Fat and Lazy?

This month, I am featuring the second in a series of guest editorials. Jan Chait, a frequent contributing writer to DIABETES HEALTH who has type 2 diabetes, writes this one.

Jan addresses the study published in the September 13 issue of the New England Journal of Medicine (see page 18 which says that 90 percent of type 2 cases can be avoided by exercising more and dieting better). But, is it really that simple.

-Scott King, Editor-in-Chief

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An article on page 18 of the September 13 issue of the New England Journal of Medicine cites a study that says 90 percent of cases of type 2 diabetes can be prevented if people exercised more and watched what they ate. In other words, be “fat and lazy” and get diabetes.

I’m angry. Type 2 diabetes is not associated entirely with weight, folks.

Type 2 diabetes also has a genetic component. The majority of people in this country who are overweight do not have diabetes. Maybe people who develop type 2 diabetes should do more than diet and exercise; they should also do a better job of picking their ancestors.

Let me propose another scenario to you: What if the diabetes comes first?

What if you get “fat and lazy” because you have diabetes?

I did not invite the “Diabeastie,” as I call it, into my house. Here’s how I believe it came in:First came the weight gain. Weight that I could not remove no matter how closely I watched my food intake; no matter how many miles I walked or rode my bike. Two other people have told me similar stories of how they began gaining weight and could not take it off, no matter how hard they tried. One has type 2 diabetes now. The other had gestational diabetes during her pregnancy.

As for my weight gain and me, I was mortified. I’d never weighed more than 120 pounds in my life!

And, oh, was I hungry!

What was happening here? Looking back, I believe the insulin resistance was causing it. My pancreas manufactured more and more insulin to control my blood-sugar levels. I remember getting very cranky if mealtime came and I didn’t get food. Much the same as I feel now when my BGs drop too low. When, as my husband tells me, my eyes glaze over, I get cranky and I look as if I could bite the head off a rattlesnake.

Was I going low then? I don’t know. I only know that I became ravenous and got an overwhelming urge to shovel food into my mouth.

Then, I began to be hungry all the time. Was it because the insulin-resistance had gotten so bad that my cells were absorbing very little sugar? Was my body signaling that I needed to eat to give needed energy to my cells? Was I literally starving-even though I was eating?

Fatigue set in-debilitating tiredness that caused me to fall asleep almost as soon as I sat down. I became afraid to drive any distance by myself for fear that I would doze off at the wheel.

Exercise? C’mon! All I could do was to drag myself out of bed in the mornings, stumble to my job as a newspaper reporter and forcibly drag myself through the day until I could file my last article and go home. There, I would sit down and fall asleep.

So, my pancreas was pumping out insulin but the insulin couldn’t enter my cells and I was starving even though I was eating. The sugar began to build up in my bloodstream when my pancreas couldn’t keep up. I developed that overwhelming fatigue that comes from running consis-tently high blood sugarsÉ and then I was diagnosed with type 2 diabetes on January 2, 1986, with a fasting level of 311 mg/dl. My weight had ballooned up to more than 300 pounds.

Happy new year!

Did I get diabetes because I was “fat and lazy?” Or did I become “fat and lazy” because I had diabetes? (And, no, I don’t weigh that much any more, although I am what you might call… um… fat.)

I always joke that I snatched all the “short and dumpy” genes so that my younger brothers could have all the tall, skinny genes for themselves. The fact of the matter is that I am built like my grandmother and father, who both had type 2 diabetes. My brothers are built like my mother, who does not have type 2 diabetes. My brothers don’t, either.

So I contend, in this “chicken-and-egg” scenario, that diabetes comes first, characterized by an initial trickle of excess insulin that promotes weight gain, that leads to insulin resistance that leads to high blood sugars that leads to constant fatigue that puts the kibosh on exercise that leads to more weight gain, thatÉ

Well, I think you get the idea.

I am sick and tired of having the finger of blame pointed at me because I have type 2 diabetes. I didn’t invite it in. Now that it’s here and settled in for the long haul, I am dealing with it. But I’m angry that it plundered its way in and I don’t need people blaming me.

Type 2 was staved off by 90 percent of the people in the NEJM study? Good.

But their lives aren’t over yet. Chances are, if the Diabeastie wants to get in your door, sooner or later nothing is going to stop it. Try not to feel guilty about it.

Jan Chait is a freelance writer who lives in Indiana. She manages her type 2 diabetes with an insulin pump.