9 ms·

Myths about Diabetes

51 points by vo2maxer 7y ago

will4274 7y ago
Bit frustrating how myth 2 is totally devoid of facts that would permit further reading. What's the scientific names for these different types of insulin and the actual physiological difference between their effects?
- m348e912 7y ago
  This was one of the comments posted below the article that may answer your question: Epistemologist2: As a physician myself, with Type I diabetes for the past 56 years, I have lived through quite a lot of change in the management of my diabetes. I am particularly concerned about the discussion in Myth #2. The inexpensive insulin, U-100 Regular Insulin, is readily available and it is just as potent, unit for unit, as the newer synthetic insulins. What is different is the rate of onset of action. Regular Insulin does not "turn on" as quickly as the others, but if taken in advance of a meal will do the job sufficiently well that you can maintain reasonable blood sugars. The over-riding intent with insulin therapy is to mimic natural insulin production/action in one's body. The expensive modified insulins become active much faster and consequently will more closely mimic natural insulin release, but it is critical to note that once injected, those insulins do not turn off as promptly as naturally produced insulin from the pancreas, and this can be a serious problem! In my case, I had had my diabetes for about twenty years and was adequately controlled using those "old" insulin products extracted from beef and pork pancreas after which we got the now inexpensive Human Insulin, chemically identical to that from the human pancreas, and it did not "turn on" any faster than the predecessor products. It was not until 1996, 33 years into my own diabetes, that we saw the introduction of a synthetic insulin with much faster onset of action. Bottom line is that the price of the fancy new insulins should not be such a barrier that it leads to one's death. The inexpensive older products work, just like you old "dumb" phone works to do its basic job. Newer is better, but not critical, and neither doctors nor patients should forget that using older techniques and products is a viable option. It is the doctor's failure to think outside the box to adequately educate the patient that causes death.
- projektfu 7y ago
  Broadly speaking, there’s insulin in solution (insulin-R or regular insulin) and crystalline insulin. Insulin-R is relatively short acting and is frequently used in acute therapy or intensive care. It used to be the only type, and can be used in a mode where it’s given before a meal and as needed. Insulin-N (NPH, neutral protamine Hagedorn insulin) and protamine zinc insulin (PZI) are the first generation crystalline insulins. They have longer lasting (baseline) effects as well as peaking effects that allow them to be given easily on schedule based on the sizes of meals. There’s a variety of modern insulins now, which are substituted with different amino acids to give them different effects. Insulin glargine and insulin detemir are the most popular. They are supposed to have blunted peaks and are given at regular intervals such as every 24 hours. They mimic the baseline insulin secretion. Insulin pumps are also available that monitor blood sugar and secrete insulin to keep it controlled. There are also experimental “artificial pancreases” that will also secrete glucagon. Another comment mentions that cheap insulin can be just as good. This is true but it requires a careful lifestyle. Messing up is more common and if you’re on your own you may be unable to help yourself, e.g. comatose. Currently, insulin-N and -R are cheap. Detemir and glargine are constantly going up in price despite the existence of multiple suppliers of glargine. (This sort of implicit agreement without actual price fixing is common in the pharmaceutical industry). Essentially, the competitor is a small fraction cheaper, can take some of the market, but most people will continue writing and filling scripts for the incumbent because it’s what they know, on the formulary, etc. I’m not sure of the use of PZI in human medicine. It’s popular in my patients, as is glargine.
hirundo 7y ago
Much of this contradicts my N=1 experience. I have controlled my type 2 diabetes by keeping my carb intake below 25 net grams per day. * My diabetes controlling diet is high in fat. I have found that without the presence of carbs, fat is the safest macronutrient in terms of keeping my blood glucose level down. I can eat fat and protein while barely budging my levels. * Sweet desserts are not okay, not even once in a while. They make my blood glucose soar, and it can take days to get it back under control. I get some of my diabetes symptoms and carb cravings back within hours of indulging. This is not about sugar though, it's about all of the carbs I've tested, including fruit. Sugar seems to act just as a concentrated carb. * Yes too many sweets can give you diabetes. I believe that's how I earned it, by indulging my sweet tooth for year after year. It seemed like an extreme change for me to go low carb, but as a result I have a reasonable blood glucose level without any drugs. And the actual change was more joy than slog. I now love this way of eating and don't (much) miss the high carb foods. I'm afraid this myth buster needs some of her myths busted.
- jokowueu 7y ago
  I wonder have you tried something similar to the 200 calorie diet the NHS trialed a few years ago ? I found this very interesting I just haven't seen or heard anyone trying it https://www.bbc.com/news/health-42154666 https://www.bbc.com/news/health-42154666 https://www.bbc.com/news/health-47456418 https://www.bbc.com/news/health-47456418
  - hirundo 7y ago
    Fasting has an extremely positive and rapid effect on my blood sugars. 200 calories isn't far from fasting.
- maxerickson 7y ago
