Type 2 Diabetes

As a person with type 2 diabetes, I am well aware of the stereotypes and erroneous beliefs about my disease:

• I must have type 2 diabetes because I brought it upon myself eating chips 24/7 on the couch while watching TV.
• I must not diet or exercise as much as I say I do, because otherwise I would be a waif.
• I should "just" be able to give up all carbs and sweets.
• I should "just" be able to exist on four lettuce leaves a day and a cherry tomato.

Even some friends with type 1 diabetes get very insulted for being mistaken as someone with type 2 diabetes, "the one caused by poor lifestyle."

The root cause of diabetes is not yet known.  Many people are quick to say extra weight is the cause.  However, there are many more fat people in the world without diabetes than there are fat people with diabetes.  There is debate about whether excess weight precedes diabetes, or diabetes precedes gaining excess weight.  In other words, does our body somehow change into a fat-making, fat-storage machine because of something not working correctly?  There is research that seems to point that way, but the fact is we really don't know yet.

While we may not know when physiologic changes happen to cause easy weight gain and weight loss resistance, we know it does happen in the disease.  People diagnosed with diabetes may have their bodies working against them.  Hyperinsulinemia, a condition that happens in type 2 diabetes, can make it difficult to lose weight.  It might cause fat retention despite hard work and calorie restriction.  It can also feel like you took a pill that increased appetite and cravings.  This makes sense because our cells starve when their energy source (sugar) remains in the bloodstream.  Signals are sent to the brain demanding food, especially quick-fix sugar. This is the reason why someone with diabetes can still have strong cravings after eating a big meal.

So people with diabetes have to jump over bigger hurdles than people without diabetes.  It's like running a race with a 50 pound millstone around your neck and your millstone-free opponent is bragging they are faster than you.

The good news is that if you make smart lifestyle changes and have awareness of what is happening, you may be able to lessen the challenging effects and have an easier time losing weight and dieting.  The problem is that many people are just given general one-size-fits-all advice for diet and exercise and they are not aware of the current general guidelines for people with diabetes.  Read about Smart Diabetes Lifestyle Changes to help make things easier and improve your quality of life.

Learn more about how Hyperinsulinemia Can be Mistaken for Low Fitness Motivation. 

Did you know that lifestyle changes are more powerful than medications?  In addition, diabetes is a disease that is not made up of just one symptom (high blood sugar).  We often deal with high triglycerides, high blood pressure, high insulin levels, and other conditions.

Each symptom or associated condition of diabetes could be treated with different medications, but lifestyle changes could bring sweeping changes across the board.  Granted, lifestyle changes may not be enough for everyone.  However, it doesn't hurt to give them a try.

Read about Diabetes Lifestyle Changes that could change your life.

My refrigerator's vegetable drawers are usually brimming with bunches of kale and kale drying in a strainer on the counter.  Kale grows in pots in my back yard.  I use it in juice, purees, stir fries, salads, soups, and egg scrambles.  I love kale because I just plain feel good when I eat it.

Kale is considered one of the healthiest, most nutritious foods on the planet.  It is beneficial for your general health and can be helpful for your diabetes prevention or management.

Learn more about the nutritional benefits of kale.  Try this baked kale chips recipe, one of my favorite ways to enjoy it.

Do you enjoy kale?  How do you use it?

Eating less animal fat and cholesterol might decrease a woman's risk for gestational diabetes in pregnancy. Eat too much, and the risk almost doubles.  This is according to a recent study from the National Institutes of Health and Harvard University.

The increased risk of gestational diabetes due to a diet high in these fats was not lowered by other factors such as exercise which have been found to reduce risk.  Women whose total fat or other fat consumption was high (not animal fat or cholesterol) did not have increased risk.

This has been the largest study conducted on pre-pregnancy diet and it's effects on gestational diabetes.  Researchers used information from over 13,000 women from the Nurses' Healthy Study II.  Subjects were divided into groups according to percentages of calories from animal fat.  The women in the group with the highest percentage had almost twice the risk as those in the group with the lowest percentage.  Women in the group with the highest cholesterol consumption were 45% more likely to develop gestational diabetes

Gestational diabetes is one of the most common pregnancy problems.  It is a condition where blood sugar levels rise too high in pregnancy and increase the risk for complications for mother and baby.  Having gestational diabetes in pregnancy increases the mother's risk of developing type 2 diabetes in the future.  There are usually no symptoms, so most women are screened in pregnancy for the condition.

Have you heard this?  Maybe you heard someone say they had it.  It's an occasional oddity I have encountered and didn't have a clue where the term came from or exactly what it meant.

