Diabetes: What You Need to Know

Worldwide, 382 million people are diagnosed with diabetes.  Diabetes related deaths claim the lives of 1 American every 3 minutes and is the leading cause of blindness, kidney failure, amputations, heart failure and stroke. Besides the enormous physical and mental strain, people with diabetes face the huge cost to treat diabetes. The total cost of diagnosed diabetes has risen to $245 billion in 2012 from $174 billion in 2007 – according to the American Diabetes Association.

The Basics

All cells in the human body need energy.  When you eat or drink, food is broken down into glucose, a simple form of energy the body needs and uses.  Insulin, a hormone produced by the pancreas, helps remove glucose from the blood stream where high levels cause the symptoms of diabetes. Think of insulin as the mediator that is required to carry glucose from the blood stream to the body’s cells where it can be utilized for energy.   Diabetes occurs when there is a problem with insulin production or activity and results in high blood sugar levels. Let’s take a look at some of the differences between type I and type 2 diabetes.  For our purpose in this blog, we will further examine Type 2 diabetes below.  

*Genetics contribute to both types of diabetes

What causes type 2 Diabetes?

Although we don’t know all of the causes of type 2 diabetes, we know that it is likely a combination of genetics and lifestyle factors.  The good news is that type 2 diabetes can often prevented and reversed through changes in lifestyle habits.  In this blog, we examine the relationship between four key areas of health and type 2 diabetes.   

Physical Activity

Lack of exercise is usually correlated with higher amounts of body fat- which interfere with the body’s ability to properly utilize insulin and, therefore, remove glucose from the blood stream.  During exercise the body is forced to use stored energy as fuel for the workout.  When we don’t exercise, our body is not able to utilize its fuel (glucose) as efficiently.  A higher waist circumference (aka “belly fat”) is also highly associated with increased instances of developing diabetes.  This is because excess abdominal fat produces hormones and other substances that cause harmful effects on the body such as an increase in the production of LDL (“bad” cholesterol), heart disease, and increased insulin resistance

How can I prevent/reverse it?  Move more.  Exercise decreases body fat and promotes weight loss.  Both of which have been shown to have a positive impact on diabetes management.  Unhealthy amounts of body fat can impair the system that regulates hormones involved with diabetes. Conversely, muscle helps the body improve the process of insulin and blood glucose regulation.  The recommended amount of physical activity for those with or approaching diabetes is the same as for those without diabetes: 150 minutes of moderate to vigorous activity per week.  Taking a brisk walk, bicycling, and swimming are all good examples of ways to meet this goal. 

Dietary Intake

The typical American diet is high in white bread, pasta, soda, highly processed food, and junk food.  Foods like this which are high in carbohydrates can have a negative impact on diabetes. When too many carbohydrates are consistently eaten, blood glucose levels remain high, and over time, the body becomes less efficient at utilizing insulin to reduce blood sugar levels.  The whole process starts to malfunction and this is the beginning of insulin resistance and diabetes.

How can I prevent/reverse it?  Focus on replacing, not eliminating food groups.  Carbohydrates have a much larger impact on blood sugar levels than fats or proteins, so that’s why it’s important for people with diabetes to be mindful of carbohydrate intake.  In spite of what is commonly said, managing diabetes isn't as much about completely eliminating foods from your diet. It’s more about replacing sugary, starchy food sources like, fried food, soda, and sweets with healthier choices like protein based dishes, low carb fruits and vegetables, and water.  Portion size is a key factor.  Typical meals should consist of a protein, a healthy fat, and a whole grain carbohydrate; a small sweet treat should be reserved for special occasions only. 

Sleep

Research has demonstrated the correlation between sleep loss and risk for weight gain, insulin resistance, and type 2 diabetes.  When sleep deprived, our body’s hormones are thrown out of balance.  For example, the stress hormone cortisol is higher when sleep is inadequate.  Elevated levels of cortisol can prompt insulin resistance which interferes with the body’s metabolism and ability to properly regulate blood glucose levels.  Reduced sleep has also been shown to reduce levels of the hormone leptin which is an appetite suppressant; and increase levels of the hormone ghrelin which is an appetite stimulant.  With these two key hunger hormones out of balance, it is more difficult to regulate dietary intake and this is when we often see overall increased caloric consumption as well as increased consumption of carbohydrates, specifically. 

How can I prevent/reverse it?  Prioritize Sleep. For some, improving sleep may be a matter of prioritizing an earlier bed time.  For others, a deeper delve into personal sleep habits may be needed.  One place to start is to make sure you are maintaining a regular schedule by getting up and going to bed at the same time every day. Secondly, make sure to eliminate all sources of caffeine (soda, coffee, tea, chocolate) at least 6 hours prior to bedtime.  Lastly, make your bedroom a haven for sleep.  A bedroom that is favorable to sleep is one that is dark, quiet, cool, and comfortable. 

Mind/Body

Both mental and physical stress can have an impact on people with diabetes.  Stress hormones like the aforementioned cortisol, and epinephrine can negatively impact diabetes.  Let’s think about the fight or flight process.  When we react to an urgent, stressful situation our body releases a series of hormones that start a cascade of processes that draw energy from our stores which increases blood glucose levels and allows us to utilize energy for our fight-or-flight response.  For people with diabetes, exposure to long term stress hormones decrease insulin’s ability to remove glucose from the blood stream and blood sugar levels become more imbalanced.  It can be a viscous cycle. 

