Wednesday, August 04, 2010

Reversal of (Mis)Fortune?

The following is a response to a topic suggested by my friend Mike Hoskins. Thanks, Mike!

Point one: Type Two diabetes is a very serious illness.

I don't see this to compare it to Type 1, or to Type 1.5, or to any other condition. I don't say this as an editorial about research priorities or an argument for or against any particular public health policy. I just state it as an unassailable fact.

Let me say it again, and expand a bit:

Type Two diabetes is a very serious illness, and it becomes more serious over time. If uncontrolled, and sometimes even in spite of control, it can steal sight, destroy organs, calcify the heart, and rot extremities. Extreme hypoglycemia and hyperglycemia pose the same dangers to a Type 2 that experiences them as they do to any other diabetic.

Point two: Because Type Two diabetes is a serious illness that grows more serious over time, the possibility that patients may be able to delay either its onset or its more serious serious stages MUST be taken seriously by those patients and their physicians.

The development of Type 2 diabetes appears, as I understand it, to depend on:
1) genetics;
2) risks such as age and obesity that are usually present (but aren't always); and
3) other factors not yet understood which may include environmental exposures or something(s) else.

We can't do much about 1) or 3) at present, either as individuals or as a society. So that leaves 2).

Point three: With all this horse manure, there's got to be a pony in here somewhere!

There's an awful lot of nonsense being spouted about "reversing" Type 2 diabetes. A great plenty of this nonsense is coming from snake oil salesmen who want to go on talk shows and sell books. Some of it is coming from people who honestly (I think) hope to address T2 as a public health problem by trumpeting warnings about the diabetes risks of obesity, overestimating (I think) the power of fear to promote lasting healthy lifestyle changes. Both groups slide over points 1) and 3), and omit distinctions between types of diabetes almost entirely, in an effort to present the simplest possible message: obesity causes diabetes. Reduction to absurdity.

The damage from this approach is felt by diabetics of all types who wind up being blamed for their illness by those around them. This is probably most unfair, and screamingly frustrating, to PWDs of Type 1 and Type 1.5, and some of Type 2, who had NO role in the development of their illness. But it just might be most damaging to we Type 2s who DO (or did) have the lifestyle risk factors and therefore must carry the burden of the misconception, all too often in our own hearts.

But all the nonsense, all the lies, all the misunderstandings, all the snake oil should not be allowed to wash away a truth that's becoming pretty evident:

Point four: Many newly diagnosed Type 2s, and many of those with elevated blood glucose numbers that do not yet meet the current diagnostic criteria, can delay the onset or progression of their disease via good diet, exercise, and weight loss where appropriate.

I have no idea what percentage "many" represents in the previous sentence, but whatever that percentage is represents a lot of people. And that's why we can't dismiss this point, however corrupted and misused in the media and however often its used to bash us over our heads.

If your life is touched by diabetes of any type, wouldn't you have wanted to delay the onset of the disease, were it possible?

Point five: Just because many can, that doesn't mean everyone can.

Using diet and exercise to delay the onset or development of Type 2 diabetes doesn't work for everyone. Unfortunately, the ability of many Type 2 PWDs to produce insulin is already pretty damaged by the time of diagnosis. For those of us with serious lifestyle-related risk factors, even when diagnosis comes early, that diagnosis does not necessarily remove whatever barriers to healthy living existed before diagnosis. I am one that was unable to make serious change. I don't know what part of that failure is rooted in laziness or warped psychology, or to what extent the metabolic deck is stacked against me, but there you go.

Point six: "Reversal" is just a word.

In preparation for writing this post, I spent a few minutes trying to find responsible medical opinion on the subject of reversing Type 2 diabetes. I did find a WebMD article that made a pronounced distinction between "reversing" T2, which the author believed in, and "curing" T2, which is clearly not yet possible. I don't know, but I'm guessing that to a physician, "reversing" a disease may be something equivalent to my layman's understanding of putting a condition into remission.

I'm interested in linguistics, and you're never going to hear me say that words don't matter. But sometimes, particular words do more to disrupt understanding than they do to promote it. I think "reversing" diabetes has become an example.

So, in review, let's review what seems to be true and not true:
-- Nobody can currently say with any truth that any type of diabetes can be "reversed" if "reversed" means "cured".
-- Nobody can say with any truth that diabetes of types 1 or 1.5 can be "reversed" in any meaningful sense through ANY amount of diet or exercise.
-- However, it CAN be truly said that SOME type 2 diabetics or "pre-diabetics" can delay the onset or profession of their illness though good diet, good exercise, and weight loss where appropriate.

I don't like the term "reversing diabetes" because it sounds too much like "curing" to my ears.

But I LOVE the concept. Even though I couldn't make it work for me.


  1. I like this post a lot! This would be such a great thing for "the media" to read to clear up several misconceptions regarding diabetes truths.

  2. I love this post!! You bring to light a man who understands his disease. I think that is too infrequent today. I am also glad you acknowledge the folks who don't seem to know what is wrong with them without calling them idiots. So, I'll do it for you-"morons, think before you speak". As usual great post!!!

  3. Indeed, until we are able to reverse beta cell damage, insulin receptor damage, insulin molecule misfolding, insulin-reception interference by other hormones and lipokines, inappropriate glycogen response, and all other factors that might go into a particular T2PWD's persistent hyperglycemia, that person's T2DM has not been "reversed" -- has not been "cured" -- but may possibly have "been arrested" (damage rate slowed to at or near zero) or "gone into remission" (the condition exists and can start up again at any time, but for now, there are no direct or indirect symptoms, nor observable progressing damage due to that condition).

  4. Great post, Bob, and thanks for the shoutout! Happy to be of help, whether in spawning ideas or sparking debate. I couldn't agree with your points more. Particularly on the use of the word "reversing" and "curing," which are often used (incorrectly) interchangeably. Thanks for sharing your thoughts on this. Hope we can all work together to help reshape the media portrayal and public perception on all of this.

  5. I love the way you approach these touchy topics.

    You always seem able to distance yourself from the emotional aspects of it, yet still inject your personal experiences.

    And you always get me thinking (you'll grow tired of me saying that I think).


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T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.