  "Yes too many sweets can give you diabetes." Someone just reading your comment here might not realize that the article has a reasonably nuanced discussion of this.
  - kop316 7y ago
taxicabjesus 7y ago
My passenger, Mr. "Who Are Your Lifelines" [0], was turned into a type 1 diabetic as an adult, seemingly through his interactions with the family court system. At one point I spoke to his sister, who said he was repeatedly thrown in jail when he couldn't pay his assessed child support. He was 18 or 19 years old at the time, and had previously made $100k/year (computer-something, in the 1990's probably), then lost that job. The judge didn't have the ability to reassess the child support amount. The sister said the law was later changed, but it was too late to prevent the destruction of my passenger's pancreas. Maricopa County Jail did a A1C test on him on intake, and decided this passenger needed a daily time-release insulin injection. If he tried to refuse the injection, he would be sent to solitary confinement. When combined with the jail's starvation diet, this forced use of insulin is a form of torture: I understand insulin without carbohydrates -> low blood sugar -> cortisol release -> muscle wasting. When he got out he told me he'd developed an intestinal blockage that required surgery. When he was locked up again 2 years ago (on account of missing a drug court hearing, 2.5 years before), I took pity on him and deposited some funds on his jail account so he could buy snacks to sort of keep himself out of stress-induced deterioration. I have a postcard that said it was incredibly helpful knowing someone on the outside cared about him. He supposedly sent me three postcards, but I only got one. "Do the most expensive thing possible" seems to be the guiding philosophy for the American approach to Medicine. The doctors quoted in my recent submission [1] pointed out that they can do expensive things for their patients, but have no ability to provide what their patients actually need. My step-sister's husband is a type 1 diabetic. I just learned he had a bad case of the chicken pox just before he was diagnosed as a 3 year old child. A friend's 2 year old daughter became a type 1 diabetic soon after her first weekend at her biological father's house -- this was the first interaction with her birth father; I'm sure the kid was like "who the hell are you and where is my mother????". I bet in 20 years the new myth of Diabetes will be that it's a chronic condition that can only be treated palliatively. "Stress" seems to be the cause behind the symptoms of diabetes. If doctors treated stress instead of the end result of stress (pancreas dysfunction / insulin resistance -> high blood sugar levels), people would certainly have much better outcomes. [0] https://www.taxiwars.org/p/who-are-your-lifelines.html https://www.taxiwars.org/p/who-are-your-lifelines.html [1] https://news.ycombinator.com/item?id=21728864 https://news.ycombinator.com/item?id=21728864
- 7y ago
projektfu 7y ago
Would someone mind listing the myths? It’s hard to understand which myth is referred to by number when you can’t read the article.
- vo2maxer 7y ago
  http://archive.ph/NSt4G http://archive.ph/NSt4G
  - projektfu 7y ago
    Thank you. 1. Only kids get type 1 diabetes 2. Wal-mart insulin is just as good as expensive insulin 3. Eating sugar gives you diabetes 4. You can't eat sweet foods if you have diabetes. 5. You can treat type 1 diabetes without insulin.
    - RandomTisk 7y ago
      #3 as a myth would be better stated as: Anyone can get diabetes by eating too much sugar
calibas 7y ago
I hate that they begin with "No, you don’t get it from eating too many sweets." Then later they admit that Type 2 diabetes risk is greatly increased by an unhealthy diet. So you can get diabetes from an unhealthy diet, like a diet with too many sweets.
- ng12 7y ago
  It's explained in the article: > Type 1 diabetes develops as a result of genetic risk and an unclear trigger; it’s not caused by eating sugar — or anything else... The story for Type 2 diabetes is a bit more complicated.
  - calibas 7y ago
    That explains the difference between Type 1 and Type 2. I made sure to be clear which type I was talking about though.
- Kye 7y ago
  This kind of false attribution is how we got a market full of "low fat" foods packed with sugar. It seems like "don't eat too much sugar" should be a harmless, practical abstraction, but people will go off and eat a diet that still leads to type 2 diabetes while avoiding obvious sugars. And missing non-obvious ones. For example: A "healthy" serving of plain corn flakes with a serving of plain milk has lots of sugar in it. Foods can have low added sugar, or low some-kind-of sugar, and still lead to type 2 diabetes. Focusing on sugar will lead to the same health disaster that came from focusing on salt or fat.
  - gowld 7y ago
    Your example is still high sugar. The anti fat crusade was a marketing lie sponsored by sugar /corn syrup manufacturers. No one's confused into thinking sugar is good, they just like eating junk food.
- dghughes 7y ago
  If you have diabetes you crave sweets due to having diabetes. Sugar doesn't cause diabetes. You eat food because you are hungry. Food doesn't not cause hunger.
metacritic12 7y ago
