2) TYPE 2 DIABETES CONTROL
a, Introduction
A diagnosis of diabetes is invariably a real shock. Like many life changing shocks, a person will go through any phases in the first few weeks and months after diagnosis: denial, anger, depression, sadness, and self recrimination will all surface. This is perfectly normal and expected. It is important to talk about the disease to a confident, counselor, educator or significant other. Denying its existence and just pretending nothing is wrong will solve nothing. It is all up to the person who has the diabetes as to how well he or she beats the disease, it is a matter of self control. In a way it is a lot like alcoholism! It's a matter of personal responsibility. And it is best to simply take it all one day at a time! It is also important to take control of the disease yourself. Don't just blindly follow doctor's orders. Doctors dispense medications, they do a lousy job dispensing advice. In any case, medications do a lousy job of controlling the disease, exercise, weight loss and diet are far more important. And a Doctor can't exercise, lose weight or eat for someone with type 2 diabetes. The person with type 2 diabetes has to do that themselves. The person with type 2 diabetes is in the drivers seat. They and they alone determine how the progression of the disease will go. Type 2 diabetes is a very serious disease and it should be a powerful motivator for a person to exercise, lose weight and eat properly.It is very important to educate yourself in all the nuances of this very complex disease. A person who educates themselves on the disease of type 2 diabetes can handle the disease much better than someone who doesn't understand this disease. As we said before, there is an excellent book by Gretchen Becker "The First Year, Type 2 Diabetes" (Marlowe and Company, New York, copyright 2001) which should be the first book anyone with type 2 diabetes reads. At the back of this Book is a section on searching the internet by David Mendosa. If you really want to learn about the disease this is how to do it, read this book then do internet searches on topics you want to know more about. Type 2 diabetes is a serious disease and there is no such thing as too much education about it. Type 2 diabetes is especially serious when one considers that anyone with type 2 diabetes almost invariably will have some degree of heart disease.
Take the experience one particular person (the author) with type 2 diabetes (and undoubtedly some heart disease), a 240 pound, five eleven, pot bellied couch potato with genetic type 2 insulin resistant diabetes evident on both sides of his family. He loved pizza, ice cream, milk shakes and fries, all the "good but really bad" stuff. He had a definitely unhealthy 8.3 A1c (a measure of blood sugar levels) and a horrible blood cholesterol profile (200 LDL cholesterol, 687 triglycerides, 22 HDL cholesterol). Yet he was able to drop 60 pounds in 6 months, get to a 5.4 A1c (relatively good for anyone) and bring his LDL cholesterol to 94, triglycerides to 74 and HDL cholesterol up to 48 using the recommendations in this book; which is based on only the latest research on type 2 diabetes. And he felt much better!
But it took a lot of self control and hard work, and the battle continues every day for him, as he have another twenty pounds to lose and he wants his LDL cholesterol to be less than 70 and his A1c to less than 5.0. He takes medications to control his cholesterol and blood pressure in addition to exercising to ward off heart disease. If an individual with type 2 diabetes exerts the self control necessary and follows the recommendations of this book, they can reduce their risk of serious life threatening complications by more than 80%. It is not hopeless! It is definitely possible to reverse the progression of the disease of type 2 diabetes. It doesn't have to get worse with time.
One thing you won't find in this ebook is any pulling of punches. Diabetes is not a disease to be coddled, it is a serious life threatening disease. An A1c level of 7.0 is not a good level. Getting your weight down ten pounds so you're only slightly less obese is not doing a "good job". Taking a leisurely stroll through the mall twice a week is not getting exercise. It is not OK to keep your intake of carbohydrates high and to simply change to whole grain products. Eating small amounts of refined carbohydrates every two hours is not a good diet plan. It is not alright to have a small dish of ice cream every night. Getting your cholesterol and triglycerides to 150 isn't "good enough". Doctors and the American Diabetes Association want to "put a positive spin" on everything so anyone with type 2 diabetes won't get discouraged and just give up. My personal belief is that people are more intelligent than that and shouldn't be lulled into a sense of false security, they should be told the truth. You don't tell a smoker with lung disease to cut back to one pack a day. You don't tell an alcoholic with cirrhosis of the liver to cut back to three drinks a day. So why do the same thing with someone who has type 2 diabetes?
