So recently, the people at CrossFit have started a new campaign insinuating sugar (and namely, Coca-Cola) kill people and give them diabetes. Their distasteful tweet went out to say...

"Make sure you pour some out for your dead homies."�Greg Glassman #CrossFit #Sugarkills @CrossFitCEO pic.twitter.com/QnwXOe4BTQ

� CrossFit (@CrossFit) June 29, 2015

This is the height of DISGUSTING morals and disrespect for a people with a poorly understood health condition, massive misinformation, and families and relatives who have passed away! As someone who lost her father to type 2 diabetes in 2003, I am deeply offended!

I do not just appeal to you to write CrossFit, as these people are surely not going to give a DAMN about what we have to say -- but hit them in the pockets with a potential lawsuit by writing Coca-Cola. Together, we can fight back. This is my letter. Modify as you need to... You may submit yours at https://secure.coca-colacompany.com/ssldocs/mail/eQuery_product.shtml. (Copy and paste in your browser).

"To Whom It May Concern,

I am an advocate for people with diabetes. It has recently come to my attention, and the attention of many other advocates and persons with diabetes that a certain company calling itself "CrossFit" has appropriated part of Coca-Cola's logo and good name as a means to attack and tarnish the reputations of people with type 2 diabetes, as a part of their scare tactic campaign and dissemination of misinformation.

As advocates, we work endlessly with other agencies such as the American Diabetes Association, JDRF, and the Joslin Diabetes Center to educate persons on the nature of diabetes, its various types, and any means of prevention possible. While we recognize that good nutrition is key to maintaining a healthy weight, we strongly denounce the tactics of this company. Consuming sugar in and of itself does NOT lead to any form of diabetes.

This campaign is deeply offensive to people with diabetes, and our voices are being ignored by this company. We would like to appeal to Coca Cola and their good name, to help us stand against this company -- not only because this is hurtful for people with diabetes, but because it damages the good name and brand of Coca Cola and its affiliates.

At this time, the "Crossfit" company is using parts of the Coca Cola logo, with an attached catchphrase of "open diabetes" which they claim is trademarked.

The information is being spread all over Instagram, Twitter, and Facebook, and may be seen at these links:

https://instagram.com/p/4hHG9htDUL/
https://twitter.com/CrossFit/status/615539464232902656

Thank you for your time, and we hope to hear from you soon.
Lizmari M. Collazo

Diabetes Advocate and Freelance Writer
http://theangrytype2diabetic.blogspot.com/"

» Read More...

The headline declares: "Curing diabetes via surgery, without weight loss". It's a bold statement. It's enough to make one stop, and read. I admit I did just that.

Every week, it seems, we are bombarded with a new article declaring the magical, curative qualities of gastric bypass surgery. These articles make it seem like gastric bypass is the simplest, most sensible way of managing diabetes -- and gosh darn it -- everyone ought to pursue it so we can put a stop to this overwhelming epidemic that's going to just take over America, and murder us all. (Please note I am being sarcastic here.)

I admit I don't have all the answers -- if I did, I'd have long ago found a cure for all of us, and retired to my white castle atop a hill, facing the ocean. But what I can tell you is that I have a lot of questions and skepticism. And so should you.

Whenever there are articles like this, I look for red flags:

• Is the article edited properly? It might seem like a simple thing, but honestly, if someone in a professional, journalistic setting, doesn't care enough to edit their articles for grammar, spelling, content, and accuracy, they certainly might not care about outright lying to you to get some readership.
• Is the article unusually chipper or eager to present this as an 'all around' solution to a problem? Does it present ALL sides of the debate? Does it present ALL alternatives?
• Does the article portray accurate medical conclusions, information, and accurate explanations, or does it confuse the public about its target audience? 
• Does the article present accurate, statistical data, as has been reported by other research outlets, and scientific journals? 
• Is the study funded by third parties with deep pockets, and deep interests in the outcome of said study?

Taking all these questions into account, let's look at this week's gastric bypass article (which I have linked to above.)

Red Flag #1

The article starts off by telling us about Cristina Iaboni (a woman who was selected as a test subject for gastric bypass in leaner patients), and offers this description of her situation:

"Cristina Iaboni had the dubious distinction of being not quite obese enough. For all the pounds on her 5'5" frame, she did not meet the criteria for bariatric surgery to help control her type-2 diabetes.  

Yet six years of medications and attempts at healthy living had failed to rein in her blood glucose, leaving Iaboni terrified that she was on course to have her kidneys fail "and my feet cut off" -- common consequences of uncontrolled diabetes." 

Right off the bat, I'm kind of concerned about the quality of medical care Mrs. Iaboni may have received. Did her medical team question everything that needed to be questioned? Was she on insulin? When I read "6 years of medications," it literally screams at me that they kept her on every oral medication combination out there, and did NOT put her on insulin, like they should have. What kind of 'healthy living' changes did she attempt to make? Was she she still consuming a high carbohydrate diet, and just substituted her carbs for wheat, and whole grains? Did she even know how to carb count? Did her doctor ever test her for antibodies, and is she a LADA, instead? While the article declares she's 'cured,' I have the strong feeling this woman might rebound down the road.

Red Flag #2


Follow this logic statement with me: "If smoking triggers lung cancer, than smoking cessation should cure cancer."

Oh, it doesn't work that way, you say? Once you have it, you're stuck with it? Oh. Then why do some media and some 'researchers' assume that if obesity triggers diabetes (in those who are genetically predisposed, mind you), that losing weight should cure the diabetes?

The simple answer is "I don't know." The complex answer is "Because they probably have something to sell you."

Certainly, one can assume smoking cessation helps better manage cancer -- I am sure. One will be healthier, and respond better to treatments, and will have a stronger immune system... But one cannot say one is suddenly cured of the cancer. (Even when one is in remission.) Diabetes and weight loss are much the same: weight loss merely makes one healthier, and be able to respond better to treatments (ie, be more insulin sensitive, use less insulin and medications, sometimes none, etc.) These are only ways of tightly controlling diabetes, though, and slowing down it's progression. The absence of medicine is NOT an absence of illness. In this case, it is the strict diabetic patient's regimen that is the patient's medicine. The pancreas has damage, and this damage is irreversible, thus far. It is not, suddenly, magically healed.

