it is simply much more manageable as your body more efficiently uses the insulin it makes. But what about the cases of Type 2 in which the body doesn’t produce enough insulin in the first place? In these cases, it’s not insulin resistance that is the problem, but insulin deficiency. Many Type 2 patients have some features of both of these problems. Again, as pancreatic function decreases and produces less insulin over time, the symptoms of diabetes will return down the road for many of the patients who are initially able to eliminate them through diet & exercise/weight loss.
I should add that although my sister and I have Type 1 Diabetes, my dad has Type 2. He was able to manage his through diet and exercise alone, which led to a 30 lb weight loss. He no longer has to check his BG several times a day or even several times a week, but he is still careful to watch what he eats and exercise as he should. His endocrinologist, whom he still sees every six months, still considers this Type 2 Diabetes, albeit well controlled. Any diabetes expert will tell you this…Diabetes is a lifelong disease, and although it can definitely be well managed through the lifestyle changes you’re suggesting, it never goes away, and to suggest this is simply dangerous. I’ve read literally a dozen books on the subject over the past five months since my diagnosis, and I keep up with the latest news and research related to it on a daily basis. The best response I can give you is an excerpt from the ADA’s Complete Guide to Diabetes (4th Ed., 2005, pg. 48):
“Despite what you might read in the newspaper or be told by friends or relatives, there really is no such thing as a ‘touch’ of diabetes. What people may be talking about is type 2 diabetes, which often responds well to healthy eating and regular exercise and may not have yet shown any signs of damaging body parts. Or they may be describing gestational diabetes, impaired glucose tolerance, or pre-diabetes.
The reality is that diabetes is a serious, life-long disease. Describing someone as having a touch of diabetes is like saying a woman is ‘a little bit pregnant’—it just isn’t true because both are ‘yes or no’ conditions.
Once diagnosed, diabetes doesn’t go away, although there may be times in your life when it’s easier to manage. If this happens, you may be tempted to think your diabetes is cured, but don’t forget that there will also be frustrating periods when nothing you do seems to help keep blood glucose levels where you want them. Aging, weight gain, an injury that makes it harder to get regular exercise, or a gradual slowdown of insulin production all make diabetes harder to manage. When these things happen, you’ll need to adjust your diabetes therapy to match your body’s new needs.”
Again, managed. Not eliminated. This may seem like a minor distinction, but I think it's important to differentiate between being asymptomatic and being cured. Yes, weight reduction often does decrease the symptoms of diabetes and can make it more manageable, even leading to a decrease or elimination of treatment in some cases, but the disease is still there. If that person goes back to their unhealthy habits or gains the weight back, the symptoms of the disease will return, as the will in many cases simply due to aging and a decline in insulin production. To suggest that diabetes is "cured" in these cases is irresponsible because it causes those who should be monitoring their disease (even if they are symptom free at the time) to not give it the proper attention, which could lead to complications. If they didn't realize that they needed to begin treatment again and their blood glucose levels are rising (which in many cases doesn’t lead to obvious symptoms), it is doing damage to their organs in the meanwhile.
I am also well aware of the example of Drew Carey "curing" himself of Type 2 Diabetes with weight loss, but as you can see from the online diabetes community, his statements have angered many of us who have to live with this disease. He had the opportunity to educate the public on diabetes, and instead contributed further to misinformation. Please read this blog post written by sixuntilme, a well-known and respected diabetes blogger and person with diabetes. She explains the whole "weight loss/diet & exercise as a cure for Type 2 diabetes" thing wonderfully.
It's your choice if you would rather believe anecdotal "evidence" or hearsay over scientific fact and medical expertise, but please take care when you express these opinions as fact in the public arena...As sixuntilme points out, it really does make life harder for those of us dealing with this disease because it minimizes its seriousness and further contributes to the wide array of misinformation and myths surrounding it.

I hope I wasn't too harsh in my responses, but it truly does irritate me when people who know very little about diabetes try to impress their "knowledge" upon me.  Not only that, but as I said in my replies, portraying personal opinions (which in this case, are simply myths and anecdotal evidence) as scientific fact not only has the potential to harm those who need to closely monitor their disease, it also reinforces the misconceptions about diabetes that those of us who deal with it on a daily basis fight to correct. 

