Can we “prevent“ diabetes with weight loss? Or would it be better to say we can “delay“ diabetes with healthy behavior?
Often people are reluctant to admit that they have diabetes or to initiate treatment. Many times the cause of the delay in treatment is feelings of guilt (they feel like diabetes is all due to their weight). I had a patient who delayed treatment for three years, thinking that he could treat diabetes with weight loss and exercise. He was at a healthy weight and was a marathon runner. Instead of starting medication or getting diabetes education, he increased activity to three marathons per month. He decreased calories in his diet, which resulted in weight loss that produced a BMI of 17. Despite the weight loss and exercise, he was still admitted to the hospital in DKA and had significant neuropathy that limited his ability to continue the exercise.
Maybe not to this extreme, but many people delay treatment for diabetes as they feel like it is all their fault. If he had not been admitted for DKA, his diabetes treatment might have been delayed further, and he may have had even more complications from diabetes. But if he would have come for an education at diagnosis, he may have avoided significant neuropathy.
- When people think that only obesity causes type 2 diabetes, it is hard to understand the concept of thin people with diabetes.
- When you understand that insulin resistance causes hunger and fatigue (due to poor delivery of glucose to cells), you understand that insulin resistance leads to less activity and more food. The decrease in activity and increase in calories leads to weight gain AND more insulin resistance. Perhaps insulin resistance is a cause for obesity, rather than obesity causing insulin resistance.
- When you understand the above, then you can understand why, when you have an insulin production problem rather than an insulin resistance problem, you can be thin with type 2 diabetes and not have a problem with blood pressure or cholesterol.
- I have often seen this kind of scenario where insulin production decreases gradually. At some critical point, glucose toxicity hits, and suddenly production drops to the point that DKA occurs.
- It is important to remember that type 2 is not always about insulin resistance and being overweight. Teach and treat the patient relative to his or her individual needs.
- Placing blame for diabetes on obesity/weight can have a very detrimental effect on motivation for treating diabetes.
- Refer to diabetes education upon diagnosis. Follow up to make sure he or she is receiving appropriate education and care. If not, explore information, misinformation, barriers, and ways to get over the barriers.
Laurie Klipfel, RN, BC-ANP, CDE
SSM St. Clare Health Center
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