
Myths about Diabetes - vo2maxer
https://www.washingtonpost.com/outlook/five-myths/five-myths-about-diabetes/2020/01/03/9002680e-2d83-11ea-bcb3-ac6482c4a92f_story.html
======
hirundo
Much of this contradicts my N=1 experience. I have controlled my type 2
diabetes by keeping my carb intake below 25 net grams per day.

* My diabetes controlling diet is high in fat. I have found that without the presence of carbs, fat is the _safest_ macronutrient in terms of keeping my blood glucose level down. I can eat fat and protein while barely budging my levels.

* Sweet desserts are not okay, not even once in a while. They make my blood glucose soar, and it can take days to get it back under control. I get some of my diabetes symptoms and carb cravings back within hours of indulging. This is _not_ about sugar though, it's about all of the carbs I've tested, including fruit. Sugar seems to act just as a concentrated carb.

* Yes too many sweets can give you diabetes. I believe that's how I earned it, by indulging my sweet tooth for year after year.

It seemed like an extreme change for me to go low carb, but as a result I have
a reasonable blood glucose level without any drugs. And the actual change was
more joy than slog. I now love this way of eating and don't (much) miss the
high carb foods. I'm afraid this myth buster needs some of her myths busted.

~~~
maxerickson
"Yes too many sweets can give you diabetes."

Someone just reading your comment here might not realize that the article has
a reasonably nuanced discussion of this.

~~~
kop316
I don't think it's very nuanced.

The paragrpah in question is:

The story for Type 2 diabetes is a bit more complicated. Obesity and
inactivity play huge roles in the risk for the disease, but genetics are also
a factor, even more so than for Type 1. "

If you go to the link she references, theres a lot of statistics about gentic
factors on Type 1, but very little in Type 2.

Type 1 has:

"If you are a man with type 1 diabetes, the odds of your child developing
diabetes are 1 in 17. If you are a woman with type 1 diabetes and your child
was born before you were 25, your child's risk is 1 in 25; if your child was
born after you turned 25, your child's risk is 1 in 100.

Your child's risk is doubled if you developed diabetes before age 11. If both
you and your partner have type 1 diabetes, the risk is between 1 in 10 and 1
in 4.

There is an exception to these numbers. About 1 in every 7 people with type 1
diabetes has a condition called type 2 polyglandular autoimmune syndrome. In
addition to having diabetes, these people also have thyroid disease and a
poorly working adrenal gland. Some also have other immune system disorders. If
you have this syndrome, your child's risk of getting the syndrome—including
type 1 diabetes—is 1 in 2."

And Type 2 has:

"Type 2 diabetes runs in families. In part, this tendency is due to children
learning bad habits—eating a poor diet, not exercising—from their parents. But
there is also a genetic basis."

It seems that Type 1 genetic factors are much more understood, and there is a
correlation in Type 2.

------
metacritic12
While this article is technically correct, I think it is actively harmful to
the landscape of general public knowledge.

A lot of this article is just playing "gotcha", where she's pointing out
technically a lot of cultural glosses about diabetes only applies to type-2
diabetes. However type 2 diabetes occurs at a rate >10x as much as type 1
diabetes [1], and it's the type that is more preventable by behavior and diet
change.

Statements close to the "myths" she's debunking is approximately true, while
her "technical facts" if not handled with care will lead to far worse wrong
beliefs.

Approximate myth that we want: "Generally, diabetes is strongly related to
high BMI and bad diet which often includes diets high in sugar". Technical
truth that muddies the conversation: "Actually the above relationship excludes
T1D, which is a vast minority of diabetes."

Approximate myth we want: "Many diabetes is preventable by eating well."
Technical truth that muddies the conversation: "Actually some T1D is adult
onset 2-3%, so you may not be able to prevent those!"