It's like the time that a lady told my mom that her preacher used lemon juice to lower his blood sugars, and that my sister and I should keep a bottle of it nearby in case we have highs.  It's in those cases that usually I shake my head and say "okay," while in reality I'm thinking, "Seriously, lady?  My pancreas doesn't work.  It doesn't produce insulin any longer.  Lemon juice will not do diddly squat to reduce my numbers..."

The reason this "advice," though I'm sure well-meaning, angers people with diabetes is because it minimizes the effort it takes to truly control the disease.  Those who don't have to deal with the several times a day (or sometimes hourly) finger sticks; oral meds with not-so-fun side effects (I'm talking about you, metformin!); injecting insulin into our abdomen, thighs, arms, or butt; constant worrying about where your blood glucose numbers are at, whether they'll lead to long-term complications, and hoping your insurance will cover all the numerous doctors visits, testing supplies, medications, and medical devices it entails, simply can't understand what it takes to make sure that this disease stays well-controlled and simultaneously trying to not let it take over your life.  I know I didn't until I was diagnosed.  Not until you've walked a mile in my shoes...

Furthermore, as sixuntilme pointed out in her similar blog post (which I highly recommend reading if you're interested in the subject, the argument that weight loss is a "cure" for diabetes simply perpetuates the myth and the thinking that those of us who have the disease simply aren't working hard enough to keep it in check.  This thinking is not only dangerous, since there are already so many people with diabetes who ignore their disease, but it also diminishes its importance to the point where it may affect funding for research.  We need a real cure, and what we're getting instead is a bunch of bologna from people who have no idea what they're talking about.  I'm no medical expert, but as soon as I was diagnosed I made it my personal mission to learn as much as I can about the disease so that not only can I properly manage my diabetes life, I can advocate and educate people on it. 

This type of media coverage (along with the celebrities' stories on "curing themselves" or "switching from Type 1 to Type 2 by 'weaning themselves off insulin'" [hello, Ms. Halle Berry]) isn't the kind we need.  It's people like Kevin Kline and Brett Michaels (who are both careful to keep their public statements on diabetes in line with scientific fact) who are true examples for the diabetes world and ambassadors to the general public.  And not to mention my fellow D-life bloggers, Lyrehca, sixuntilme, lisafromscratch, and the TuDiabetes Community, to name a few.  They help those of us dealing with diabetes feel like we're not alone (as it often seems) with this disease.  Because let's face it, sometimes it feels like it's us against the non-diabetes world and it helps to know there's someone out there, even if they're halfway across the country, who is going through the same things we are.


Natalie said...

It makes me feel SO good that you had the courage and tenacity to keep going after these people even after they continued to respond with inaccurate messages. I am a "Type Weird" diabetic -- normal BMI, mild insulin resistance and low pancreatic function, and NO, it won't go away if I just lose weight and eat right. It especially pleases me that you, as a Type 1, have taken the time to learn about Type 2! So keep on blogging! :-)

Ashley said...

Thank you so much =) If there's anything about diabetes that truly bothers me, it's not the finger sticks, the highs and lows, or the constant attention it's the incorrect and oftentimes negative misperceptions people have about the disease. I try so hard to take every opportunity I can to educate these people in the hopes it will make a difference in the way they might treat someone else with diabetes. I can handle the negativity and hurtful comments, but I know a lot of people (especially the young kids and teenagers already struggling with not being able to have a "normal" childhood) can't.

When I was diagnosed in August, I was originally pegged as Type 2; but later on, they figured out that I'm just a slow-onset Type 1-er. My younger sister was diagnosed as Type 1 four years ago at age 16, and my dad (along with a lot of my extended family) has Type 2; therefore, both types are close to my heart!

kousalya said...

Wonderful blog & good post.Its really helpful for me, awaiting for more new post. Keep Blogging!

Pre Diabetes Symptoms

durga said...

Hey, nice site you have here! Keep up the excellent work!
Pre Diabetes Symptoms

Post a Comment