Interestingly, this article seems ready to admit (though hesitantly so) that gastric bypass -- since people seemed to be 'magically' better just days after surgery -- proves that a diabetic 'cure' is NOT about weight control, or weight loss. However, here is where the red flag comes in: they are NOT willing to admit that the extreme dietary restrictions a patient must submit to (caloric and, consequently, carbohydrate level restrictions), post op, will play a role and immediately make less glucose available to the patient, and therefore, less high blood glucose issues. Now, normally, a patient who chose to control diabetes with diet and exercise would take a bit longer to achieve euglycemia (or normal blood glucose levels) when consuming a diet lower in carbohydrates and eating 'normal' amounts of food -- but they don't get a head start. A pre-op gastric bypass patient has to be on a type of fast with limited food and liquid intake, so they're already starting out with less available glucose in their system for a couple of days. Yes, they are going to have great numbers in just a few days. Barring other variables, yes, it's that simple, sometimes. I don't think this is rocket science.

Quite frankly, a patient could just go on the restricted diet, and skip the surgery, and achieve similar results... And not that long ago, some of these 'researchers' were practically claiming this same argument: A 'very low calorie diet' could cure type 2 diabetes. 


This article though, quickly sidesteps the discussion and dismisses it without much more than an acknowledgement.


Red Flag #3


The idea that type 2 diabetes begins in the gut is not a new one. It has been, however, a seldom reported one.

More commonly, you see articles speculatively linking the bacteria most known for leading to peptic ulcers (h. pylori), to endocrine disorders (as well as diabetes), and these have been quietly making the rounds since at least 2009, maybe even earlier. There's even an interesting study dating back to 1999, and involving children with type 1 diabetes, insulin requirements, and the presence of h. pylori. The most recent finding came this month, and it involves h. pylori and it's impact on A1C.

The underlying message is clear: bacteria, and inflammation, alter the body's ability to process glucose -- whether in the stomach, or in the gut.

But are the researchers missing the obvious clues? They mention that 'in the past,' patients with peptic ulcers who had surgeries altering their stomachs, and gut connection, 'cured' their diabetes. Or did they just achieve better control of their diabetes because a.) they were now having to, forcefully, eat far less, and b.) the surgery removed chronic inflammation from bacterial infection (which would have dramatically raised blood glucose levels)?

Other articles, and research, have pointed to a bacterial imbalance in the gut as a trigger to an imbalance in processing glucose, and development of type 2 diabetes, but they do NOT suggest surgery for 'curing' the disease. In fact, they suggest a more preventative method -- receiving gut microbiota transplantation. This seems to me like the less invasive, less dangerous, less costly and time consuming, way to go when it comes to researching a cure. Why are we not investing in this? Why is there such a PUSH for getting this dangerous surgery?

The attempts to also connect this surgery to a potential 'cure' or reversal of type 1 diabetes seem a bit far fetched, and improbable to me, and make me question if this researcher has a proper understanding of the etiology of type 1(a) diabetes -- and that it isn't just an insulin insufficiency scenario. I'm pretty sure people need insulin to live, and for many various metabolic functions, and just 'bypassing' a gut mechanism isn't going to make a person insulin independent. I'd like to see more than just three sentences in a poorly edited FOX news article, on the matter.

Red Flag #4


Numbers.

These articles always seem to exaggerate diabetes incidence numbers. This one is no exception. It claims that 8.3% of the world's population has diabetes, and that 11.3% of Americans, have it. Honestly, I don't know where the 11.3% figure came from, with these folks -- but according to the most recent data (released January 26, 2011 -- and not the 2010 date these folks claim) released by the American Diabetes Association, only 8.3% of Americans have diabetes -- and this includes all types, and the undiagnosed. 


Similarly, these folks make these grandiose claims for the 'remission' rates of Roux-en-Y to be 80-85%, and to be incredibly superior to other forms of gastric surgery. But major studies DON'T show that.

"New research reports that no procedure for weight loss surgery is any better at treating diabetes than another. The study, presented May 7 at the International Congress of Endocrinology/European Congress of Endocrinology in Florence, Italy, uses a large ongoing study to show that improvements to diabetes in patients undergoing such surgery is likely to be due to the degree of weight loss itself rather than the type of procedure." (http://www.sciencedaily.com/releases/2012/05/120507102225.htm)

And here's a more startling fact...

"Weight loss surgery is not a cure for type 2 diabetes, but it can improve blood sugar control, according to a new study published in the British Journal of Surgery. Whereas some previous studies have claimed that up to 80 per cent of diabetes patients have been cured following gastric bypass surgery, researchers at Imperial College London found that only 41 per cent of patients achieve remission using more stringent criteria." [emphasis added by me] (http://www3.imperial.ac.uk/newsandeventspggrp/imperialcollege/newssummary/news_4-1-2012-13-32-26)

And that's the ticket here, isn't it? What kind of criteria are these folks using to claim someone is cured? What are their A1Cs, now, and what are their average blood glucose numbers like? I've had folks tell me "I have an A1C in the 6.5% range, so I no longer have diabetes." But wait a minute? That's the number used to diagnosed diabetes to begin with! 

Hey, but you no longer need medicine (for now, anyway), so you must be cured, right? It sounds so pretty... It sounds like such a good sell.

And because it sounds like such a good sell... I give you:

Red Flag #5

"The cost of the bypass surgery is covered by a grant from Covidien Plc, which makes laparoscopic instruments and surgical staplers." 

Oh, so let me see... the people who profit the most from this surgery are the ones funding a study to tell me how awesome this surgery is, how high a success rate it has (even though it is absolutely not supported by independent studies), and how I will just be so cured.

Hmmmmmmmm. Let me think about that. Fox guarding the hen house much? This reminds me of last year, when the ADA published a study done by the Australian Dairy Association, claiming that milk consumption lowered risk of diabetes.

Of course you're going to tell me it's awesome! You want me to buy more of it, and you want me to fall in love with it. You need to make money, too, like everyone else! It's MARKETING.

