NOT just lifestyle

Yes, I was disappointed when diabetes.co.uk chose to repeat the same old rubbish about lifestyles. I posted about it a week or so ago, with surprisingly few responses; maybe adverse comments are edited out. It's at viewtopic.php?f=25&t=41760. In my case, diabetes is genetic, definitely diagnosed that way. In a country with better diagnostic techniques, I would never have progressed to Diabetes. It's easy here, when doctors can stir up the press yet again, with "It's all their own fault, I don't know why we treat them". I know seriously overweight people who are not Diabetic, and diabetics who are very thin, so as a theory, weight does not equal diabetes. The magazine Scientific American had a very good article about disease inheritance a few years ago. Basically, if you have the genes, you may not develop a problem if nothing triggers it. If you don't have the genes, you won't get the problem whatever you do. In an earlier generation, my great uncle became diabetic as a result of losing a foot in WW1. In those days, everyone knew that diabetes could be started that way, i.e. traumatic shock. Now, it never gets a mention, it's just booze and fat that causes diabetes.

im sure your right, not in all cases i believe i read someone here say 20% of diabetics are not overweight, for me personally i fit into the fat lazy induced type lol although half my closest relatives are or were diabetic im sure my lifestyle caused mine because i was the perfect stereotype they are talking about so its not as upsetting for me to hear

The problem with the 50% stat being the other half! I am not sure I've seen anyone here suggest it is just lifestyle, more that it can be a massive factor and cause massive latter problems!

Sent from the Diabetes Forum App

Thank you for bringing this topic up.

I understand this is in response to our March newsletter intro to the topic of 'Reversing diabetes' which stated:
"Unlike type 1 diabetes, type 2 diabetes can be prevented through appropriate lifestyle interventions."

In some formats, such as newsletters where introductions are short, it can be difficult to present each side of the story whilst maintaining brevity. In this case, I'd say the line is not incorrect as such as type 2 diabetes can, in significantly large numbers of cases, prevent type 2 diabetes from developing, but because it wasn't worded in that way, I see how it could be interpreted as type 2 diabetes can 'always' be prevented.

We do feel it is important to address the fact that there are other cases whereby other risk factors aside from lifestyle are strong enough to mean that whilst lifestyle factors may be helpful, they may not prevent type 2 diabetes from developing at some point. We address the issue of causes on the following page:
http://www.diabetes.co.uk/causes-of-type2-diabetes.html

We also note that in cases such as medication induced diabetes and specific genetic conditions such as haemochromoatois, lifestyle factors may not play a part in prevention at all.

Thank you again for raising the issue. We shall feature this topic in our next newsletter to highlight the issue and prompt further discussion.

With many thanks
Benedict Jephcote

Online Editor Diabetes.co.uk

rinfrance said:

I get really pxxxxxd off when I see sites like this say that "type 2 can be addressed by lifestyle changes". .

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Hmm... Two years ago when I weighed in at 17.5 stones with type 2 diabetes and on ten pills per day I couldn't argue with you. Now I weigh 12.5 stones no type 2 diabetes (not cured) and on two pills per day, neither for diabetes. Can I point out that for some very lucky people like me diabetes can be put on the back burner for a while. How long I don't know. It would be nice if it was forever. I still watch what I eat. I don't low carb as much as some, in fact I eat what many would say is a fairly high carb diet. I get in some nice easy walks as I only walk in the company of an 83 year old friend.

I believe with all my heart that my diabetic condition was caused by my appaling diet and great weight. I am 5'9" and nudging 60.

I repeat what this site and many people on it say. I addressed my type 2 diabetes by changing my lifestyle. For a type 2 it is a worthwhile thing to try. If it has no affect on your diabetes then I am truly sorry. I weep for you. As I do for my sisters who can't beat theirs.

My weight on 16.9.2009 113kg approx 17st.8lb. Now 78kg approx 12st.4lb (I could probably lose another stone if I had to.)
My HbA1c level on 16.8.2009 was 56. Now it's 37.

I also lost my need for statins and some of my blood pressure pills.