Approximate myth we want: "Bargain hunting for medications when medically
equivalent is good, especially generics." Technical truth: "Actually there are
medical differences between different insulin formulations, because unlike
small-molecule drugs, different formulations are not biologically equivalent.
Some expensive modern formulations are good."

\--

A doctor with knowledge about public health and has good writing skills should
reconsider writing an article like this. Why not go after real harmful myths
like anti-vaxxers? Or how about rewording the article so that the myth is
actually approximately bad, like "Bad diets are okay for diabetes as long as
you avoid sugars".

[1]
[https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm](https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm)

~~~
dorkwood
I would argue that the approximate truth of "diabetes is preventable by eating
well" isn't useful, since members of the public often have a distorted view of
what "eating well" means.

I once had an obese friend of mine tell me I was going to give myself diabetes
-- despite the fact that I'm not even remotely overweight -- because I
regularly drank soda. To him, his diet was good, because he ate salad for
lunch and snacked from the office fruit bowl, whereas my diet was bad, because
I drank soda.

There are likely many people out there who believe that because they eat salad
for lunch they're "eating well" and reducing their risk of diabetes, when
actually they're putting themselves at risk by being overweight.

~~~
gowld
Something tells me you are onbscuring friend's breakfast and dinner, and
perhaps what goes in the salads.

A salad is better for diabetes than almost any alternative, and does reduce
risk all else equal.

~~~
dorkwood
I don't have visibility of what he eats for breakfast and dinner. What I do
know is that his overall diet has resulted in obesity.

My point is that an underweight person who consumes sugary beverages is at a
lower risk than an obese person who eats salad for lunch, whereas the general
public is likely to believe the opposite.

------
calibas
I hate that they begin with "No, you don’t get it from eating too many
sweets." Then later they admit that Type 2 diabetes risk is greatly increased
by an unhealthy diet.

So you can get diabetes from an unhealthy diet, like a diet with too many
sweets.

~~~
sithlord
You dont get diabetes from eating "too many sweets". If you have a disposition
to type 2 diabetes, and you eat too many sweets, then sure the symptoms are
more likely to show sooner.

A quit google, shows that ~40% of americans are obese, and around 9% of
americans have type 2 diabetes. If eating poorly lead to diabetes (and didnt
just expose the symptoms) then those numbers would be much closer.

~~~
everfree
> You dont get diabetes from eating "too many sweets". If you have a
> disposition to type 2 diabetes, and you eat too many sweets, then sure the
> symptoms are more likely to show sooner.

I don't think this is really a useful distinction. If you eat a lot of sugar
and "get diabetes", i.e. it becomes clinically significant, then it would be
just as correct to blame your sugar intake as to blame your genetics.

It's quite known that sugar intake is strongly correlated with diabetes:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584048/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584048/)

~~~
sithlord
I dont think anyone is arguing that sugar intake isn't correlated with type 2
diabetes surfacing. But, that same person would start showing eventually
regardless, just may not be as soon.

People with type 2 diabetes, genetically, have trouble removing glucose from
cells, this is a fact, eating too much sugar, means that the cells become full
sooner, and the body shows that it can't deal with it.

~~~
gowld
When it shows matters a lot. I hope my diabetes shows after I die.

------
will4274
Bit frustrating how myth 2 is totally devoid of facts that would permit
further reading. What's the scientific names for these different types of
insulin and the actual physiological difference between their effects?

~~~
m348e912
This was one of the comments posted below the article that may answer your
question:

Epistemologist2: As a physician myself, with Type I diabetes for the past 56
years, I have lived through quite a lot of change in the management of my
diabetes. I am particularly concerned about the discussion in Myth #2. The
inexpensive insulin, U-100 Regular Insulin, is readily available and it is
just as potent, unit for unit, as the newer synthetic insulins. What is
different is the rate of onset of action. Regular Insulin does not "turn on"
as quickly as the others, but if taken in advance of a meal will do the job
sufficiently well that you can maintain reasonable blood sugars. The over-
riding intent with insulin therapy is to mimic natural insulin
production/action in one's body. The expensive modified insulins become active
much faster and consequently will more closely mimic natural insulin release,
but it is critical to note that once injected, those insulins do not turn off
as promptly as naturally produced insulin from the pancreas, and this can be a
serious problem!

