It’s always fun to get a different take on things. You sit for years a few rows up from first base and then one day you decide to go sit out by left field. Who knew the game could look so different?
Or maybe a friend pokes you and points at a person in the crowd, “Hey, he looks like you!” Intrigued, you look at the stranger and think in quick succession, “He doesn’t look like me. Well, he doesn’t look that much like me. Hey, so that’s what I look like!”
That’s why it has always been interesting for me to check in with friends or family members who know that I have type 2 and ask them what it looks like from their vantage. Their answers have often contained some misconceptions. Here are the most common ones I’ve heard over the years:
You can’t eat any sugar, ever.
This is a great opportunity to teach people that sugar is just one among many carbohydrates, and that carbohydrates as a whole are the sworn enemy of type 2s. Whether they do so slowly or quickly, they all turn into glucose, which is the main concern of people with diabetes. For us, the real question is how many and what kind of carbs can we eat without spiking our numbers to fantastic heights. So, can’t eat sugar ever again? No. But, a lot less sugar a lot fewer times? Yes.
You have to take insulin all the time. Is it hard to hide taking it?
Many people are confused about who takes insulin. Type 1s must inject basal and bolus daily, while most type 2s go 10 or more years after their diagnosis before having to start basal shots. Segueing to bolus shots can take yet more time.
So the answer is, “No, I inject insulin once a day late in the evening in the privacy of my home.” As for being shy about injecting in public if I ever do get to bolusing, I simply say that I’ve seen many people with diabetes inject themselves discreetly and without fanfare. Given how common the disease has become, there are few people left who will be miffed or shocked at the sight of somebody squeezing off a quick shot. Bottom line: I’m not going to endanger my health just to spare some stranger’s overly delicate sensibilities.
I’m confused: Is there more than one kind of diabetes?
This is where we can help lift the cloud of confusion that scuds around in many people’s minds. I just recite an easy-to-remember formula: Type 1 diabetes is a genetic condition that people are born with. There’s nothing they can do about it. Their bodies mistakenly destroy their ability to produce insulin. Type 2 is brought on many times by poor lifestyle choices. Not always, though, since there may be a genetic component to it. But, to be clear, type 1 involves no choice; type 2 most certainly does.
You look pretty good. Tell me again how high blood sugar hurts you?
Diabetes doesn’t work on people’s exteriors. High blood sugar inflames, and inflammation isn’t an external thing. You can’t see the toll it’s taking on organs and blood vessels. The body goes into a permanent state of high alert, which stresses it beyond the normal wear and tear of everyday life. Diabetes is “progressive” in the sense that its effects on the body progress from initially mild to increasingly harmful.
You mentioned lifestyle choices as one cause of type 2. That means I could develop it. What can I do to avoid that?
I tell friends that the best way to avoid the onset of type 2 is to act as if they already have it. That means adopting a routine that we type 2s already know so well:
• Exercise–Usually walking or biking. (Short bursts of intense exercise, such as wind sprints, stair climbs, or fast treadmill workouts have also been shown to produce great aerobic results with far less investment of time than long walks or bike rides.)
• Lose weight–The rule of thumb these days is that even a 5 percent loss (10 percent is better) of total body weight often leads to dramatic reductions in blood pressure, insulin resistance, and blood sugar levels, while increasing levels of energy.
• Eat well and intelligently–Many nutritionists are concluding that “grazing,” eating several small meals throughout the day, decreases stress on the pancreas system by lessening the size of the sugar loads it has to deal with.
But more important than when you eat is what you eat: Avoid a high carbohydrate intake. The availability of cheap and abundant carbs, even the ones that are supposed to be good for you (whole-grain, low glycemic numbers), has been one of the reasons diabetes has become an epidemic. Look into research that increasingly is debunking the notion that limiting fat and protein somehow staves off cardiovascular problems and inflammatory diseases like diabetes.*
• Consider taking metformin–More and more doctors and endocrinologists who deal with some of the estimated 80 million people with pre-diabetes in the United States are prescribing metformin for them. It’s a benign and cheap drug that works by limiting how much glucose the liver produces. In combination with the steps above, taking metformin is a pre-emptive move, designed to give a body that’s heading toward type 2 a chance to avoid slipping into a permanent state of high blood sugars and insulin resistance.
*Look online for Gary Taubes, the author of two highly acclaimed books (“Why We Get Fat” and “Good Calories, Bad Calories”) that have done much to force a re-examination of the roles carbohydrates, fat, and protein play in the development of obesity and inflammatory disease. Dr. Richard Bernstein, who writes the “Q&A With Dr. Richard Bernstein” column on this website, has also written a seminal work on the role of carbohydrates in diabetes, “Dr. Bernstein’s Diabetes Solution.”