It is very easy for an individual with type 2 diabetes to go into denial and to rationalize. For someone with type 2 diabetes to not exercise and not lose weight is like someone with lung cancer not stopping smoking. Or like someone with liver cirrhosis continuing to drink. But hundreds of thousands of people are doing these counterproductive actions every day, including doctors. It is very difficult to break habits, especially when those habits are caused by very real genetic factors. And the role of genetics in type 2 diabetes (and obesity) is very very strong. It is especially difficult for individuals with type 2 diabetes to lose significant amounts of weight. Various "experts" seem to handle that problem differently, depending on which motivational school they come from. Some doctors get mad when a patient doesn't lose weight, some just ignore it. In my non-psychologist opinion the best way to handle the challenge is just of point out how severe the consequences are if a patient doesn't lose weight. The consequences of a type 2 diabetes patient not losing weight are much more severe than the consequences of a smoker who won't stop smoking, especially when it comes to quality of life issues. An obese patient with type 2 diabetes will have a really poor quality of life, period. Blindness, kidney failure, dialysis, depression, leg amputation, impotence, Alzheimers, senile dementia, stomach paralysis, repeated infections, heart attacks, and stroke are just not pleasant consequences.
It must be emphasized that only blood sugar control through diet will not control type 2 diabetes. It requires a wholesale lifestyle change that includes weight control and exercise. Just one piece of the many pieces of research is shown in the following synopsis of an excellent study (ignore the first part if you're not technically inclined, look at only the underlined line):
Tuomilehto J, 'Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance ". N Engl J Med. 2001 May 3;344(18):1343-50.,"BACKGROUND: Type 2 diabetes mellitus is increasingly common, primarily because of increases in the prevalence of a sedentary lifestyle and obesity. Whether type 2 diabetes can be prevented by interventions that affect the lifestyles of subjects at high risk for the disease is not known. METHODS: We randomly assigned 522 middle-aged, overweight subjects (172 men and 350 women; mean age, 55 years; mean body-mass index [weight in kilograms divided by the square of the height in meters], 31) with impaired glucose tolerance to either the intervention group or the control group. Each subject in the intervention group received individualized counseling aimed at reducing weight, total intake of fat, and intake of saturated fat and increasing intake of fiber and physical activity. An oral glucose-tolerance test was performed annually; the diagnosis of diabetes was confirmed by a second test. The mean duration of follow-up was 3.2 years. RESULTS: The mean (+/-SD) amount of weight lost between base line and the end of year 1 was 4.2+/-5.1 kg in the intervention group and 0.8+/-3.7 kg in the control group; the net loss by the end of year 2 was 3.5+/-5.5 kg in the intervention group and 0.8+/-4.4 kg in the control group (P<0.001 for both comparisons between the groups). The cumulative incidence of diabetes after four years was 11 percent (95 percent confidence interval, 6 to 15 percent) in the intervention group and 23 percent (95 percent confidence interval, 17 to 29 percent) in the control group. During the trial, the risk of diabetes was reduced by 58 percent (P<0.001) in the intervention group. The reduction in the incidence of diabetes was directly associated with changes in lifestyle. CONCLUSIONS: Type 2 diabetes can be prevented by changes in the lifestyles of high-risk subjects.
Since actions which reduce the likelihood of developing diabetes are invariably exactly the same actions which prevent the progression of the disease, lifestyle changes such as weight loss, exercise, reduced fat intake, and increased fiber intake can cut the progression of type 2 diabetes more than in half (58%). This is far more than any medication can do. We recommend three lifestyle changes: exercise, weight loss and diet control (avoiding both grain based carbohydrates and feedlot beef and pork).
This chapter: 2) TYPE 2 DIABETES CONTROL
a) Introduction
b) The Range of Severity of Diabetes
c) Current Expectations for a Person with Type 2 Diabetes
d) Summary of How a Person with Severe Type 2 Diabetes can Live Long
e) Specifics of How a Person with Severe Type 2 Diabetes can Live Long
f) A Fatal Error: Relying on Diabetes Medication
g) The Consequences of not Controlling the Disease
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