"Fat and Lazy," or Type 2 Diabetes—Which Came First?

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Jun 05, 2007

"Fat and Lazy," or Type 2 Diabetes—Which Came First?

Jan Chait

One of my ongoing freelance projects is writing a monthly series for my local newspaper about the top 10 killers in our area. It pretty much follows national trends, and I've already done the top four: heart disease, lung cancer, stroke, and COPD (chronic obstructive pulmonary disease). Next up is number five: diabetes.

Last week, I went to interview one of the local endocrinologists, and the first thing I said to him was: "I'm a new patient. What's the first thing you're going to tell me?"

Doc immediately began a long litany involving diet and exercise. I listened (and listened, and listened) and finally halted his dissertation. "Do you realize," I asked, "that you have yet to say anything about helping me get my blood glucose under control?"

But that's what he was saying, he insisted.

He may have thought so, but it wasn't what I was hearing.

"My A1C is 10.5%," I said. "I'm tired and hungry all the time. Besides, diets haven't worked for me in the past, so all you're doing is setting me up for failure."

Ah, wouldn't it be nice if the conversation went more like: "My, your sugars are high: You must feel terrible! We're going to get those down and you'll feel much better." And then maybe explain what helps lower blood glucose? And tell me that getting my blood glucose under control will alleviate the hunger and give me back some of that old zip?

I remember when I first began taking insulin and the lethargy went away. It was a miracle drug! Energy in a bottle! I couldn't wait to give myself the next injection! "Heh," said my boss, who had Type 2 diabetes and knew what was happening. "You just thought you were getting old, didn't you?"

The whole scenario made me think about Type 2 diabetes, attitude and reality. For example, I thought of a "chicken or egg" case: Which came first: "fat and lazy" or Type 2 diabetes?

For instance, when glucose isn't getting into your cells, your body thinks it needs more food. You're hungry. The higher levels of glucose in your blood are sapping your energy as well. You're tired. You're eating too much in an attempt to quell your hunger. You're too tired to exercise. You gain weight. It's a vicious circle.

About that point is when you're diagnosed with Type 2 diabetes—which you've already had for years.

As I write this, I'm on a cruise ship. I was sitting on the veranda earlier today, looking at the navy blue waters of the ocean. Just a flat blue. Then I looked down and the view became three-dimensional, with bubbles and water forming patterns together and pieces of seaweed under the water coming into view.

Had I not looked at the ocean from a different perspective, I would have missed seeing a deeper (so to speak) picture. Could it be that way with Type 2 diabetes? That people in the diabetes industry looked only at the surface for years, saw only "fat and lazy," and never looked beneath the surface for contributing factors?

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I actually resent the immediate assumption that weight and exercise are the cause of my diabetes. I have always been within the recommended BMI and have exercised regualary all my life. My parents are exercise nuts. My diabetes is entirely genetic. But anytime I read an article, these are the only items of recommendation.

Posted by: Linda | Jun 06, 2007 01:08 PM

My husband was recently diagnosed with Type II. Since starting Metformin he indeed has more energy, feels more like 'the old days' and has lost 25lbs. The weight loss came from changing our eating habits and walking a few times a week. Before this diagnosis he barely made it through the day without a nap! It's a terrible injustice to make assumptions about how a person became overweight or out of shape. In our experience, many healthcare professionals are wonderful at stating the 'facts' but are lacking in the area of educating the patient about their disease. If one doesn't ask the right questions or has limited access to resources of information, they likely come away from the Doctor feeling worse about themselves than before they walked in. There is so much to re-learn after this diagnosis and sometimes we need more than just the facts.