The problem comes when the money making interests muddle the big picture, and really go against the best interests of the INFORMED patient.

What am I trying to get at, with this blog post? 


Should you avoid gastric bypass? Is it a dangerous alternative?

These are questions you must weigh for yourself... but what I would like to see is for patients to be able to weigh the TRUTH against the hype. NO ONE should promise that surgery will be a success, that it will heal and cure diabetes, or that it will be complication free; but, instead, they must help guide the patient to a point where they can soberly weigh their current health risks against the surgery's very real risks and potential failures. It is easier to accept the roll of the dice when we know that risks are possibilities -- and when we aren't lead to believe that this is just a simple, routine procedure, that will fix our woes forever.

More importantly -- the type of lifestyle changes required by these surgeries are far more demanding than say, pursuing a low carbohydrate regimen (like Berstein's Diabetes Solution, or Atkins), or even raw dieting. If a patient fails at these, or simpler life style changes -- when their life is not at stake -- what makes them feel they could do okay with the dietary demands of such a surgery? Because they got 'two weeks' of psychological counseling pre-op? Disordered eating, and compulsion, take years of counseling to improve (much more to 'fix')!

Additionally, studies have shown that after some time, people's diabetic symptoms may return, and some folks even regain weight and end up pursuing additional gastric surgeries. I am not entirely sure that the costs of surgery, with it's attendant complications, are worth my getting a 'free pass' for a few more years; especially, when I can just give myself that free pass with a more calorie restricted, low carbohydrate diet.

And I don't know about you... but I just like eating food in portions larger than a peanut.

» Read More...

Copyright � 2010 Julie King 
/ Gleeful Things. All Rights Reserved.

Today, I'd like to add a fun, new, regular segment to our blog called "The Moldy Cupcake Awards."

Ya' know... It's just so inspiring to read or watch the news, every week, and see ALL manner of misinformation, quacks, outright lies and drivel, just regularly being fed to the public for the sake of ratings. So, because you've inspired us, ALL of you who are the most deserving for writing, or producing, the shittiest materials out there for the public, will get a wonderful mention here... along with a not so sweet, and oh, so moldy critique.

You've worked HARD (not!) for it, so you're gonna get it! Today's deserving green, stale, sad, and moldy cupcake goes to... The View!

That's right. Earlier this week, the View produced this GEM for it's regular audiences.

 
Let's take a moment to examine this, not so educational moment, play by play. 
Right off the bat, I am immediately annoyed because for all her education, Barbara Walters CANNOT pronounce diabetes correctly. I'm sorry Barbara, it would seem you've spent your free days watching too many Wilford Brimley commercials.
If that doesn't annoy you, then the big letters headlining "The Fat Show," in the background, should. Oh, sure, Barbara, you aren't fat. Let's see your saggy behind in a bikini. I double dare you.  
She goes on ahead, and introduces this man, David Nathan, as the Director of the Diabetes Center at the Massachusetts General Hospital. It should SCARE the beejesus out of you that someone with such a title (and employed at a hospital, mind you) would get on such a show, and FAIL to grasp the opportunity: 

"So I think everyone recognizes that diabetes is a condition where your blood sugar is elevated. We all KNOW that. What many people don't understand is that when your blood sugar remains elevated over many years, blah, blah, blah... feet falling off... blindness... blah, blah..." (Okay, that's not entirely, a literal quote.) 

Dr. Nathan, for someone who calls himself a doctor you are surely very disconnected from reality.

1. NO, people do NOT know what diabetes is about. You could've spent a minute or two, telling people that our condition is a condition in which the body FAILS to be able to process glucose adequately, and that ALL food gets converted into glucose. NO, people do NOT know the difference between sugar, and blood glucose. People think if we just stop having Paula Deen lady donut burgers, and ho-hos, that blood sugar goes down, and diabetes goes away.

This is the kind of situation that gets people bullied by idiotic people thinking they can take on the role of diabetic police.

2. Meanwhile, everyone DOES know the serious complications diabetes may bring, so since they associate them with eating too much sugar, they are ALWAYS making jokes about our feet falling off, and us going blind. You could've clarified a little better that well controlled diabetes is the main cause of NOTHING... But you really missed the boat on this one. Thanks for letting the bullying cycle persist.

Now, I don't really understand why The View would have Paula Deen as some kind of 'interviewer' for this segment, asking things she really doesn't understand because she's just too new, and uneducated -- but it matters not, because this Dr. Nathan fails to answer her questions directly. She asks him what the connection is between obesity and diabetes, and he doesn't really say... He just muddles the picture by starting to talk about other majorly recognized risk factors, and how now, younger folks are getting diagnosed because of weight. Okay? So tell us something we DON'T know. Why not tell people "gee, the more you are overweight, the more your body will struggle to produce insulin -- and if you are genetically predisposed to insulin resistance, and diabetes, the more it will likely trigger your developing the condition at an earlier age..." Is it that difficult to speak to people with truth and honesty, and clarity? Do we think The View's audience are a bunch of simpleton housewives, who only know about dish soap? I wonder...

Oh, and I love how you describe Type 1 as "the insulin dependent, juvenile form... the Mary Tyler Moore form..." That's metaphor, right there!! A definitive moldy cupcake award for dialogue. Here's a TALL idea, for you: how about calling it the "my autoimmune system sucks, so it attacked itself" form. People will have this FOREVER, and can get it at ANY age. They don't grow out of it, and gosh darn it, MANY adults, every year, get it... WAY past their 'juvenile' years. Oh, and to add to it, you make it sound like type 2s don't need insulin, when in fact, if a type 2 diabetic is diagnosed early enough in their lifetime, they will more than likely need insulin before they die. MOST type 2 diabetics will go on to need insulin. It's a fact. Hell, it's an American Diabetes Association researched fact -- even when they're trying to act like it's not. 

One thing is pretty juvenile, though -- your casual approach to discussing diabetes. You nailed that one right on the head.

