Debating Diabetes, Ctd

A reader with Type-2 diabetes joins the one with Type 1 to divorce the disease from obesity:

Your dissenting reader with the Type-1 diabetic child tells a compelling story, but the implicit conclusion you reach is all wrong. No, we shouldn’t let people with Type 1 off the “diabetes=obesity” hook. We should throw away the hook!

For one thing, the mechanism of diabetes causation is not well understood, so we simply cannot say that obesity causes Type-2 diabetes at all. The two are strongly correlated, but research strongly hints at a cluster of shared causes, rather than a straightforward chain of get fat -> stay fat for X time -> develop the diabetes you’ve earned by being fat, you obese loser that is so widely assumed, including by most press accounts.

For another thing, not everyone who develops Type-2 diabetes is or was ever overweight, or has a family history of obesity or diabetes. I know – I was diagnosed with Type 2 at age 36. I’ve never had a body-mass index over 24, and for most of my life I’ve been skinny as a string bean, as are most of the men in my diabetes-free family tree.

The first thing my doctor did after my diagnosis was pack me off to a so-you’ve-got-diabetes class at the local hospital. The class, like just every online and print resource I could find, focused its advice not on managing glucose intake and natural insulin function, but on weight loss. But I didn’t need to lose weight!

I’m 6’0″, and was down to 150. My doctor wanted me to try to gain 10 pounds! In the meantime, I was asking a question that confounded every doctor, dietitian, and American Diabetes Association hotline expert I talked to: What should I eat for breakfast? If I needed to lose weight, they had answers. If I was on insulin, they had answers. But if I was at an appropriate weight, and just wanted to find a plate of foods that my weakened insulin system could handle without unhealthy blood-glucose spikes, breakfast was a stumper. Our cultural faith in the diabetes=obesity myth runs so deep that the medical and diabetes-research professions cannot even answer the question, “What should a diabetic eat for breakfast, if he’s not fat?”

Now for the good news: I’ve managed my diabetes with diet changes, exercise, and minimal medication. I’ve kept my A1C well below 7, often below 6, since my diagnosis. The keys seemed to be significantly reducing, but also more evenly distributing, my carbohydrate intake. Chiefly, no liquid carbs (except wine and beer, because, come on). No soda, minimal juice, no sugar or flavored syrups in coffee. (Advice to your non-diabetic readers: Stop drinking sugar. Don’t go soft like Bloomberg and reduce your serving size; just don’t drink anything with sugar or corn syrup on the ingredient list.)

Yes, I miss the great big glasses of orange juice that used to start my day, and the tall glass of milk with supper, and the heaping plates of pasta too. But I’m healthier and fitter than ever before, except for, you know, diabetes. The problem is, I had to figure this out by myself, because I didn’t fit the assumed paradigm of diabetes=obesity. Riding in the annual diabetes fundraiser bike event Tour de Cure, I’ve met many people who, like me, had to figure out treatment plans themselves because their problem was having diabetes, not being fat.

I don’t see much evidence that the focus on treating obesity is actually helping people who are both fat and diabetic, but I do see evidence that this focus harms those with diabetes for whom weight is not also a crisis. Yes, people, especially kids, with Type-1 diabetes are the primary victims of the diabetes=obesity myth, but so to are a good number of adults with Type 2. So don’t just exempt the kiddos from the stigma. End the overall stigma of diabetes=obesity=you earned it.