While this article is technically correct, I think it is actively harmful to the landscape of general public knowledge. A lot of this article is just playing "gotcha", where she's pointing out technically a lot of cultural glosses about diabetes only applies to type-2 diabetes. However type 2 diabetes occurs at a rate >10x as much as type 1 diabetes [1], and it's the type that is more preventable by behavior and diet change. Statements close to the "myths" she's debunking is approximately true, while her "technical facts" if not handled with care will lead to far worse wrong beliefs. Approximate myth that we want: "Generally, diabetes is strongly related to high BMI and bad diet which often includes diets high in sugar". Technical truth that muddies the conversation: "Actually the above relationship excludes T1D, which is a vast minority of diabetes." Approximate myth we want: "Many diabetes is preventable by eating well." Technical truth that muddies the conversation: "Actually some T1D is adult onset 2-3%, so you may not be able to prevent those!" Approximate myth we want: "Bargain hunting for medications when medically equivalent is good, especially generics." Technical truth: "Actually there are medical differences between different insulin formulations, because unlike small-molecule drugs, different formulations are not biologically equivalent. Some expensive modern formulations are good." -- A doctor with knowledge about public health and has good writing skills should reconsider writing an article like this. Why not go after real harmful myths like anti-vaxxers? Or how about rewording the article so that the myth is actually approximately bad, like "Bad diets are okay for diabetes as long as you avoid sugars". [1] https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm
- vo2maxer 7y ago
  I thought the article author’s background could be of interest: https://med.virginia.edu/faculty/faculty-listing/hf4f/ https://med.virginia.edu/faculty/faculty-listing/hf4f/
- dorkwood 7y ago
  I would argue that the approximate truth of "diabetes is preventable by eating well" isn't useful, since members of the public often have a distorted view of what "eating well" means. I once had an obese friend of mine tell me I was going to give myself diabetes -- despite the fact that I'm not even remotely overweight -- because I regularly drank soda. To him, his diet was good, because he ate salad for lunch and snacked from the office fruit bowl, whereas my diet was bad, because I drank soda. There are likely many people out there who believe that because they eat salad for lunch they're "eating well" and reducing their risk of diabetes, when actually they're putting themselves at risk by being overweight.
nradov 7y ago
It's really a shame that Type 1 and Type 2 are both called "diabetes" since the causes and treatment are so different. This leads to a lot of misunderstandings in the general population. And to further complicate the situation there is a growing population of double diabetics who start out with just Type 1 and then later also get Type 2. Virta Health has had some excellent success in reversing Type 2 with carbohydrate restriction. https://blog.virtahealth.com/with-sustained-type-2-diabetes-reversal-management-is-becoming-a-thing-of-the-past/ https://blog.virtahealth.com/with-sustained-type-2-diabetes-...
mchill 7y ago
For type 2 diabetes, a plant-based diet is the way to go for prevention, management and even reversal: https://www.pcrm.org/health-topics/diabetes https://www.pcrm.org/health-topics/diabetes
- sithlord 7y ago
  You can't reverse type 2 diabetes. Using terms like "reversal" are insulting at best. Sure, you can suppress symptoms (ie management) if you were to change your diet back to what it was, the symptoms come right back.
  - mchill 7y ago
    Cure and reversal are different. It is possible to reverse type 2 diabetes to the point where medicines are no longer required to maintain healthy blood sugar levels. I agree that staying on the diet is key. It works best as a permanent lifestyle change.
    - sithlord 7y ago
      reversal and cure should be synonymous. to reverse something, would mean that you go to a state where you can do whatever and it not affect you. The correct term is treat it with diet, its still a condition you have. When I was diagnosed with t1d at the age of 24, I can't count on 1 hand how many people told me that I can "reverse" it by (going low carb/eating gluten free/eating cinnamon). I know we are talking about type 2 diabetes in this case, but
  - nradov 7y ago
    I don't understand your objection. Of course it has to be a permanent lifestyle change. It's like if I give myself a headache by hitting myself in the head with a hammer, and then I stop doing that of course the headache will go away. But if I start hitting myself again the headache will return.
    - sithlord 7y ago
man2525 7y ago
Based on the literature I've skimmed or watched, I find the correlation between NAFLD (non-alcoholic fatty liver disease) and T2D interesting. It seems that fat is distributed in different people to different sites (subcutaneous, visceral, liver) at different rates. Fat in the liver can result in NAFLD. In some cases, there seems to be elevated liver enzymes (AST/ALT) for months or years prior to overt diabetic symptoms in people who also had an A1C level considered typical for prediabetes. The following article describes research for substances that appear to protect pancreatic beta cells. It mentions that one of the substances, adipsin, is correlated with subcutaneous fat. https://news.cornell.edu/stories/2019/11/protein-finding-could-inform-new-type-2-diabetes-treatment https://news.cornell.edu/stories/2019/11/protein-finding-cou... Likely, many people with T2D have excess fat regardless of where it's distributed in the body, but in places like Japan, which is claimed to have a 10% rate of T2D despite an obesity rate of 3% (probably more relevant if measured as subcutaneous fat, i'm not really sure how they measured it), it could make for interesting speculations for some of the mechanisms leading to development of T2D.
vo2maxer 7y ago
From the author of the article, Dr. Heather Ferris, who gave permission for the following points to be shared: That column in the post is very size constrained and has a very specific format- I would have loved to expand on some areas. Second- this is really written to educate those without diabetes about the disease. A lot of the subtext, which was more explicit but edited out, is that everyone’s diabetes is different. People with diabetes get a lot of blame and unsolicited advice, but each person has their own way of managing their disease and we should accept that.

