Comment on the HuffPost site if you see any misinformation in this article. Comments here are only preaching to the choir. I’m not savvy enough about Type 2 to know if there’s misinformation in the story but it seems to be treading close to the “Type 2 is your fault” line.
http://www.huffingtonpost.com/milt-bedingfield/the-importance-of-diagnos_b_839861.html
Terry
There’s tons of misinformation in the article; but why waste one’s time arguing with people who are determined to hate other people? Type 2 diabetes is framed as a moral issue by some of the people commenting there: if you have it, it’s because you lacked the morality to take good care of yourself.
I would object to this statement “It is obviously unknown just how many people understand the cause and effect relationship of a sedentary lifestyle, overeating and weight gain, and the development of type 2 diabetes.” It’s the usual confusing cause and effect with concurrence. A basic error in logic.
Gary Taubes, in his new book, Why We Get Fat: And What to Do About It, describes a different scenario, in detail, and backs it up with solid science. He implicates carbs like flour, sugar, potatoes etc which are converted to glucose and are absorbed very quickly. Research seems to indicate that, in some people, this leads to overproduction of insulin leading to insulin resistance which leads to weight gain, uncontrollable hunger and a tendency toward a sedentary life style because of the weight gain. To complicate things further said carbs are quite addictive, at least for some people, I can personally attest to this.
The title of Mr. Bedingfield’s book is, Prescription for Type 2 Diabetes: Exercise. If you believe Taubes’ explanation of whats going on, exercise alone probably isn’t going to do it.
I agree with Frances, it usually comes down to a question of a lack of moral fiber. The basic error is assuming all of us have identical metabolisms. We all know people who can eat junk food all day long and not gain a pound. Others get addicted to exercise, again because they are built differently. It’s really not a question of moral fiber.
I do like Mr. Bedingfield’s idea about using a C-peptide test as an early diagnostic tool. The problem with the present protocol is that fasting blood glucose is used as the basic diagnostic tool. Unfortunately this is usually the last thing to go, so by the time a person is diagnosed it’s too late.
The real question is given an early diagnosis how many people would act. This would probably involve a change in diet, perhaps dealing with addictive foods that taste so good, and yes regular exercise. I’m not so sure this would reverse the current T2 epidemic, but at least it would give people a chance.
I also wonder if the chemicals we are all exposed to day in and day out are damaging our metabolism’s, but that’s for another discussion.
I had to stop reading the comments because my blood was beginning to boil. The assumption that we become diabetic because we are inactive couch potatoes that don’t know how to eat is so false. I have been active all my life. In the 10 years prior to diabetes I worked out 2-3 hours most days in the gym. I was a vegetarian, eating fruits, whole grains and no animal products. Without any family history I got diabetes. The way I manage it is to eat Low Carb/ high fat. So yes I eat lots of aninmal products and lots of saturated fat. We have diabeties because for some unknown reason our pancreas has decided not to work efficiently. It is like blaming someone who has an allergy or asthma for their disease.
The problem with using a c-peptide test as the sole diagnostic is that it does not show anything until insulin production has dropped off. The fact that some people with Type 2 diabetes (myself included) are able to control (if I can call it that!) our blood glucose levels with diet alone (and not necessarily a low-carb diet, at that) suggests that we are still producing insulin – perhaps even too much insulin, if there is insulin resistance. Similarly, a GAD antibody test will come up negative for many people with Type 1.5 (LADA) diabetes until some time towards the end of their “honeymoon” period.
That said, I think the article got it correct that there are several different types of “Type 2 diabetes”. There are some that are purely genetic (people who are in their 20’s and 30’s and have never been overweight), there are some that may be moderated or exacerbated by lifestyle, environmental chemicals, or diet. Some people can seem to eat all the bad carbs they want and still come back to 140 after 2 hours, others can’t even look at a grain of wheat or they’ll pop up over 200 and stay there all day.
What we have is, in effect, insufficiently precise protocols for the diagnosis and treatment of Type 2 diabetes. I was diagnosed with a fasting bg of 170 and an A1c of 7.8; I never had an OGTT. I would consider the appropriate suite of tests for suspected Type 2 diabetes are: fasting blood glucose, HbA1c, serum insulin, OGTT, and 48-hour continuous glucose. I would suggest they be used as follows:
Now, remember that I am not a licensed diagnostician, only a person with Type 2 diabetes who reads, observes, and synthesizes information gained from other people with Type 2 diabetes whose etiologies of diabetes differ from mine (and from each other), and who have had different successes (or lack thereof) with different treatment regimens.
tmana
Thank you for your detailed and well written response. I think you hit the nail on the head when you referenced all the different etiologies. Part of the problem is that Dr.s seem to treat T2 as one disease with one cause. Your proposed protocol takes this into account.
The thing I don’t understand is that the approach you outline doesn’t require any new research or breakthroughs. It’s simply the result of the application of logic to a problem. So why is something like this not adopted? Instead we hear time and time again, from TuDiabetes members, that their Dr.s po pooed test results that should have raised a red flag. Then treatment is not started until things are completely out of control.
Maybe it’s because the standard view is that deterioration in inevitable. It may well be for some, but we also read about people here, who seem to have arrested the progression of the disease through tight control. People should at least be given a fighting chance.
Well YEAH! Ever fact check the Huffington Post? It’s not a bad news source if you like fiction and fantasy.
Well, that kind of information comes from the truly uneducated. Most doctors I run into are not educated enough in diabetes to even be treating it. I agree that some cases of T2 could have been prevented or can be controlled with diet, exercise and weight loss, but, how about the ones that lose the weight and still can’t control. I think that if someone is obese and pre-diabetic they have a very good chance of reversing their situation with a well structured diet and exercise program. Also, most T2 don’t get tested for insulin production, I had to beg for the C-peptide test and once I finally got it I found out I have abnormally low insulin production. I was hoping my insulin production was normal because that would mean more than likely I am IR and could probably one day get off the meds. No such luck, it is what it is.
If diabetes is due to diet and weight then why aren’t all over-weight people diabetic? Genetics play a huge role in whether or not someone becomes diabetic. If I had known sooner that most of my family develops the disease later in life I could have been working with my doc to try to battle the on-set. Who knows. Fact is that when I was diagnosed my doc said I was T2 without even testing me for anything but an A1C, he said T1 are diagnosed as children, period. Some docs believe that. All I know is that it is very frustrating.
The biggest issue in getting a proper diagnosis of which type of Type 2 diabetes one has is that most of us are diagnosed by general practitioners who have very little knowledge of diabetes, nor experience in dealing with it beyond “follow this ADA diet sheet, take these pills, and come back in three months”. In short, most people on the threshold of Type 2 diagnosis will neither be diagnosed nor treated by someone who has the sort of in-depth knowledge of Type 2 diabetes that is accumulated through the sort of crowdsourcing that goes on in communities such as TuDiabetes and EsTuDiabetes. While it is one of the goals of those of us who are active in these communities and who advocate in real-life to get this information to the medical profession, it is a slow process by which trust must be gained, and crowdsourced hypotheses and reports verified by clinical scientific studies.
Which now causes me to wonder if there’s a way we, as proactive patients, can get our own cohorts together with qualified medical researchers to create the studies that would validate or invalidate our hypotheses and point the medical profession in the direction of more effective treatment paths…