5 things an endocrinologist wishes you knew about diabetes
Posted on 31 October 2019
Yes, you can eat sugar. No, Type 2 diabetes can’t be cured.
Myth 1: People with diabetes can’t eat sugar.
People often think diabetes is a sugar intake problem. Unfortunately that is an oversimplification, says Dr Elmo Pretorius, a specialist physician and endocrinologist at Mediclinic Vergelegen. He continues, “In contrast to Type 1 diabetes, Type 2 occurs because your body does not use insulin properly and your blood glucose level is higher than normal. The reason for this is insulin resistance due to abdominal obesity. Therefore, excessive calorie intake (whether from carbohydrate, fat or protein) causing abdominal obesity is the problem. A balanced, calorie-restricted diet augmented with exercise to decrease weight is what is advised.” While the type of carbohydrate can impact how fast blood glucose levels rise (referred to as the glycaemic index), the total amount of carbs you eat affects the level more than the type. Thus, a diet heavy on carbohydrates (pastas, breads and grains) can be just as hard to control as a diet high in processed sugars. “In fact, depriving yourself of sweets often leads to the overeating of other carbohydrates to satisfy the need”, says Dr Pretorius. “A sweet will give a short spike of high sugar compared to an energy-dense starch, which will give sustained high glucose.”
Myth 2: Being overweight causes diabetes.
“Type 1 diabetes, formerly known as ‘juvenile diabetes’, is a genetic susceptibility to certain environmental factors, which triggers an inappropriate immune response and in turn destroys the pancreas”, Dr Pretorius explains. “Type 2 diabetes, on the other hand, is largely genetics. People are born with genetically poor pancreatic function. Being overweight, eating an unhealthy diet, and a lack of physical activity leads to insulin resistance, but most people will still not develop the disease because they were born with good pancreatic function and are able to accommodate the additional stress that insulin resistance puts on their pancreas to produce more insulin. However, those individuals with poor genetic pancreatic function will not be able to cope with this additional stress and the pancreas will start to fail to accommodate the insulin resistance.”
Other risk factors include a family history of diabetes, high blood pressure, high cholesterol, being over the age of 45, polycystic ovary syndrome, and suffering from gestational diabetes while pregnant.
Myth 3: If you are diagnosed with diabetes, you must take insulin.
Dr Pretorius explains that if you are diagnosed with Type 1 diabetes, you must begin taking insulin. If you are diagnosed with Type 2 diabetes, you can usually manage the disease with lifestyle changes and oral medication for a long period of time. “Losing significant weight can in essence cure diabetes”, he says. “However, neglected, poorly controlled diabetes may lead to the need for insulin.”
Myth 4: Type 2 diabetes can be permanently cured.
People with Type 2 can sometimes control their diabetes with diet, exercise, and/or medicine. Bariatric surgery has also been proven to help bring Type 2 diabetes to normal blood glucose levels, according to several studies. “But even with normal glucose levels, these individuals’ genetic risk does not go away and they will remain susceptible to the disease as they age and lose pancreatic function, or if they were to regain the weight, and therefore insulin resistance”, Dr Pretorius explains.
Myth 5: People with diabetes shouldn’t exercise.
“Exercise improves insulin resistance which, in Type 2 diabetes, it is essential to manage”, says Dr Pretorius. “It also improves blood pressure and cholesterol, which are important when looking at the disease holistically. Strength training may cause high sugars, while cardio causes low sugars. Anyone taking insulin should get advice on how to find a balance between insulin intake and exercise. The more vigorous the exercise, the more likely the risk for complications from exercise, however this should not stop any person with diabetes from participating in exercise and it is your clinician’s responsibility to help you find the right combination of exercise and medication.”
Mediclinic are offering FREE diabetes screening tests at various facilities across South Africa during the month of November. For more information about your nearest screening location visit the Mediclinic website.