Now, dear Paula Deen tries so hard to stay relevant in this discussion. Paula, honey, NO ONE is born with type 1 diabetes. And I think an awful lot of parents out there would kind of take offense to your portraying their children as like 'having leukemia.' I say this, because while type 1 diabetes can be deadly and challenging, we all know you weren't trying to suggest they were 'troopers, fighters, survivors, and well adjusted kids...' No, you were trying to suggest they were sickly, weak, and likely to die from sneezing. Paula, I support your journey with diabetes, but sometimes... you gotta shut your lady burger pie hole. Okay? We should not comment on things we know not about.

I am not completely angry at the intense stupidity of this segment (okay, I lied...); I'm actually happy for your patient, Misty. I'm happy she's doing better, and is healthier.

What I'm not happy about is that Misty doesn't seem to understand what a diabetic diet is all about. She keeps talking about sugary drinks, sodas, juices. She doesn't talk AT ALL about controlling her carbohydrate intake, carefully weighing out her meals and portion control, in any way. In fact, NO ONE ever mentions carbohydrates and their role in any way -- and continuously focus on sugar!

Dr. Nathan, this is the BIGGEST disservice you can do for people -- letting them go on believing that diabetes is about sugar. IT IS NOT. Diabetes is NOT about juice boxes, soda, cookies, etc. It takes a hell of a lot more effort to control diabetes than to just cut out soda and juice boxes. In fact, I am so scared of Misty's apparent lack of knowledge of what it all entails, that I truly wonder what her A1C is, and what you justified to yourself was "excellent control" to make it seem she needed to get off the Metformin. I guarantee it's not in the 5.0-6.0 percent rating. It can't be. Not with her thinking it's just sugar. She probably goes home and has a plate full of wheat pasta, and calls it good.

"That's the beauty of type 2 diabetes... is that it is reversible." 

Diabetes is not reversible. Whenever folks discuss diabetes as 'reversible,' what they are referring to are the symptoms of uncontrolled diabetes. Blurry vision, dizziness, slow healing cuts, some forms of early neuropathy, thirst, continuous urination, headaches, mood swings, etc.

I have news, for you Paula... You'll still have diabetes, even when all those things are gone. You live life so that you CONTROL those things -- but you can't stop your routines, or those things WILL return. And quickly. Your diet is your MEDICINE. It's just exactly like medicine.

In this sense, Paula... ALL diabetes is reversible. Yes, even type 1 diabetes. It's a BOLD statement, but I know some pretty TOUGH type 1 diabetics out there that could run circles around me, any day, and to the average world look like they have NOTHING wrong with them. They have worked hard to REVERSE the horrible grip of uncontrolled diabetes which they had at diagnosis. TIGHT control is what we ALL aim for -- but it takes CONSTANT work and effort, and it is SO not a cure.

Photo by RingoFuentes

You can't go on living like just testing once a day, and not knowing what carbs do to you is, somehow, having diabetes in control. It is a full time job, and it causes a lot of psychological trauma, and exhaustion. There's just NO beauty in this pile of dung. (But you'd be a little prettier if you spoke a little less. :) Thank you.) The beauty is in US -- and how we evolve to adapt to the harsh winds of diabetes.

Additionally, Dr. Nathan, it is embarrassing that you would suggest to people that all they need to do is lose a modest amount of weight to better manage their diabetes -- this is untrue. While weight loss helps lessen some of the challenges of insulin resistance, it is NOT the way to control diabetes -- the way to control diabetes is to control one's diet and carbohydrate intake, along with weight lifting and resistance training, and sometimes, medication. When you tell people that losing 5-7% of their weight would reduce diabetes by 58%, you are leaving them with a lot of confusion, and mixed feelings. I mean... what the HELL does that even mean?????

You can't reduce diabetes by 58% when YOU ALREADY HAVE IT.

You must be talking about the poorly done, not so large, diabetic studies... who used a lot of extrapolation, inference, and ignoring of many, many additional risk factors and components, along with populations that did NOT represent a cross-section of the country... to claim that 58% of diabetes could have been PREVENTED. Which is another poorly used word. One can only REDUCE one's odds of disease -- not eliminate them. There is NO SUCH guarantee that you won't get diabetes, even if you do 'everything right.'

So, Dr. Nathan, Paula Deen, Barbara Walters... for all these reasons -- and I'm sure -- many more... You have earned yourself a Dung Cupcake. But they don't make dung cupcakes, so here's a moldy one, instead. You've earned it.

One big, so not so heartfelt, THANK YOU... for all the work you DON'T DO. You make the world one heck of a crappy place for diabetics everywhere.

(Oh, and in case you didn't get it... That's called sarcasm. It's a young people thing.)

. . . 

If you would like to submit 'nominees' for the week's crappiest stories worthy of a Moldy Cupcake Award, feel free to 'Contact Me,' and they shall be thoughtfully considered. :D We shall leave no moldy cupcake left behind. 

» Read More...

When it comes to Diabetes, and the messages being put out there in the media, it is really hard for myself and other folks not to become angry -- if not downright furious. I have to tell you, I generally look through articles, and skim through different headlines, and just tend to "cherry pick" what's going to be real news, and ignore and pass over the fluff. If I were to read it all, I might be en route to a heart attack in less time than you can say "duck fiabetes."

But on Wednesday, just having gotten home from a long, physically and mentally exhausting shift at work, I failed to listen to my own advise. A dear friend of mine shared a news article, in my "Living with Diabetes" Facebook group... and I just lost it. I don't think I have ever been so outraged by an article before. (Well, except maybe for Wendell Fowler's abusive tirade against little Type 1 Diabetic children having ice cream. OMG, how dare they! That's almost as dangerous as Paula Deen having a cheeseburger! *snark, snark*) I was seeing so many shades of red, and purple, I just could not think straight. I said a bunch of things, in my group, about the article, and to my husband... went and kicked a few things around... flipped off Dr Oz on the TV... and then I felt like my head was going to explode. It was just too much.

Having taken at least, a few days, to calm down... I can probably now tell you what I really think about this piece, with a little more perspective. The piece is called "Curing Diabetes: How Type 2 Became an Accepted Lifestyle" (Yes, you are reading right... That IS the headline for this article), and it was written for The Atlantic, by reporter John-Manuel Andriote, who has supposedly been specializing in HIV/AIDS reporting since 1986. I guess, I would like to think that being exposed to such a world would have given Mr. Andriote some perspective, and a keener sense of tact, and to an extent it has... but, apparently, not enough to have helped him rethink such a terrible headline.