So I answered my own question and figured it out.

What is Sugar Diabetes?

Our days are full of little choices that can make a big difference. Over time those decisions can add up with either positive or negative results.

Living in Tucson, Arizona and being part of a family that has been here for hundreds of years, Mexican food all around me is just a given.  I have to make the "corn or flour" tortillas decision at least once a week.

My friends and family from the northern states of Mexico are flour tortilla fans and traditional recipes have morphed to include more cheddar cheese and frying.  The ones from central Mexico eat mostly corn and prepare food in more traditional ways.  At least in my little world, it seems the people from central Mexico who eat more traditionally enjoy better overall health.

I have compared corn tortillas versus flour tortillas and although it's not hard to figure out the winner, it can be enlightening to learn why the winner is such a good choice.

Paula Deen, the famous 64-year-old television queen of decadent southern cooking, revealed on the Today Show yesterday that she has type 2 diabetes after years of rumor and speculation.  She has had diabetes for three years and made the announcement the same day her diabetes website was announced.  This is a website sponsored by a pharmaceutical company (Novo Nordisk) that is paying her to be a spokesperson to peddle a diabetes drug (Victoza).  Her two sons are also being reimbursed for their endorsements and one son has started a new cooking show on the Cooking Network featuring lighter versions of his mom's recipes.

Today Deen is facing a backlash.  She has now announced she is in a position where a percentage of the endorsement money can go to the American Diabetes Association.  She did not reveal the percentage and at the time the ADA said it was not aware of the offer. She has also announced she will participate in select ADA health expos and will not receive any money for that.

The outcries and criticism are from those who feel she should have revealed the truth sooner given what she is famous for, should not have continued to promote unhealthy eating, and is a horrible example.  They accuse her of being like a person who owns a windshield repair service as well as a service that throws rocks off overpasses.  They also feel she could have used her celebrity to help people make lifestyle changes rather than turn to a drug and perhaps could have given some of her time selflessly to her fans who may need the help.

My Personal Opinion?

• Her example:  I don't think Deen eats deep fried stuffing on a stick daily. She has said she practices moderation, and I believe her. I know firsthand how diabetes can transform your body into a very efficient, streamlined, fat-making and fat-retaining machine. Eating that way 24/7 would be much more obvious on her frame.  However, I think her example should have been better before offering to help others.  We have seen other celebrities go public with a diabetes diagnosis and they don't try to influence or help others until they have made some obvious lifestyle changes and have improved their health. We have seen the transformations of Delta Burke, Drew Carey, and Sherri Shepherd. They can talk the talk because they have walked the walk. They have earned their respect and credibility. They inspire us. They are also very honest and frank about their weight, weight loss, weight gain, diabetes control, and regimen.  Paula Deen says she wants to help others with her story. If so, it would be nice if she shared the details, especially when she says of her website, "I'm going to be there for you and help you manage every day of your life with this because it can be done." She would be more credible if she could prove she has climbed that mountain before offering to be our guide.

• Her food:  I do not have issue with her continuing to share recipes with questionable nutritional value and applaud her for offering healthier versions.  Many people successfully manage diabetes eating what they want while practicing portion control.  It's a matter of personal choice and what works best for you.  If you choose to have a meal that consists of a 1.5" x 1.5 " serving (and can stop at that), that is your choice.

• Her support of moderation:  Deen has said, "You can have diabetes and have a piece of cake. You cannot have diabetes and eat a whole cake." It needs to be said however, that your diabetes management should be good and that a piece of cake be worked into your diet plan.  By the way, according to the ADA exchange lists, a serving of cake is three inches square with no icing.

• Her drug endorsement:  What makes this situation sticky is that her position puts her into a win-win situation.  She wins ethically if she can show people how to manage their diabetes successfully.  However, she also wins double monetarily if they choose to practice moderation using her recipes by using more diabetes drugs such as Victoza to control their blood sugar levels.

What Paula is Doing Right for Her Health

• No more sweet tea. Given how much sweet tea she claims she drank daily, this alone has probably cut down a lot of carbs from her regular diet.
• Walking a mile or more on her treadmill daily. Exercise is powerful. Hopefully she is getting the equivalent of 10,000 steps a day or approximately 5 miles on average.
• Moderation. If done properly, someone with diabetes can eat anything, even sugar, if it is worked into their diet plan.
• Getting treatment.  Unfortunately many with diabetes do not get or follow treatment, and she may inspire others to become more conscientious and proactive.

