The Flawed One-Size-Fits-All Approach to Type 2 Diabetes

Posted by on Jun 28, 2014 in Management & Care, Treatment & Medication |

The more I observe the general approach being employed by many in the medical and diabetes health communities to address the ‘diabetes epidemic,’ the more I wince.

At the heart of the matter, there seems to be a general undercurrent of belief regarding the condition: diabetes type 2 is a straightforward situation, so just exercise more, and eat less. I get that vibe a lot when I watch TV, read the news, or read the blogs of many a well-meaning health professional and health advocacy organization. While this is generally true in principle and the advice and ideas of many of these folks are helpful, one comes away with the impression that they consider diabetes to be a one-size-fits-all situation, where people are simply undisciplined. This is a nearsighted perspective that is unhelpful for the patient – it fails to truly address the multi-dimensional psychological aspects of a person living with the condition, and thus, their ability to truly embrace the challenge.

What do I mean by this?

What I mean is that diabetes is simply a symptom of a problem. Let’s think about this situation for a moment. Would we tell an anorexic or bulimic patient who has developed heart disease to simply start eating more, or to simply stop throwing up? No. We understand that these behaviors are symptoms of a larger problem – that there are psychological challenges at work, creating disordered eating in this person’s life. We can tell a person with anorexia how undereating will kill them, or a bulimic how throwing up will damage the enamel of their teeth – but no amount of information is going to stop the disordered behavior. There needs to be intense psychological intervention in order to address the warped perceptions in the patient’s life.

This is just one example of how a chain of events can lead to chronic condition in someone’s life. Every ‘someone’ ought to be treated in ways which are tailored to their life experience. Now, while not all persons with diabetes are obese, the fact of the matter is that the majority of persons with type 2 diabetes have some disordered eating, are overweight, or are obese, and the reasons for this need to be addressed.

  • There are some folks who may have gained some weight simply because they are very busy — be it busy parents with families, or busy professionals – and they might just need some help tweaking their habits. These types of folks could benefit from just a bit of guidance on how to readjust, and minimize just reaching for the convenient meal or junk food snack;
  • There are folks who’ve gained weight due to illness, medications, or immobility, and could use some help juggling the situations; and
  • There are some folks who genuinely have disordered eating, and have gained massive amounts of weight: folks who use food as a form of comfort, as a form of treating pain or depression, as a form of coping with life much in the same ways a person might use drugs or alcohol, etc.

Whatever that person’s reason to struggle with disordered eating which has lead to weight gain – it needs to be addressed first. We recognize that disorders like anorexia and bulimia are dangerous, and not just a matter of ‘eating more,’ and stopping the dangerous habits. So why don’t we recognize that a large number of people who are obese also have a deadly eating disorder and are in need of psychological attention? Would we throw an eating plan at folks with anorexia, or bulimia, and expect them to fix themselves? Or would we give them much needed psychotherapy, and coaching, to help them succeed?

We need to understand that type 2 diabetes can affect a large variety of people who are in many different walks of life, and with many different social challenges. Assessing the patient in a wholistic way – addressing the level of psychosocial support and therapy that a patient might need in order to overcome their health challenges will be ESSENTIAL to managing the diabetes epidemic. There is no amount of healthy foods, exercise facilities, and information that can fix a person whose mind is warped by the thoughts and cycles of disordered eating. Therapy is needed, and it must not be ignored.

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Angry For Change: A Type 2 Diabetic’s Diagnosis Story

Posted by on Aug 5, 2013 in Diagnosis Stories | 2 comments

Most of us can remember the moment when we were diagnosed: we were at the doctor’s office; we were at the hospital; we were at home and got a phone call; etc… Time just seemed to stop. We knew our lives were never going to be the same… and we were scared.

I’m no different. I’m just like you. Perhaps even more like you, than you think. I can tell you all about that day… Or was it that week? When did it all start? You see, I can tell you exactly how and when I was diagnosed, but I have a hard time pinpointing when it all started.

I know I had been fighting chronic yeast infections — an embarrassing situation which often leaves many wondering about one’s own personal hygiene habits. The RN at the local clinic, annoyed at my continued return and my requests for more medications, gave me pamphlet upon pamphlet on how to care for, and avoid getting them… and even my husband got treated, just on the chance he was passing the infections right back to me. When nothing else worked, the RN decided, on a hunch, to test the level of glucose in my urine. I remember she came back into the room, pale as a sheet. She really didn’t seem comfortable telling me that my blood glucose was very, very high, and that I needed to visit with my PCP as soon as possible.

So, I went out to lunch, had some Subway with my husband (unaware of the role of carbohydrates on blood glucose), went home… sat on the sofa, while contemplating the Christmas tree, and then I fell asleep. Right on the sofa, and just like that. Like narcolepsy.

I went over to see my PCP, after having paid for my own lab exams at the hospital. I was simply not confident the woman was going to take me seriously, nor investigate the matter further. My fasting blood glucose was 235 mg/dL, and my A1C was 10.5%… And I was right. She looked at the numbers, and scoffed. Asked if I was sure. Asked if I had tested more than once, at over 200 mg/dL. Yes I was sure, and yes I had. I’ll never forget her poor reassurance of “Well, let me go to the American Diabetes Association website, so I can tell you what to do…”

I can tell you that, at the moment, I was very ANGRY at my PCP. You see, it was November 17 of 2009, when I was diagnosed, but I had already spoken to my PCP, back in June, regarding high blood glucose. I hadn’t been feeling well, for a while. I was sluggish, tired all the time, and hardly eating many meals. I remember that my husband said he thought I might have diabetes. I remember using his meter to test after having a meal — roughly 3 hours later. I remember the number being over 150.

