Diabetes Self-Management Blog

Most people have linens in their linen closet. I have five kittens in mine. In addition to the linens, of course. The kittens are living behind the washcloths. Number one was born on my scooter seat (I wasn’t in it at the time) last Thursday. I think. I lose track of these things. Once Mama Cat got her eldest offspring cleaned up to her satisfaction, she trotted off with it to the linen closet and had four more.

That brought our menagerie of seven cats to 12, which includes two seven-month-old kittens, alternately called M(2) and Ritz, Frick and Frack, or the Katzenjammer Brats. Those two are polydactyl cats, meaning they have extra toes. Their front paws look like mittens, so they basically have opposable thumbs. M(2) can take the keys out of my scooter. One, or both, of them can turn the lever-style faucets on in the bathroom sink. I shudder to think what they’ll be able to do as they age. I can see them opening the front door, which has a lever instead of a knob, when they get big enough to reach it. One day last week, they invented a game: They knocked some papers off the dining room table and would run, jump on the papers, and slide across the floor.

They’re about as frustrating as listening to talking heads do a report on diabetes. Twice in the past three weeks, I’ve hit the ceiling during a report about diabetes on television. The problem is, I’m very much a print person and tend to not remember very well if it’s audio. I have to listen to it several times.

Be that as it may, the latest was yesterday morning when some cardiac kind of doctor went on to announce, alarmingly, that whole wheat (or maybe whole-grain) breads…get this…raise your blood sugar! Just the same as white bread does! Horrors! And this happens, mind you, in people with diabetes, with prediabetes, and even pre-prediabetes.

What in the blue blazes is pre-prediabetes? I certainly don’t know, and the interviewer didn’t ask. Maybe it’s people with beta-cell dysfunction, which precedes diabetes. I know it precedes Type 2. I don’t know if “beta cell dysfunction” would also define your body attacking and killing the beta cells, as it does in Type 1.

On the glycemic index, stone-ground whole wheat bread is 53, white bread is 70, and 100% whole wheat is 77. The GI is a measure of the extent to which blood glucose rises after eating different foods. The lower the GI number, the less of a rise. But it’s still going to rise. If you have diabetes.

I’m beginning to understand why people with Type 1 are angry at the portrayal of diabetes and with being lumped in with Type 2s. I’m getting angry myself, and I’m Type 2.

The thing is, whenever diabetes is discussed, the images shown are of wide bottoms, thunder thighs, and beer bellies. I have what I would call a typical Type 2 shape: Big bazonkers, a round tummy, a flat bottom, and skinny legs.

Plus, if you look at the statistics, chances are the shots aren’t even of people with Type 2 diabetes.

Those of you who have been around me for a while know I don’t like to commit math. I’m not a math “person.” Nevertheless, I committed math. Just for you. I went to the Centers for Disease Control and Prevention (CDC) site and looked up stats on diabetes and on overweight and obesity.

The CDC does not make it easy. For diabetes, a publication from 2011 tells you that roughly 26 million people in the United States have diabetes and 79 million have prediabetes. It does not differentiate among types.

For overweight and obesity, the CDC gives you percentages. Broken down into age groups, into states, into whatever they can break it down into. Anything to avoid giving you straight national numbers.

I’m going to tell you how I did this so you can correct me if I flubbed:

• Took the population of the United States, which is about 308,745,538.

• Multiplied by 0.68% (the percentage of people 20 and older who are overweight or obese — 34% in each group — which was 209,946,966

• To which I added 12.5 million for the 2–19 years age group (it gave you a number for that age group in addition to the percentage). The total then was 222,446,966 people in the United States who are overweight or obese.

And I should tell you these were different years, albeit close together. The CDC and the US Census Bureau can’t seem to get their years together.

So. We have 308.7 million people in the United States, of which nearly 222 million are overweight or obese. But only 105 million have diabetes or prediabetes. What happened to the other 117 million people? The ones who are overweight or obese, but who do NOT have diabetes or prediabetes? What would that be? More than half of the people who are overweight or obese do not — and probably will not — have/get Type 2 diabetes?

How dare they be fat and not have diabetes! It goes against every message “they” are sending us! Get fat; get diabetes! Could it be that their beta cells are just fine, thank you very much? That the genetics for Type 2 diabetes just aren’t there? That they’ll never get Type 2 diabetes? (Actually, those numbers make me feel pretty good. It lessens the guilt that it’s “all my fault.”)

People just don’t understand this, and the media keeps perpetuating misinformation.

