{"id":23,"date":"2010-10-03T16:50:16","date_gmt":"2010-10-03T16:50:16","guid":{"rendered":"http:\/\/blog.beliefnet.com\/medicinetomoveyou\/2010\/10\/treating-not-just-preventing-diabetes-with-lifestyle-change.html"},"modified":"2010-10-03T16:50:16","modified_gmt":"2010-10-03T16:50:16","slug":"treating-not-just-preventing-diabetes-with-lifestyle-change","status":"publish","type":"post","link":"https:\/\/www.beliefnet.com\/columnists\/medicinetomoveyou\/2010\/10\/treating-not-just-preventing-diabetes-with-lifestyle-change.html","title":{"rendered":"Treating, Not Just Preventing, Diabetes with Lifestyle Change"},"content":{"rendered":"

There is one word that strikes fear in the hearts of every
\ndiabetic that I have ever diagnosed in my office.  <\/span>One word that conjures up images of needles,
\nsyringes, blood, pricking yourself day in and day out, chasing high blood
\nsugars and low blood sugars to avoid the dismal future of uncontrolled
\ndiabetes.  <\/span>This word, as you already have
\nguessed, ‘insulin’ is one we avoid in practice, because patients liken it to be
\ngiven a terminal disease- as though we have told them, “There is nothing else
\nwe can do for you at this point in your disease, so we regret to inform you that
\nyou must start insulin to save your life.” 
\n<\/span><\/p>\n

Currently, physicians have big organizations that advise
\nthem on when it would be best to start insulin therapy for Type 2
\ndiabetics.  <\/span>Type 2’s used to be called ‘adult
\nonset diabetics,’ but that was when 50 year olds used to be the bulk of the
\nnewly diagnosed.  <\/span>Now, with more and more
\nteenagers being diagnosed with Type 2 diabetes, we can no longer use the words ‘adult
\nonset.’  <\/span>Based on some guidelines, if you
\nwere diagnosed before the age of 30 or if you have had diabetes for over 15
\nyears, you should have been considered for insulin?  <\/span>My bet: most of the people you know who meet
\nthese criteria are likely not on insulin. 
\n<\/span>Why?  <\/span>Well, physicians are humans
\ntoo.  <\/span>They don’t want to start you on
\ninsulin just as much as you don’t want to take it!  <\/span>Ok, maybe patients win on this tug-o-war in
\nreal life, but you get the point.  <\/span>Here’s
\nan interesting excerpt from Diabetes Health magazine:<\/p>\n

“The overwhelming majority of type 2s eventually require insulin
\nto obtain or preserve satisfactory glucose control and an A1c of 7% or less
\n[see below explanation of A1c<\/b>].
\nResearch clearly shows that achieving good control early on prevents diabetic
\ncomplications, including nerve, kidney, eye and heart disease, up to twenty
\nyears later.<\/span><\/p>\n

Deciding exactly when to begin insulin therapy is problematic for
\nphysicians who treat type 2 diabetes. Patients’ misguided fears about needles, hypoglycemia,
\nand weight gain often lead to reluctance and physician inertia. A recent survey
\nfound that fewer than half of all physicians made any change in diabetes
\ntherapy even for patients with A1c’s of over 9%.<\/span><\/p>\n

A similar study at Johns Hopkins found that it took an average of
\n240 days before doctors added insulin or another drug for patients who could
\nnot achieve good control. By the time they finally took action, two-thirds of
\ntheir patients had A1c levels approaching 10%.”<\/span><\/p>\n

How depressing is this for diabetic readers!  <\/span>Luckily, Integrative Medicine does not take
\ninsulin sitting down- literally!  <\/span>It is
\nwell known that 95% of Type 2 diabetes is caused by poor lifestyle.  <\/span>That is to say, that 95% of why teens and
\nadults with Type 2 diabetes get the disease is because they choose unhealthy
\nways of moving (or lack thereof), unhealthy ways of eating, and unhealthy ways
\nof managing stress.  <\/span>Changing lifestyle
\nis just as powerful as any drug, even as powerful as insulin and we see this
\nevery day in our office.<\/span><\/p>\n