Posted by: mylove4him | Jun 06, 2007 01:16 PM

I was diagnosed with Type 2 diabetes in March of 1999. I was overweight but could not lose weight no matter what I did. I was and still am active bowling 3 times a week during Sept - April and playing softball weekly from April- Sept. I also ride bike, hike etc.
When I was finally diagnosed because my feet were tingly all the time and I requested to be checked for diabetes along with whatever the doctor was looking for (he didn't think it would be diabetes). I then met with a dietitian who helped me understand carb counting, portion size and I also added walking to my exercise program. I did lose about 75 pounds (have gained back about 20 and holding it steady now), however I don't think I would have gotten so heavy if my body would have been working correctly for all the years before the diagnosis. So I guess what I am trying to say is that at least in cases like mine the diabetes probably was there before the fat as I was never lazy

Posted by: Renee Thanig | Jun 06, 2007 02:18 PM

Frequently when I have a new diagnosis T2DM patient, they will be filled with guilt thinking that if they had not allowed themselves to become fat, they would not now have diabetes. Their families tell them that, medical professionals and the diet industry all do.
I tell them the effect of hyperinsulinemia on appetite and the storage of fat. But the pressure from society is still there.

I remember when I was first diagnosed with T2DM, 9 years ago. My endocrinologist listened as I cried in her office for 30 minutes and beat myself up for the many years of obesity. She then told me it would be ok, that I have a condition that is hereditary, that weight loss will help to control it, but that I need not focus on losing 100 pounds. She told me to focus on lifestyle changes. I left feeling better about having diabetes, better about myself and empowered to make lifestyle changes. I did lose weight without dieting. I followed her advice. I will always remember how she made me feel.

Posted by: Diana Baltodano RN.,C,C.D.E. | Jun 06, 2007 02:27 PM

Why do some folks always point that finger at something that has made their lives less than what it should be, but invaribly fail to look down that arm and see that there are three fingers pointing right back at the real cause.

I have been diagnosed with type 2 since 1997 (Halloween Day). The first thing they told me was I had to lose weight and exercise more or I had a good chance of having my feet aputated later on down the road. I was told to just try and loose a pound or two a month. Just try eating one scoop of ice cream instead of 5. Eat just a palm size of meat instead of an arm length size.

Was it easy, not at first, but now 10 years down the road, it actually is. Just like taking insulin, that first shot was real scary, and I begged my doctor for two years, but once I did it, I thought how redicules it was to have been so frightened over nothing. The shot is 10 times less painful than the prick to test your blood. Yes, I said 10 times LESS painful.

Posted by: bncriss | Jun 06, 2007 06:05 PM

I'm still so confused about my Diabetes! I was diagnosed 11/05. I had lost roughly 25 lbs.,stayed tired most of the time(even though I fought through it), and had pretty much every other symptom there is. This seemed to start 5 months before I was diagnosed. I have never been overweight and have always been pretty active. As a matter of fact, I've ben trying to gain weight for as long as I can remember. Now I can't seem to gain a pound! I have not gained back any of my weight since. So, could "skinny" have come before Type 2????

Posted by: Y2rooster | Jun 06, 2007 09:31 PM

Jan,

I have been reading your blog for quite some time and really like to hear your opinion on things. You hit the nail on the head with this topic.

For most of my life I have been a "noraml" weight person. I was exteremely active being a competitive swimmer ( I went to the state championships twice). I also did Diving, Gymnastics and Tap Danced. I continued with swimming throughout my adult life.

It was when I became pregnant that I found out that I had Gestational Diabetes and ended up on insulin. the first sign was a lot of weight gain in the begining of my pregancy. After the insulin, I started loosing weight.

After the baby was born, I was ok - no diabetes, until 8 years later. I kept on gaining weight, mind you I was still swimming. Doctors would say to me try doing some exercise not even asking if I was doing any. Well I ended up with type 2 diabetes and now I have a weight problem. So did the chicken come first or the

Posted by: Diane | Jun 07, 2007 09:42 AM

I loved the insight here. I've been officially diagnosed with Type II for about 6 months, went straight on Lantus and metphormin, but know I've had it for years. And yes, the fat and lazy thing is very accurate. Partly due to the fact that we, as a nation, are somewhat lazy... leading to being fat.

If my doctor had put it to me like, "your sugars are crazy high, if you don't get this under control you'll be a full-blown diabetic in a few years" instead of "well, you should really get more exercise and try to lose some weight... and hey, here's HOW to do that", I may have been more inclined to save myself.

