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This is an assumption that one sees quite a bit and I'd like to examine the reasons for it.

First of all, lets define diabetes. Juvenile or type I is pretty uncontroversial...the body no longer is capable of making any or extremely little insulin. The only "cure" for this currently is a pancreatic transplant, and I'm not sure how long that cure lasts for most people. I do know that it doesn't seem to be something that is done all that often. The standard treatment is diet, exercise, stress management, and sugar control through injected insulin. Some also take oral medication.

I admit to knowing much less about type II, or adult onset diabetes than I do about Juvenile, so please jump in and offer your interpretations and your basis for those interpretations. IIRC, there are actually many ways in which you may be a type II, and it is in some ways a symptom of various conditions. Some of the conditions are as follows:

-poor food and exercise habbits
-insulin resistance
-PCOS
-hormone imbalance

I'm sure there are many others.

The primary driver I'm aware of in type II is that your resistance to insulin increases making it necessary for your body to produce more insulin to deal with the same sugar loads. Over time if this is left unchecked, you can stress your pancreas out so badly that it litterally burns out and you become a type I. That is if you survive the high sugars that may arise in the meantime as your resistance to insulin gets worse and worse. There are many drugs that are given to help decrease this resistance, (again, not my strength,) and the various cardiovascular issues that crop up due to the elevated insulin levels. The good news is that you can also control your insulin levels by severely limiting your carbohydrate intake. This results in lowering blood pressure and improving your cholesterol and lipid profile as well as minimizing your insulin needs and improving insulin sensitivity. All without or with fewer drugs.

But can this be called a cure? Certainly not in that similar to a person who has had a heart bypass, if you don't change your eating and exercise habbits permanently you will wind up with the same problem years later. (Point of information: most people who have a bypass wind back up on the OR table within 10 years with their arteries reblocked because they did not change their habbits.) It is not good enough to lose the weight and then go back to your old eating habbits. Permanent change must take place. I submit however, that if you can permanently change your eating and exercise habbits, (and no one is saying that is an easy thing to do,) most type IIs can permanently eliminate their need for synthetic drugs while keeping their sugars in control, lowering their blood pressure, and improving their cholesterol count.

So I simply do not buy into this permanently diseased state with a lifetime need for medication that DRs seem to be spouting. Food is also a drug, causing reactions and interactions with our bodies. Change your input, (what you eat,) your catalyst, (stress management and the exercise you do,) and you can change the chemical reactions in your bodies, (insulin resistance, high blood pressure, clogged arteries,) before the diabetes becomes permanent through the burnout of your pancreas.

I look forward to the discussion.

InParadise
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So I simply do not buy into this permanently diseased state with a lifetime need for medication that DRs seem to be spouting.

You may not want to, but that does not change the fact that if your body can not process glucose properly, it can not currently be fixed. That is the nature of an incurable disease. Incurable does not mean unmanageable, whether through medication, diet, and/or exercise.
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You may not want to, but that does not change the fact that if your body can not process glucose properly, it can not currently be fixed.

But is this truely the case? Were all type IIs diabetic before the symptoms presented themselves, or for many is it because they have allowed themselves to become overweight and are eating incorrectly? Is perhaps diabetes, at least for some, more of a symptom of being seriously overweight and improper nutrition vs a permanent disease? If the weight is lost, nutrition improved, and the diabetic symptoms disappear, are you still diabetic given that your body can now process glucose properly under the existing conditions?

In an extreme analogy, if I'm a routine cutter, I'll bleed a lot, but this bleeding will go away when I stop cutting unless I'm a hemophiliac. Some diabetics may not be curable, similar to the hemophiliac. (sp?) Some are just cutting and can go back to normal when they stop abusing themselves.

InParadise,
with lots of questions and few answers.
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with lots of questions and few answers

When I was first diagnosed, I asked my doctor some of your questions. I was trying to figure out what I did to become diabetic. He was very careful to tell me that the cause of diabetes is unknown. It is true that there are contributing factors, but that what changes a person from being at risk for diabetes to being diabetic could be just about anything. He also said that if they live long enough, even the person with the lowest risk will become diabetic. And he is working with me to lower my need for medication, NOT just writing prescriptions. And although I don't agree with their high carbohydrate diet, the diabetes educators I worked with also said this. We just don't know at this time.

It does a great disservice to diabetics to try to point the finger at what they did to cause themselves to become diabetic. As with many medical condition, attitude has a direct effect on the outcome of the treatment and whether the person living with the condition will take an active part in their treatment. Blame is counterproductive.