51 points by vo2maxer 7y ago

Bit frustrating how myth 2 is totally devoid of facts that would permit further reading. What's the scientific names for these different types of insulin and the actual physiological difference between their effects?

m348e912 7y ago
This was one of the comments posted below the article that may answer your question: Epistemologist2: As a physician myself, with Type I diabetes for the past 56 years, I have lived through quite a lot of change in the management of my diabetes. I am particularly concerned about the discussion in Myth #2. The inexpensive insulin, U-100 Regular Insulin, is readily available and it is just as potent, unit for unit, as the newer synthetic insulins. What is different is the rate of onset of action. Regular Insulin does not "turn on" as quickly as the others, but if taken in advance of a meal will do the job sufficiently well that you can maintain reasonable blood sugars. The over-riding intent with insulin therapy is to mimic natural insulin production/action in one's body. The expensive modified insulins become active much faster and consequently will more closely mimic natural insulin release, but it is critical to note that once injected, those insulins do not turn off as promptly as naturally produced insulin from the pancreas, and this can be a serious problem! In my case, I had had my diabetes for about twenty years and was adequately controlled using those "old" insulin products extracted from beef and pork pancreas after which we got the now inexpensive Human Insulin, chemically identical to that from the human pancreas, and it did not "turn on" any faster than the predecessor products. It was not until 1996, 33 years into my own diabetes, that we saw the introduction of a synthetic insulin with much faster onset of action. Bottom line is that the price of the fancy new insulins should not be such a barrier that it leads to one's death. The inexpensive older products work, just like you old "dumb" phone works to do its basic job. Newer is better, but not critical, and neither doctors nor patients should forget that using older techniques and products is a viable option. It is the doctor's failure to think outside the box to adequately educate the patient that causes death.
projektfu 7y ago
Broadly speaking, there’s insulin in solution (insulin-R or regular insulin) and crystalline insulin. Insulin-R is relatively short acting and is frequently used in acute therapy or intensive care. It used to be the only type, and can be used in a mode where it’s given before a meal and as needed. Insulin-N (NPH, neutral protamine Hagedorn insulin) and protamine zinc insulin (PZI) are the first generation crystalline insulins. They have longer lasting (baseline) effects as well as peaking effects that allow them to be given easily on schedule based on the sizes of meals. There’s a variety of modern insulins now, which are substituted with different amino acids to give them different effects. Insulin glargine and insulin detemir are the most popular. They are supposed to have blunted peaks and are given at regular intervals such as every 24 hours. They mimic the baseline insulin secretion. Insulin pumps are also available that monitor blood sugar and secrete insulin to keep it controlled. There are also experimental “artificial pancreases” that will also secrete glucagon. Another comment mentions that cheap insulin can be just as good. This is true but it requires a careful lifestyle. Messing up is more common and if you’re on your own you may be unable to help yourself, e.g. comatose. Currently, insulin-N and -R are cheap. Detemir and glargine are constantly going up in price despite the existence of multiple suppliers of glargine. (This sort of implicit agreement without actual price fixing is common in the pharmaceutical industry). Essentially, the competitor is a small fraction cheaper, can take some of the market, but most people will continue writing and filling scripts for the incumbent because it’s what they know, on the formulary, etc. I’m not sure of the use of PZI in human medicine. It’s popular in my patients, as is glargine.