So I’ve begun my own little campaign. Feel free to join me. I make sure I have the e-mail address of whatever news or opinion programs I tend to have on. When there’s a diabetes story with inaccuracies or stereotypes, I whip out an e-mail, provide a correction or a complaint, and ask that they have somebody learn about diabetes so the interviewer can ask intelligent questions.

I am tired of being portrayed as having given Type 2 diabetes to myself because I am fat and lazy. I am NOT lazy.

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Comments
  1. Good points. Being fat and / or inactive does not cause diabetes. Granted, weight loss and exercise can delay it, sometimes prevent it, but as you pointed out, there are lots of obese and overweight people who do not have diabetes. People with diabetes did not cause themselves to get it! And should not be made to feel guilty about it. Let’s face it, losing weight is easier said than done. Our bodies seem to have been made to survive a famine, but we have not faced a famine in a long time in the US. Most of us face and overabundance of food around us nearly every wakeful minute of every day!

    Posted by BK CDE |
  2. Jan, Prediabetes, like diabetes, is a definition decided by a group of “experts,” and the definition has changed with time, as it has for diabetes.

    Used to be you weren’t considered diabetic until fasting was over 140. Now the cutoff is 126.

    Prediabetes means fasting higher than “normal,” whatever that is, but not so high as to be diabetic, namely, 100 to 125. Prediabetes used to be considered 110 fasting but in 2003 they lowered this to 100. They may lower all the cutoffs in the future.

    They used to call this early diabetes stage “impaired glucose tolerance” or “impaired fasting glucose,” but in 2002, they combined those categories and called them all “prediabetes.”

    Obviously this all depends on the accuracy of the testing, and we all know that you could be 94 on Monday (no prediabetes) and 103 on Tuesday (prediabetes diagnosis), so it’s not really not very accurate. But it’s suggestive.

    I’ve written a book on prediabetes if anyone wants to know more:

    http://www.amazon.com/Prediabetes-What-Diabetes-Marlowe-Library/dp/1569244642/ref=sr_1_2?s=books&ie=UTF8&qid=1317241075&sr=1-2

    Also a blogpost:

    http://www.healthcentral.com/diabetes/c/5068/129926/understanding

    Posted by Gretchen |
  3. Hey Gretchen

    It wasn’t prediabetes I was confused about: It was the pre-prediabetes. Know anything about that?

    Jan

    Posted by Jan |
  4. Oops. Sorry, Jan. I should have known you’d know about prediabetes. I read quickly and sometimes misread. You’d think I’d learn, but . . .

    I’ve never heard the term pre-prediabetes, but I suspect it’s referring to that study that showed that people in some sub-prediabetes category like fastings of 90 to 99 were more apt to get diabetes.

    Now we’ll probably need a pre-pre-prediabetes for those 80 to 89, etc.

    Posted by Gretchen |
  5. I found the article I was referring to, and they do use the term “pre-prediabetes,” meaning high-normal BG. I haven’t read it in detail:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690430/

    Posted by Gretchen |
  6. I have a friend that is tall and stick thin. At about the age of 50 she was diagnosed with diabetes-Type 2. Her father, and all his siblings, also tall and thin, all of them, around the age of 50 were diagnosed. Heredity factor, I definitely think so. Yes, ‘fat’ folk are always pictured in the diabetes meds ads in magazines and newspapers. Yep, if your FAT your gonna be diabetic. But statistically, that just isn’t so. Or everyone overweight would be and everybody under/normal weight wouldn’t be. But the media sure wants you to believe it! Have you addressed the ads for medications? Hope you do!!
    Thanks, you made me smile today!

    Posted by Dawn |
  7. What about all these “wellness” programs that employers are using to get their employees “healthy”? Those with diabetes are considered fat, stupid, and lazy.

    As a slightly overweight 70 year old with Type 2, I was told I must take a “diabetes management course” to learn how to manage my “disease.” Never mind that my HbA1c is 5.4 and my fasting glucose is usually around 90 and has been for years except for a 6 month period last year when my HbA1c went to 5.6.

    A year ago I had a complete hip replacement after a fall that also split my femur. Their wellnes expert told me do water aerobics and jog in order to raise my heart rate. I was also told to join a gym even though I was still going to therapy three times a week. This was about 3 months after my fall. A year later I am still out of the water (infection) but am now allowed to participate in 5Ks as long as I walk.