JK in KC

Posted by: jk | Jun 07, 2007 10:34 AM

My doctor sounds like yours. I so agree with you when you said having Type 2 diabetes means just fat and lazy.
I have had my meds changed so many times i have lost count and now of them work yet my doctor doesn't seem to be concerned with trying to control my sugar just about how much I weigh and to GET THE WEIGHT OFF. Do these doctors really think I just love being over weight? I would love to be the size I onced was yet no matter what I do I just gain weight.I was told everything I eat turns to sugar and my body stores the fat and sugar so why won't the doctor get me the right meds to control the sugar and something to help me loose weight? If I was famous I bet I could get some kind of diet pill that worked.
When it is so important not to be fat with diabetes I would think the doctors would try everything they could to help get and keep the weight off,but no--all I ever hear is loose weight and I am so tired of hearing about my fat.
Hope you all have a better doctor then I do.

Posted by: Debbie | Jun 14, 2007 06:05 AM

i was diagnosed 27 nov 2007 with type 2 diabetes i was clinically depressed for a day or two.im trying hard to accept ths new diagnoses as i had atrium and aorta valves replaced 2005.im on warfarin and also have chronic anaemia so i need lots info and emotional support.

Posted by: mow | Dec 01, 2007 08:56 AM

Hi...newly diagnosed and been told by lot of ppl that i brought it on myself for being overweight. I did have panreatitis after a gallbladder op 3 years ago ...cud that be a factor ? I mean not everyone who is overweight has dabetes right ??? or am i ?

Posted by: bmbr | Feb 20, 2008 06:58 PM

bmbr, I wrote a blog that ran May 29, 2007. Try reading that earlier entry and see if it answers some of your questions.

Posted by: Jan Chait | Feb 21, 2008 02:33 PM

thanks for the info...i am only 41...i have been overweight for a few years now.....so i prob didnt help myself....however i think now that the symptoms for diabetes have act been there for quite some time and i hadnt realised....i went to doc with extreme swelling of the ankles and he ran some bloods to rule out kidney disease ( act had many many kidney probs all thru my teenage yesars )and thats wen my high blood sugar showed up...so just a random test showed it...have been exhausted for years and running to toilet a lot for about a year so looks like it may have been there.

thanks again for info

Posted by: bmbr | Feb 24, 2008 10:18 AM

Thank you all for your comments. It's nice to know there are places on the internet to go and see what others have experienced, or are experiencing. I'm 49 years old, officially diagnosed with Pre-Diabetes, or Insulin Resistant, but I'm certain mine has turned to full-blown type II diabetes. I have an appointment to see the doctor on Tuesday, 7/1/2008, but I wondered if anyone had any advice for me. My situation is... I am 6' tall and weigh 330lbs. I was first alarmed when I started having problems with my vision about 3 months ago and now I have ups and downs throughout the day, and they all seem to be related to before I eat, or after I eat, which leads me to believe these symptoms are glucose related.

Right now I do nothing for diet except try not to each as much as I used to (and it does no good) and I cannot exercise because of severe back problems. I severely injured my back in 1981, again in 1999, and I haven't been the same since. I think the most I can do is walk and swim. These hurt quite a bit too, but I can do them if I'm willing to suffer a bit for a day or two afterwords.

Is there anyone else out there with a similar history, that has found success with medicine, diet, limited exercise, etc.? I look forward to someone, anyone, that can give me some degree of hope. Also, the doctor I am seeing is a Family Practice physician, a D.O. to be specific. Can I expect help from her or should I be seeing a specialist?

Posted by: Mike in Phoenix | Jun 26, 2008 05:12 PM

Type 2 Diabetes

The Stigmata of Diabetes (12/04/08)
The Great Thanksgiving Buffet Disaster (12/03/08)
The Rising Costs of Treating Type 2 (10/31/08)

Diagnosis

Diabetes Blog as Time-Saver (09/04/08)
Knocking Out Prediabetes (07/25/08)
"National Diabetes Goal" Set (05/09/08)

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