In my case, I had had my diabetes for about twenty years and was adequately
controlled using those "old" insulin products extracted from beef and pork
pancreas after which we got the now inexpensive Human Insulin, chemically
identical to that from the human pancreas, and it did not "turn on" any faster
than the predecessor products. It was not until 1996, 33 years into my own
diabetes, that we saw the introduction of a synthetic insulin with much faster
onset of action.

Bottom line is that the price of the fancy new insulins should not be such a
barrier that it leads to one's death. The inexpensive older products work,
just like you old "dumb" phone works to do its basic job. Newer is better, but
not critical, and neither doctors nor patients should forget that using older
techniques and products is a viable option. It is the doctor's failure to
think outside the box to adequately educate the patient that causes death.

------
mchill
For type 2 diabetes, a plant-based diet is the way to go for prevention,
management and even reversal: [https://www.pcrm.org/health-
topics/diabetes](https://www.pcrm.org/health-topics/diabetes)

~~~
sithlord
You can't reverse type 2 diabetes. Using terms like "reversal" are insulting
at best. Sure, you can suppress symptoms (ie management) if you were to change
your diet back to what it was, the symptoms come right back.

~~~
nradov
I don't understand your objection. Of course it has to be a permanent
lifestyle change. It's like if I give myself a headache by hitting myself in
the head with a hammer, and then I stop doing that of course the headache will
go away. But if I start hitting myself again the headache will return.

~~~
sithlord
My objection is that you are not reversing anything, you are treating it.

Do you "cure/reverse" bradycardia and heart block by getting a pace maker? no
you treat it.

By your definition you cure/reverse any condition by taking a medicine/getting
a treatment for the rest of your life.

Also...Clinically, most people who can treat type 2 diabetes with diet when
they are younger, still have to go on some sort of medication (metformin) when
they get older, even if their diet stays clean.

------
nradov
It's really a shame that Type 1 and Type 2 are both called "diabetes" since
the causes and treatment are so different. This leads to a lot of
misunderstandings in the general population. And to further complicate the
situation there is a growing population of double diabetics who start out with
just Type 1 and then later also get Type 2.

Virta Health has had some excellent success in reversing Type 2 with
carbohydrate restriction.

[https://blog.virtahealth.com/with-sustained-
type-2-diabetes-...](https://blog.virtahealth.com/with-sustained-
type-2-diabetes-reversal-management-is-becoming-a-thing-of-the-past/)

------
man2525
Based on the literature I've skimmed or watched, I find the correlation
between NAFLD (non-alcoholic fatty liver disease) and T2D interesting. It
seems that fat is distributed in different people to different sites
(subcutaneous, visceral, liver) at different rates. Fat in the liver can
result in NAFLD. In some cases, there seems to be elevated liver enzymes
(AST/ALT) for months or years prior to overt diabetic symptoms in people who
also had an A1C level considered typical for prediabetes.

The following article describes research for substances that appear to protect
pancreatic beta cells. It mentions that one of the substances, adipsin, is
correlated with subcutaneous fat.

[https://news.cornell.edu/stories/2019/11/protein-finding-
cou...](https://news.cornell.edu/stories/2019/11/protein-finding-could-inform-
new-type-2-diabetes-treatment)

Likely, many people with T2D have excess fat regardless of where it's
distributed in the body, but in places like Japan, which is claimed to have a
10% rate of T2D despite an obesity rate of 3% (probably more relevant if
measured as subcutaneous fat, i'm not really sure how they measured it), it
could make for interesting speculations for some of the mechanisms leading to
development of T2D.

------
projektfu
Would someone mind listing the myths? It’s hard to understand which myth is
referred to by number when you can’t read the article.