I was familiar with bad numbers, though not exactly where they began. My father had type 2 diabetes, and passed away from complications from the disease — so I had an idea. I suspected this was not an okay number, and so I brought it up to my PCP’s attention. I was thinking — well, at the least, they can run a glucose tolerance test (which I had had earlier, in my youth) — and then we can know for sure.  But that’s not what happened. I was simply told the number was fine, and that I shouldn’t worry about it. “Just eat better, and lose some weight.”

I was very depressed, at the time. I had severe clinical depression. I can’t say that I had it in me to follow the doctor’s advice. I just didn’t. While I was really not eating much, the things I was eating were not the healthiest — simply quick meals one can eat, and then just go back and die on the sofa. I had been sick for a while. Back in 2008, I had developed a very big, and terrible abscess on the crease of my right thigh, and buttock. I thought it was probably from the laying so much on the sofa… but it was likely infected from high blood sugar, and my body’s inability to fight back.

But when did the depression start?

I know that I became ill in 2007, roughly around Spring. I began having panic attacks, and anxiety. I began having extreme anxiety at the thought of being at work. My job was going through a series of changes — new bosses, the company was sold, massive layoffs, etc. Between these changes, and my increasing mental health problems… I just couldn’t hang on.

For most of 2007, I had been hospitalized, and put on countless depression medications, each one stronger than the next. No one ever bothered to really check my overall health, or my glucose levels, at all… except for liver function tests. It turned out, I developed fatty liver. Fatty liver is one of the major indicators of type 2 diabetes — yet no one thought to check my blood glucose, in any way. They still kept me on the dangerous medications I was on — until I had a massive seizure at my desk, which was one of the final straws that lead to my dismissal. In Fall of 2007, having exhausted my Family Medical Leave, my employer let me go… and I was no healthier, and no better than I was when it all started.  I saw myself as a broken vessel. Shamed, and broken, and never able to work again. I got, and lost, many jobs after that — never able to quite hang on to my own mental health.

But did I have any signals before my depression ensued?  Yes… Back in December, of 2006.

I was under the care of a different PCP, at the time… and I remember I was having chest pains, and palpitations. The doctor ran a series of tests, including a stress test, and a fasting glucose test. All the tests found nothing, but my fasting glucose was 143. I was told I was fine. No one ever told me I could have diabetes, nor that there was anything wrong… In fact, they never sent for a single follow up test. It never dawned on me that it was a bad number, until one day, a few months after my diagnosis; a few months after I had gained knew knowledge… I was looking through my old medical paperwork, and I found the tests.

I was very, very angry… I can’t tell you how betrayed I felt. I got seriously ill, and I could have developed all manner of complications. It’s only by chance, and luck, and my decision to tackle my diagnosis right away, that I’ve fared so well. But it lead me to believe that something was seriously WRONG with our medical systems if so many red flags went up and none were investigated. I  hear stories like mine all the time… and they are one of the driving factors behind my desire to advocate, and blog.

Nowadays, I keep looking back… back into my history: where did it all start? When did all the dominoes begin to fall?

As a child, I used to be thin and active. I was a happy child. But one day, I began to gain weight, my hair lost it’s luster, and I developed darkened patches around my neck, my knees, and my inner thighs. My growth became stunted, and I never grew past 4’9″ tall. Puberty made a mild appearance, and then took off. My period came, and then left, never to return on its own. I lost all energy, and after years of blame from my parents, I was eventually diagnosed with Polycystic Ovarian Syndrome (PCOS), and Hypothyroidism, at the age of 15.

For years, I thought those conditions were my fault, my own doing; that I made myself fat, somehow. The negative interactions regarding my health, between my mother and I, lead to binge eating disorder, which aggravated my weight gain. I made myself sick between dieting, deprivation, binging, and guilt cycles… But a new age was dawning — the age of the internet — and in 1994, armed with new information, I learned a lot more. PCOS is one of the most common, reproductive endocrine disorders, which can affect a woman of reproductive age — anywhere past the age of 7. Little is known about the condition, except that it is suspected to cause hyperinsulinemia (a mass production of insulin), which can then lead one’s ovaries to enlarge, and fail at releasing eggs. It can also lead to massive weight gain, insulin resistance, high cholesterol, high blood pressure, and type 2 diabetes.

I can’t say for sure that it was just ONE factor which lead to my diabetes — I’m sure family history, genetics, ethnicity, depression, weight gain and the hyperinsulinemia from PCOS, were all contributors. But I can tell you something… I did not bring this on myself — and neither did you.

And while I still struggle, and I am far from perfect, and while I fall a lot… I get back up. I get back up because I’m angry… and I am angry enough to change the one person in the world which I can change… MYSELF. I do it for my father, I do it for my grandfather, I do it for my friends and my family. I do it for you… and I do it for me. And you can do it, too.

 

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