hirundo 7y ago

Much of this contradicts my N=1 experience. I have controlled my type 2 diabetes by keeping my carb intake below 25 net grams per day. * My diabetes controlling diet is high in fat. I have found that without the presence of carbs, fat is the safest macronutrient in terms of keeping my blood glucose level down. I can eat fat and protein while barely budging my levels. * Sweet desserts are not okay, not even once in a while. They make my blood glucose soar, and it can take days to get it back under control. I get some of my diabetes symptoms and carb cravings back within hours of indulging. This is not about sugar though, it's about all of the carbs I've tested, including fruit. Sugar seems to act just as a concentrated carb. * Yes too many sweets can give you diabetes. I believe that's how I earned it, by indulging my sweet tooth for year after year. It seemed like an extreme change for me to go low carb, but as a result I have a reasonable blood glucose level without any drugs. And the actual change was more joy than slog. I now love this way of eating and don't (much) miss the high carb foods. I'm afraid this myth buster needs some of her myths busted.

jokowueu 7y ago
I wonder have you tried something similar to the 200 calorie diet the NHS trialed a few years ago ? I found this very interesting I just haven't seen or heard anyone trying it https://www.bbc.com/news/health-42154666 https://www.bbc.com/news/health-42154666 https://www.bbc.com/news/health-47456418 https://www.bbc.com/news/health-47456418
- hirundo 7y ago
  Fasting has an extremely positive and rapid effect on my blood sugars. 200 calories isn't far from fasting.
maxerickson 7y ago
"Yes too many sweets can give you diabetes." Someone just reading your comment here might not realize that the article has a reasonably nuanced discussion of this.
- kop316 7y ago

taxicabjesus 7y ago

My passenger, Mr. "Who Are Your Lifelines" [0], was turned into a type 1 diabetic as an adult, seemingly through his interactions with the family court system. At one point I spoke to his sister, who said he was repeatedly thrown in jail when he couldn't pay his assessed child support. He was 18 or 19 years old at the time, and had previously made $100k/year (computer-something, in the 1990's probably), then lost that job. The judge didn't have the ability to reassess the child support amount. The sister said the law was later changed, but it was too late to prevent the destruction of my passenger's pancreas. Maricopa County Jail did a A1C test on him on intake, and decided this passenger needed a daily time-release insulin injection. If he tried to refuse the injection, he would be sent to solitary confinement. When combined with the jail's starvation diet, this forced use of insulin is a form of torture: I understand insulin without carbohydrates -> low blood sugar -> cortisol release -> muscle wasting. When he got out he told me he'd developed an intestinal blockage that required surgery. When he was locked up again 2 years ago (on account of missing a drug court hearing, 2.5 years before), I took pity on him and deposited some funds on his jail account so he could buy snacks to sort of keep himself out of stress-induced deterioration. I have a postcard that said it was incredibly helpful knowing someone on the outside cared about him. He supposedly sent me three postcards, but I only got one. "Do the most expensive thing possible" seems to be the guiding philosophy for the American approach to Medicine. The doctors quoted in my recent submission [1] pointed out that they can do expensive things for their patients, but have no ability to provide what their patients actually need. My step-sister's husband is a type 1 diabetic. I just learned he had a bad case of the chicken pox just before he was diagnosed as a 3 year old child. A friend's 2 year old daughter became a type 1 diabetic soon after her first weekend at her biological father's house -- this was the first interaction with her birth father; I'm sure the kid was like "who the hell are you and where is my mother????". I bet in 20 years the new myth of Diabetes will be that it's a chronic condition that can only be treated palliatively. "Stress" seems to be the cause behind the symptoms of diabetes. If doctors treated stress instead of the end result of stress (pancreas dysfunction / insulin resistance -> high blood sugar levels), people would certainly have much better outcomes. [0] https://www.taxiwars.org/p/who-are-your-lifelines.html https://www.taxiwars.org/p/who-are-your-lifelines.html [1] https://news.ycombinator.com/item?id=21728864 https://news.ycombinator.com/item?id=21728864

