Understanding Diabetes – Dispelling Myths and Decreasing Stigma

A friend sent me this picture:

 

And then commented “that’s just sad – fight type 1 [diabetes] by getting type 2 [diabetes]”

Yet again I realize how uneducated so many are about diabetes, both Type 1 and Type 2. (note: I am not discussing gestational diabetes in this post)  Not only uneducated, but misinformed.  Unfortunately, this comes with a huge stigma for those who have either type. Many people think diabetes is all about obesity, and eating sugar, and a laxidasical lifestyle. So when you say “I have diabetes,”almost immediately people start to judge – assuming the person is unhealthy, that the reason they got the disease was their own fault.

Hopefully, today’s post will help a few people understand what diabetes is and dispel some myths.

Simply put:

Insulin: insulin is the common issue for both Type 1 and Type 2.  It is a hormone made in the pancreas that converts food into energy. Type 1 diabetics don’t make any insulin.  Type 2 diabetics don’t make enough insulin or the insulin they make is not effective enough.  Without insulin, the sugars broken down in the body from carbohydrates (note – this includes grain products like bread.  when reading labels look at the total carbohydrate content, not the “sugar” in nutrition facts) don’t get into the blood cells.

Blood sugar: Testing blood sugars is how diabetics can monitor their disease and decide whether insulin is needed or food is needed depending on whether it is high or low.  A normal blood sugar is about 100 mg/dl.

High blood sugar: This is when insulin is needed.  High blood sugars mean the sugars in the body are not getting into the blood cells. High blood sugars are anything over about 150 mg/dl.

Low blood sugar: This is when sugar is needed because the body has an excess of insulin. Low blood sugars are anything under about 70 mg/dl.

Type 1 Diabetes: This used to be called Juvenile Diabetes because it affects many children, but it also can develop in adults (I was diagnosed a week before my 20th birthday while in college – having lost 25 lbs in about a month though eating everything in sight).  The cause of Type 1 is unknown – it has nothing to do with eating unhealthily or being obese.  Type 1 is an autoimmune disease (like Celiac Disease, Multiple Sclerosis, or Lupus) where the person does not produce insulin.  Because the don’t produce insulin, they have to take insulin through shots or an insulin pump.

Type 2 Diabetes: This is the most common type of diabetes.  It is what most media refer to when talking about diabetes.  Type 2 diabetes is highly genetic and disproportionally affects Native Americans, African Americans and Hispanics.  While diet, exercise, and obesity are linked to Type 2 diabetics, those are not necessarily the cause. Type 2 diabetics still make insulin but they may not make enough or it may not be effective. To treat this, most Type 2s can take oral medication.  Unfortunately, many Type 1 diabetics get treated like Type 2 diabetics though the diseases (cause and treatment) are completely different.

For both types of diabetics diet and exercise are important – as they are for EVERYONE on the planet. Eating healthy means eating a balanced diet of fruits, vegetables, proteins, and grains.  Exercise isn’t just to reduce the risk of Type 2 diabetes, but it helps improve your mood and increase energy.  It helps the body function properly – strengthening the heart and other muscles.  No matter who you are or what diseases you have (if your doctor okays it) you should be exercising.

To Dispel Some Myths:

Myth: Diabetes is caused by being unhealthy

Fact: While obesity is a factor in developing Type 2 diabetes, it is not the only factor.  Genetics and other environmental causes also contribute.  The cause of Type 1 diabetes is unknown.

Myth: If you are diabetic, you can’t eat sugar.

Fact: No one can live without sugar.  Sugars are in so much of what we eat – fruits, vegetables, grains.  Like anyone, sugar in the form of candy or sodas (known as more simple sugars) should be eaten in moderation (as should all foods, but more so with these).  But a diabetic can eat ice cream or cookies if they are monitoring their blood sugars through insulin or medication.  In fact, when a diabetic has a low blood sugar, then simple sugars like a coke or an orange juice is needed immediately.

Myth: You can cure diabetes.

Fact: There is no cure for either type of diabetes.  Type 2 diabetics can reduce the effect of their disease through diet and exercise but this is treatment and management of the disease, not a cure.

Myth: Diabetics are overweight.

Fact: Again, obesity plays a role in the development of Type 2 diabetes for some but diabetics are not all fat and many obese people don’t have diabetes.  Mary Tyler Moore (the face of the Juvenile Diabetes Research Foundation) has Type 1 diabetes, as does Nick Jonas, Halle Barry, Bret Michaels, Sonia Sotomayor, Gary Hall Jr., and Jay Cutler.  Famous Type 2 diabetics include Sherry Shepard, Larry King, Mike Huckabee, Patti LaBelle, Joe Gibbs, Randy Jackson, Dick Clark.  DLife has a list of famous people with diabetes on their site. These people didn’t develop diabetes because they are fat and as you can see, diabetics come in all shapes and sizes, all races and can affect anyone from a pop star, to a justice of the Supreme Court, to an athlete.

Another Fact: The stigma around diabetes and obesity among other factors leads many Type 1 diabetics to become diabulimics – which is to skip shots to lose weight.  In doing this the body is starved of the energy it needs and will thus resort to breaking down other parts of the body much like happens in anorexia.

