Choosing Diabetes

If you had the choice to go blind, lose a limb, go on dialysis or lose weight – which would you choose? Individuals with pre-diabetes or type 2 diabetes have the power to change the course of their lives by making healthy lifestyle changes. “I’ve had a number of type 1 diabetes patients over the years ask me ‘What is wrong with people with type 2 diabetes that they don’t lose weight and cure themselves?’ I tell them I have no clue,” said Tamis Bright, M.D. assistant professor and chief of the Division of Endocrinology in the Texas Tech University Health Sciences Center (TTUHSC) El Paso Department of Internal Medicine.

Diabetes Mellitus

The pancreas is an integral part of the digestive system and the hormone it secretes (insulin) is needed to convert sugar, starches and other foods into energy. Diabetes mellitus is a disease in which the pancreas produces insufficient amounts of insulin, or in which the body’s cells fail to respond to insulin appropriately. There are two types of diabetes:

  • Type 1 diabetes, in which the body does not produce insulin and cannot be cured – but it can be treated. It is usually diagnosed in children.
  • Type 2 diabetes, which develops once your body fails to use insulin properly and causes blood glucose levels to rise to a higher than normal level.  Type 2 diabetes is diagnosed when the fasting blood glucose (sugar) level is over 126 mg/dl and pre-diabetes is established when fasting glucose is over 100 but under 126 mg/dl.

For almost 20 years, Dr. Bright has seen her share of type 2 diabetic patients and those at risk for the disease due to obesity. The latest data from the National Health and Nutrition Examination Survey showed that 68.5 percent of adults over 20 years old were overweight, while 35 percent were obese. “Developing type 2 diabetes correlates directly with obesity. Unfortunately, our culture now views obesity as acceptable. Many people have terrible diets and lack exercise despite our great weather,” she said.

“If you have pre-diabetes and do not lose weight – you WILL get type 2 diabetes. By the time you are diagnosed with type 2 diabetes, a significant portion of the pancreas is already dead and not recoverable,” Dr. Bright conveyed. “It means that people need to take responsibility for what they eat. There is an endless blame game for why people don’t change their diets. ‘That’s what my wife or mother cooks – I have to eat it!’ or ‘I don’t have time to eat healthy’,” she continued. “Basically, you want to eat your carbs because they taste good. Somewhere along the line, people started thinking that Supersize was the appropriate size.”

What is most striking about the statistics is the rate of children between the ages of two and 19 with type 2 diabetes. “Twenty years ago, type 2 diabetes in kids was unheard of for the most part. Now there’s a significant number of kids who are affected by the disease,” said Dr. Bright.

A glimmer of hope is that type 2 diabetes can be reversed if patients act quickly. “If a patient’s pancreas is still making insulin, they just need to lose the weight and it will be cured.” But Dr. Bright clarifies that in all of her years as a physician, she’s only had two patients do this. “Given all of the horrible complications of diabetes mellitus – early death, dialysis, heart disease, stroke, amputations, blindness, dementia, increased cancer – you would think that people would immediately diet and exercise to drop the weight. There is obviously a psychological component involved since many individuals eat to comfort themselves.”

Dr. Bright also commented that multiple new drugs were approved this year to treat type 2 diabetes, including some excellent medications that are taken once a week, and that more medications are currently in phase 3 trials that should be out soon.  “Consequently, controlling glucose levels is getting easier and if the glucose levels are controlled, patients don’t get complications. Unfortunately we do not have medications for obesity that are truly useful.”

To ward off diabetes, Dr. Bright urges individuals to stay away from liquid calories (juice, soda, alcohol, sports drinks), cut down total calories (less simple carbs, more green vegetables, berries, apples, pears, etc.), eat lean meats (chicken, fish, less red meat) and become physically active (walk, swim, run, bike, life weights). She also recommends behavioral treatment/therapy to help alter old habits. “Combining all three is the most successful method for weight loss and maintenance.”