The fact is I live with diabetes. It is an ever-present condition and, barring a true cure, I will live with diabetes the rest of my life. I try to educate myself and others about diabetes, including risk factors. I also educate myself about the treatment options to avoid/delay complications from diabetes. This is what I can do.

Please note, this is the way I approach my situation. As with most things, YMMV.

Susan
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It does a great disservice to diabetics to try to point the finger at what they did to cause themselves to become diabetic. As with many medical condition, attitude has a direct effect on the outcome of the treatment and whether the person living with the condition will take an active part in their treatment. Blame is counterproductive.

I agree with you that blame is counterproductive, but so is a sense of helplessness, of being a victim. I live on an island with a surprisingly large percentage of diabetics. The culture here is that there is nothing one can really do about diabetes, it is a disease that will get them at one time or another. Because of this, there is little concern for sugar levels and a high level of blindness and amputation.

Perhaps my arguements is like that of alcoholism. Maybe for some people there is a genetic predisposition towards not being able to handle alcohol, but I think (and I know I am not alone on this,) that for many the disease label of alcoholism provides an excuse to do nothing about their choices that landed them with the label in the first place. For some it is a matter of getting their heads in the right place and making better choices, which may indeed include moderate consumption of alcohol after identifying and dealing with the root causes that triggered their alcohol overconsumption in the first place. IIRC, AA says that an "alcoholic" should never consume alcohol again since once you acquire the label you are labeled forever and incompetent of making alcohol choices ever again.

If by proper food choices for your metabolism you are able to have a body that functions properly without medication, are you still considered a diabetic and diseased? If someone were raised in a low carb way and never experienced the normal American eating pressures of supersizing their fries and soft drinks, does not manifest diabetic symptoms but would if they ate the typical American diet, are they diabetic?

In many ways, sugars are like a drug and for some tend to be addictive. They affect my non-diabetic mother like speed and she has to take prescription drug sleep aids on days she eats sugar. (Now that she understands that, she is working on eliminating sugar from her diet.) Some drugs make people psychotic, but when they are not under the influence of the drugs and acting more "normally", are they still considered psychotic?

These are the questions that make me wonder why some diabetes can not be considered curable through diet. If we stop "drugging" ourselves with sugar and simple carbs, causing our diabetic symptoms to disappear, are we still diabetic?

It is not an issue of blame, but an issue of taking back control and rejecting labels.


Perhaps it is all too theoretical.

InParadise
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As with many medical condition, attitude has a direct effect on the outcome of the treatment and whether the person living with the condition will take an active part in their treatment. Blame is counterproductive.

I don't think InParadise was talking about blame. I did not read her post that way at all.

In my limited understanding of the subject, there ARE plenty of Type IIs whose condition is not yet so serious that it cannot be reversed OR, as they say, "controlled through diet and exercise alone." These would largely be the newly diagnosed or those whose insulin resistance is not yet terribly serious. I understand insulin resistance to be a continuum - it's not like being pregnant, where you either are or aren't! - it's a progressive condition, and while it perhaps can't be fully halted or reversed, it can be controlled very well in many individuals without the need to resort to drugs.

Every one of us has a tendency to become slightly more insulin resistant as we age - it is considered a normal part of the aging process. Some people have a pronounced genetic tendency which makes their odds of developing insulin resistance, given a poor diet and lifestyle, enormously greater. I am not totally clear on whether there IS any other way to develop insulin resistance other than through (a) aging and (b) lifestyle. The unfortunate thing is that, due to genetic variability, a lifestyle that wouldn't significantly harm one person might be perfectly sufficient to cause Type II diabetes in another person. We all need to eat right and exercise to be healthy, BUT it seems that some people are significantly more damaged than others by a failure to do this. That's just the luck of the genetic draw.

Here's the thing - that genetic tendency isn't just a rare abnormality affecting a measley few people. It's probably as common as mud. Why? In evolutionary terms, an ability to produce lots of insulin at times when there happens to be a abundance of calories available, particularly</ii> calories from carbohydrate, is a useful thing. One couldn't get in much trouble from this because in nature it would be a rare occurrence to run across a huge stash of carbohydrate calories - fruits rot quickly (they are designed to) and there is lots of competition for them during the time they are available, and a honey tree would be a rare and valued find. Anyway, it would be to one's evolutionary advantage to be able to store fat rapidly and effectively during these rare times when lots of these calories are available, because one would then better survive during periods of famine, and be better able to reproduce (since women need a certain percentage of body fat in order to be fertile.)

Put an organism that evolved under these conditions in a new environment where tons and tons of calories are available all the time, particularly calories from refined sugars and carbohydrates, and you will get a lot of unintended consequences.

