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How about we stop masking the problem of insulin resistance by pumping type 2 diabetics with insulin? Why don’t we start telling diabetics the truth — your die

How about we stop masking the problem of insulin resistance by pumping type 2 diabetics with insulin? Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training. We don’t need more insulin to shove the massive onslaught of blood sugar from your crappy diet into your cells (which are telling you they’ve had enough, AKA insulin resistance), we need more honesty. The healthcare industry is morally and intellectually bankrupt. All the honest people who got into it trying to make a real difference don’t stand a chance, the truth doesn’t survive for an instant in this corrupt industry more focused on how much they can get out of insurance companies than treating patients.

hannasm 8y ago
Diabetes is an incredibly scary disease and we need more focus on the underlying causes and permanent solutions instead of pumping all this money and effort into stop gap measures that perpetuate the problem.
- sbenitoj 8y ago
  Exactly!
- JamesBarney 8y ago
  Like increase NIH funding for basic science?
- InclinedPlane 8y ago
  By "perpetuate the problem" do you mean "keep people alive"? Because that is incredibly heartless.
tptacek 8y ago
Just a small fraction of type 2 patients use insulin, and type 1 diabetics can't avoid insulin by "avoiding most carbs and doing strength training". (The numbers in this article appear to be off).
- sbenitoj 8y ago
  Where did I say anything about type 1? And even though most type 2 diabetics aren’t (yet) on insulin, the advice they get does nothing but ensure they’ll be on insulin soon enough.
  - tptacek 8y ago
    Again, the overwhelming majority of type 2 diabetics do not end up on insulin, no matter how poor their squat PR is.
    - sbenitoj 8y ago
      I love that you’re completely ignoring that I’m making a broad, philosophical recommendation that people need to fundamentally focus on improving their diets and engaging in a specific type of exercise proven to improve glucose disposal and your only response is to be snarky.
edwardhusarcik 8y ago
> Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training. We already tell diabetics the "truth". In medical school, we're taught how to properly inform the patient in an unbiased, nonjudgmental way. It isn't up to the physician to force them to change their lifestyle, but instead for a mutual agreement to be made. Most people aren't able to change their lifestyle for a variety of reasons from being economically disadvantaged to lacking the knowledge of proper nutrition. It is not as simple "your diet is broken and needs to be fixed; avoid most carbs, do strength training.". I really wish it was.
- sbenitoj 8y ago
  Read this article and then tell me whether you think there is anything fundamentally wrong with the ADA’s and the CDA’s approach https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes-edition-d9332c42d38c https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes... It seems to be that these organizations are in the business of SICKcare, not HEALTHcare. It is much more profitable to keep people just a little sick (and dependent) than to cure them (which most diabetics are not even told is even a possibility).
jm__87 8y ago
First of all, diabetics take insulin because it keeps them from dying, not because it cures diabetes. Prior to getting on insulin, type 2 diabetics have likely already been on a drug which does not exacerbate insulin resistance (e.g. metformin). As the disease progresses, the pancreas starts to crap out and you eventually end up on insulin since your body can't produce enough insulin on it's own. > Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training. Yes, since no diabetic person has ever heard this advice before... as someone who is not diabetic but knows many people who are, every single person who is diabetic knows that diet and exercise will help them, yet they can't seem to get it sorted out. To me, this says knowledge and willpower are not the problem. Also, if someone has made it to the point where they are on insulin, their body is already pretty screwed up at that point and making these drastic lifestyle changes is going to be very very difficult (though not impossible). Regardless, we should have some more compassion for these folks - it is a very difficult disease to deal with and shitting on people for being sick is just mean, regardless of how they got there.
- sbenitoj 8y ago
  Read this article and then tell me whether you think there is anything fundamentally wrong with the ADA’s and the CDA’s approach https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes-edition-d9332c42d38c https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes... It seems to be that these organizations are in the business of SICKcare, not HEALTHcare. It is much more profitable to keep people just a little sick (and dependent) than to cure them (which most diabetics are not even told is even a possibility).
  - jm__87 8y ago
    I'm not saying the ADA and CDA are right or that your advice on diet and exercise is wrong, I'm saying the issue is more complicated than you are making it out to be. Your average diabetic knows what causes the disease and what is making it worse, yet they have a very difficult time making the lifestyle changes required to improve their outcome. If you're familiar with Jason Fung's work, you'll know that he himself raises this point, and this is why he is such an advocate of intermittent fasting - this lifestyle change seems to be easier to make for someone who is diabetic than improving diet and exercising more.