7y ago

projektfu 7y ago

Would someone mind listing the myths? It’s hard to understand which myth is referred to by number when you can’t read the article.

vo2maxer 7y ago
http://archive.ph/NSt4G http://archive.ph/NSt4G
- projektfu 7y ago
  Thank you. 1. Only kids get type 1 diabetes 2. Wal-mart insulin is just as good as expensive insulin 3. Eating sugar gives you diabetes 4. You can't eat sweet foods if you have diabetes. 5. You can treat type 1 diabetes without insulin.
  - RandomTisk 7y ago
    #3 as a myth would be better stated as: Anyone can get diabetes by eating too much sugar

calibas 7y ago

I hate that they begin with "No, you don’t get it from eating too many sweets." Then later they admit that Type 2 diabetes risk is greatly increased by an unhealthy diet. So you can get diabetes from an unhealthy diet, like a diet with too many sweets.

ng12 7y ago
It's explained in the article: > Type 1 diabetes develops as a result of genetic risk and an unclear trigger; it’s not caused by eating sugar — or anything else... The story for Type 2 diabetes is a bit more complicated.
- calibas 7y ago
  That explains the difference between Type 1 and Type 2. I made sure to be clear which type I was talking about though.
Kye 7y ago
This kind of false attribution is how we got a market full of "low fat" foods packed with sugar. It seems like "don't eat too much sugar" should be a harmless, practical abstraction, but people will go off and eat a diet that still leads to type 2 diabetes while avoiding obvious sugars. And missing non-obvious ones. For example: A "healthy" serving of plain corn flakes with a serving of plain milk has lots of sugar in it. Foods can have low added sugar, or low some-kind-of sugar, and still lead to type 2 diabetes. Focusing on sugar will lead to the same health disaster that came from focusing on salt or fat.
- gowld 7y ago
  Your example is still high sugar. The anti fat crusade was a marketing lie sponsored by sugar /corn syrup manufacturers. No one's confused into thinking sugar is good, they just like eating junk food.
dghughes 7y ago
If you have diabetes you crave sweets due to having diabetes. Sugar doesn't cause diabetes. You eat food because you are hungry. Food doesn't not cause hunger.

metacritic12 7y ago

While this article is technically correct, I think it is actively harmful to the landscape of general public knowledge. A lot of this article is just playing "gotcha", where she's pointing out technically a lot of cultural glosses about diabetes only applies to type-2 diabetes. However type 2 diabetes occurs at a rate >10x as much as type 1 diabetes [1], and it's the type that is more preventable by behavior and diet change. Statements close to the "myths" she's debunking is approximately true, while her "technical facts" if not handled with care will lead to far worse wrong beliefs. Approximate myth that we want: "Generally, diabetes is strongly related to high BMI and bad diet which often includes diets high in sugar". Technical truth that muddies the conversation: "Actually the above relationship excludes T1D, which is a vast minority of diabetes." Approximate myth we want: "Many diabetes is preventable by eating well." Technical truth that muddies the conversation: "Actually some T1D is adult onset 2-3%, so you may not be able to prevent those!" Approximate myth we want: "Bargain hunting for medications when medically equivalent is good, especially generics." Technical truth: "Actually there are medical differences between different insulin formulations, because unlike small-molecule drugs, different formulations are not biologically equivalent. Some expensive modern formulations are good." -- A doctor with knowledge about public health and has good writing skills should reconsider writing an article like this. Why not go after real harmful myths like anti-vaxxers? Or how about rewording the article so that the myth is actually approximately bad, like "Bad diets are okay for diabetes as long as you avoid sugars". [1] https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm https://www.cdc.gov/mmwr/volumes/67/wr/mm6712a2.htm

