A Personal Note Re: Diabetes and Obesity

Andrew Sullivan has been hosting an ongoing series of emails from readers on the differences between Type II and Type I diabetes.

The reader who kicked off the topic wanted to draw a line between II, which results from a drop in insulin effectiveness in the body, and is often correlated with old age and/or obesity, and I, also often referred to as juvenile diabetes, often caused by an auto-immune reaction in which the body’s insulin producing cells are destroyed. While all of us probably know someone who suffers from Type II (I know several), Type I is more rare.

My brother was diagnosed with it around age four though. One day he just started guzzling apple juice and peeing constantly. When it was brought up to my mom, a nurse, she brought back testing equipment from work. Surely enough his blood sugar was sky high and his pee was full of glucose.

The interesting part came next though. While at the hospital to receive the official diagnosis and have his condition monitored for a little bit, it became quite clear that none of the doctors or nurses involved had any idea how to manage it.

One of Sullivan’s readers mentions something similar,

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.

My parents encountered a similar lack of information. Even in the hospital they were serving my little brother chicken nuggets, pudding, and other junk. That kind of food would be unhealthy for anyone, but completely understandable in a circumstance where trying to make the child feel better emotionally, psychologically, is taking precedence over long term health risks.

In my brother’s situation though, these were short term health risks. The mantra then (this was in the mid 90s) was just go back to having a normal life and pump yourself full of insulin as the need arises. Literally: have your cake and eat it to.

My suspicion is that most of us interact with medical professionals so rarely, and know for a fact how much they’ve studied and how much information they do have, that we nevertheless trick ourselves into thinking they know a lot more than they actually do. I don’t want to generalize too much from anecdotal evidence. But even given my own experiences with the field (various knee surgeries), I’ve observed a level of disagreement between different physicians that left me much less confident in their opinions than I would have otherwise been.

One orthopedic doctor would recommend one course of action, while a second and third suggested different things (repair the cartilage, remove it, or just try physical therapy).

Perhaps this is just part of how we practice medicine in this country. That is, we got to people when we need to get fixed rather than having health experts guiding us all along. I’m sure I’m not the only one whose been to a doctor for a check up only to realize he or she wasn’t much interested in my diet, sleep habits, or other day to day activities.

Which might explain why, when it comes to things like diet and physical activity, so many of us feel on our own. With my brother, my parents lucked out in that a variation on the Atkins diet worked wonders for him, keeping his blood sugar well regulated and helping him ace his tests at the endocrinologist. But that was only after much trial and error with little to no guidance from the health professionals available–either because of a lack of information or of interest.

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6 thoughts on “A Personal Note Re: Diabetes and Obesity

  1. It’s also been my experience dealing with GERD that doctors know how to do the medicine, but know almost nothing about the lifestyle effects of disease. After I was diagnosed, my GP had a list of things to try, don’t eat within 3 hours of going to bed, elevate the head of my bed, etc, that he found in a brochure, but my Gastro guy had nothing to say except, “let’s double your dose of medicine.” It wasn’t until my Mother got me a book on dealing with GERD by changing diet that I actually started getting the problem under control. It seems obvious that if you have stomach acid problems, one should change the types of food one eats, but no doctor had that advice. Reading the book felt like reading one of those quack medical tracts or fad diet books because we’re trained to listen to doctors and to shun alternative methods, but reading that book and following the advice on changing diet was the number one biggest help in minimizing my acid reflux. It seems it often turns out that the best advice comes from people who share your disease, and not the doctors who treat it.

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    • Chasm, this was very much the experience of my brother. They told him to basically maintain his diet–eat the regular kinds of foods regular kids your age would eat. They were so set on trying to maintain normalcy rather than how to best manage the condition.

      The best info my parents got usually came from other parents who had been doing it longer and met with similar resistance from their physicians. They were lucky the Internet had just begun to really take hold by that time too, otherwise it would have been that much harder to find the networks and groups that were sharing that kind of information–down to very precise charts of protein/fat/carb intake vs. the types of insulin cocktails best for those kinds of foods.

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  2. I think you also have to recognize that there exist different philosophies of medicine. These might not be unified theories of practice as much as they are a concoction of the doctor’s personality, the personality of his teachers, and the specifics of his training.

    I had an ankle issue. Doctor #1 said we should operate. Doctor #2 advised physical therapy. I went the latter route and the issue resolved itself. Does that mean doctor #1 was wrong? No. It is highly likely that surgery would have similarly resolved the issue. But doctor #1 was more aggressive. Doctor #2 never took surgery off the table, he simply thought we should try to avoid going under the knife if possible. If PT failed, he would have recommended the surgery. He was more conservative. So, it isn’t so much that one doctor was smarter or better or more informed than the other, they simply had a different view of the situation, informed by their different experiences and views of best practice.

    These are my views as a patient. I’d love to see Russell weigh in.

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  3. A new FDA approved diet pill called Belviq just went on the market. Belviq make people more likely to succeed with weight loss since they feel full more quickly and it reduces food cravings. People who take Belviq with diet and exercise were 2 times more likely to lose 5% body weight and 3 times more likely to lose 10% body weight than the people who just did diet and exercise alone. The label states that if you do not lose 5% of your body weight in 12 weeks then consider stopping. Those that do respond in 12 (about 45% of patients) weeks go on to lose over 10% of their body weight in one year. Losing 22 pounds for a 220 pound person is life changing. So 45% of those taking Belviq lose significant amount of weight.
    Belviq has a second mode of action to reduce blood sugar which may end up preventing diabetes in many cases. Diabetics and pre-diabetics who took Belviq, REGARDLESS of weight loss, saw their blood sugar numbers drop by double digit percentages. IE HbA1c -0.9 to -1.2 and fasting glucose feel -27. The cost of medications to reduce HbA1c levels exceeds the cost of Belviq. (seeArena’s BloomDM phase III trial) These reductions in diabetic symptoms plus the weight loss at the same time makes Belviq a medical bargain.

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  4. I have some experience here, particularlly related to breakfast and maintaining correct blood sugar. I rarely eat carbs that come from anything but veggies, other than slowly absorbed carbs like steel cut oatmeal. I also exercize a LOT. That pulls sugar out of the blood.

    I got all this from interweb searches and watching my body’s response to various food inputs over a year.

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