The Truth About Insulin, Obesity and Blood Sugar with Dr. Arthur Chernoff, The Steven, Daniel and Douglas Altman Chairman of Endocrinology, Einstein Healthcare Network
According to the American Diabetes Association, 25.8 million people in the United States have diabetes. An additional 79 million more people have prediabetes, the ADA reports. What is diabetes and prediabetes? What can be done to prevent the diseases or stop their progression? Dr. Arthur Chernoff, chairman of Einstein Healthcare Network's endocrinology department, sets the record straight.
Myth: Diabetes is a result of obesity.
Truth: Diabetes is caused by a combination of factors, including genetics and lifestyle.
"Type 2 diabetes is common because we have a set of genes — not just one gene, but perhaps as many as 100 — that regulate our metabolism and use of calories," Chernoff explains. Some of them compose the “thrifty” gene hypothesis, an evolutionary skill that once helped humans avoid starvation by storing calories. But put those genes into a culture where food is available 24/7, and people get fat. That, says Chernoff, is what drives the emergence of diabetes.
Myth: Too much sugar causes diabetes.
Truth: Too much of any food can cause diabetes.
It's calorie consumption that matters, Chernoff explains, and eating too much of any food skews the body's blood sugar-insulin ratio. Fatty, sugar-heavy foods and drinks have a lot of calories and little nutritional value, so they are most guilty of triggering diabetes.
Myth: Patients know that they have diabetes when they faint or get shaky.
Truth: The symptoms of diabetes are less dramatic — and often go undiagnosed.
In fact, Chernoff says, people can have diabetes without having any symptoms. But the typical symptoms are increased thirst, frequent urination, fatigue, blurred vision and hunger. Anyone experiencing this combination of symptoms should talk to their doctor about being tested for diabetes.
Myth: Prediabetes is not a big deal, and there is nothing to do about it.
Truth: Prediabetes should be cause for alarm — and action.
Prediabetes should be the warning signal that patients need to change their lifestyle. In fact, Chernoff wishes that he saw more patients who were prediabetic. "By the time diabetes is diagnosed, people have lost about 50 percent of the cells that make insulin," he says. "In addition, many people, especially those who are overweight, are resistant to the insulin that they do make. That causes high, uncontrolled blood sugar. Over time, that can cause blindness, kidney and nerve damage and cardiovascular problems. I want to see the person who is just starting to experience elevated levels of blood sugar — even when there are no symptoms. That is the time when diabetes can be prevented or delayed. Damage to other organs can be avoided; why wait?”
Myth: Insulin is a last-resort drug.
Truth: Diet, exercise and the right medication can control diabetes.
Chernoff says that insulin is frequently the right tool for patients who have uncontrolled high blood sugar. "I know it works," he says, "and the sooner the blood sugar is returned to normal, the faster the patient will feel better and the sooner the damage that high blood sugar causes can be reversed."
Chernoff also employs the drug Metformin to control the advancement of diabetes, especially in prediabetes. But there is nothing more effective than a healthy diet and regular exercise. "Studies show that Metformin prevented diabetes in one-third of cases — but diet and exercise prevented diabetes in two-thirds of patients," Chernoff says. “The diet and exercise goals are straightforward: lose about 7 percent of your weight in one year and do 30 minutes of exercise five times per week. Do that, and you can control your blood sugar — and your health.”