While there is a LOT I can do (and am doing) to control my disease, it's not my fault that I have polycystic ovary syndrome (PCOS) and immediately gained weight upon reaching puberty. If I'd had any idea what was going on with me or known why it was I was overweight despite eating an overall healthy diet and being a very active teen, then maybe it would be my fault, so to speak. I didn't have that information, so my rational side says I can't be to blame (sometimes my self loathing side says otherwise). When I knew better, I did better. I had to get myself diagnosed and bring up the possibility of PCOS with my doctors. I took control, and I'm proud of that.
I didn't choose to be born to an otherwise healthy father who is type 2, either, while we're discussing the subject. I'm overweight, but he is not.
I'm a pediatrician and I spend half my days helping kids and parents lose weight. ( trying my best, anyway)
I have to agree if you do not modify your behavior after many years of bad nutrition and not exercising, you will have type two, so " fault " lies therein.
Now if you want to get into a huge discussion of class, race, inequality, etc... then that is another discussion entirely. Yes, there are many folks who really never had a chance, poor parenting, poor neighborhood, crappy food alternatives, etc...
I don't know the answers... has anyone read Francine Kauffman's Book " Diabesity" ? I bet she has some good ideas...
I have to agree if you do not modify your behavior after many years of bad nutrition and not exercising, you will have type two, so " fault " lies therein.
I am surprised that, as a pediatrician, who should know better, that you can say that. You, of all people, should know that 33.8% of Americans are obese, and if obesity caused diabetes, why aren't all of them diabetic? If you include ALL people with diabetes, it only comes to about 8% of the population, so 25% of Americans are obese, may or may not have bad eating and exercise habits, and miracle of miracles, they DON'T have diabetes, and most of them never will.
YOU are the kind of doctor I'm scared of, because if YOU don't know your stuff, who will be there when someone needs REAL help?
Count me on on the PCOS and instant weight gain upon hitting puberty. I was the skinny kid in my neighborhood -- super active, tall and rail-thin. I got teased about being thin aaaaaaaaall the way through elementary school.
Within the first year post-puberty I gained about twenty-five or thirty pounds of body fat and have been fighting my weight ever since. I had one huge ovarian cyst when I was in my twenties, horribly irregular periods (anywhere from 21 days to 65 days apart, lasting anywhere from three days to a month, yes a continuous month of menstruation -- I thought I was going to bleed to death!) Doctors had no name for what was wrong with me. No clue.
I was finally diagnosed with PCOS in my late forties. Along with the decades of borderline anemia, the auto-immune thyroid disease, the reactive hypoglycemia, and now the T2, maybe, just maybe, I should have been staying away from carbs, especially starches, because my body is too screwed up to handle them? It took me...what? Forty years to figure that out? All the while I was being bombarded with information: "Fat bad, whole-wheat bread good. Red meat bad, grapes and bananas and apple-juice good."
We do so love to blame and shame the obese in this culture, but most of us have complex and complicated hormonal and biochemical stuff going on with our bodies that doctors barely understand. Why, why, why can't we recognize and acknowledge that almost NO ONE would CHOOSE to be obese in a culture that HATES fat people?!?
obese is 1 part, and lets admit it, a large part of metabolic syndrome. It is one factor towards a slippery slope to T2 imo. Its not the only factor (hence why not all 33% of americans are diabetic).
"Type 2 diabetes is caused by a complicated interplay of genes, environment, insulin abnormalities, increased glucose production in the liver, increased fat breakdown, and possibly defective hormonal secretions in the intestine. The recent dramatic increase indicates that lifestyle factors (obesity and sedentary lifestyle) may be particularly important in triggering the genetic elements that cause this type of diabetes." (emphasis mine)from here.
If you google type 2 diabetes genetics there are loads of references. This is the simplest one I found on a quick look.
My only quibble is over term Insulin abnormalities.
Human body uses a distributed glucose storage system ( including Liver) that store glucose throughout the skeletal muscles. As these muscles will all each have varying levels of glucose stored, these cells all must have the ability to either take on more glucose or ignore the body insulin so as not to poison themselves. On top of this, current theory suggest that if skeletal muscle's will not absorb nay more glucose, the insulin or the cells response to insulin must be defective rather than it being a logical response to prevent overstuffing the glucose.
The storage capacity of the skeletal muscle cells is finite. They are not as current theory would suggest are medical infinite motion machines taking on more and more glucose. Won't go in, must be not enough insulin or needs actos to stuff more in.
Only sufficient exercise burns off the stored glucose in the skeletal muscle cells ensuring there is always room to absorb more glucose and keeping blood system glucose level regulated or it backs up in the blood system rotting everything out.
MRI spectography studies done and research conducted has located this glucose storage and tests done suggest that cells defend themselves against excess glucose by turning off cell response to insulin command.
The concept of glucose saturation is never considered nor addressed. Yet in a distributed storage system like this that keeps human body hot to trot when the saber tooth tiger comes around the corner for a quick snack, overloading the cells with glucose on a system designed for starvation prevention and no internal optimization to prevent glucose overloading; saturation is a distinct possibility.