Myth: Diabetes can be “managed” or “controlled”

Fact: Diabetes can be treated and with careful monitoring, diabetics can maintain blood sugar levels that are between 70 and 150.  However these diseases cannot be managed or controlled.  There are too many environmental and biological factors that influence blood sugars. No matter what, diabetics will experience high and low blood sugars for various reasons including exercise, illness, and stress or for no known reason at all.  To ask someone to “manage” or “control” their diabetes is to ask them to function as a pancreas, which no human can.

Myth: Diabetics must eat an “ADA” diet

Fact: The ADA diet refers to the standards promoted by the American Diabetes Association.  Unfortunately many hospitals still follow an arcane notion of this diet and it is often recommended by providers.  It refers to a meal plan counting “starches” and allowing a diabetic to only have a certain number of those “starches” at each meal.  The truth is a diabetic can eat ANYTHING.  They can eat just what you eat.  The only difference is that a Type 1 diabetic takes insulin from the outside, and a Type 2 diabetic uses medication to increase the effect of the insulin they have.  Whether diabetic or not, everyone should eat healthy, balanced meals.

Myth: General Practitioners can help treat diabetes

Fact: I’ve never met a general practitioner or hospitalist who knows the first thing about treating diabetes other than the typical medicines used and what a normal blood sugar should be.  An endocrinologist, particularly an endocrinologist who specializes in Type 1 or Type 2 diabetes, is the only doctor that can provide the right care.  For Type 1s, endocrinologists can help the diabetic work out their insulin regime either through shots or an insulin pump (I don’t know any general practitioners or hospitalists who has a clue about insulin pumps).  For Type 2s, an endocrinologist is essential in education and monitoring medication.  Don’t just assume that all doctors know all diseases or the best treatment for a particular disease.  That’s why we have specialists, to ensure the appropriate care.

Just the Facts (collected from JDRF and the American Diabetes Association)

Statistics

  • Nearly 26 million Americans have diabetes (8.3 percent of the population):
    • Diagnosed: 18.8 million
    • Undiagnosed: 7 million
  • As many as three million Americans may have Type 1 diabetes.
  • Diabetes currently affects 285 million people worldwide and is expected to affect 435 million by 2030.
  • In 2007, diabetes accounted for $174 billion in health care costs in the U.S.
  • Diabetes accounts for 32 percent of all Medicare expenditures.
  • The nation spent $11,700 annually on each person with diabetes in 2007 compared to $4,400 on each person without diabetes.
  • Americans with diabetes incur medical expenses that are approximately 2.3 times higher than those incurred by Americans without diabetes.
  • An estimated 22 percent of hospital inpatient days in the U.S. were incurred by people with diabetes in 2007.
  • More than 60% of nontraumatic lower-limb amputations occur in people with diabetes.

Long Term Complications of Diabetes:

  • Kidney failure (called nephropathy and leading many to be on dialysis)
  • Blindness (called retinopathy and leading many to need a particular laser eye surgery)
  • Nerve damage (called neuropathy)
  • Amputations caused by ulcers that are easily infected
  • Increased risk of heart disease
  • Shortened life – a diabetic may have 7-10 years less to live

The risk of developing these complications can be reduced by proper treatment (ie – keeping your blood sugars as close to 100 at all times).

Warning Signs for Type 1 (related to high blood sugars and ketoacidosis):

  • Extreme thirst
  • Frequent urination
  • Drowsiness or lethargy
  • Increased appetite
  • Sudden weight loss
  • Sudden vision changes
  • Sugar in the urine
  • Fruity odor on the breath
  • Heavy or labored breathing
  • Stupor or unconsciousness

So please don’t label diabetics as fat.  Do not judge lifestyle habits of those with diabetes.  You need to eat just as healthy and exercise just as much as diabetics.  Do not fall into perpetuating the myths above.  If someone says they have diabetes, don’t assume what type it is and don’t say “well, my grandma has diabetes” or “my friend has diabetes.” Type 1 and Type 2 are very DIFFERENT diseases that have different treatments we must be aware of that.  Most people refer to type 2 when they say diabetes but they don’t say Type 2 leading to uneducated masses about how these diseases really work.

Realize that your misconceptions about diabetes can lead to real harm including contributing to a diabetics depression about their chronic illness or diabulimia.  The misconceptions and stigma can lead to shame and frustration, isolating a diabetic and perhaps preventing them from getting the proper treatment or assistance. These diseases shouldn’t come with anything but support and medication, they should not come with judgment or misinformation.

For the best information about Type 1 Diabetes visit the Barbara Davis Center’s Online Books Page and Read “Understanding Diabetes” (also known as the Pink Panther book).

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3 Responses to Understanding Diabetes – Dispelling Myths and Decreasing Stigma

  1. Ron says:

    what a great post! I did not know most of this.

  2. […] exhausting. Trying to function as your own pancreas is flat out difficult. And because of both the stigma surrounding this disease and the nature of HIPPA laws, it can be downright lonely sometimes. Even […]

  3. […] The stigma around diabetes is so bad I stopped referring to myself as having diabetes and tell people that I have an autoimmune disease that affects my pancreas.  Because that is what type 1 is all about. […]

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