Posted by: Nige
on Jun 03, 2010
These two myths are linked, so it makes sense to look at both at the same time. We'll start with progression.
Myth #6 - Diabetes is Progressive
Its generally accepted that diabetes is a progressive condition, although this is being questioned more and more as diabetics learn from each other more on the web and gain better control. Because of bad health advice and low expectations in the past there is an assumption that patients will be diagnosed, move quickly onto pills, then onto insulin with their health deteriorating along the way.
The problem is that historically, the expectations have been low and the targets unambitious. The ideal of course is to have blood test results which are the same as those for non-diabetics and this is achievable for the majority of diabetics. However if you get halfway towards that target then most GPs will be perfectly happy with that. Also the dietary advice in particular from health professionals (see myth #5) makes it almost impossible to reach non-diabetic numbers as well.
Running high blood glucose over a long period does cause deterioration and so diabetes under those circumstances really is progressive. The pills will stop working and you will move onto insulin.
But its doesn't have to be like that. People who manage to get good control by learning what works to help control their blood glucose tend not to deteriorate or at least if there is progression, it is slowed down considerably. The risks of diabetic complications such as blindness and kidney failure fall rapidly the closer you get to non-diabetic numbers.
So perhaps if our control is good enough we can avoid any progression at all. Unfortunately things are never that simple and other things in life conspire to make things difficult, including other medical conditions interfering, but the better control we have overall, the less progression there will be.
So in a sense, diabetes is as progressive as you allow it to be, but its not all in your hands and luck is involved. At the very least you can slow the progression right down.
Myth #7 - Pills or insulin mean failure
People want to avoid medication if possible and thats certainly understandable. Its something we would all prefer to be without because even at its best its an extra little hassle you could do without.
But many people feel that if they have to start taking pills or have to start using insulin then its some kind of failure.
There's several reasons for this including the vague general preconception of the public that all diabetics have to do is stop taking sugar in their coffee. But doctors can also often give the impression that they are "threatening" insulin or pills if you do not improve. But one of the biggest factors which influences this sense of failure is the way that diabetes is seen as progressive. Because there are some people out there who seem to be able to manage their diabetes with just diet and exercise, it seems to be assumed that everyone can and that they can do it forever. So if you need medication to help control diabetes, you've not done as well as them and you have somehow failed.
This is quite definitely a misconception. Diabetes affects different people to different degrees. Genetically we are all different and our bodies react in different ways to all kinds of things. So because we are all different, the degree to which diabetes is controllable is going to be different. Plus our bodies age and if we are not expected to be as physically fit as 60 as we are at 18, we can assume that our bodies will be less able to cope with diabetes later in life than when we were younger.
In addition, the longer that diabetes is undiagnosed and untreated, the more of an effect it is likely to have. Above I discussed how uncontrolled diabetes is progressive. So if you were diabetic without knowing it for a period of years before being diagnosed, then the damage has been done and diabetes is going to have more of an effect on you. This is in no way your fault, but its the situation you are faced with.
So just because one person can get away with treating their diabetes just with diet and exercise simply means they are lucky in that it was caught early enough to do something about it or their genetics mean they can get away with more.
But there's one more factor in this. My prescription is 1500mg of metformin per day. I estimate it would be possible for me to do without the metformin altogether and just control it with diet and exercise, but I won't. Its techically possible for many type 2s to eat such a low carb diet that they do not need any medication at all, perhaps also doing an awful lot of exercise along the way.
But that is the point where it takes over your life completely. Food is one long exercise in denial and exercise may have to be scheduled in after every meal in order to control blood glucose. You could reach a point where your entire life is taken over by simply staying alive. Is that really worth it? Is someone in that position really better off just for the sake of avoiding taking a couple of pills every day? Before the discovery and production of insulin, type 1 diabetics ate an almost no carb diet and usually died young. If taking pills or insulin are a failure, they were a resounding success.
So medication can simply be a way of making life easier, even allowing you to have some kind of life which does not revolve around diabetes. Even if you could techincally manage without the medication, it can take the pressure off enough to make things an awful lot easier.
If someone is blind then a white stick or a guide dog is not a symbol of some kind of failure. They are just tools to get things done because they are either necessary or make life easier.
The biggest "threat" is that if you do not control diabetes well enough, you will need insulin. If like me you are needle-phobic then its not a nice prospect at all. But I would cope. I know that if thats whats needed, then thats simply whats needed and I will get on with it. From talking to insulin users for years I know its not as bad as people fear anyway.
When it comes to insulin there are even advantages which non-users do not have. For starters, if someone is on a decent basal/bolus insulin regime then they can modify their dosage to balance for their carb intake. So a type 1 can typically handle more carbs without going hyper than I can. While its true that reducing carbs means less margin for error, a basal/bolus user can be a bit more "naughty" more often than me and has a tool which allows them to do it.
Even pills have their advantages as well. Metformin for example is cardioprotective, so a type 2 diabetic taking metformin is less likely to have a heart attack than a type 2 diabetic who isn't. ACE inhibitors such as ramipril are primarily for controlling blood pressure, but prevent kidney damage in the long term as well.
So rather than medication being a sign of failure, its simply a tool which might make things easier, have additional advantages and avoiding it could cause you further damage while you lose BG control.
So perhaps to some people since I take medication I am some form of "failure". But I'd rather "fail" than be "successful" and dead.
This is a series of blog entries about diabetes myths. Diabetes Myth #1 - Its all your own fault Diabetes Myths #2 - Its all about sugar
Diabetes Myth #3 - Calories Count Diabetes Myth #4 - Cures Diabetes Myth #5 - The Diabetic Diet Diabetes Myths #6 and #7 - "Diabetes is progressive" and "Pills or Insulin mean failure" Myth #8 - Glycemic Index is the answer. Now whats the question? Diabetes Myths #9 - Cholesterol Diabetes Myths #10 - HbA1c is an Average
Posted by: Nige
on Feb 18, 2010
This is the first in a series of blog posts about the most common diabetes myths.
This is something you see all the time in the media, in general news reports, newspaper articles and the implication is everywhere, even if the words aren't. Type 2s are made to feel like its their own fault they got diabetes because if you get fat, you get diabetes, right?
Wrong.