Thank you for your fascinating post. As a very obese T2, I have myself experienced quite a bit of variability in my insulin resistance in the 12 to 36 hours after strenuous exercise. Due to age-related (or possibly diabetes-related) stiff muscles and creaky joints, I find it very difficult to engage in even 1/10th of the weight-bearing and aerobic exercise that I did quite easily as a much younger person. Your post reminds me that all T2's should be engaging in as much exercise as we can tolerate, to aide our cells in taking up and burning glucose rather than resisting it due to glucose saturation and sending our blood glucose soaring. It's quite the vicious cycle, isn't it?
I've already cut carbs way back, but based on reading I've been doing over the past several years, I think some of us (especially people like me with Native American genes in the mix) are really designed to do 14 or 15 hours per week of strenuous exercise. When I have done that much (as a martial artist, later as a swing dancer, and then as a gym rat) I saw a big improvement in my health in general each time.
Unfortunately, each time a serious injury (or surgery) cut my activities short, but I can still walk and I can still do chair exercises. Engaging in moderate, consistent exercise while avoiding injury seems to be the key for me in employing exercise as part of my diabetes program. If I push too hard and get injured, I'm back to square one, or get bad hypos. If I inch up on it and keep it consistent and gentle, it really helps lower my insulin requirements (not completely, but a measurable improvement.)
You have caught what I found happening on my old body where morning dawn effect and liver over dumping would hammer my body every am.
During that time BG would be rammed up to 238 to 240 and insulin - 26 units of 75/25 insulin would do nothing - like sticking needle into a wood post.
I would walk 2 miles each am and see the excess glucose burn off to 140 and see the blood glucose level burn to a 100 as insulin kicked back in and started working rather then ciculating around in body doing nothing as muscle cells ignoring.
EVery time I walked the glucose off, the body became really responsive to insulin.
In addition, studies have suggested that the glucose transport on muscle cells is one way in and stays there until burnt off.
I had a stroke in 2007 and had to learn to walk again using my thinking brain to do that and make up for stroke having nailed the right side balance. After a couple of years, I could finally walk again. After 30 days in hospital, using a walker I barely made it once around the hospital inside around the nursing station floor of rehab. Initially it would take about an hour to walk one mile and gradually got that down to 30 minutes.
One does not need to be strenuous but as best one can without killing oneself.
The Pharoh's of Egypt could never have built the pyramids by hand if it were not for all the rich carbs that could be grown on the rich river delta land of the Nile.
Best wishes with your health and sharing your situation.
Emmy, I don't see any much flaming except for one post that I remember that was rebutted by T1/LADAs. We are a community of PWD, and each one of us is different. I enjoy the mix of participants in our discussions, I learn from everyone.
Of course, in a community of over 20k people, there are a few who are not as accepting as most, but it comes with the territory. I do know where you are coming from, I was mis-dx with T2 for years, but I find your post discriminatory as well? (NOT a flame!)
I'd prefer it if we would all just pretend we're Switzerland when it comes to type. We're all diabetics. We all fact the same long-term complications. We have many of the same day-to-day issues.
I don't comment where I have no knowledge (e.g. on threads about pumps I may read but almost never comment) but if a T1 wants to chat with me about low-carb recipes, logging, treating lows, what supplies I carry to the opera, how "out" I am at work or frozen shoulder issues, why not?
I just expect EVERYONE to show one-another respect and human compassion. We're all human beings dealing with a potentially dangerous and difficult disease, after all.
I'm not surprised. People tend to parrot whatever they hear from doctors & other medical experts & many of them blame diabetics for having diabetes. Of course, none of them have a viable explanation for the many thin individuals who primarily eat junk food & never get diabetes.
On other non-diabetes forums, whenever someone brings up diabetes, others will always post a photo of a very obese person grocery shopping, riding in a powered cart full of cookies & chips - obviously implying that's the only way to get diabetes.
I couldn't find Emmy's post -- maybe she took it down. But I wanted to share one reaction. It's easy to see and understand why T2's have strong emotional reactions to all the misinformation floating around, and the shame and blame game, and those reactions are totally justified. But T1's have their own emotional issues, too, and those are not dealt with nearly so often. One of them is being lumped into the shame and blame game, which they rightfully feel they don't deserve (but T2s don't deserve it, either), and another is the toll that the stressful T1-enforced lifestyle takes on parents and kids (and former kids), such that they really concentrate on their own issues, and are not particularly aware of T2 issues. T1 is truly a wild roller-coaster ride (except in the case of AR, and I don't know how he does it) and while they are so busy fighting it, learning about T2 is not high on their list of priorities.
I don't know if anyone notices, but I am very careful in my posting NOT to take sides, and not to demean ANY type of diabetes, because in the end, while the causes and treatments may vary, it ALL sucks. And it's NOT anyone's fault.
But it's SOOOOOO much more fun to pick on people. Especially on the interwebs. I do my level best to ignore all negativity unless it's right in my face.
Of course, I have found the antidote for all negativity...music:
