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What's This?

The recent news that Paula Deen, (the “celebrity” southern  chef  whose specialties include deep fried lasagna and a burger with bacon and cheese between two donuts) has diabetes may come as no surprise to anyone.

However, as a physician, I am constantly surprised and disappointed by how poorly this condition is understood, especially among my patients that have it.  The amount of incorrect information in this week’s news has only further confused the issue.

So, what is diabetes? Did Deen’s diet contribute to it? Can your diet cause it? And what does it mean for your lifespan and what can you do about it?

What is Diabetes?

There are two types of diabetes, Diabetes Mellitus Type 1 (DM1, going forward), and Diabetes Mellitus Type 2 (DM2).  While the causes and science behind the two are very different, the end result is the same—the body does not have sufficient insulin.  For this post today, I’ll focus mainly on Type II Diabetes, the diagnosis that Paula Deen was given, and the more common condition.

How the body is supposed to work: In people without diabetes, when you eat something with sugars in it, your blood glucose level rise → your pancreas secretes insulin→ insulin causes your cells to be able to take in glucose → your blood glucose level normalizes.

In Diabetes Type 1, which is usually genetic and often occurs in younger people, the pancreas is unable to make insulin, so the blood glucose level rises dangerously, and the body cells are effectively “starved” for nutrients and glucose.  These patients have to take insulin medications to replace the insulin that they are unable to make.

Diabetes Type 2 is an entirely different condition.  It is highly associated with obesity, poor diet, and decreased physical activity.  In DM2, it appears that after long periods of a diet with high levels of sugars and obesity (all of which trigger high levels of insulin), the body starts responding to the frequent high levels of insulin by decreasing its sensitivity to insulin.  Think of this like a noisy neighbor—at first, it bothers you and you react to it, try to intervene, but eventually you just become accustomed to it, and the noise eventually does not bother you as much.  The body works similarly—if the levels of insulin and glucose are frequently high due to obesity and bad diet, then the body decreases its response, and you have the condition known as insulin resistance, which eventually leads to diabetes.

 What causes diabetes?

As I mentioned above, development of Type 1 Diabetes is largely genetically based, less associated with lifestyle factors.  I’ll focus on the risk factors for Type 2 Diabetes here.

  • Obesity: Studies have shown that the risk of type 2 diabetes increases with increased body weight.  Patients with body mask index (BMI) above 26 have almost twice the risk of diabetes as someone with a BMI 24-26, and a BMI less than 24 is about half of that.  Interestingly, the pattern of fat distribution appears to play a part, with the risk highest in people with their fat centered in their abdomen (more likely “male-type” patterns), although scientists don’t know why this happens.
  • Exercise: Physical activity has been proven to reduce the incidence of DM , while a more sedentary lifestyle will increase the risk
  • Smoking: The data is not entirely clear, but it appears that there is an association between smoking and diabetes.  Scientists are not entirely sure of how the smoking contributes to diabetes, but they believe that smoking can impair insulin sensitivity in the body, as well as worsen inflammation.
  • Diet: One study followed over 42,000 men, and found that a western diet (high in red meat, processed meat, high fat dairy products, sweets and desserts), increased the risk of diabetes.  Eating this diet AND being obese (which often do tend to go together), increased the risk by ELEVEN TIMES greater.

What are the consequences of Diabetes?

  • Heart attack: The risk for a heart attack in a patient in diabetes is so high that doctors consider diabetes a “coronary heart disease equivalent”, meaning that someone with diabetes is at as much risk for a heart attack as someone who has already HAD a heart attack.  One study followed 140,000 patients over nine years, and found that those with diabetes had an almost FIVE times greater risk than someone without diabetes.  In addition, their risk of death from a heart attack is seven times greater than someone without diabetes
  • Stroke: Patients with diabetes have twice the risk of stroke as those patients without it.
  • Diabetes puts patients at significantly higher risk for MANY diseases.  In addition to heart attack and stroke, patients with diabetes develop visual changes and blindness, painful neuropathies, and increased risk of infections.

So what can you do about it?

