Myth Buster: Dishing the Details on Diabetes
Nearly 30 million Americans have diabetes. And though it’s quite common, it’s an often misunderstood disease. UR Medicine endocrinologist Dr. Victoria Hsiao dispels some diabetes myths.
Myth: Eating sugar causes diabetes.
Fact: When you eat carbohydrates—which include sugary foods and starches—they are digested into glucose. Glucose is the body’s primary energy supply. Glucose levels in your body are regulated by a hormone known as insulin, and diabetes is caused by changes in insulin.
Insulin allows glucose to travel from the blood vessels into organs, so the organs can use the glucose for energy. When the sugar isn’t processed properly, blood glucose levels rise and people develop hyperglycemia, which can cause fatal damage to vital organs.
There are two major forms of diabetes:
Type 1 diabetes: Previously called juvenile-onset diabetes, Type 1 is usually diagnosed in children and adolescents, though it can be found in older patients too. It occurs when a person’s immune system attacks the insulin-producing cells of the pancreas, making it unable to make insulin.
Type 2 diabetes: Type 2, which we used to call adult-onset diabetes, has its roots in a condition known as insulin resistance. The pancreas makes insulin, but the organs do not respond as they usually do. This allows glucose levels in blood vessels to rise. Initially, the pancreas works harder to produce more insulin. Over time, the pancreas can lose its ability to make insulin. Type 2 diabetes is associated with being overweight or obese, occurs more frequently in certain ethnicities, and is also linked with high cholesterol and high blood pressure.
Myth: People have diabetes only because they eat too much food and way too many sweets.
Fact: There are genetic factors that affect a person’s risk for both types of diabetes, but the genetic links are stronger in Type 2 diabetes.
Lifestyle choices also play a role in Type 2 diabetes. People who are overweight are at greater risk of developing diabetes, yet those with normal body mass index (BMI) also struggle with the disease. Choosing a healthy diet and increasing exercise can greatly reduce a person’s risk. That means eating a diet rich in plant-based foods and lean meats, and low in saturated fats, and limiting salt and sugar, especially regular sodas, juices, and other sweet drinks. And get moving—aiming for 30 minutes a day, five days a week—to maintain a healthy weight.
Myth: Diabetics can’t eat tasty foods.
Fact: It’s unrealistic and unfair to tell someone that they will never be able to eat tasty foods. The key is how much we eat and how often we eat them. Understanding portion size is essential, along with choosing a variety of healthy foods. Nutritionists and diabetes educators are key members of the health care team to help people with diabetes use their diet to manage their blood glucose levels.
Myth: If you have diabetes, you need to take insulin shots.
Fact: For Type 1 diabetes, insulin is essential and a life-saving medication, and is started at the time of diagnosis.
For people with Type 2 diabetes, prescribing insulin is usually not the first step. It’s a progressive disease and the first line of defense is a combination of oral medications along with diet and exercise. But, over time, the pancreas can produce less insulin and oral medications may not be good enough to keep blood glucose levels normal. That’s when doctors consider prescribing insulin, though the type and dose of insulin must be carefully determined and adjusted. Also, people on insulin have a higher risk of weight gain, so those who use it need to learn steps to take to avoid this.
Myth: Diabetes during pregnancy will always harm the baby.
Fact: Some women develop diabetes while they are pregnant. Known as gestational diabetes, obstetricians screen to check the mom-to-be’s blood-glucose level. If it’s too high, it may raise the baby’s blood glucose level. In turn, the baby’s pancreas makes more insulin to reduce the blood glucose. After delivery, the infant is at risk from low glucose levels and may need more intensive monitoring and treatment.
Uncontrolled diabetes can be harmful to both mother and child. In early pregnancy it elevates the risk of birth defects and miscarriage. Later in pregnancy, it raises the chance of large babies and complicated labor and delivery. Studies have shown that babies born to mothers with uncontrolled diabetes have a higher risk of diabetes later in life. Also, mothers who had gestational diabetes are more likely to have it with future pregnancies and develop Type 2 diabetes later. They need close follow-up with their physician after delivery to be sure the diabetes has resolved.
Myth: Everyone with diabetes will go blind, need dialysis, or need an amputation.
Fact: Diabetes increases the risk of complications like eye, kidney, and nerve damage, but effective treatment can help avoid or minimize them.
Eyes: Diabetics are at higher risk for vision problems, such as glaucoma, cataracts and retinopathy (damage to the back of the eye). It is important to work with an eye doctor and take preventive steps to avoid vision problems or stave off symptoms and progression. Advanced testing allows for detection and treatment of retinopathy before it impairs vision.
Kidneys: Kidney damage, or nephropathy, is caused by high blood sugar (glucose) and uncontrolled blood pressure. Diabetics should routinely monitor their blood pressure.
Nerves: Elevated glucose levels cause damage to nerves, a condition called neuropathy that is common for diabetics. Neuropathy may lead to painful, burning/tingling sensations in the feet. It can cause foot numbness and, if diabetics injure their feet, wounds can go undetected and infection can occur. Left untreated, it can lead to further injury. Diabetics with these complications should pay close attention to their feet with daily inspections and good hygiene. Unfortunately, neuropathy is the leading cause of non-traumatic amputation in the U.S., which makes effective preventive measure so very important.
Victoria Hsiao, M.D., Ph.D., is an assistant professor in the Division of Endocrinology and Metabolism. She specializes in diabetes care and management. For more information about UR Medicine’s diabetes care, call 585-275-2901.