Thursday, May 14, 2015

Changing the Misunderstanding of Type 2 Diabetes

I'd like to talk about the terrible stigma that comes with Type 2 diabetes.  I know that everyone with diabetes of any kind has to deal with stigma and blame and bad feelings about the condition, but it is particularly bad with Type 2.  And the key reason is that obesity and weight gain are associated with Type 2.  But we make a fundamental mistake if we make the leap in logic to think that just because something is associated that therefore it must be the cause.  Today, I'm going to talk about how we can try to change things to both better understand ourselves how obesity and Type 2 are related and how we can try to work to share that with the general population, the healthcare system (who actually don't seem to understand it) and our government.

So first, let me describe my general understanding of how Type 2 typically emerges.  I know everyone is different and people may argue with my understanding, but I would suggest that a lot of people would agree with me.  First, somebody with Type 2 becomes insulin resistant.  Their body doesn't use insulin as efficiently as it should.  At first, nothing overt happens, you just produce more insulin and your blood sugars are still fine.  But often that high level of insulin will have an effect on your body, you will gain weight.  After all insulin is the "Fat Storage Hormone."  Not everyone gains weight, but a lot of people do.  They may overeat, but I argue the underlying driver is high levels of insulin.  Eventually, your blood sugars start to go.  Usually you get Impaired Glucose Tolerance (IGT) going high after meals but your fasting blood sugars and A1c are still ok.  So the doctors think you are fine, but you are not fine.  Then as time goes on it gets really bad and not only does your blood sugar soar after meals but you get Impaired Fasting Glucose (IFG) and you A1c rises.  Finally you get diagnosed and if you are "lucky" you get diagnosed as pre-diabetes.  But that is a lie.  You have diabetes, you have had it a while, maybe a long-time.  You are not only insulin resistant but it is so bad your body has lost control of your blood sugars.  So by the time this has happened many people with Type 2 have experienced significant weight gain.  And this is where the fundamental mistake is made.

So we can see the logical reason that leads to Type 2 diabetes and obesity being associated.  It isn't that obesity causes diabetes, it is because insulin resistance causes both obesity and diabetes.  It is this fundamental misunderstanding that I wish to change.  It breaks my heart to see people with Type 2 demonized for having a lifestyle disease.  Criticized for overating, being lazy and making themselves obese and giving themselves diabetes.  For the vast majority of people with Type 2 that is a incorrect, hurtful and harmful stereotype and I wish to change that and I ask anyone that reads this to help.

So I'd like to call on all of us to focus on some near term goals in this.  The first goals is to share with each other in the DOC this better understanding of Type 2.  Lots of people with Type 2 believe the stereotype and live their lives with blame and shame over their condition.  I'd ask everyone out there to read my words and rethink your view of Type 2.  You don't get Type 2 because you made bad lifestyle choices, you get Type 2 because of your genetics and a fundamental mismatch between the modern environment (particularly nutrition) and our evolved bodies.  And I would ask everyone with any kind of diabetes to help spread this understanding within the DOC.

So that is a short term goal, but I have a long term goal for change.  And that is to change the way that the public, health care system and our government have embraced this incorrect stereotype.  This is a most serious problem, making a fundamental scientific mistake confusing association with cause.  It means not only will health care and government propagate the hurtful stereotype, but diabetes could be a further escalating problem with a treatment strategy that doesn't address the causes of diabetes but rather treats the symptoms.

So first, we need to deal with the stereotype.  I think we should all work towards speaking out to correct the stereotype.  We should comment on news articles.  Write about particular egregious examples.  We should call people out for the mistake.  Only by speaking out will we change this.  There is just too much self-reinforcing opinions out there.  If nobody speaks out things will not change.

And that being said, my most alarming concern is our health care system and government which seems to have bought into the fallacy totally.  Our government has essentially gone "all in" on the Diabetes Prevention Program (DPP).  The core concept of the program is to teach people with "pre-diabetes" that diabetes is a lifestyle disease and that if they just didn't eat as much and exercised then they could "Prevent" diabetes.  This is a total embodiment of this scientific fallacy.  And it is even worse, the education program seems to actually mislead patients.  Patients are not educated on insulin resistance or that carbohydrates raise their blood sugar.   When I look through this education program I am shocked.  There is no mention of insulin resistance.  No mention that carbs raise your blood sugar.  In fact sugar is only mentioned 10 times and carbs are mentioned 6 times.  But wait, fat is mentioned 571 times.  Yes FAT is mentioned FIVE HUNDRED AND SEVENTY ONE times.  Does anyone see a problem here?  Anybody going through this program is taught that their diabetes is caused by their being fat and therefore the prevention (or cure) is simply to not be fat.  And of course the solution is to eat a low fat diet.  This just leaves me speechless.  Not only do patients come out being indoctrinated with the stereotype but they have been set up to fail and then believe they failed because they "didn't do it right."  This whole scientific fallacy pervades our health care system. This is a long-term project, it won't be easy.  But it is important.  The fundamental scientific mistake and the resulting incorrect stereotype leaves patients with a terrible stigma and sense of self blame.  And worst of all, the incorrect focus on obesity misleads doctors, educators and patients from really dealing with Type 2 diabetes.  To really deal with Type 2 diabetes you have to take on the real cause, the real culprit, insulin resistance.