Paula Deen had said that whether or not you get diabetes is like playing a game of “Russian Roulette”.  This suggests that there is nothing you can do to prevent or improve your risks, so you may as well do what you want….correct?

Not true.

Ninety percent of people with type 2 diabetes are obese.  Genetics do play a significant role, but the important takeaway is that YOU have far more power to control your health.

  1. Weight Loss: The “Diabetes Prevention Program” was a study to investigate the benefit of weight loss compared with medications for people with diabetes or pre-diabetes.  They had to stop the study a year early because it was so clear that losing 7% of someone’s body weight cut people’s risk of developing diabetes IN HALF.
  2. Exercise:  Doctors recommend exercising 150 minutes per week, for optimal blood sugar control.   A combined program of both aerobic training with resistance (weight) training seemed to offer the best outcomes. Brisk walking for exercise, compared with being sedentary, shows a 30% reduction in the risk of developing diabetes (regardless of your BMI).
  3. Diet: While the impact of one’s diet appears to be greatest as it pertains to weight, it does have independent benefits. Diets high in fruits, vegetables, nuts, whole grains, olive oil, and low-fat dairy seem to be the most protective.

Interestingly, while genetics and ethnicity definitely do play a factor, some studies have shown that ethnicities that have higher incidences of diabetes have even a GREATER benefit when they follow a healthier lifestyle.

Key takeaway? Don’t let casual news mis-information make you feel helpless.  We all have genetics that can make us “luckier” or “unluckier”.  But what you do with what you are given is what makes the difference.   You can reduce your risk for diabetes TODAY.  And I’m here to help.

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4 Comments

  1. Dr. Darria,
    this was a wonderfully informative article. Obesity ia a major problem in this country and this woman obviously pushes food that is good for no one, even herself. I wish that you would consider writing about what is a good gauge to use for effective exercise at different ages. Keep up the good work!

  2. Rod Nixon

    Dear Dr Darria

    Your articles, like this one are all very consumable (excuse the pun) and relevant to everyday life. Thank you! I always wanted to understand more about diabetes and why some people have it young and others later in life.

    Questions: What are the symptoms of someone having too much sugar in the blood (maybe they forgot to take their insulin injection)? Is there any short term ‘first aid’ that can be applied by a ‘lay’ person before getting them to a hospital or doctor?

    Thank you.

    • Rod–that is an excellent question. Both high blood sugar (hyperglycemia) and low blood sugar (hypoglycemia) can be very dangerous conditions that need to be addressed rapidly.

      Patients with high blood sugar often have symptoms of increased thirst, headaches, increased urination, and mental status changes that range from just blurred vision and difficulty concentrating to outright coma. This can be caused by missing a scheduled insulin dose, but high blood sugar levels can occur at times when the body is “stressed”–for instance, in the setting of an infection elsewhere in the body, surgery, or injury. The standard treatment for high blood sugar is to administer the patient’s insulin and make sure that they are taking in plenty of fluids (to prevent further dehydration caused by high blood sugar).

      Patients with low blood sugar can start to have symptoms when their blood sugar level falls below 70, and can include feeling anxious/jittery, having cold, clammy/sweaty skin, having a quick heartbeat, and nausea. As their sugar level drops lower (less than 55), they can start to have mental status changes, such as confusion, difficulty with coordination, and may even appear to be having a stroke (they are not necessarily having one, but the symptoms of severe hypoglycemia can often mimic traditional stroke syndromes). If a patient has mild symptoms (not significantly confused), then you can give them a quick source of sugar, such as glucose tablets, juice or soda, raisins, sugar, honey, or candy. It’s interesting to know that foods with fat, such as chocolate or cheese, will not raise a person’s blood sugar as quickly so are not as helpful in an emergency. Some patients have been prescribed a glucagon shot by their doctor –for these patients, if their sugars are low, they should have this shot, which will quickly raise their blood sugar levels.

      Take care, be healthy, and keep up the good questions!
      Dr. D

  3. In the search for blood glucose regulation information this site stood out for having accurate and valuable information on diabetes.

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