The truth about type 2
First, a primer on what type 2 diabetes is: blood glucose governs your body’s energy, and under normal conditions, a complicated set of interactions move glucose from the blood into muscle cells as quickly as possible. In type 2 diabetes blood sugar (glucose) levels rise higher than normal because the body makes insulin—the key hormone for regulating blood sugar—but can’t use it properly.
Nearly 30 million Americans—a number that has doubled over the last two decades—have type 2 diabetes. Despite its prevalence, misinformation surrounds the disease, from what causes it to which foods are forbidden and even how to treat it. Here, experts reveal the biggest diabetes myths and set the record straight.
Myth: Type 2 diabetes is not that serious
Not everyone with type 2 diabetes needs insulin, so it may not seem that serious, says Sarfraz Zaidi, MD, endocrinologist at Los Robles Hospital in Thousand Oaks, Calif. “In reality it’s a silent killer, also because those with type 2 don’t have many symptoms,” he says. In actuality, type 2 is more complex than type 1, says Dr. Zaidi, who describes type 2 diabetes as a manifestation of an underlying disease process called insulin resistance or metabolic syndrome. “This causes high blood pressure, heart disease, and contributes to the growth of cancer and gout,” he says.
Myth: Symptoms of type 2 diabetes are easy to spot
Nearly 28% of people who have type 2 diabetes don’t even realize it. While the symptoms of type 1 and type 2 diabetes are very similar—increased urination and thirst, fatigue, blurred vision, among others—type 1 symptoms tend to have a dramatic and abrupt onset (usually in children and adolescents, but sometimes adults), while type 2 comes on much more slowly. Many people can walk around with type 2 diabetes for years without showing symptoms, says Dr. Zaidi. “Your blood sugar may be mildly elevated in the early stages of the disease but you wouldn’t know it without a blood test.” However, even this mild elevation—know as prediabetes—is thought to be dangerous, raising the risk for heart attacks and other problems.
Myth: Herbal supplements help diabetes
Chances are you’ve spotted online ads for supplements and vitamins that promise to eliminate diabetes. That may explain why people with diabetes are more likely to use dietary supplements and herbal therapies than people without diabetes, according to the American Diabetes Association. “Everyone wants a magic bullet,” says Dr. Zaidi. “They think, ‘If I take this pill for a couple of weeks I don’t have to worry about anything,’ but it’s not true.” Stick with well researched medication prescribed by your doctor, and if you’d like to take a supplement in addition to standard medication, consult your MD first.
Myth: Eating too many sweets causes type 2 diabetes
It’s an old wives tale that diabetes is caused by eating sugar and candy. What definitely does increase your risk of type 2: being overweight or obese, and of course consuming too much sugar (or calories from any other source) could cause weight gain. Anyone can develop type 2 diabetes (even life-long athletes like Billie Jean King). All it takes is the right combination of lifestyle factors and genetics, says Gerald Bernstein, MD, an endocrinologist and the director of the diabetes management program at Beth Israel Medical Center in New York City. In the past, most people were diagnosed in their 60s or 70s. Extra pounds speed up a diagnosis, meaning more people now get diabetes in their 30s, 40s, or 50s, or even younger.
Myth: Exercise can’t help prevent type 2 diabetes
Part of the essence of prevention and treatment of type 2 diabetes is exercise, says Dr. Bernstein. “Exercise burns glucose and makes the cells more sensitive to insulin,” he says. This better enables your cells to take up glucose during and after activity. Exercise may even be more effective than diabetes drugs when it comes to preventing the disease in people most at risk. In a study published in the New England Journal of Medicine, people with prediabetes were given a placebo, the drug metformin, or were prescribed a lifestyle modification program with the goal of 7% weight loss and at least 150 minutes of exercise a week. After about three years, the lifestyle interventions reduced diabetes incidence by 58%, while the drug reduced it just 31%, as compared with the placebo. “Drugs alone are not the answer,” says Dr. Zaidi.
Myth: If you have diabetes, you can never eat sugar
“Eating more sweets doesn’t cause diabetes, and those with diabetes can eat sugary foods from time to time,” says Joel Zonszein, MD, director of the clinical diabetes center at Montefiore Medical Center in the Bronx, New York. The American Diabetes Association recommends keeping sweets and dessert portions small, since most sweets contain high amounts of carbohydrates. Diabetics can swap out a small portion of dessert for another carb-heavy food in your meal. For example, substitute a small portion of pumpkin pie for a dinner roll or sweet potatoes in the main course.