Lee.

Sure not all can be addressed by lifestyle changes but 50% is still worth noting.
I would say that looking at your lifestyle is a good thing in all cases.

One issue is that type 2 can have different causes which are all lumped together.
I think the prevalent cause now is diet and lack of exercise causing insulin resistance which can probably be helped.

Of course there are a lot of people who that doesn't apply to but that shouldn't mean that we don't discuss those that it does.
Those are the people who can "easily" make a big difference for themselves so ....

I wasn't very overweight either but am controlling things by diet, exercise and testing so don't knock it.
My diet was rubbish and I think that was the main problem even though I wasn't overweight.

Its true that the 80% of diagnosed T2 diabetics who are overweight can make considerable differences through lifestyle changes.

It is also true that many skinny/thin/normal weight T2 diabetics can have visceral fat which causes insulin resistance which can be addressed through lifestyle changes.

It is also thought that genes have a lot to do with T2 diabetes and that in many cases it is seen to run in families. Those who want to look into this possibility can search for gene "TCF7L2 variants and diabetes".

Healthier lifestyles hurt no one and can do a lot of good to many and should never be poo poo'd even by those who say/assume their diet is good. Most of us eat processed foods of one sort or another be it foods like ham at one end of the scale to fully processed TV meals at the other and almost everything in between. Most foods today are processed in some way and its not always easy to spot the healthy choices unfortunately.

Hands up all those that assumed a roast dinner ready meal was good for you.

charon said:

Hands up all those that assumed a roast dinner ready meal was good for you.

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Never touch 'ready meals', but I would assume there would be nutritional information & ingredients on the packaging.

On a side note - I saw an article re: DUK going off somewhere or other to demand better care for T1 diabetics.

How about they represent ALL diabetics & demand better care FOR ALL?
They seem happy enough to ask for donations from ALL!

DUK = :thumbdown:

Sure there is a huge genetic element to T2 but, increasingly, scientists are talking about the expression of genes. Simply having a gene does not mean it will affect your health.

It seems that our modern processed food lifestyle can lead to the genes that lead to T2 becoming expressed in an increasing number of people.

Diabetes is unique amongst medical conditions in that we, the patients manage the condition with a little help from our Doctors and Diabetes Nurses. While some of us are more than capable of building up an understanding of our own condition and acting on it to obtain tight control the condition (I have managed to bring my BG and lipids under control, by making significant lifestyle changes involving exercise and diet alone and the result is clearly visible), many are not.

The current message from DUK and from NICE is an attempt at a one-size fits all approach to T2 DM, which is in fact a symptom, not the actual disease. This message has its merits in a world where those, like us, who are serious about controlling our BG, will go out and find the information that relates most closely to us leaving the medics more time to help others, for whom the general message is not appropriate and the information available here, and elsewhere, is not helpful.

I understand that it can be frustrating that the general advice can be of no help to someone who has lived a healthy lifestyle all their life, yet still has DM and that the medics don't seem to believe many of us have the resolve to properly control our BG, the fragmentation of information that would result from any other message would be far worse than the status quo.

I agree entirely with the OP.
I thought it quite novel at first when people kept saying you can't be type 2, you're too thin!
But now with DUK and the BBC (Five Live's) recent coverage of type 2 diabetes both confusing METABOLIC SYNDROME with Mature on-set Type 2 diabetes - IT IS TIME TO CHANGE!
I'm just into my fourth year since diagnosis, and despite the nutritionists all agreeing my diet was perfectly good, I have reduced carbs and increased exercise, but the medication is having less and less effect.
There is a group of Type 2 patients who are personally insulted every time you link Type 2 with obesity and poor lifestyle choices without adding some caveat that there are other causes, if this was to do with ethnicity or gender there would be some re-dress - it's time to change.
Re-designation has been discussed many times on this forum, not only would it make the different types easier to understand and give us a sensible, common language, but it would help in communication and open up new options for research on failing/under-active pancreatic output, rather than ignoring all that group and insulting them with un-educated messages about making lifestyle changes that aren't needed and would be impossible and even harmful in some cases.

witan said:

I agree entirely with the OP.
I thought it quite novel at first when people kept saying you can't be type 2, you're too thin!

