The Truth About Diabetes

UAB Comprehensive Diabetes Center Director Sheds Light on Common Myths

By Tara Hulen

0911_diabetes2Though diabetes is prevalent in Alabama—one recent study placed the state in a Diabetes Belt stretching across the southern United States—there are many myths about its causes and treatment options. And these misconceptions often lead people to make bad decisions based on bad information, says Anath Shalev, M.D., director of the UAB Comprehensive Diabetes Center and professor of medicine in the Division of Endocrinology, Diabetes, and Metabolism. Here, Shalev shares the truth about the most common myths.

Myth: "Sugar or eating sweets is the cause of diabetes."

It’s not the sugar; it’s the effect of too many calories of any kind, because obesity is a major risk factor for type 2 diabetes. Lack of exercise is another major contributor to type 2 diabetes, especially a sedentary lifestyle combined with large portions of high-caloric, fatty, food. But the scientific answer about the cause of diabetes is far more complicated than whether you have fried chicken, fries, sweet tea, and banana pudding at lunch, then take a nap instead of a walk.

Fact: There is no magic bullet for treating or avoiding type 2 diabetes.

Shalev says the best prescription to help avoid type 2 diabetes is simply to eat a healthy diet and maintain a healthy weight and exercise.
She also advises caution over the news that diabetes disappeared in a significant number of diabetic patients who had bariatric surgery for extreme obesity. The outcome is interesting, Shalev says, but there is a lot of work to be done to discover why it happened and what it means—research that could lead to eventual advances in diabetes therapies. Until then, the news is not a good reason for someone to seek this very serious surgery, she says.

A number of different genetic factors have started to be unraveled and there are different types of diabetes. “Type 1 diabetes is caused by an autoimmune process that destroys the beta cells (which produce insulin) in the pancreas. With that, the sole source of insulin —the hormone responsible for maintaining normal blood sugar—is destroyed,” Shalev says. “Type 2 diabetes, on the other hand is the result of insulin resistance (which is most often caused by obesity) and beta cell dysfunction.”

Myth: “Kids with type 1 diabetes can’t have anything sweet.”

While in the past people with diabetes were discouraged from having any sweets, advances such as fast-acting insulin therapies and different monitoring protocols allow for the occasional treat and make meal planning easier for children and adults, Shalev says. A child can have a piece of birthday cake, for example, as long as parents dose him or her properly beforehand and monitor closely. “It’s an intensive insulin regimen, so patients check more frequently, but they gain more freedom,” Shalev says. “It is a lot of work, but they can enjoy the simple pleasures in life.”

Myth: “Only obese people get diabetes.”

“While obesity is the strongest risk factor for type 2 diabetes, patients with type 1 diabetes or other less common forms of diabetes are often very lean,” Shalev says. “I have seen several triathletes who are type 1 diabetics.” Patients such as these who participate in high-intensity sports or a strenuous exercise programs should have a careful monitoring and dosing plan created in consultation with an endocrinologist, she adds.

Myth: "Type 1 diabetes, in the past often called juvenile diabetes, only affects the very young."

In fact, type 1 diabetes can affect people at any age, though it is more common for younger age groups. “Excessive thirst, urination, and weight loss should always be warning signs and warrant a doctor’s visit,” Shalev says.

Myth: “There is nothing you can do about type 2 diabetes.”

Healthy Stop
The UAB Comprehensive Diabetes Center is participating in a new free health center in downtown Birmingham that could help reduce diabetes levels and detect other health issues. UAB HealthSmart, located on the corner of 20th Street and 3rd Avenue North, offers free services such as health screenings and personalized disease-prevention programs. It’s an initiative of the UAB Minority Health & Health Disparities Research Center and the UAB Division of Preventive Medicine.

Some people look at their family tree and their own waistline and assume they are doomed to get diabetes. “Some people will have a constellation of genes that put them at a higher risk,” Shalev says. “But that doesn’t mean they will develop diabetes. In most cases, type 2 diabetes can be delayed and sometimes even prevented with adequate lifestyle modifications, including exercise and healthy diet. Monitoring and early intervention are important to improve the overall outcome.”

Myth: “Starting insulin injections in type 2 diabetes is the beginning of the end.”

“It’s a myth that the prognosis will just get worse and worse once you need insulin,” Shalev says. Still, patients often panic and resist when told the injections are necessary. Actually, it’s just the next logical step if oral medication doesn’t work, Shalev says.

By helping to control blood sugar levels better, insulin can help patients avoid complications such as stroke and heart attack, Shalev says. Emerging research suggests that starting insulin treatment early in the disease process also can reduce strain on the beta cells. “These cells are under continuous stress to produce more and more insulin, and at some point they just can’t do it anymore. That’s when oral medications are no longer sufficient,” Shalev explains. Injections “give beta cells a break.” 

She adds that the need for insulin injections is not always permanent. Some patients with type 2 diabetes can eventually stop taking insulin if they also make lifestyle changes to help with their disease.

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