Myth: Only overweight people get type 2 diabetes
Although obese and overweight people are at a higher risk for developing type 2 diabetes, thin people can also become diabetic, says Dr. Zaidi. “Ethnicity plays a big role,” he says. Populations at a higher risk for type 2 diabetes in general includes African Americans, Alaska Natives, Japanese, Chinese, Koreans, American Indians, and Hispanics/Latinos. A family history of diabetes also makes it more likely you’ll develop the disease. More research is needed to determine exactly why minority groups have a higher type 2 diabetes risk, but some believe these groups may have inherited a “thrifty gene” that helped their ancestors get through alternating periods of feast and famine—in other words, their bodies cling to fat to prepare for long periods without food, an evolutionary adaptation that’s no longer necessary. Others believe that poverty and lack of access to health care play a role.
Myth: Diabetes means you have to give yourself shots
“Type 2 diabetes rarely requires insulin shots,” Dr. Zonszein says. If you need insulin shots, it’s likely only one injection a day and without any diabetes pill. Managing type 2 diabetes more frequently includes stress reduction, diet, exercise, and oral medication, says Dr. Zaidi. “Stress increases blood sugar levels substantially,” he says. Along with diet and exercise, Dr. Zaidi recommends practicing mindfulness as a way to avoid blood sugar spikes due to stress. “Be in the now, keep your mind and body in the same place.”
Myth: It’s easy to tell if your blood sugar is high by how you feel
Typical symptoms of high blood sugar include increased thirst and urination, dry mouth, fatigue, and blurred vision. Low blood sugar may trigger shakiness, sweating, irritability, dizziness, and lack of coordination. But often those with diabetes “adjust” to these feelings and don’t know their true blood sugar without checking it, says David Kerr, MD, director of research and development at William Sansum Diabetes Center in Santa Barbara, Calif. “The brain can adjust to high and low blood sugars, and rarely can a person ‘feel’ when their sugar’s low or high. It requires a blood test to know for sure.”
Myth: If you don’t take care of your diabetes, you’ll end up on insulin
Around 25% of people developing type 2 diabetes will need insulin. “It’s not because they have done anything wrong, simply that the insulin-producing cells in the pancreas have become so fatigued they cannot produce enough insulin to cope with the demands of food,” Dr. Kerr says. This “insulin exhaustion” is often worse in those who are overweight, as this given amount of insulin is less effective at keeping blood glucose levels under control.
Myth: Insulin makes you gain weight
Insulin does not cause weight gain on its own, but people going on insulin often do report weight gain, says Dr. Kerr. “Insulin injections make a person super efficient at keeping hold of any excess calories that they previously lost through the kidneys when the diet was not as well controlled,” he explains. If this happens, check with your doctor to be sure you’re not on too much insulin. “This can cause excess weight gain when people ‘feed up’ their insulin to stop their blood glucose levels from going too low,” says Dr. Kerr.
Myth: Once you’re diagnosed with type 2 diabetes, you have it for life
A lot of people who develop type 2 diabetes are carrying excess weight, says Dr. Kerr. “And they often don’t exercise as much as they should. The good news is that if you’re overweight and have type 2 diabetes, losing the extra pounds by cutting portion sizes and exercising more will be beneficial.” In some cases, people can even reverse the diabetes process, especially if those lifestyle changes happen as soon as diabetes is diagnosed. In one study, losing an average of 15 pounds through lifestyle changes reduced the risk of developing type 2 diabetes by 58%over three years.
Myth: Diabetes is the same for everyone
Symptoms, dietary approaches, and reactions to various foods all vary individually in type 2 diabetes, says Dr. Zaidi. “Some people have no symptoms until they experience a heart attack. While in the hospital they find out their blood sugar is sky high but they had no prior idea they were diabetic.” Whether or not you exercise can play a significant role in determining your blood sugar after eating a certain food as well, says Dr. Zaidi. “You can give the same number of calories to two different people and their blood sugar may be different, depending on fitness level and even ethnicity.” Keeping a food diary with foods and blood sugar reactions two hours after a meal helps determine an individual’s reaction to specific foods, he says.
Myth: Diabetes means you’ll go blind or lose a limb
Left uncontrolled, diabetes can cause serious damage, including heart disease and stroke, blindness, kidney disease, and loss of a limb. But the risk can be greatly reduced by keeping blood sugar under control, says Dan Nadeau, MD, endocrinologist at Allen Diabetes Center at Hoag Hospital in Orange County, Calif. “Better glucose (blood sugar) control, the right medications, and smart choices about foods are critical for reducing the risk of complications. Working to achieve ideal weight is another powerful tool to avoid complications.” Early detection helps reduce the risk of complications, along with regular eye exams, urine tests, and foot exams.