Now, the Type II diabetes epidemic that we are currently facing has got to demonstrate something. We didn't just suddenly mutate as a species so that we are suddenly developing Type II. The numbers, when you look at them, are pretty terrifying. In the 90s alone, the prevalence of Type II increased 33% Among people in their 30s the incidence increased 76%. That's in JUST TEN YEARS. And of course everyone knows about how Type II diabetes is not called "adult-onset" any more because so many children are developing it.

I am not sure I fully buy the usual explanation that we somehow got so significantly more sedentary in the 90s that it played a huge role in this. I don't think we are much more sedentary than we were in the 70s or 80s or even in the 50s or 60s. That's a pretty ahistorical point of view. *Maybe* children have gotten more sedentary, but I'm not all that sure about that either, despite the constant attempts to blame video games for childhood obesity and Type II. I seem to recall that plenty of kids in the 70s were zonked out in front of the TV for long periods of time without even moving so much as their thumbs. Of course more activity would help with Type II prevention, but I don't think lack of it can be blamed as a primary cause for the epidemic.

I suspect we will find that most of the problem lies in our diet. Of course as a low-carber I think excess carbohydrate plays a huge role here, exacerbated by the obsessive focus on fat as the primary dietary evil, to the point where even sugar has gotten a free pass in many people's minds. Rather odd, when you consider the fact that fat does not raise the blood sugar at all, and yet "a low-fat diet" has been the mantra for both obesity prevention and diabetes prevention. But I wouldn't stop there - I think there are probably other elements in the diet, that got particularly bad in the 90s due to the food industry's practices, that are playing a role here.

Among the possible suspects I'd identify:

(1) Excess refined carbohydrate and refined sugar - with refined sugar being a particularly ubiquitious ingredient in all kinds of processed foods;
(2) There are those who would claim that high-fructose corn syrup is a particularly bad form of sugar and it's in almost EVERYTHING - because it is cheap (corn is subsidized in the US) and it lends certain properties that are useful in formulation of processed foods;
(3) Trans fats - I am sure we don't even know yet the extent to which trans fats damage our health, and I think natural fats have gotten a bad rap largely because we've failed to distinguish their health effects from the effects of trans fats and other junk they're eaten with;
(4) Extreme fear of fat leading to the diet being even more carb-heavy, since some people avoid or minimize protein foods to avoid all possible fat intake;
(5) Possible lack of important nutrients may play a role here - because we eat too much processed food, not enough fresh whole foods, and also because our agricultural soils are depleted of many nutrients;
(6) Other additives in our food? Other kinds of environmental hazards? I'm sure there's some stuff we have yet to learn about that is playing a role here.
(7) And then we have the highly destructive high-carbohydrate diet that is *specifically prescribed* for people with insulin problems - obesity, heart disease, Type II - just at the point when an intervening to control carbohydrates would be most helpful, we tell people to increase their carbohydrates even more, again because of widespread (and misdirected) paranoia about fat. Thankfully, that's changing somewhat these days.

** ** *** ***

So on the one hand, you can consider that people should be accountable for their lifestyle choices and recognize the huge role that lifestyle plays in the development of Type II diabetes. You can call this 'blaming' the victim if you want, but to refuse to face it is denial, which isn't helpful either.

OTOH, you can see just how horrifying the American diet has become, how much junk is being eaten all the time by most people, and reflect on the unintended consequences of that. I am sure that most people think it's perfectly normal to eat the products of industrial food processing all or most of the time, and they are hardly to be blamed for not realizing en masse that they should become dietary mavericks. That's a hard, hard choice to make in our society.

I think the desire for a "quick fix" is endemic in all areas of our society. It's easier to take a pill than it is to turn your whole life around and start living a different way...easier for the doctor, easier for the patient. And there's a gigantic industry that profits from this attitude. Oh, I am not one of those conspiracy theorists that believes that the drug industry really *wants* us to be sick and helpless....at least not overtly. Many drugs are a huge boon to humanity and I wouldn't want to return to a time when they were not available. And it's equally a mistake to take the purist view that no one should be taking drugs, because they are genuinely helpful in so many cases.

I have often wondered what kind of societal revolution it would take to turn our current health emergency around. Among the low-carbers I spend so much time talking to, there are plenty of people who think that if only the gospel of Atkins could be preached more widely, it would fix everything. It's a tempting attitude to fall into, especially for someone who has personally benefitted so dramatically from a low-carb way of eating. But, realistically, there are plenty of ways in which low-carb can be corrupted too. Already there is an ever-increasing plethora of processed foods available for low-carbers (heaven forbid we should all be eating fresh meats and vegetables all the time when the wheels of industry are there to serve us). And we have all encountered those people who think a low-carb diet means no vegetables and lots of processed meats. Junk is still junk, even when it's low-carb.