The article itself makes a few key mistakes, which well, to an outsider would not be as self evident. And why would they? Our current government, medical advisory agencies, and medical industry want to do all they can to pass blame onto the Type 2 patient, entirely, and take on NO responsibility themselves. I've shared on this, before, many times. Especially, the deep denial of how multi-faceted the triggers are for Type 2 Diabetes, and the roles pollution and other medications, etc., have in the development of the disease. It is unfortunate that everyone in the industry quotes such poorly done research studies that do not take these complexities into account, or even consider to do so, to blanket claim that 80% of all Type 2 Diabetes is "largely preventable." These simplistic allegations lead to discrimination, misunderstanding of a very complex disease, denial of health management resources and tools by the insurance industry, and uneducated reporting that often leads to societal abuse, bullying, and further discrimination.

Still, there is some good, among the bad, to be found in this article. I do feel that, had the author taken some time to meet with members of the diabetic online community, this article could have really shed some light more adequately, on a lot of issues that affect our community, without contributing so much to the problems it so tries to 'address.'


The Good in this Article: 

• Right off the bat, the article addresses the issue that the medical industry does not like to discuss with patients, or at least seldom does, the idea that they can manage their diabetes without medications, much less what Diabetes even IS. This is, indeed, a struggle we have right now. But it is a deep, and complex problem involving a lot of ethical concerns which affect almost every aspect of the health industry, including the American Diabetes Association itself (it's probably not an accident that they recommend diabetics keep their blood glucose levels at or below 180 mg/dL -- a very high, and potentially long term dangerous, blood glucose level), as well as other diabetes medical guideline agencies. The fact is, many medical professionals receive kick backs and incentives from the pharmaceutical industry -- large kickbacks and benefits -- and it's in their pocketbook's best interests to keep as many of their patients taking certain medications. This is not something exclusive to the diabetes industry, though. I am sure this is one of the prime reasons why there are now, commercials on mainstream media, for prescription only medications. It's BIG business, and there's no better salesman out there than your doctor. 
• Andriote does some thinking outside the box, which is helpful: Chronic illness, particularly obesity and diabetes, are multi-faceted diseases which do not have just one contributing factor to them (though at times he seems to suggest they do) and thus, will need a multi-sector response. He speaks about our sedentary jobs, and a poor transit system, and the lure of the food industry, and how addicting high fat/high sugar/high salt/food combinations can be... and the supposed "myth" that healthy foods cost more than unhealthy foods. He even quotes an article from someone who supposedly "destroyed" this myth. What is perhaps not understood by people who claim that healthy food is cheaper than fast food is that most dedicated Type 2 diabetics don't consider healthy food what they consider healthy food, and they have to cut back on carbohydrates in order to control blood glucose, and not rely solely on their medications for control. I'd like to see Andriote actually trying to live a lower carbohydrate lifestyle, at a grocery store, with a maximum of $350 for 2 people, for a month worth of groceries, and not being able to eat as many starches, grains, and other foods which ARE the cheaper foods, for their value and how far they go. Living on lean proteins, and veggies, and cutting back on all those starches and breads, and grains is NOT cheap. Also, per the fast food cost example he uses, if one assumes poor people buy value meals at fast food joints to feed all of their family members, one might be very, very naive: there is such a thing as a dollar menu, or less, at these places... And people KNOW this. How can you beat $2 for two double cheeseburgers at McDonald's??? It costs me $2.88 a lb alone, for chicken! (And it's cheaper in Iowa, than in many places...) 
• Andriote talks about the need for balance in media industry reporting (Surprisingly): On the one hand, you don't want people dismissing diabetes as 'not serious' enough, but on the other, you don't want to create a public backlash for patients. "When the media do focus on type 2 diabetes, said Sarah Gollust, assistant professor at the University of Minnesota School of Public Health, they give twice as much coverage to the behavioral risks for it than any of the other factors that contribute. But this over-emphasis on personal responsibility tends to blame and stigmatize people with type 2 diabetes or who are obese. Those living with the disease may feel it's their fault if they can't always maintain the ideal blood sugar level. Worst of all, said Gollust, public support could erode as people are expected to cover the costs, however they can, of a medical condition it's believed they brought on themselves ... Public support for addressing diabetes is imperative when you consider the tremendous amount of money it costs to manage the disease." This is a very important reality that we, as Type 2 Diabetes patients face as we strive to manage this disease. We NEED support, and we can't succeed without it. However, many of the undercutting remarks Andriote makes, including his headline, are FAR from being fair and balanced, and certainly not supportive! On page 2, Andriote has a "listing" of facts, and goes on to say that "Although there is a genetic predisposition for type 2 diabetes, the vast number of cases are the outcome of poor diet, obesity, and a sedentary lifestyle." Of course, this is contradictory... because ALL cases are of genetic predisposition. If not, then ALL obese persons would have diabetes -- and this is simply not the case. (I won't even go into his usage of the phrase "people of color" to talk about African-Americans, Latinos, and other minorities...) 

