Book review: Lifestyle Makeover for Diabetics and Pre-Diabetics

1

This is a great reference book for folks with a can-do attitude who are not faint of heart. The author, George F. Tohme, is an experienced pharmacist, and has a very direct and blunt writing style. I think some people will find this to be motivating and highly useful for its clarity, and others will feel alarmed by what can sometimes read as alarmist or "doomsy". In a nutshell, his message is "take good care of yourself or your diabetes will kill you, and here's how to take good care of yourself". Reading it is not like getting a back rub or a hug, but it IS like taking a class... which is really, really useful.

Personally, I'm not all that alarmed by the "doomsy" stuff (okay, there was a bit about alcohol consumption that freaked me out), but I also don't love reading it. So to be perfectly honest I skipped a bunch of sections where The Problem was laid out, and went straight to The Solution. Most of the points in the book are made this way: 1. Here's the condition (high blood sugar, obesity, poor nutrition...) 2. Here's what it can lead to (loss of eyesight, loss of mobility, loss of hair...) 3. And here's how to fix it (insert a slew of healthy lifestyle habits, and some medications, as applicable).

The book is packed with information about symptoms, medications and side effects. So for example, the next time a doctor gives me some new medication for a fleeting ill I'm experiencing and my blood sugar skyrockets, I'm going to look it up in this book! Better yet, I'll look it up in the book beforetaking the new med :) My personal experience is that doctors don't always know when a medication can affect blood sugar, but a pharmacist probably does. Also included is a great deal of information that is not diabetes-specific alone, but has to do also with the digestive tract, sexual function, circulation etc.

And as long as I'm talking about sexual function... There's a whole section about it entitled "Women and Men: Boost Your Sexual Health at Any Age". Pretty nifty. It's even got tips on boosting your libido.

Now, I will say that this book will probably make some folks very angry. Tohme makes crystal clear his belief that smoking, drinking to excess, taking illegal drugs and being over-weight are birds of a feather, meaning that all 4 reflect poor decision-making, and folks who make those decisions pretty much have themselves to blame when (not if) their health suffers. The follow-up message is "so stop doing that, and do this instead". We all know it's not really that simple, because humans have complicated psychology and there are usually good reasons why we make the choices we do, even when they are deleterious. And sometimes the simple admonition "change your mind" is not helpful. For this reason I think this book is best for folks seeking information who can receive and make use of it without taking the assertions about health-related choices personally, or who have health-related habits they want to change, and need information about how to do so.

2

Is this book geared to Type 1 or Type 2; I can see how some things apply to both, but I'm always leery of books geared to "diabetics". They are either type 2 and not saying so, or they are a mush of things that are too general to really help either one.

3

I'm glad you asked, Zoe! Because in this book Tohme does something that I would have considered irresponsible in the past, but which I now believe to be ESSENTIAL: he explains the differences between types 1 and 2, and then directs the information to BOTH (my apologies to folks with the variety of types OTHER than 1 and 2. You should not be left out of this conversation. Tohme does include information about gestational diabetes, but not LADA or MODY). This is not to say that he implies everyone with type 2 needs insulin, or people with type 1 need oral meds. But he does not treat us as separate animals with completely different care instructions. The same nutritional guidelines are healthy for both, the same exercise guidelines are healthy for both, the same complications occur in both... True that we may at times have different concerns to keep an eye on, and Tohme recognizes those when they apply, but in fact our care is not so different, and with the exception of "dead in bed" (a fowl term, I think), the consequences of poor habits are the same for all of us.

Frankly, I think Tohme's approach to type 1 vs. 2 is the wave of the future. Especially as more and more people with type 2 are taking insulin, and people are being diagnosed with type 2 at younger ages, I think we are beginning to look a lot more similar than we used to. This book actually moved me further away from my previous die-hard stance that the two types are completely different diseases, because I saw how much of the information contained really does apply to both.

4

I'll keep an open mind, Emily, but in general I find the mindset as well as the practical details pretty different, and do see it as two different diseases. Not that one is "worse" (or better) than the other, or that we don't share some commonalities, but that it is a different condition in more ways than just the presence or absence of antibodies.

Diet is one of the things that I think is different. Though it's not politically correct to acknowledge, many Type 2's are overweight and so weight loss is an important factor in their regimen; with the added complication of insulin resistance, this is a hard row to hoe! Many Type 2's are on oral meds often for many years, before their insulin is depleted and those meds bring a whole different set of issues than insulin use does. If/when they are put on insulin, again, they must still deal with insulin resistance.

I don't think the diet issues are the same either. While many of the same things help both Types, Type 2's often consider things like the glycemic index and whole grain vs white where with type 1's this makes little difference for many of us. Type 2's who are still able to manage on just diet and exercise on the other hand, need to be pretty strict in their carb intake where type 1's have insulin to cover their carbs (though some take this liberty too far imho). I can't speak to the exercise question, but from what I've heard on here, for type 2's it is often a tool to reduce blood sugar in the absence of insulin, and type 1's need to deal with the balancing act between insulin and exercise.

Type 1's are much more likely to go into DKA than Type 2's. Type 2's are way more represented in the media and thus in the public's eye. If one is above a certain age, it is inaccurately assumed they are type 2. (whether they are late onset type 1, been type 1 for 30 years, or actually are type 2).On the other paw, Type 2's deal with the stigma that "you caused it yourself". Type 2's deal with the X cluster (I can't remember the right name) of high blood pressure and cholesterol. Type 2's would have a struggle to get a pump even if one were the appropriate treatment.

Others can probably think of more examples, that's just what came to mind. Again, my goal is not to be divisive or to say one has it harder than the other, but just to say I think they are two different diseases.