    Posted by Ann |
  8. On a number of occasions, I have heard a person with a healthcare background say that diabetes is a “lifestyle disease”. While I know what that implies, I will then ask, “Whatever do you mean?” They state: “overweight, bad diet and not enough physical exercise”. Of course, if I was feeling a bit guilty before asking, their answer just piles on that remorse. Interestingly enough, I have excellent eating habits and work (workout) physically harder than most people half my age (62). Personally, I think they should know better, and that is the problem. It is a social issue of ignorance when one segment of the population considers a disease as a punishment for bad behavior on the part of another significant segment of the population.
    As to the pre-pre-pre this or that, along with the diabetes is the healthcare professional who automatically suggests that you be taking blood-pressure and cholesterol medication as a precautionary measure, even though you do not show any obvious symptoms today. Knowing what I know about the insidious side effects of any number of the drugs and the problems of negative interaction, I find it incredible that many doctors put patients on an automatic “cocktail” just because you are diabetic. Blood boils!!!

    Posted by Eugene Gaudreau |
  9. Eugene’s comments are bang on and I sympathize.

    Unfortunately, though, the fix needed to stop the body rot of this problem is due to the design of the body and its early optimization against starving 10,000 years ago and requires one today to manage energy input and get sufficient hearty exercise in conjunction with any required meds.

    My layman’s understanding of the reason for the problem lies at the feet of the incredible advances by science after the second world war that found ways to increase the bounty many fold of the high energy grains, corn and rice grown on huge farms along with the development of computers that have led to the most incredible collection of couch potato laptop tools, video games, wide screen TV along with cars to transport us everywhere.

    Unfortunately this massive change in the food energy content availability was matched with an incredible drop in energy burn at same time. Our present bodies were designed and optimized to survive in times past when food was scarce, scrawny and poor calorie content and required huge effort to find, catch and collect. Except in extremely occasional good random times would the energy input easily exceed the energy expended.

    In fact there were many periods of lean, starvation times. The current body is optimized for this by all the steps the body can take with its glucose storage in liver, kidneys, fat cells and skeletal muscle cells along with all the processes to convert/scavenge fat stores and muscles back to energy in a pinch.

    Worst off, the hunter gatherer gene digestion track grabs every available calorie from food eaten and converts to glucose and loads into the blood stream. In the past it was simply not possible to overfill the body’s finite glucose stores on any regular basis making it unnecessary that energy input and exercise was balanced out.

    Under today’s present situation; it would have been better to have either a less efficient gut/intestine or one that could throw over the side the excess calorie/glucose when the internal body glucose stores are filled up.

    The body’s glucose regulation system is based upon storing spare glucose using insulin which depends on the fact that the glucose stores of the fat cells and especially the skeletal muscle cells always have room available to store more glucose on command of the insulin. When no more room exists, the skeletal muscle cells will turn off the power of the body’s insulin to stop glucose transfer from blood stream to the storage sections of the skeletal muscles. That is insulin resistance.

    Therefore under today’s situation; it is critical for a type 2 insulin resistant diabetic to carefully manage carbs-energy input and insure sufficient exercise to flush out the glucose stores so that the glucose regulation storage loop of the body stays functioning and under control and to do so must always have room to store more glucose.

    It is then the persons responsibility to ensure that energy input and exercise match up so as to keep the energy glucose stores partly empty. This was not a requirement in years past and agricultural innovation prior to the second world war but certainly seems so today.

    As for cures for this, they may be better answers tomorrow with better diagnostic tools and drugs but stopping the rot today necessitates the combined punch of meds coupled with carefull energy management of carbs-energy consumption and matching exercise. Yes that obviously will impact one’s life style.

    Thank science for the help.
    I say all this from my own experience cleaning up my own mess after a stroke that resulted in meds to shut off a leaky liver, a 1200 calorie diet and one to two miles walking a day or its equivalent.

    Anybody doing hearty physical labour – ie moving 2 ton stone blocks by hand for the pharaoh’s tombs and edifices probably does not have to worry about this situation and probably needs to ensure they eat sufficient rich grains, corn, rice etc to ensure they keep their weight up.

    Posted by jim snell |
  10. Actually, Ann, I have written about an experience with a wellness program. It posted on July 26. I’d paste the URL in here, but my computer don’t wanna!

    Jan

    (Editor’s note: Here is the blog entry Jan is referring to.)

    Posted by Jan |
  11. You have some very valid points, but the fact is that if your body is pre-disposed to insulin issues and you pile on that a high simple carbohydrate diet, a high fat diet, and lack of physical exercise (lazy has nothing to do with it) your body will fight and fight to normalize until it gets to the point it can’t fight any more.