hannasm 8y ago

Diabetes is an incredibly scary disease and we need more focus on the underlying causes and permanent solutions instead of pumping all this money and effort into stop gap measures that perpetuate the problem.

sbenitoj 8y ago
Exactly!
JamesBarney 8y ago
Like increase NIH funding for basic science?
InclinedPlane 8y ago
By "perpetuate the problem" do you mean "keep people alive"? Because that is incredibly heartless.

tptacek 8y ago

Just a small fraction of type 2 patients use insulin, and type 1 diabetics can't avoid insulin by "avoiding most carbs and doing strength training". (The numbers in this article appear to be off).

sbenitoj 8y ago
Where did I say anything about type 1? And even though most type 2 diabetics aren’t (yet) on insulin, the advice they get does nothing but ensure they’ll be on insulin soon enough.
- tptacek 8y ago
  Again, the overwhelming majority of type 2 diabetics do not end up on insulin, no matter how poor their squat PR is.
  - sbenitoj 8y ago
    I love that you’re completely ignoring that I’m making a broad, philosophical recommendation that people need to fundamentally focus on improving their diets and engaging in a specific type of exercise proven to improve glucose disposal and your only response is to be snarky.

edwardhusarcik 8y ago

> Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training. We already tell diabetics the "truth". In medical school, we're taught how to properly inform the patient in an unbiased, nonjudgmental way. It isn't up to the physician to force them to change their lifestyle, but instead for a mutual agreement to be made. Most people aren't able to change their lifestyle for a variety of reasons from being economically disadvantaged to lacking the knowledge of proper nutrition. It is not as simple "your diet is broken and needs to be fixed; avoid most carbs, do strength training.". I really wish it was.

sbenitoj 8y ago
Read this article and then tell me whether you think there is anything fundamentally wrong with the ADA’s and the CDA’s approach https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes-edition-d9332c42d38c https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes... It seems to be that these organizations are in the business of SICKcare, not HEALTHcare. It is much more profitable to keep people just a little sick (and dependent) than to cure them (which most diabetics are not even told is even a possibility).

jm__87 8y ago

First of all, diabetics take insulin because it keeps them from dying, not because it cures diabetes. Prior to getting on insulin, type 2 diabetics have likely already been on a drug which does not exacerbate insulin resistance (e.g. metformin). As the disease progresses, the pancreas starts to crap out and you eventually end up on insulin since your body can't produce enough insulin on it's own. > Why don’t we start telling diabetics the truth — your diet is broken and needs to be fixed; avoid most carbs, do strength training. Yes, since no diabetic person has ever heard this advice before... as someone who is not diabetic but knows many people who are, every single person who is diabetic knows that diet and exercise will help them, yet they can't seem to get it sorted out. To me, this says knowledge and willpower are not the problem. Also, if someone has made it to the point where they are on insulin, their body is already pretty screwed up at that point and making these drastic lifestyle changes is going to be very very difficult (though not impossible). Regardless, we should have some more compassion for these folks - it is a very difficult disease to deal with and shitting on people for being sick is just mean, regardless of how they got there.

sbenitoj 8y ago
Read this article and then tell me whether you think there is anything fundamentally wrong with the ADA’s and the CDA’s approach https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes-edition-d9332c42d38c https://medium.com/@drjasonfung/unf-yourself-type-2-diabetes... It seems to be that these organizations are in the business of SICKcare, not HEALTHcare. It is much more profitable to keep people just a little sick (and dependent) than to cure them (which most diabetics are not even told is even a possibility).
- jm__87 8y ago
  I'm not saying the ADA and CDA are right or that your advice on diet and exercise is wrong, I'm saying the issue is more complicated than you are making it out to be. Your average diabetic knows what causes the disease and what is making it worse, yet they have a very difficult time making the lifestyle changes required to improve their outcome. If you're familiar with Jason Fung's work, you'll know that he himself raises this point, and this is why he is such an advocate of intermittent fasting - this lifestyle change seems to be easier to make for someone who is diabetic than improving diet and exercising more.