The Bad in this Article: 

• Andriote, sort of, implies that most Type 2 Diabetics could manage their condition without the need for medications, if they just try a little hard, and then they would be cured. There is a BIG disconnect in here: 
• For one -- he fails to realize that by the time the average person is diagnosed with Type 2 Diabetes, their disease is so advanced, they have lost nearly 40-80% of their beta cell function, making it extremely challenging to near impossible to control blood glucose levels without the assistance of oral medications, or insulin. Again, being the multi-faceted disease that it is, diabetes NEEDS a more aggressive and aware medical community, as well as increasing efforts in continuous education FOR the medical professionals, as well as patients. A medical professional who cannot think diabetes, and catch all the symptoms and markers of diabetes, in an age when it's being considered as an "epidemic," is a medical professional who will endanger lives, and contribute to the rising costs of the disease when it comes to complications that are not being caught on time. 
• Secondly -- The kind of lifestyle changes to achieve true remission and euglycemia, are a lot more stringent than what the ADA might tout. You *cannot* reach euglycemia -- true euglycemia -- while thinking that blood glucose numbers below 180 mg/dL are normal. True euglycemia are levels that are below 140 mg/dL or lower, after 2 hours of eating, and in fact, rarely exceed that. In fact, some might even say below 120 mg/dL at 2 hours, or less. Not everyone can achieve those levels -- especially, if they struggle with hypoglycemia, or  have other health related dietary considerations to make that might not allow them to easily cut back on carbohydrates, or increase certain levels of exercise, etc. I, for example, have to consume 80-100 grams of carbohydrate a day, at a MAXIMUM, in order to maintain my euglycemia. This is unrealistic to many people... and it's not a character flaw! It is HARD, often unrealistic, work. 
• Thirdly, he goes on to claim that if folks worked hard at it, they could "cure themselves," and he uses an opinion paper, mind you, to try to back up his assertions. He even goes as far as claiming that this is the opinion of the American Diabetes Association (ADA), by claiming that the ADA says that "maintaining normal blood sugar without medication for at least a year could be considered a "complete remission,"" when in fact, the ADA specifically highlights a the end of the second paragraph, in that same opinion paper that "The opinions and recommendations expressed herein are those of the authors and not the official position of the American Diabetes Association." Moreover, the panel of those expressing their opinions recognized that they had clear conflicts of interest in the matter, and also, found it difficult to reach consensus considering the wide arrange of questions to be considered. The group does, though, make a very telling distinction between a cure, and a remission... which the author of this article seems to gloss over, quite nicely, to what he could take out of context, and better fit into his piece: "Medically, cure may be defined as restoration to good health, while remission is defined as abatement or disappearance of the signs and symptoms of a disease (3). Implicit in the latter is the possibility of recurrence of the disease. Many clinicians consider true cure to be limited to acute diseases. Infectious diseases could be seen as a model: acute bacterial pneumonia can be cured with antibiotics, but HIV infection, currently, can at best be stated to be in remission or converted to a chronic disease. The consensus group considered the history of childhood acute lymphoblastic leukemia, which evolved from a uniformly fatal disease to one that could be put into remission to one that can now often be considered cured (4). Conversely, chronic myelocytic leukemia is now considered to be in prolonged remission, but not cured, with therapies such as imatinib ... For a chronic illness such as diabetes, it may be more accurate to use the term remission than cure. Current or potential future therapies for type 1 or type 2 diabetes will likely always leave patients at risk for relapse, given underlying pathophysiologic abnormalities and/or genetic predisposition. However, terminology such as �prolonged remission� is probably less satisfactory to patients than use of the more hopeful and definitive term �cure� after some period of time has elapsed. Additionally, if cure means remission that lasts for a lifetime, then by definition a patient could never be considered cured while still alive. Hence, it may make sense operationally to consider prolonged remission of diabetes essentially equivalent to cure. This is analogous to certain cancers, where cure is defined as complete remission of sufficient duration that the future risk of recurrence is felt to be very low."

You see, it is one thing to call something a "cure," because it is more hopeful, and more satisfactory to a patient... than for that to be, actually, a cure. The likelihood might be low, but it is, in fact, not a cure. As a comparison to HIV made above, for example, people like Magic Johnson have had their HIV infection in remission for years, but would would we say that he's cured? Not in a million years. Just because I can't "infect you" with diabetes does not mean I'm cured. This debate among colleagues does not equate to something actually being "officially" considered a cure. Obviously, operationally, we cannot treat presently uncontrolled diabetes in the same way as diabetes in tight control, or in remission... So DUH, it can be "operationally" a cure, but not in truth. Remission is remission. A cure, is a cure. This is truly, irresponsible journaling at it's best. 

I would add that the amount of mental focus that is required in maintaining diet, food carbohydrate counts, exercise, and meal planning often borders on obsessive and unhealthy, and ends in many an eating disorder for many diabetes patients. The psychological ramifications of attaining euglycemia, at all costs, for many... have NOT been assessed, and yet, they are just as much a part of the disease as hyperglycemia and other markers. Diabetes is NOT just a disease of high blood glucose!  

• The author uses statistical scare tactics to put the fear of God in you: But he does not put them in perspective. It's one thing to discuss how the rate of diabetes will triple, or double, or whatever. It's quite another to not discuss the rate of population growth, right along with that. Obviously, people ARE reproducing, and diabetes isn't just happening in a vacuum where the rate is growing by leaps and bounds larger than what it is. It's hard to say, because what will the population be in 2050? Our population is EXPLODING to what are potentially unsustainable levels, and of course, that's going to make numbers for any disease seem scary high, without some perspective. What would the rate be in RELATION to total population at that time? THAT is what the question should truly be... In addition, the author wrongly states that the prevalence of obesity has been increasing, year after year, when the prevalence of obesity has remained STEADY for the last 12 years.  Could it change, tomorrow? Sure... but for now, I think we can say many folks are starting to be more conscious of obesity, and their health, even if they might not see themselves as 'overweight.' Andriote fails to keep balance in the picture he's trying to paint.
• While Andriote wants to instill a sense of seriousness to diabetes, while claiming we need support, he attacks commercials with friendly faces and role models, claiming that persons who are fit, or joggers, or younger folks -- are not what most Type 2 Diabetics are like. Perhaps not (some) newly diagnosed Type 2 Diabetics, but is it wrong to have positive role models to aspire to? Is it wrong to see that some of us HAVE made changes, and CAN live a healthful life? Is it wrong for me to see another 35 year old I can relate to, on the tv? I fail to see just what he wants to accomplish, here. Does he want a fat, old Joe, sitting on a sofa, not able to move, and popping pills, or doing 'leg exercises' from a chair, because he can't move? Would THAT be more appropriate? Or perhaps, he wants people with their limbs amputated, like the city of New York's shocking diabetes ad campaign? I'm not sure what's the alternative he's looking for, here, and what's running through his mind. 