What Paula Could do Better for Her Health

• Make more dietary changes. She claims she hasn't made many other changes in her cooking or diet. Of course, we don't know exactly what her regular cooking or diet is. However, if she made more changes in her diet, perhaps she may not need the pharmaceutical drug or as much.
• Weight loss. She could have very powerful results with weight loss. A study has found that people over 60 can reduce their diabetes risk much more dramatically after just a 5-7% weight loss than their younger counterparts.  While diabetes drugs help to alleviate the symptom of high blood sugar, increased weight and poor diet choices still increase risk for diabetes-related conditions such as heart disease and stroke.
• Get Educated.  In her interviews, she seems to downplay the importance of diet, exercise, and lifestyle in diabetes development and management and does not seem well versed in diabetes management.

What You Need to Know About Her Website

Deen will offer healthy recipes and information through her website called Diabetes in a New Light. The website is sponsored by Novo Nordisk and they compensate Deen to promote their diabetes drug called Victoza, a once-daily non-insulin injection.

The website is pretty basic and appears to be aimed at newly diagnosed diabetics. The look and feel is very familiar to me.  It looks similar to websites I've seen from non-profit companies that use celebrities for awareness campaigns.  On their Diabetes Basics page, there is very brief and casual information on diet, exercise, weight loss, and stress. The only medical treatment mentioned is linked to a page that claims to have more information about a naturally-occurring bodily substance called GLP-1 that can help control blood sugar levels. When you click the link, you go to the drug page for Victoza, a synthetic version of GLP-1. The site states "Victoza is not recommended as the first medication to treat diabetes" but it is the only medical treatment listed on this page.  Victoza has been in the news due to safety issues.

What I Would Like to See From Paula

I would like to see Paula lead the way with more lifestyle changes and more openess before offering herself as an example.  I think it would be interesting and helpful if Paula were to continue to offer her decadent traditional and novel recipes full of carbohydrates and fats, but illustrate what a diabetes-friendly serving looks like to truly help give an idea of what moderation should mean. This might be educational (and maybe surprising) to both Paula and her viewers.

It would be nice if a generous portion of the endorsement proceeds go to diabetes organizations that offer help and search for a cure.  It would also be nice if she committed to more than "select ADA health expos" out of the goodness of her heart.

Deen is in a unique position where she can learn a lot more about successful diabetes management, it would be nice to follow her along that journey with her trademark humor.

_{Image: Dave Kotinsky / Getty Images Entertainment}

As the countdown to the New Year draws near, you might find yourself celebrating with liquid spirits on New Years Eve.  Learn the facts about alcohol and diabetes.  Make use of safety tips and learn serving sizes to ensure you are smart while you celebrate.

The Facts About Alcohol and Diabetes

Arizona State Museum at the University of Arizona in Tucson, Arizona collaborated with local popular Native American artist Ryan Huna Smith to develop a comic book and digital mobile app to help educate teens about type 2 diabetes and behaviors that could reduce risk.  Smith was chosen for his exciting artwork that blends traditional Native American subjects and themes with main-stream comic book style.

The result is a beautiful comic book called It's Up 2 You! and an interactive free mobile app with a digital version of the comic available for iPhone, iPod Touch,  and iPad through iTunes.  A limited number of printed comics were also made available for free at a public health fair.

The mobile app features the digital comic in English, Spanish, and O'Odham.  Included in the app is a healthy challenge game.

Don't have a smart phone?  That's okay, there is a web version.  Hint: Read the comic by clicking "Download Here" on the comic book cover.

The comic book was featured as part of a larger exhibit called Through the Eyes of the Eagle: Illustrating Healthy Living for Children which is a traveling exhibit that features artwork, media, and storytelling from a children's book series of the same name.  The series of four books was written by Georgia Perez and illustrated by Patrick Rolo and Lisa A. Fifield and developed by Indian Health Services and the Center for Disease Control.  The books encourage a return to healthy traditional ways to reduce the incidence of diabetes in a culture where diabetes has become an epidemic.  The exhibit will be on display across the U.S. through 2013.

_{Photo:  My print copy of It's Up 2 You! / Elizabeth Woolley}

The beginning of the New Year is around the corner.  Hopefully you take this time to think about what you can do to improve your health and quality of life.

Diabetes is a complicated disease that effects all bodily systems. As you ponder setting new goals or resolve to work harder in a particular area, here are some links to simple advice for better control.

Effortless Weight Loss
Easy Exercise
Quick Tips for Estimating Portion Sizes

I wish you a wonderful New Year!