21 comments:

  1. "And of course the solution is to eat a low fat diet."

    Why yes! Brilliant! Because if you just eat more, let's see---Pasta! Rice! Bread! Potatoes!--that'll fix it right up for you! No problem with those healthy foods for PWDs, right? How could there be? "Gee doctor I've cut out the burgers and I've been having pasta salads for dinner and chicken with rice for dinner. How come my BG is still so high?"

    Dear god I had no idea the DPP was that misguided. Thanks for a truly important and enlightening post Brian!

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    1. Thanks, I get particularly upset at the DPP. I get really upset that we depend on government advice to be objective and when I learn that it is so tragically flawed I can't help but feel hurt by the whole system.

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  2. Wonderful post, great insight, my thoughts exactly. The only thing I disagree with, is prediabetes being a lie. IMO prediabetes exists, which means that you are at a great risk to develop diabetes. While the treatment and the diet are essentially the same, in your mind it's still not a full blown diabetes which is mentally is easier to accept. When I was first diagnosed, I was in shock and in denial, while the GP couldn't see through this.

    I'm blogging on the WordPress but will see if I can reblog your post.

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    1. Thanks for your comment. I don't disagree with you on technical definitions, I just feel that we have misunderstood type 2 diabetes. The fundamental defect is insulin resistance, it isn't about reaching a threshold where you are diagnosed as an overt type 2. I think we would both agree that anyone suffering from insulin resistance should embrace limiting carb as a core way of living a healthy life. Thanks for reading and commenting.

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  3. Brian, I'm with you 110% on this. Spot on post, which I intend to share. Well said, friend. Thank you.

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    1. Thanks Kate, I know that we are comrade in arms. I will continue to depend on you as my ally to help work to overcome these damaging stereotypes. ...brian

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  4. Awesome post Brian! I hope it's ok I put a link this post in my blog. Let me know if not and I will remove it. http://onestepclosertothecure.blogspot.com/2015/05/changing-minds.html

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    1. Thank you for sharing Susan. You help me be one step closer to my goal of achieving change.

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  5. I don't know whether Type 1 or Type 2 is the "bad one," but for sure Type 1 is the "stupid one" because Type 2 is much more complicated.

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    1. Thanks Laddie, I think any type of diabetes is a "bad one." But together we can make sure nobody makes the mistake of misunderstanding how bad any type of diabetes actually is.

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    2. With all due respect Laddie, as someone with T1 I don't find that comparison, or the choice of the word "stupid" as a label for something I've struggled with for 31 years, particularly helpful. And it seems to go against the spirit of greater understanding between people on both sides of the disease that Brian's post helps to foster.

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    3. I don't think it was Laddie's intent to suggest T1 is stupid, only that we should not leap to oversimplify things. My biggest wish is that we could stop seeing this as a T1 vs T2 view of the world, this is a diabetes issue. Anybody with T1 who deals with insulin resistance is just the same as me in my battle with insulin resistance. And as DrBB says, we all have a mission to foster greater understanding of diabetes.

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  6. Fantastic post, Brian. Certainly one of the best explanations of Type 2 Diabetes that I've ever read. Couldn't agree with you more. I'll definitely share it.

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    1. Thank you Mike. I sometimes feel it is hard explaining Type 2 to the world, thank you for your help in making that happen.

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  7. You win the Internet today Brian! This is an awesome post. I will share.

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    1. Thanks Liz. I'm not sure what I won, but if I didn't try then I sure won't win.

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  8. Wishing everyone could read this and even better - understand it. Nice post!

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    1. Thanks, I hope this message can spread. My hope was that if we can help to make the message clear and understandable it would be easier to share.

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  9. I'm a few days late, but WOW, you are spot on !!! GREAT post, and I'd love permission to share this. Wish everyone saw type 2 this way, especially the medical community.
    Thanks so much.

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    1. Thanks for reading. Of course you can share this.

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