Of course, I can't end without discussing... that headline. "Curing Diabetes: How Type 2 Became an Accepted Lifestyle" ... I'm guessing he's trying to say most people just "accept" and take the diagnosis as a given, that they will need to live with this disease, forever... and take pills forever. But boy, is it an uneducated headline. Yes, people can live pill free, for a while... and depending WHEN they were diagnosed, if it was late in life -- maybe they might never have to take any meds, ever. But no, it's not a cure. Type 2 Diabetes IS a progressive illness, and the likelihood of a need for medications increases with the LENGTH of time we've had this disease -- and not exactly with how well we've taken care of it. Time goes by, and not in vain... our bodies DO age. Things break down. My father was in remission for years, yet he was never cured; diabetes still progressed, and still took his life. It happens.

Diabetes is not an "accepted lifestyle" anyone chose, anymore than people who got AIDS or HIV (by whatever method), CHOSE that as their lifestyle. I bet you $1,000,000 that this author would NEVER dream of writing "Curing HIV: How HIV Became an Accepted Lifestyle," merely because he read an opinion piece on how one can keep HIV in remission for YEARS. The headline even seems to sort of imply that we "coddle" people into being lazy about their care, and lazy about "curing themselves," so that we don't need to support them. It's not a disease, if you would, it's a "lifestyle." Yes, because Type 2 Diabetes is sooooooo glamorous. It's the lifestyle of the fat, and sloppy, and just give me my Metformin, over here. I'll take it with a side of that value meal, please. 

Sadly, Andriote could have done SO MUCH to advocate and help our community, but instead he chose the low road of blame, and veiled vitriol in between his lines. How someone who has written for the AIDS community can be so close minded about the needs of another equally ostracized community is BEYOND me. 

» Read More...

"Well, my husband is a board certified endocrinologist, and he told me that whenever a Type 2 patient is 'good,' and gets their numbers 'normalized,' that he removes the Type 2 Diabetes diagnosis, and changes it to a 'Metabolic Syndrome' diagnosis, instead, to help them out." -- Misinformed Mrs. Know-It-All.

The woman was very angry at me. How dare I suggest Type 2 Diabetes has no cure. And furthermore, I could go get a gastric bypass surgery, if I wanted. That, for certain, was also a cure. This, of course, was followed by a few "You people will never be like us; you need to stop comparing yourselves to us... You keep trying to act like we are the same, or have it worse than us, or that your disease is just as bad as ours" type of comments. I can't say that I blame her entirely for her misinformed, self righteous attitude. (Okay, I know she was being kind of a bitch. I'm just trying to be nice, here.)

This is the every day bread of Type 2 Diabetes awareness. Raising Type 2 Diabetes awareness is not easy. In fact, it's one of the most painful things I've ever had to do in my life. My husband certainly doesn't understand it, sees a redundant theme in it, and wonders why I don't just get out of it... since it's obvious I can't change the world. I've gone to bed crying, on more than a few nights.

The comment above, is of course, ridiculous. If there is a board certified endocrinologist out there, doing this, he needs to have his license revoked. Simple as that. He is doing NO ONE any favors. He is hurting his patients a lot more than he knows. I understand that insurance companies love judging us -- hey why not, the media has done a great job of misinforming the world, and insurance companies get their news just like the rest of us, and want to use that to safeguard their old, mighty dollar -- but the value of a 'small defense' against an insurance company does NOT outweigh the psychological harm and denial you feed into a person by acting like their diagnosis doesn't exist. Would these people dream of telling someone who had AIDS "If you're good, and your labs come back good, I'll change your diagnosis to HIV positive, instead?" Yeah, I don't think so! (It's not entirely a perfect analogy, but you get the idea...)

But people don't GET the permanence of Type 2 Diabetes. What's worse is that, while we preach day and night that this is an epidemic of epic proportions, our medical establishment does not act like it! (Oh, lots of people are acting like it, don't get me wrong... but it's, mostly, the people who want to scam us, and take advantage of us...) If this is such a serious threat, why isn't the American Medical Association, and the American Association of Clinical Endocrinologists, making it a priority to get doctors educated, and prepared, for diagnosing, and empowering patients? Why are they not working hard to give patients the weapons to fight back, and effectively not feel themselves the hopeless victims of this disease? (I know someone out there will claim that they are... but the proof, or lack of proof, is in the pudding, folks.)

• Patients are out there, going undiagnosed, not because they don't regularly see a doctor (though some, undeniably don't...), but because doctors don't know how to recognize the signs of diabetes, or are UNWILLING to mark down a "diabetes diagnosis" in a patient record, thanks to insurance company scheming. More and more Type 2 Diabetes patients are being diagnosed by other medical professionals, such as gynecologists, urologists, dentists, and eye doctors. Often, a patient even gets misdiagnosed based on ridiculously old knowledge, like assuming that an adult could not be a Type 1 Diabetic, instead, leaving the patient vulnerable to Diabetic Ketoacidosis, and Diabetic Coma.  
• Most doctors, especially Primary Care Physicians (or Family Doctors), get a MINIMAL amount of diabetes education in medical school, and NO extended diabetes education throughout their careers. Diabetes information, care, and knowledge is growing about as fast as technological advances are... why should doctors remain in the dark, if we, as patients, can't afford to do so? Some doctors are going by on 20, and 30 years of OLD diabetes education! As a consequence, when a diabetic patient gets diagnosed, thanks to this lack of knowledge and insurance company scheming, patients get denied access to specialists, denied access to certified diabetes educators, denied access to dietitians, denied access to insulin, etc. Doctors, ROUTINELY, give NO information or direction to a newly diagnosed Type 2 Diabetes patient, leaving them vulnerable to whatever might be out there, on the internet. There is something vastly wrong with an insurance company that denies access to a dietitian, or certified diabetes educator, but is happy to approve gastric bypass surgery. In other scenarios, doctors give patients extreme misinformation, such as "STOP eating ALL fruit because they are high in carbs." Ummm, hello, not all fruit is made the same... We need to learn to MANAGE food, not put the fear of God in people.   
• The medical establishment is allowing itself to be ruled by the treatment guidelines of the American Diabetes Association -- an Association with clear conflicts of interest, per a recent study done by the Mount Sinai School of Medicine, and which has been SLOW AS MOLASSES in embracing the future of diabetes tight control, and management. What's worse, they have GREATLY contributed to diagnoses getting delayed and delayed. This is WRONG and unacceptable. Doctors and Endocrinologists need to be educating the ADA, and not the other way around! 
• Instead, more and more "doctors" and "medical professionals" are taking advantage of the serious need for diabetes patient education, as a door to write books, push supplements, spread their own pseudoscience, and MAKE MONEY. 

