Curing Diabetes: How Type 2 Became an Accepted Lifestyle

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Diabetes is big business, and many have been convinced that managing it forever is their only option. But it is possible to cure the disease.

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Chuck Lynch figured that after being diagnosed with type 2 (adult onset) diabetes, he was destined for a life of daily finger sticks and medication to keep the glucose level in his blood at a normal level.

Everything he'd heard about type 2 suggested strongly that his only choice was to make the best of it. "I thought it was something you managed for the rest of your life," said the 62-year-old Lyme, Connecticut, resident. "I didn't know you could cure it."

Experts hesitate to talk about "curing" diabetes, given the medical complications it can cause that will require lifelong monitoring. But the American Diabetes Association says that maintaining normal blood sugar without medication for at least a year could be considered a "complete remission."

It's not a message you hear very often if your information about type 2 diabetes comes mainly from TV commercials for the devices and medications used to manage the disease. Diabetes is a big business, worth tens of billions of dollars to the health care system and the pharmaceutical companies that hold the patents on those devices and medications.

Another reason you don't hear about remission is it takes a great deal of effort. Even the health care system seems content to prescribe complex lifelong treatment regimens instead of equipping people with the tools they need to effectively manage type 2 diabetes, possibly reverse the disease or, best of all, avoid it completely.

Chuck Lynch created his own diabetes-reversal program, and it has become the retiree's new job. He dropped 30 pounds with the help of Weight Watchers, and now carefully measures every morsel and drop that goes into his mouth. He joined a gym where he does yoga, water aerobics, and other exercise classes several times a week.

Don't be fooled: Diabetes kills. And maims. This year alone it will kill 3.2 million worldwide. It's the seventh-leading cause of death in the United States.

"I went to town on it," he said. And it has paid off. "I feel better than I have in years. I want to keep it that way."

FRAMING THE PROBLEM

Slender joggers, hardly typical people with type 2 diabetes, laud their glucose-reading meters and test strips to evening network TV news viewers, typically middle-age and older, prime type 2 targets. Friendly older gentlemen speak of their "diabeetus" medication in other commercials as if the deadly disease is a pal who stopped by to shoot the breeze.

Don't be fooled: Diabetes kills. And maims. This year alone it will kill 3.2 million people worldwide. It's the seventh leading cause of death in the United States. As many as 80 percent of people with diabetes will die from heart attack or stroke. Half will likely experience damage to the nerves in their limbs. Diabetic foot disease, caused by changes in blood vessels and nerves, often leads to ulceration and eventual amputation. In fact, diabetes is the leading cause of non-traumatic lower-limb amputation. Ditto for kidney failure. One of every 50 people with diabetes will become blind within 15 years.

The World Health Organization (WHO) calls diabetes a "slow-motion catastrophe." From an estimated 30 million living with it in 1985, to 171 million in 2000, a minimum of 366 million people will have been diagnosed with diabetes by 2030.

Meredith E. Young, an assistant medical professor at Montreal's McGill University, researches the role of language in shaping how the media present, and the public perceives, medical conditions. She said in an email that "media attention to particular disorders seems to influence public perceptions of what is serious, rather than what is seriously driving public attention (and therefore media attention)."

When the media do focus on type 2 diabetes, said Sarah Gollust, assistant professor at the University of Minnesota School of Public Health, they give twice as much coverage to the behavioral risks for it than any of the other factors that contribute. But this over-emphasis on personal responsibility tends to blame and stigmatize people with type 2 diabetes or who are obese. Those living with the disease may feel it's their fault if they can't always maintain the ideal blood sugar level. Worst of all, said Gollust, public support could erode as people are expected to cover the costs, however they can, of a medical condition it's believed they brought on themselves.

Public support for addressing diabetes is imperative when you consider the tremendous amount of money it costs to manage the disease. One of every five health care dollars spent in the U.S. is for someone with the disease. Medicare, the federal insurance program for seniors, pays 60 percent of the nation's annual $83 billion diabetes-related hospital bill; Medicaid, the federal-state insurance program for low-income citizens, pays another 10 percent.

"Right now we're having a diabetes epidemic," said American Diabetes Association president for health and education Geralyn Spollett, an associate nursing professor at Yale University's Diabetes Center. "People don't realize the urgency of the problem we have with people at high risk." Spollett said the challenge is to realistically frame diabetes so it's not scary to the point of making people feel powerless. On the other hand, she added, "If you give a message that everything is fine, the seriousness of the disease doesn't come through."

THE THIN LINE

Susan Dentzer, editor-in-chief of Health Affairs, calls in the journal's diabetes-focused January 2012 edition for "an all-out assault on the condition -- and, since obesity and diabetes walk hand-in-hand, a long-term commitment to radically reshaping the obesogenic environment we live in."

The fat-creating environment makes it exceedingly difficult for people at risk for diabetes -- because of poor diet, obesity, and lack of exercise -- to resist the forces that work against their own good health. The environment typically features structural factors such as impractical transit systems, and towns and cities dependent on the car; desk jobs and non-physical recreation such as TV watching, video-gaming, and web-surfing; and a savvy food industry that has hooked the public on a great deal of unhealthy food items.

Most perniciously of all, the diabetes-inducing environment -- let's be frank: America in general -- fosters a casual attitude toward obesity and ignorance of its impact on individuals, families, and the nation.

Despite its extraordinary consequences, a 2009 University of Chicago study found that most Americans are not seriously concerned with obesity. Although more than half of us are overweight, the study authors said that less than 25 percent of the 909 adults they surveyed saw their own weight as a serious or very serious problem.

It's hard to pinpoint any one reason for the obesity epidemic, said Dr. Jeffrey P. Koplan, director of the Emory Global Health Institute at Emory University in Atlanta. "Our daily lives and environment have changed significantly over 50 years," he said, "creating an environment that is more favorable to taking in excess calories and getting less exercise. Portion size, snacking, how and when we eat, who we eat with, how food gets prepared -- there's a bundle of issues there, virtually all of which promote eating when we don't need to, eating the wrong things, and eating too much."

Add to poor eating habits our reduced opportunities for even simple exercise in the course of our day -- how many of us actually walk or ride a bike to work? -- and Koplan said the increase in obesity and type 2 diabetes is no surprise.

What may surprise you is the food industry's role in manipulating our eating habits and undermining the most determined of our New Year's resolutions to lose weight.

Writing in the Journal of the American Medical Association, Koplan and Kelly Brownell, from Yale University's Rudd Center for Food Policy and Obesity, observed: "Billions of dollars have been spent convincing individuals (children in particular) that highly sweetened beverages and cereals, salty snack foods, and a vast array of products high in fat, sugar, and salt are fun, athletic, sexy, popular, healthy, and even have beneficial properties."

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The author of Victory Deferred, John-Manuel Andriote has specialized in HIV/AIDS reporting since 1986. His research materials, correspondence, and recorded interviews are part of a special collection curated by the Smithsonian.

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