Monday, May 19, 2008

Childhood obesity and type 2 diabetes

Over the weekend, the Washington Post ran the first article in a series about the dangers of childhood obesity. Because part of this epidemic is the rising number of children with type 2 diabetes — a condition that used to only affect older adults — I thought the article deserved a mention in my blog.

The article does a great job of discussing all the ramifications of childhood obesity. Besides the numerous adult diseases appearing in overweight children (high blood pressure, high cholesterol, and of course, type 2 diabetes), being obese during childhood appears to have a lasting impact on an individual's weight. Apparently childhood obesity creates a set point in the child's metabolism, because most overweight children grow up to be overweight adults.

When I was growing up, we rarely had soda, sugary snacks, or fast food. As I got older, and I became more influenced by my peers and by advertising, I remember thinking it was unfair that I didn't get more junk food when all my friends did. But looking back as an adult, I think my mom was exactly right: Soda and fast food appear to be two major contributors in childhood obesity.

While I have my mom to thank for the autoimmune gene (she has hyperthyroidism), I also have her to thank for my normal weight, fast metabolism, and conscientious eating habits. And I will definitely be following her example and restricting my kids' access to soda and fast food when I am a parent!

Friday, May 9, 2008

Horseback riding as a diabetic

One of the biggest challenges I face as a type 1 diabetic is accounting for exercise. I'm not actually terribly active, but I do own a horse and try to ride him several times a week. Even some of the lesser stuff, such as grooming or mucking, can be surprisingly good exercise.

Exercise is challenging for insulin-dependant diabetics because of the risk of hypoglycemia. I have had instances where I am riding my horse or cleaning his stall, and suddenly find myself dizzy and shaky. And sometimes it has even happened later in the day, hours after I've returned from the barn.

Exercise brings on hypoglycemia because of the fact that the insulin is already in my body. Most diabetics take some sort of long-acting insulin that is design to hold their sugars steady over an extended period of time. (The exception is the insulin pump, which delivers short-acting insulin at a steady rate the the diabetic can change as needed — or even stop altogether.)

When a person exercises, his or her body suddenly gets several times more efficient at using insulin. A non-diabetic person's pancreas slows insulin production by about 80 percent while he or she exercises, in order to compensate. But since I take a shot of 24-hour insulin (called Lantus) every evening, I'm stuck with that amount of insulin.

In order to prevent myself from crashing, I need to remember to always eat a snack before I exercise. I've taken to running my blood glucose slightly high before I head to the stables, since I never really know how much the exercise is going to affect me. I can always check my blood sugar again and correct as needed when I return home!

Saturday, May 3, 2008

Bariatric surgery as a cure for type 2 diabetes?

Today I saw the following article on The Washington Post, about bariatric surgery now being used as a cure for type 2 diabetes.

Bariatric surgery basically reduces the size of the stomach — and the length of the intestines. It is used as a "cure" for obesity, because it literally forces the person to eat less at meals — and since it bypasses part of the intestine, fewer calories are absorbed into the person's body.

Recently some doctors have been using it as a cure for type 2 diabetes, too. The surgery is offered as an option for type 2 diabetics who are obese and whose blood glucose levels are way out of control. Patients often find that their sugars become more controllable within days of the surgery.

I can't help but be a little skeptical about this. It seems to me like this makes it far too easy for a type 2 diabetic to say, "Well, losing weight and monitoring my sugars is too much work, so I'll just get surgery to correct the problem for me." Plus, you have to consider that by reducing the size of the digestive tract, you could actually be doing more harm than good — after all, our intestines are the length they are for a reson.

What are your thought on using bariatric surgery as a cure for type 2 diabetes?

Which type of diabetes is worse? Part 2

After blogging about Jay Cutler's diagnosis the other day, I ranted a bit about the assumption that type 1 diabetes is worse. I'd like to add a little more to that rant.

People usually assume type 1 diabetes is worse because it requires insulin injections in order to treat, whereas type 2 only requires oral medications. Shots are associated with hospitals and illness, whereas pills have become commonplace in our society.