Don't get me wrong, here. I am not anti-doctor... and I understand that doctors are humans, too, who can make character and judgement mistakes. There are some AMAZING, well educated, empowered doctors out there, working hard to help empower diabetic patients, and help out in the online diabetic communities... But the overall lack of education, and standards, in general, for our medical professionals is wrecking havoc in our lives, as patients, and it's wrecking havoc in our ability to garner empathy, build awareness, and motivate outsiders to help donate their time and money in the hopes of finding a cure. Who donates to something they think already has a cure? 

Dear doctors, you have MUDDLED the language of Diabetes, and made it a messy affair. Every time you get on TV, write a self serving book, misinform a patient in your office, you MAKE IT HARD for us to live, control, master, and grow, with this disease. How can we, as patients and advocates, have power behind our voices, if you tell lies to people with an M.D. next to your name? Who is going to believe US over you? 

• STOP making up statistics to sell books! No, 50% of Americans don't have diabetes... 33.8% of Americans are obese, but only 8.3% of Americans have diabetes, and that number INCLUDES all types of diabetics, including the undiagnosed. Anyone who claims these things NEVER quotes any real studies, double blinded studies, studies published in any legitimate journal of medicine, of any kind. They make up catchy terms to feed on people's biases, and fears for self serving purposes. Stop getting on Dr. Oz to sell LIES. Broccoli is NOT going to cure anyone's Diabetes. (I'm looking at you, Dr. Hyman.)  
•  STOP telling people gastric bypass will cure their Diabetes. It will most certainly NOT. And what pisses me off the most, is many of you have gotten on TV, and the news, and told everyone that it is, and that it's 100%. Now I can't frigging walk anywhere without some moron asking me why don't I just get bypass, or some other form of that. Well... don't mind if after being called misinformed, and uneducated, by people the likes of Misinformed Mrs. Know-It-All, above... that I get angry when articles like this hit the news, FINALLY admitting the truth... No I am not in crazy denial! It is NOT a frigging cure, or a guarantee of anything! Remission is NOT a cure, it is tight control. And this surgery is a Russian roulette! And, hello, I can improve my OWN care without a surgery, and *I have*, thank you very much. Someone should staple your mouth, instead. :S 
• STOP throwing terms like "reverse", "remission," and "cure" around, in exchange for tight control. Even a Type 1 Diabetic can achieve tight control, and reverse complications, and that does not mean they are cured. Type 2 Diabetes is a progressive illness that requires vigilance, and ongoing monitoring, and with time, those medication free moments will be just a thing of the past, and we will need oral medications, and insulin, to keep healthy, and in tight control... Most full blown Type 2 Diabetics will eventually need insulin, in their lifetime. We may be able to prevent complications, or even slow or 'reverse' the progress of some of them, but there is NO reversing or curing Type 2 Diabetes. Stop bullshitting people. We are big boys, and girls. We can deal with the truth.
• STOP telling people that losing weight will make their diabetes go away! Stop telling patients that they are cured, while they are in your office! These are harmful lies, for all the reasons I mentioned above. Weight loss does NOT remove Type 2 Diabetes. It only helps MANAGE it. Type 2 Diabetes has NO CURE. 
• STOP telling people they can prevent Type 2 Diabetes. NO ONE can prevent anything. This creates feelings of insecurity, self blame, and inadequacy when a person gets diagnosed with diabetes despite having done everything in their power to change their odds. Why not simply talk to people about REDUCING THE RISK of getting Type 2 Diabetes? Isn't that, instead, a little more realistic? Diabetes is NOT a zero-sum game. Everything has risks. Nothing is black and white. 
• STOP equating diabetes with obesity. I GET IT. I am not a moron. I know that there is a very STRONG link with diabetes and obesity. It is a risk factor. Obesity, however, does not mean diabetes.  There is NO SUCH disease as "Diabesity." Obesity is it's own disease with its own complications, and Type 2 Diabetes is an autoimmune and metabolic disease. There is no known cause for Type 2 Diabetes. Why not all obese people develop an autoimmune response that leads them to Type 2 Diabetes? No one knows. And why are not all Type 2 Diabetics overweight? (Sure, some are misdiagnosed, but many are not...) The fact is, no one knows. There is also a very strong link between diabetes and pollution and pesticides, BPAs, drugs (such as statins, beta blockers, antidepressants, antipsychotics, steroids, etc.), other illnesses (like Polycystic Ovarian Syndrome), surgeries, drinking, smoking, etc. Why can't we discuss ALL of those risks? Why can't we be realistic about Type 2 Diabetes? Why can't we speak to people with the entire truth? There has been a 400% increase in antidepressant use by Americans.  Don't you think THAT has had more than a little hand in raising the Type 2 Diabetes incidence? 

And another thing... if it's so easy for you to tell a patient with Polycystic Ovarian Syndrome that it would be helpful in controlling their disease to "eat a balanced diet low in carbohydrates," WHY IS THIS SO FRIGGING HARD TO TELL TO A DIABETIC PATIENT, AS WELL????? (Oh, that's right... it's because pills to treat PCOS don't cost an ARM AND A LEG, and don't make you any kickbacks.) It's not that that is all that is required for better health, but come on, throws us a bone! People are out there avoiding sugar, and all fat, thinking this is what made them diabetic, and thinking what we eat in itself gives us diabetes! It is NOT. 

Doctors, this may not be entirely your mess... But you sure have lathered yourselves with GUSTO with the manure of laziness, and greed. I hold you PERSONALLY accountable for the state of our nation's health when 2050 rolls around. Get some guts, and fight on our behalf.  

 

 

 

» Read More...