What How can I prevent/reverse it?  Being more mindful of daily lifestyle habits is a good place to start.  According to the American Diabetes Association, you can decrease your risk for type 2 diabetes by making lifestyle modifications like the ones listed below:

Overweight & Obesity Stigma: Shaming Helps No One

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Fat shaming is a form of public humiliation aimed at evoking a change in the name of “health”. It occurs every day to people of all ages, races, sizes, educational and socio-economic backgrounds. It happens at home, school, and work. At its most detrimental level, it’s precipitated by those whom we trust the most: our family members and health care providers. Often, these shameful thoughts and generalizations are internalized and eventually we become our own bullies.

The stigma associated with being overweight and obese often manifests into discrimination-which can be just as damaging as other forms of discrimination. The consequences bear devastating mental and physical health outcomes. In the past decade, the prevalence of weight discrimination in the United States has increased by 66% and is still climbing. This issue is something we can no longer avoid as a society.

The Impact of the Media

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Fat shaming can be seen just about everywhere you look. Take for example a recent Scooby-Doo movie that “cursed” Daphne with being overweight, emphasizing to children that being overweight is something to be ashamed of…a “curse”.

The “fitspo” aka “fitness inspiration” community has no doubt reinforced this message. With mantras like “if you just run 5 miles a day or do this specific workout…you will look like this” [insert picture of extremely lean and toned, shirtless guy/girl in spandex],

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the focus is often skewed toward appearance rather than health. What the fitspo community fails to mention is that the model in the picture doesn’t do that particular workout at all. Everyone’s body is different and will respond to a workout in its own unique way.

The idea that reaching and maintaining a healthy weight is a matter of trying hard enough is apparent in almost any infomercial and/or print media for an exercise routine, diet, or supplement. Advertisements emphasize the idea that weight loss and being healthy is a matter of calories in and out, using the right products, or engaging in the right exercise routine (which you too can partake in for the right price) and that people must be lazy if they are overweight. The diet and fitness industry capitalize off the belief that being overweight is a character flaw, evoking a demand for their product by those in need of gaining back lost virtue.

A 2008 study revealed the tendency of the media to selectively report on scientific article findings and to frame weight and health related news stories in a way that dramatizes the content and fosters individual blame. However, recent research has shown that this is not a good strategy to evoke positive public health change. For example, studies have shown that fat shaming actually has the potential to lead individuals already struggling with weight management to gain more weight in some cases, thus, the original intention of the shaming backfires. As it should- bullying, shaming and discrimination overall, have never been shown to be beneficial to anyone.

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So much of what we see in the news and in product advertisements conveys that body weight is a direct indicator of health. Although we agree that weight is an important factor in assessing health, it’s much more complicated than that and additional factors must be considered for a complete picture. Recent research indicates thin people too, can be “fat”. This is a direct message to not judge a book by its cover. Research has more than established at this point that thin does not necessarily equal healthy, and overweight does not necessarily equal unhealthy. What we see on the surface is only a small representation of what going on below the surface.

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Missing the Mark

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Take for example, the 2012 Strong4Life ad campaign which is part of Children’s Healthcare of Atlanta Pediatric Hospital’s five-year, $25 million initiative designed to curb childhood obesity in Georgia. The campaign features pictures of seemingly overweight children with a “warning” that states “it’s hard to be a little girl if you’re not” and “fat prevention begins at home…And the buffet line”. Their newest video demonstrates how a fat child, enabled by “bad” parenting, is led to have a heart attack through a series of lifelong bad habits.

It’s hard to understand why people say and do the things they do in relation to overweight people. A concerned parent of an obese child may think they are helping their child by saying something like “a minute of the lips, forever on the hips”. But in reality, these types of comments are embarrassing and will not encourage the child to make healthier choices. Instead, a more likely outcome is they’ll learn to eat alone and in shame during their next meal.

By the same token, health care providers are often uncomfortable approaching the subject and may not realize that simply telling someone to eat less and exercise more will not always help. In a recent interview, Dr. Rebecca Puhl, Deputy Director for the Rudd Center for Food Policy & Obesity at Yale, spoke about the issue of weight related bias in the health care system. “Women with obesity report that doctors are one of the most common sources of weight bias in their lives – 69% of women reported these experiences with doctors. Negative weight related attitudes and stereotypes toward patients with obesity have been documented among physicians, nurses, medical students, dietitians, psychologists, and even health professionals who specialize in obesity. Stereotypes include assumptions that patients with obesity are non-compliant with treatment, lazy, and lack willpower and motivation to improve their health.” said Puhl. This brings to light the complexity of the issue. Oftentimes health care providers may think they are helping a patient lose weight by “encouraging” them, but in all actuality, that’s not what happens. Simply put: you can’t shame people into being “healthier”.

Adverse effects

People that are exposed to more weight based discrimination are more likely to experience shame, gain weight, stop seeking medical treatment, and avoid exercise. Depression, emotional eating, and low self-esteem also play a role. Research has shown that overweight people who reported discrimination based on weight were more than twice as likely to be obese four years later than people who didn't experience such discrimination. As research has more than established, making someone feel bad about themselves does not encourage healthy behavior change.

The Need for a Shift

It’s time for a shift in the conversation- from body size, numbers, and shaming to a positive focus on individual health behavior change. As a community, we need to encourage and enable everyone to make healthier lifestyle choices. Shame does not have a place in health promotion and is not an effective motivator of change.

 

Image Sources: Daphne; Glacier; Strong4life;