On the LBYM board we talk all the time (well, on those rare occasions when we are actually on-topic) about the need to live in a different way from what we're being sold...the ads we are exposed to, the horrific financial habits of so many of our fellow citizens. Well, when it comes to personal health, we need to live a different way too. I am afraid it will always mean swimming upstream.

At least in some respects the forces of capitalism have made healthy living easier - I have access to a terrific gym because someone can make money running it, and terrific food because there is a market niche for whole foods that's being well-filled in my city. And because of the Internet, I have access to a lot of information right at my fingertips practically all the time (lucky for me that I have critical thinking skills to help me sort through it.)

I guess this post wandered pretty far away from the original point you made that inspired it. I guess what I'm trying to say is that there are elements of personal responsibility in prevention of this particular disease but there are also hugely powerful societal and economic forces that make it hard to even know how to be responsible. Not so different from the problem of being LBYM after all. I guess, as with LBYM, the really great saving grace is that the information and support IS available to those who want to live a different way and take an active role in managing their own health. In the age of the Internet that information and support is easier than ever to come by...for that I am profoundly grateful.

nitpicker
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You know, it just drives me insane that the Motley Fool does not let you edit a post after submitting it.

I am going to stop using HTML italics because there's ALWAYS going to be one where you forgt to do the closing tag properly!

nitpicker
grumpy
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You say you have questions but few answers. We have the answers - you just don't want to accept them.

Regardless of how your body chemistry gets off kilter, once it is, it will not get back on track. Diet and exercise does not fix anything. All it means is that your faulty glucose processing is not so bad that you can't avoid more extreme management techniques. All the medical analysis, however, shows that this is not a correction but a delay. Once you start down the diabetic path, eventually you will deteriorate into more serious health problems.

Understand that being borderline diabetic is not healthy but at risk. You would not be borderline if something was not wrong. I have adult onset diabetes which means my BG is continually higher than normal but not yet in the type II danger zone. I weighed only 185lbs when diagnosed, and have settled on a weight between 145 and 150lbs.

I had no genetic disposition (at least none that I have detected). I may not have eaten the most healthy, but I was not that bad. I have been in a stressful work situation for years, so I have chosen to blame my employer. But it may easily just have been fate.

I can not eat like my non-diabetic friends. I can't even eat like my diabetic friends on medication, as they can simply take a pill after eating the meal of their choice. If I choose to not modify my eating habits, my body can not handle the carbohydrates, resulting in a rise in blood sugars. If I falter long enough, I will have no choice but to go on medication. Eventually the medication will be insufficient and I will suffer more serious problems in my eyes, kidneys, and extremeties.

Diabetes is a degenerative disease, for which there is no cure. How fast it progresses depends in part on how you react to the diagnosis. If one is unwilling to accept that, then they are only fooling themselves.
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Hmmm...

>>I had no genetic disposition (at least none that I have detected). I may not have eaten the most healthy, but I was not that bad. I have been in a stressful work situation for years, so I have chosen to blame my employer. But it may easily just have been fate.<<

I found out that I AM genetically predisposed to the disease. My mother's side of the family has the disease and she, too, was in a stressful occupation. Unfortunately, I wasn't told till after my mother's passing from cancer which I am also predisposed. Pretty much bites for me. What I'm getting from this board, I'll either die a from a horrific death from the complications of diabetes, no matter how I try to control it with lifestyle or medication, or I'll die cancer ridden. Neither one sounds appealing to me.

In many ways I agree with what you said. However, I have a bit more faith in people (who wish to live) and science. And if there is a cure someday, you know the drug companies will probably come up with a preventative vaccination.

Be well

Apathy4All
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What I'm getting from this board, I'll either die a from a horrific death from the complications of diabetes, no matter how I try to control it with lifestyle or medication, or I'll die cancer ridden. Neither one sounds appealing to me.

NOOOO! It does not have to be this way, at least not for everyone. For some reason unknown, not all diabetics react the same way to their inputs, which supports my idea that diabetes for some is a symptom of another issue rather than a disease in itself, (which it obviously is for others.) High blood pressure is the same way in that there are many causes for it, most of which are actually unknown. You can have two diabetic people on the same kind of diet and the same kind of meds and they can react very differently. DH has been a type I for over 30 years now. He thinks that stress as an early teen is what did it to him. He also has doctors telling him that he is the healthiest 30 year diabetic they've ever seen. Some of this is due to his anal personality that has led to relatively tight control. Some of it is just pure dumb luck. As far as diabetes goes, he's had it pretty easy. Other than the 1 time when he was taking glucophage experimentally and it depressed the release of emergency glucose at night, he has always woken from a severe low sugar in time to take something. This is a response which typically deteriorates over time, the lack of which as you can immagine is pretty dangerous. His eyes are pretty good as are the rest of the diabetic danger zones. We consider ourselves lucky as hell, but are also cautious to do what we can to minimize deterioration.