~~~
vo2maxer
[http://archive.ph/NSt4G](http://archive.ph/NSt4G)

~~~
projektfu
Thank you.

1\. Only kids get type 1 diabetes

2\. Wal-mart insulin is just as good as expensive insulin

3\. Eating sugar gives you diabetes

4\. You can't eat sweet foods if you have diabetes.

5\. You can treat type 1 diabetes without insulin.

~~~
RandomTisk
#3 as a myth would be better stated as: Anyone can get diabetes by eating too
much sugar

------
vo2maxer
From the author of the article, Dr. Heather Ferris, who gave permission for
the following points to be shared:

That column in the post is very size constrained and has a very specific
format- I would have loved to expand on some areas. Second- this is really
written to educate those without diabetes about the disease. A lot of the
subtext, which was more explicit but edited out, is that everyone’s diabetes
is different. People with diabetes get a lot of blame and unsolicited advice,
but each person has their own way of managing their disease and we should
accept that.

------
taxicabjesus
My passenger, Mr. "Who Are Your Lifelines" [0], was turned into a type 1
diabetic as an adult, seemingly through his interactions with the family court
system. At one point I spoke to his sister, who said he was repeatedly thrown
in jail when he couldn't pay his assessed child support. He was 18 or 19 years
old at the time, and had previously made $100k/year (computer-something, in
the 1990's probably), then lost that job. The judge didn't have the ability to
reassess the child support amount. The sister said the law was later changed,
but it was too late to prevent the destruction of my passenger's pancreas.

Maricopa County Jail did a A1C test on him on intake, and decided this
passenger needed a daily time-release insulin injection. If he tried to refuse
the injection, he would be sent to solitary confinement.

When combined with the jail's starvation diet, this forced use of insulin is a
form of torture: I understand insulin without carbohydrates -> low blood sugar
-> cortisol release -> muscle wasting. When he got out he told me he'd
developed an intestinal blockage that required surgery.

When he was locked up again 2 years ago (on account of missing a drug court
hearing, 2.5 years before), I took pity on him and deposited some funds on his
jail account so he could buy snacks to sort of keep himself out of stress-
induced deterioration. I have a postcard that said it was incredibly helpful
knowing someone on the outside cared about him. He supposedly sent me three
postcards, but I only got one.

"Do the most expensive thing possible" seems to be the guiding philosophy for
the American approach to Medicine. The doctors quoted in my recent submission
[1] pointed out that they can do expensive things for their patients, but have
no ability to provide what their patients actually need.

My step-sister's husband is a type 1 diabetic. I just learned he had a bad
case of the chicken pox just before he was diagnosed as a 3 year old child. A
friend's 2 year old daughter became a type 1 diabetic soon after her first
weekend at her biological father's house -- this was the first interaction
with her birth father; I'm sure the kid was like "who the hell are you and
where is my mother????".

I bet in 20 years the new myth of Diabetes will be that it's a chronic
condition that can only be treated palliatively. "Stress" seems to be the
cause behind the symptoms of diabetes. If doctors treated stress instead of
the end result of stress (pancreas dysfunction / insulin resistance -> high
blood sugar levels), people would certainly have much better outcomes.

[0] [https://www.taxiwars.org/p/who-are-your-
lifelines.html](https://www.taxiwars.org/p/who-are-your-lifelines.html)

[1]
[https://news.ycombinator.com/item?id=21728864](https://news.ycombinator.com/item?id=21728864)

~~~
pkaye
> If doctors treated stress

How would doctors treat stress?

~~~
taxicabjesus
Stress is a generic, non-specific term. I think the important change to
improve the treatment of diabetes would be to stop treating it as a chronic
condition, and making an effort to figure out what's actually behind the
symptom of pancreatic dysfunction/insulin resistance resulting in high blood
sugar.

Bodies can recover if they're given a chance.

