Recently, I was reading some of the readers’ postings on this Web site. Some of these postings expressed fairly strong opinions about how one should best manage his or her diabetes. Of course, one of the many good things about living in the United States is our right to freedom of speech, and postings such as these certainly get people thinking. However, it’s all too common for misconceptions about diabetes to abound. Whether it’s the belief that eating sugar causes diabetes, or that starting on insulin can make you go blind, or that having to start taking diabetes pills or insulin means that you’re a “bad diabetic,” as a dietitian and diabetes educator, I feel compelled to set the record straight whenever I can.
So, what’s the best way to control diabetes? When it comes to Type 1 diabetes, which accounts for 5% to 10% of all diabetes cases, that’s a no-brainer. A person with Type 1 diabetes must take insulin to survive. His pancreas has—to put it
simply—”pooped out,” meaning that it no longer makes enough insulin. Of course, a person with Type 1 diabetes has choices as to how he takes insulin. The choices nowadays range from the traditional vial and syringe to an insulin pen to an insulin pump to an inhaler. The future holds more possibilities for insulin delivery as well. People with Type 1 diabetes must still incorporate meal planning and physical activity into their daily management.
About 90% to 95% of people with diabetes have Type 2. But Type 2 diabetes is a little less clear-cut in terms of how it’s best managed. The reason is that Type 2 diabetes is a progressive condition. When someone is first diagnosed with Type 2 diabetes, the cornerstones of management are often, initially, what many health-care professionals term “diet and exercise,” or, more appropriately, “lifestyle changes.” In other words, a person in the early stages of Type 2 diabetes may be able to control his blood glucose levels nicely by following a carbohydrate- and calorie-controlled meal plan, losing some weight (if necessary), and fitting regular physical activity into his or her schedule. At this stage of the game, the body is still making enough insulin, and healthy eating and activity help the body use its own insulin quite efficiently.
Over time, however, diabetes progresses, and lifestyle changes simply aren’t enough anymore to control blood glucose levels. At this point, a person with Type 2 diabetes will likely need to start taking medicine in addition to continuing with those healthy lifestyle changes. Medicine is usually in the form of one or more diabetes pills. Many people with Type 2 eventually go on to require insulin.
People with diabetes often feel like they’ve failed because they have to go on diabetes drugs. The truth is that their pancreases have failed them. It’s not their fault. If you’re looking to place the blame on someone, look to your family tree. Genetics plays a big factor in who gets Type 2 diabetes and who doesn’t.
The natural course of Type 2 diabetes is for it to progress to a point where, if the person lives long enough, he or she will have to take insulin. No one is to blame, nor is eating that piece of cheesecake or failing to take a walk after supper. There’s evidence that incorporating healthy lifestyle behaviors may stave off the need to take medicine or insulin for a while, and it’s important for people with Type 2 diabetes to work with their health-care teams on these behaviors. But the bottom line is that Type 2 diabetes will eventually take its course. Family, friends, and coworkers can best help the person with Type 2 diabetes by being supportive and encouraging instead of being hurtful or disparaging.