Just this last week, my physician assistant Karen, was jubilated
\nafter seeing the latest blood work of a patient with whom she had been treating<\/i> with therapeutic lifestyle
\nchange.  <\/span>This 40+ year old woman came in
\nwith vague complaints and was found to have horribly controlled diabetes
\nthrough her initial labs.  <\/span>Her HgbA1c was
\n10.9.  <\/span>By the way, HgbA1c<\/b> is a 3 month test score of how your blood sugars are running
\nand the goal for diabetics is less than 6.5%. 
\n<\/span>Based on her A1c, we should have started her on insulin per guidelines.  <\/span>However, she accepted that her lifestyle was
\nless than optimal and she agreed to make radical changes in order to avoid
\ninsulin.  <\/span>Now, let’s just stop here and
\ntalk about something.  <\/span>Whenever someone
\ngets in trouble or faces a dreadful prospect, there is some sincere bargaining
\nthat soon starts.  <\/span>When this patient
\nagreed to change her ways, we were happy but not blissfully ignorant.  <\/span>We were on her like ‘white-on-rice’ to be sure
\nher promises were not hollow.  <\/span>We
\ninitiated a rigorous detoxification program followed by a strict low glycemic
\nindex, anti-inflammatory diet to help treat the underlying cause of her
\ndiabetes… POOR LIFESTYLE!!!  <\/span>We followed
\nher blood sugars closely until she was in a safer place.  <\/span>Her latest A1c was under 7, using just one oral
\ndiabetic medication plus a whole lot of healthy living.  <\/span>Let me put this into perspective- if she
\nwould have been diagnosed and managed by the standard medical approach as it is
\npracticed today, she would have been placed on 2, if not 3, medications easily
\nand still might not have avoided injecting insulin at the end of the
\nstory.  <\/span>Back in our world, she is loses weight,
\nfeels better, has less aches and pains and her associated fatty liver disease
\nis on the mend. That is therapeutic<\/i>
\nlifestyle change in all its glory!<\/span><\/p>\n

Insulin is a powerful and necessary drug for many patients;
\nhowever, it is avoidable for many Type 2 diabetics if they are willing to
\nchange their lifestyle.  <\/span>Until the
\nmedical community puts the appropriate emphasis on really teaching patients how
\nto avoid or treat diabetes with proper lifestyle, we will continue to need more
\nand more medications like insulin in our medicine cabinet.  <\/span>My opinion: 
\n<\/span>The current 2 day diabetic diet education courses that are available are
\nwell-meaning but lack the power to change a patient’s lifestyle for any
\nsignificant length of time.  <\/span>It’s like
\ngoing to church for 2 days and thinking you’ve got God figured out!  <\/span>Good lifestyle is a daily practice of
\ndiscipline requiring guidance by experienced lifestyle medicine providers.  <\/span>An easy measuring stick for anyone giving you
\nlifestyle advice…are they practicing what they preach and working to live their
\nhealthiest life?  <\/span>If not, move on and be
\ninspired by someone who does.  <\/span><\/span><\/p>\n

 <\/span><\/p>\n

This information is intended for informational and
\nentertainment purposes only and is not a substitute for medical advice,
\ndiagnosis or treatment.  <\/span>Please consult
\nyour physician.<\/span><\/i><\/p>\n","protected":false},"excerpt":{"rendered":"

There is one word that strikes fear in the hearts of every diabetic that I have ever diagnosed in my office.  One word that conjures up images of needles, syringes, blood, pricking yourself day in and day out, chasing high blood sugars and low blood sugars to avoid the dismal future of uncontrolled diabetes.  This…<\/p>\n","protected":false},"author":220,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[11,4,9,5],"tags":[],"class_list":["post-23","post","type-post","status-publish","format-standard","hentry","category-get-moving","category-healthy-eating","category-integrative-medicine-patient-stories","category-medical-tips"],"yoast_head":"\nTreating, Not Just Preventing, Diabetes with Lifestyle Change - Medicine to Move You<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.beliefnet.com\/columnists\/medicinetomoveyou\/2010\/10\/treating-not-just-preventing-diabetes-with-lifestyle-change.html\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Treating, Not Just Preventing, Diabetes with Lifestyle Change - Medicine to Move You\" \/>\n<meta property=\"og:description\" content=\"There is one word that strikes fear in the hearts of every diabetic that I have ever diagnosed in my office.  One word that conjures up images of needles, syringes, blood, pricking yourself day in and day out, chasing high blood sugars and low blood sugars to avoid the dismal future of uncontrolled diabetes.  This…\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.beliefnet.com\/columnists\/medicinetomoveyou\/2010\/10\/treating-not-just-preventing-diabetes-with-lifestyle-change.html\" \/>\n<meta property=\"og:site_name\" content=\"Medicine to Move You\" \/>\n<meta property=\"article:published_time\" content=\"2010-10-03T16:50:16+00:00\" \/>\n<meta name=\"author\" content=\"Dr. Shilpa P. 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