I remember talking to a coworker who was type 2 shortly after my diagnosis. When I told her that I was taking insulin, she said mournfully, "Oh, you've got it bad."

This, despite the fact that I had virtually perfect control of my sugars just weeks after my diagnosis — while she started out each day with a blood glucose of about 160, and after only a year of diabetes had already begun to lose sensation in her feet! She was on medication, but since she only checked her blood sugar first thing in the morning, there was no telling how far it climbed during the day.

Which brings me to a final point about why I believe I am better off having type 1 diabetes than type 2: I can control my own treatment. A type 2 diabetic has to get a prescription from a doctor for a medication, take it for several weeks before it starts to take full effect, see the doctor again to have him analyze the results, and have him adjust the pill dosage as necessary. Too weak of a dose will mean high sugars all the time, while too strong of a dose will mean lots of hypoglycemic episodes until the doctor changes the dose.

Compare that to my situation, where all I have to do is check my blood sugar and adjust my insulin dose up or down as needed. Which boat would you rather be in?

Friday, May 2, 2008

Which type of diabetes is worse? Part 1

Last night I blogged about Jay Cutler's diagnosis of type 1 diabetes. The article in the Denver Post reveals a breathtaking mix of scientific fact and popular misunderstandings about diabetes.

Take, for example, the statement that type 1 is "the most serious type of diabetes." Actually, judging from everything I've read and been told by my doctors, I'd actually say that type 1 diabetics actually have it better.

Consider the facts:

* Only 10 percent of all diabetics are type 1. You know those headlines that talk about how diabetes is becoming this epidemic, that more and more people are becoming diabetic all the time? That's type 2 they're talking about. Type 2 is the epidemic.

* Type 1 diabetes is an autoimmune disease, which means my immune system attacked and killed the insulin-producing cells in my pancreas. Compare this to type 2 diabetics, whose condition typically is caused by poor diet, lack of exercise, and obesity. (Not always, mind you, but again -- the epidemic certainly is due to these factors.)

* Type 1 diabetics are typically diagnosed young, many even younger than I was. This usually means that they are more willing to adapt to their condition in order to ensure tight control. Type 2 diabetics, on the other hand, often are unwilling to change their diet or exercise more. They're usually older, so they have had many years to become set in their ways.

All of this begs the question: Which type of diabetes is really worse?

Imagine you have two people with liver problems. One of them has problems that stem from a naturally occurring disease, perhaps a childhood condition. The other is steadily drinking his liver to death, and although his condition is perhaps not as far advanced, it's quickly getting worse — and he shows no signs of letting up. Which one would you consider to be worse off?

Of course, this isn't a perfect analogy, as type 1 and type 2 diabetes are actually dramatically different diseases. As I already mentioned, type 1 diabetes is an autoimmune disease that basically kills off most or all of the insulin-producing cells in the pancreas.

In type 2 diabetes, however, the body actually becomes resistant to its own insulin. It is unable to use the insulin correctly, so it continues to make more and more insulin, which only increases the body's insulin resistance. I believe obesity also contributes to increased insulin resistance.

In any case, my point is that type 1 is usually more treatable, because the patient is generally more willing to manage their diabetes. On the other hand, type 2 diabetics (according to my doctors) tend to be more stubborn and set in their ways, refusing to take the steps that could virtually cure them of their condition.

New type 1 diabetic: Jay Cutler, Denver Broncos quarterback

This story comes from my hometown: Denver Broncos quarterback Jay Cutler was just recently diagnosed with type 1 diabetes. He just turned 25, so he is about 3 years older than I was when I was diagnosed. (I was diagnosed with type 1 diabetes 6 years ago, at the age of 22.)

Apparently they are expecting a lot of public concern, because they keep stressing that he is doing fine with it:

"People need to understand this is very treatable," said a Broncos source. "Jay's going to be fine."

They also were careful to point out that Cutler has been practicing with the rest of the team, and that there has been no move to replace him.

The fact that they even need to say that frustrates me. There are many cases of world-class athletes competing with type 1 diabetes, yet every time they make headlines like it's a brand new situation.