We know other type Is who do everything right but are extremely brittle. Their sugars are all over the place and there seems to be no rhyme or reason between their inputs and their body's reaction. This is an extremely individual disease.

As far as cancer goes, our boys will be getting healthy doses of susceptibility from both sides of the gene pool. From what I've seen in my family, attitude (and of course early detection) is key. My brother at 35 contracted a rare and aggressive form of cancer that is typically found in children in Africa. According to the doctors, he is a "text book miracle cure." He should have died many times over. As much as I believe in the man upstairs, I think it had much to do with bro being too damned stubborn to die. That was 15 years ago. IMO, you let your attitude slip in any situation, and you lower your body's immune system significantly.

In meeting with a new Dr., I had to give my family history. He told me that I had better hope I was adopted. I shrugged my shoulders and told him that my family was huge and old, (I'm the youngest of 6 who is the child of the youngest of 10,) and that my lifestyle was very different from that of my relatives. We no longer go to work in the factories after graduating 8th grade, and my diet is significantly different as well. Though I wasn't going to ignore my history, I wasn't going to let it worry me either.

You can't control everything, but you can control how you react to that which happens to you.

InParadise




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Regardless of how your body chemistry gets off kilter, once it is, it will not get back on track. Diet and exercise does not fix anything. All it means is that your faulty glucose processing is not so bad that you can't avoid more extreme management techniques. All the medical analysis, however, shows that this is not a correction but a delay. Once you start down the diabetic path, eventually you will deteriorate into more serious health problems.

And it is exactly this fatalistic attitude with which I have such a problem. I strongly suggest you get counseling, because attitude has such an impact on health. Believing that there is nothing you can do to prevent the catastrophic symptoms of uncontrolled diabetes is a harsh sentence to inflict upon yourself, and typically a self-fulfilling prophecy.

Where is all this medical analysis that you reference? As a chemist with a strong concentration in biology, I refuse to believe that by varying the body's input you cannot change the output. Lets face it, our bodies are just big old test tubes and garbage in will equal garbage out. Now if you're lacking the abillity to produce needed chemicals, as are type Is, you are correct in that there is no cure without radical processes like a pancreatic transplant.

For type IIs it is much less black and white. Some systems will be wacked out enough chemically that those people will be permanently dependent on chemicals to correct it. For others, and given the meteoric rise in the number of diabetics in the past couple of decades coinciding with the low fat high carb diet craze I would venture to say for many, their diabetic symptoms are not so much diabetes itself, but symptoms of poor diet and exercise. This should be 100% correctable.

But don't take my word for it. Go to your local library and pick up any of these books for an eye opener:

Protein Power by Drs Eades

Reversing Diabetes by Julian M. Whitaker, MD

Dr. Richard Bernstein's Diabetes Solution, (or something like that.)

These are just a few off the top of my head. I'm sure there are more.

If you are truely convinced you are on your way to type I, and there is more and more data showing that for many the road to type I is not an overnight process, pick up Bernstein first. It is critical that your preserve as much insulin production as possible.

I wish you well.

InParadise

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And if there is a cure someday, you know the drug companies will probably come up with a preventative vaccination.

Certainly I am hopeful science will come up with the means to make be whole again. Until then I will do my best to fend off the worst aspects of the disease for as long as possible. But it is that possibility that things will get worse that motivates me to take my diet and exercise seriously.
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If you are truely convinced you are on your way to type I, and there is more and more data showing that for many the road to type I is not an overnight process, pick up Bernstein first. It is critical that your preserve as much insulin production as possible.

I never said I was convinced I was on the road to type 1, not that I feared an overnight degradation. In fact, my doctor has clearly said it is OK to spend a week at Disney eating resposibly but with without hesitation, or eating birthday cake (chocolate) at my nephew's camping trip at Stone Mountain. My goal remains to do exactly that - to preserve as much natural insulin production/processing as possible for as long as possible. IF I can delay the need for insulin suppliment, then I can delay future effects.

There is ample evidence that people can live a long time with diabetes if they manage their lifestyle well. When they do pass, however, it is usually due to complications related to diabetes. It is my hope that through my efforts, this will be my case when I am 90 and not a moment sooner.
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