Myth Buster: Dishing the Details on Diabetes

Nearly 30 million Americans have diabetes. As common as it is, diabetes is an often-misunderstood disease. Is it caused by eating too much sugar? Do all diabetics need insulin shots? UR Medicine endocrinologist Dr. Susanne Miedlich dispels some diabetes myths.

Myth: Eating sugar causes diabetes.

Fact: Eating sugar does not cause diabetes. When you eat carbohydrates – which include sugary foods and starches – they are digested into glucose (also called sugar). Glucose is the body’s primary energy source. Glucose levels in your body are regulated by hormones; insulin lowers glucose and glucagon raises it. Diabetes is caused by an impairment in insulin secretion and/or function.

Insulin allows glucose to travel from the blood into the cells, so the organs (mainly heart, skeletal muscle and fat cells) can use glucose for energy production. When the glucose isn’t processed properly, its levels rise outside and inside of cells, which can cause fatal damage to many vital organs over time.

There are two major forms of diabetes:

• Type 1 diabetes is usually diagnosed in children and adolescents, though it can be found in adult patients too. It occurs when a person’s immune system attacks and kills the insulin-producing cells of the pancreas.
• Type 2 diabetes is usually diagnosed later during adult life and has its roots in a condition known as insulin resistance. The pancreas makes insulin, but the organs do not respond to it normally. Initially, the pancreas works harder to produce more insulin in order to maintain normal glucose levels. Over time, the pancreas loses its ability to make more insulin and diabetes ensues.

Myth: People have diabetes because they eat too much.

Fact: Yes and no. It’s complicated.

Type 1 diabetes is a disease related to the lack of insulin, not because of people eating too much. Type 2 diabetes has some roots in genetic factors resulting in insulin resistance and perhaps affecting insulin secretion. Type 2 diabetes is associated with being overweight or obese, as the latter affects insulin resistance. It also occurs more frequently in certain ethnicities, and has been linked to high cholesterol and high blood pressure.

Maintaining a normal weight by eating a healthy diet and staying physically active can greatly reduce a person’s risk for type 2 diabetes. That said, for people with either type 1 or type 2, healthy dietary choices and regular exercise can greatly help with diabetes control and reduce the need for insulin or other diabetes medications.

• A healthy diet is one that is rich in plant-based foods and lean meats, is low in saturated fats, and limits salt and sugar, especially regular sodas, juices, and other drinks that contain sugar.
• Get moving – aim for 30 minutes a day, five days a week (and/or 10,000 steps  day) – to maintain a healthy weight and to stay fit. Remember, building muscle means building the organ that burns glucose.

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 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: Fruit is healthy; you can eat as much as you want.

Fact: While it is true that fruit contains many healthy nutrients and fibers, it also contains sugar. Therefore, consumption of fruit should be limited in people with diabetes. That said, a whole fruit, particularly one rich in fibers, such as an apple, is still miles better than a processed apple, i.e. in apple sauce.

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 lines of defense are diet and exercise, followed by a combination of a growing number of non-insulin medications. Over time, the pancreas may produce less insulin and non-insulin medications may not be enough to keep blood glucose levels normal. That’s when doctors consider adding insulin, though the type and dose of insulin must be carefully determined and adjusted. Also, people treated with insulin have a higher risk of weight gain, so those who use it need to take steps to take to avoid this. Again, a healthy diet and regular exercise reduce the need for insulin.

Myth: Diabetes during pregnancy will harm the baby.

Fact: Not if the diabetes is controlled. Some women develop diabetes while they are pregnant. Known as gestational diabetes, obstetricians screen to check the mom-to-be’s blood glucose levels. 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 much more likely to have it with future pregnancies and develop type 2 diabetes later in life. They need close follow-up with their physician after delivery to be sure the diabetes has resolved. They will also benefit from maintaining a healthy diet and staying physically active following the pregnancy.

Myth: People with diabetes will go blind, need dialysis (a lengthy procedure replacing kidney function), or need limb amputations.

Fact: While it is true that diabetes increases the risk of complications like eye, kidney, and nerve damage, effective treatments, i.e., close-to-normal glucose control, can avoid or at least greatly reduce these complications.

High glucose levels mainly damage the small blood vessels in eyes, kidneys and nerves.

• Eyes: People with diabetes are at a higher risk for vision problems, in particular retinopathy (damage to the cells in the back of the eye that sense light), but also glaucoma (elevated pressure in the eye) and cataracts (degeneration of the lens). It is important to see an eye doctor and take preventive steps to avoid vision problems. Advanced testing allows for early detection and treatment of retinopathy, but also glaucoma and cataracts, if or before it impairs vision.
• Kidneys: Kidney damage, or nephropathy, relates to the impaired filtration function of the kidneys, leading to protein in the urine and ultimately complete loss of kidney function and thus, the need for dialysis. Kidney damage also increases blood pressure. Therefore, people with diabetes should routinely monitor their blood pressure.
• Nerves: Damage to the nerves, a condition called neuropathy, is common in patients with uncontrolled diabetes. Neuropathy may lead to painful, burning/tingling sensations, in particular in the feet. It can also cause numbness and thus, skin injuries to the feet. Since they don’t hurt, wounds can go undetected and infection can occur. Left untreated, deep wounds develop, which can include the bones. Diabetic patients with nerve damage should pay close attention to their feet with daily inspections and good hygiene and they should wear comfortable shoes. Unfortunately, neuropathy is the leading cause of non-traumatic amputations in the U.S., which makes effective preventive measures so very important.

Susanne Miedlich, M.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.