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It always used to be said that people who are overweight and who take no exercise are at an increased risk of getting type 2 diabetes. This does not preclude thinner and more active people from getting diabetes, nor does it imply that diabetes is caused by being overweight and inactive. It is simply a reflection of risk. But our media, obsessed by the need to dumb down all the time, have interpreted this as meaning that people who are overweight and who take no exercise cause type 2 diabetes. What next, being unemployed will turn you into an unmarried mother?

An interesting link - although a little bit technical - that supports the cause of re-defining the types of Diabetes...
http://www.diapedia.org/downloads/category_error.pdf
Edwin Gale refers to the two extremes of Type 2 Diabetes as Obese Insulin-resistant (OIR) and Lean Insulin Deficient (LID) - which would be a good place to start.
But as he eloquently states our current approach limits what we can embrace..."As a result, we are trapped in a
mental loop; we tell medical students that type 2 diabetes
arises because of a combination of insulin deficiency and
insulin resistance. This amounts to telling them that
glucose rises because we do not have enough insulin,
and that we do not have enough insulin because we do
not have enough insulin."
The Glucose metabolism is one of the most complex in the body and impacts on almost every organ, it very likely has tens, if not hundreds of causes, to move from treating the symptoms to defining the causes we need not only pure diabetic research but centres of excellence seeking solutions to it in all its forms, types and sub-types. Re-classification is just the start, as it is difficult to research something that has not been classified!

I'm a genetic T2 also. Although a bit heavy, I've never been what you'd normally call "obese". However, I've always had trouble keeping my weight down.
My theory is that abnormal carb metabolism CAUSES weight gain. Not the other way round; even if there is deffinitely a link.
It's made worse if you follow the "Official healthy eating" guidance. I know better now. I might have saved myself if I'd learned earlier.

Genes survive and propagate because they offer some advantage which tips the balance in favour of survival in certain situations. So for example, sickle cell anaemia, normally seen in modern western populations as a debilitating genetic condition is widespread in sub sahran africa because the sickle cells offer some protection against malaria. Factor five leiden mutation, a genetic blood clotting disorder which increases the risk of a number of thrombotic conditions was quite useful in pre history as it helped heal wounds and helped women stem excessive bloodloss during childbirth. My own Y chromosome line, haplogroup I comes with a 50% increase in coronary artery disease but the numbers of descendants of the one individual who founded this line about 20,000 years ago are found in many parts of europe. So, we haven't done too badly.

Agreed to the 'one size fits all' approach letting us ALL down. If Type 2 Diabetes were an 'easy sum up'.. Medical science would be able to cure it. They're having so much trouble finding out the 'triggers' of the disease. I have to agree with Sid Bonkers here that a 'better lifestyle' is just plain 'good' - for ALL. Visceral (around our bellies) fat increases risk for insulin resistance which itself can be a trigger or, to use another poster's words, 'the environment for a gene to express itself'. I am one of those 'highly insulin resistant in the presence of visceral fat' guys. I've been up and down with the weight over the last 4 years since DX.. and when I'm down I need no long acting insulin and can control with only diet. When I'm up in weight I need a lot more insulin and daily diet has little affect on my numbers. If I got down to my 'prescribed weight' I'm convinced I would have NO expression of Diabetes at all. But that's me.

To show how confusing this topic is and why I also AGREE with another poster who said we need new 'designations' for sub divisions of Type 2 - the stats are actually this:
1) Only 20% of the world's obese people have or will ever get T2 Diabetes.
2) 80% of the world's T2 diabetics are obese..

Now -- how do you make those two 'stats' jibe??? That's a mind-boggling set of stats and again points to why it's so hard to classify this disease and paint with broad brush strokes. All I know - is that for me -- ever stone I lose makes controlling my blood sugar easier - to the point where it would be totally 'in remission', if you will, if I were to be 'normal weight'.