vo2maxer 7y ago
I thought the article author’s background could be of interest: https://med.virginia.edu/faculty/faculty-listing/hf4f/ https://med.virginia.edu/faculty/faculty-listing/hf4f/
dorkwood 7y ago
I would argue that the approximate truth of "diabetes is preventable by eating well" isn't useful, since members of the public often have a distorted view of what "eating well" means. I once had an obese friend of mine tell me I was going to give myself diabetes -- despite the fact that I'm not even remotely overweight -- because I regularly drank soda. To him, his diet was good, because he ate salad for lunch and snacked from the office fruit bowl, whereas my diet was bad, because I drank soda. There are likely many people out there who believe that because they eat salad for lunch they're "eating well" and reducing their risk of diabetes, when actually they're putting themselves at risk by being overweight.

nradov 7y ago

It's really a shame that Type 1 and Type 2 are both called "diabetes" since the causes and treatment are so different. This leads to a lot of misunderstandings in the general population. And to further complicate the situation there is a growing population of double diabetics who start out with just Type 1 and then later also get Type 2. Virta Health has had some excellent success in reversing Type 2 with carbohydrate restriction. https://blog.virtahealth.com/with-sustained-type-2-diabetes-reversal-management-is-becoming-a-thing-of-the-past/ https://blog.virtahealth.com/with-sustained-type-2-diabetes-...

mchill 7y ago

For type 2 diabetes, a plant-based diet is the way to go for prevention, management and even reversal: https://www.pcrm.org/health-topics/diabetes https://www.pcrm.org/health-topics/diabetes

sithlord 7y ago
You can't reverse type 2 diabetes. Using terms like "reversal" are insulting at best. Sure, you can suppress symptoms (ie management) if you were to change your diet back to what it was, the symptoms come right back.
- mchill 7y ago
  Cure and reversal are different. It is possible to reverse type 2 diabetes to the point where medicines are no longer required to maintain healthy blood sugar levels. I agree that staying on the diet is key. It works best as a permanent lifestyle change.
  - sithlord 7y ago
    reversal and cure should be synonymous. to reverse something, would mean that you go to a state where you can do whatever and it not affect you. The correct term is treat it with diet, its still a condition you have. When I was diagnosed with t1d at the age of 24, I can't count on 1 hand how many people told me that I can "reverse" it by (going low carb/eating gluten free/eating cinnamon). I know we are talking about type 2 diabetes in this case, but
- nradov 7y ago
  I don't understand your objection. Of course it has to be a permanent lifestyle change. It's like if I give myself a headache by hitting myself in the head with a hammer, and then I stop doing that of course the headache will go away. But if I start hitting myself again the headache will return.
  - sithlord 7y ago

man2525 7y ago

Based on the literature I've skimmed or watched, I find the correlation between NAFLD (non-alcoholic fatty liver disease) and T2D interesting. It seems that fat is distributed in different people to different sites (subcutaneous, visceral, liver) at different rates. Fat in the liver can result in NAFLD. In some cases, there seems to be elevated liver enzymes (AST/ALT) for months or years prior to overt diabetic symptoms in people who also had an A1C level considered typical for prediabetes. The following article describes research for substances that appear to protect pancreatic beta cells. It mentions that one of the substances, adipsin, is correlated with subcutaneous fat. https://news.cornell.edu/stories/2019/11/protein-finding-could-inform-new-type-2-diabetes-treatment https://news.cornell.edu/stories/2019/11/protein-finding-cou... Likely, many people with T2D have excess fat regardless of where it's distributed in the body, but in places like Japan, which is claimed to have a 10% rate of T2D despite an obesity rate of 3% (probably more relevant if measured as subcutaneous fat, i'm not really sure how they measured it), it could make for interesting speculations for some of the mechanisms leading to development of T2D.

vo2maxer 7y ago

From the author of the article, Dr. Heather Ferris, who gave permission for the following points to be shared: That column in the post is very size constrained and has a very specific format- I would have loved to expand on some areas. Second- this is really written to educate those without diabetes about the disease. A lot of the subtext, which was more explicit but edited out, is that everyone’s diabetes is different. People with diabetes get a lot of blame and unsolicited advice, but each person has their own way of managing their disease and we should accept that.