    Diabetes, for some people, is a lifestyle disease. That does not mean they are bad people, or lazy. When I was 100 pounds overweight I was anything BUT lazy. However, I ate a high calorie, high fat diet, and did not get regular healthy exercise. I was pre-diabetic in my 30s.

    Now in my 40s I am a ‘healthy’ weight, exercise daily, eat just about anything I want but choose to stay away from some things, and monitor my calories. I decided that monitoring my calories and exercise was preferable to monitoring my glucose levels and taking medications to stabilize my body. I have even had part of my pancreas removed (not related to diabetes) and am healthy as a horse (with half a pancreas) with no insulin issues. I work with people who are living with Type 2 diabetes and upon getting physically active, and cleaning up their diet even a little bit, some are able to drop their medications down, or even altogether. It is not because we all suddenly became “less lazy” or grew a brain. It is because we allowed our bodies to do what they were intended to do; eat appropriate calories and move each day.

    The truth is, we need to intentionally choose to move every day. We no longer have the “work sun up to sun down” lifestyle our ancestors did. As Jim pointed out, there was very little need to seek our exercise back in the day because life WAS moving all the time. Now we do. We may not like it. We may want to deny it’s part of our issue. We may insist we “can’t” when really we “won’t” (I’ve developed workouts for people wheelchair and bed bound).

    You, yourself, stated that you are not lazy, in reference to being fat and lazy. I agree, but you are overweight. That is not a judgment, it is a fact and that weigh is impacting your body in a negative way. You can deny it, but I can deny gravity and it doesn’t let me rocket into the sky. It’s a fact. It is a proven, medical fact that obesity contributes to a variety of health issues, and that obesity in our modern day society is attributed to how we live our lives, in other words “lifestyle”. It is not attributed to us being bad, lazy, small, tall, or loving cats. It is ONE aspect in this horrible disease, and one that is controllable. Not easy, by any means, to control, but it is controllable.

    Posted by TK |
  12. I take umbrage with last response in that:

    Claiming that lifestyle causes this problem is short sighted, unhelpful and useless.

    That said, chaning ones life style, diet and exercise are crucial along with any required meds are critical to get monster back in cage.

    Having been there, done that and now on the mend, the idiotic useless response by many professionals - just add more insulin - to type 2insulin resistance diabetes - in this field are causing the doubling and tripling of the number of cases of type 2 cases.

    The incredible improvement of grain production and quality of said items coupled with the massive reduction of human energy burn by couch potato exercise of laptops, cars, computers, dvd, hdtv, video games have more to do with this.

    Its time for professionals in trhe field to put up and shutup and start solving the real problem.

    The hunter gatherer super efficient gene and digestive track have more of a major role in causing this problem rather than personnal life style.

    Posted by jim snell |
  13. I agree wholeheartedly with you. I too am Type2. I was diagnosed when I was 51. Nobody in my family has ever had diabetes, so when you hear all these reporters on t.v. talk about how it’s caused by being obese and not getting enough exercise it really angers me. I am overweight, and do not belong to a gym, but I am not fat and lazy. My doctor has never told me I am too overweight and gave myself diabetes. I wish the media would stop portraying diabetics as if it were our fault we have this disease. Then they start talking about the costs of health insurance, as if people with diabetes make the costs rise. Hello! I and certainly many, many others pay our insurance premiums. We are not being taken care of for free by the government or health care system. They always sound as if it’s our fault we have diabetes and we alone make the costs of health insurance so high.

    Posted by Sandy Schmidt |
  14. Thanks for the great discussion of how the media mishandles the causes of both types of diabetes. My family member with type 1 gets tired of other young adults saying, “Oh, you have diabetes. So does my grandmother.” There are so many differences between type 1 and type 2. It can be frustrating to try to explain the challenges that you face.

    Posted by Suzie |
  15. Every carbohydrate that you eat, takes you trwoad insulin resistance. When your resistance becomes high, you are pre diabetic. When your resistance is so great that you can not make enough insulin, your blood sugar goes up, and you are known as a diabetic. The great thing is that when you are in the pre-diabetic stage, it can be completely reversed. A month or two on a sever carbohydrate restriction will reset your resistance by 10 years. Then all you have to do is balance your carbs, fats, and proteins. Stick with the natural saturated fat, as these new fake fats, like trans fats and canola, will kill you.

    Posted by Abhay |

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