Setting The Record Straight.

My local paper runs a national column by Dr. Peter Gott, a general internist who has a practice in Connecticut.  Though I don't usually read his column, it happens to run right under another column I read, so more often than not, I skim it.  Today, Dr. Gott attempted to answer the following question:

Dear Dr. Gott: I have been a Type 2 diabetic for four years now. What is the difference between Type 1 and Type 2 diabetes?

Of course, this instantly got my attention.  As I read his answer, I became at first surprised - then shocked - and finally, angry.  He had a chance to finally provide the public an accurate account of the differences between the two diseases, and he totally blew it.  When members of the medical community who have a public spotlight make such blatant errors, it's a little unbelievable.  I will be writing Dr. Gott a letter this evening, but also wanted to address it here.  I will copy his reply (so you can see what I'm disagreeing with) in italics, with my responses in bold, following his text.

Dear Reader: Diabetes is a disorder in which blood-glucose levels are above normal. People develop diabetes either because the pancreas doesn't produce adequate insulin or because the cells in the muscles, liver and fat don't use insulin properly. This results is glucose remaining in the blood and elevating levels at the same time cells crave the energy necessary to function properly. 

No arguments here.

 There are two types of diabetes, Type 1 and Type 2, with the latter being most common. Type 1 indicates a person is dependent on insulin and requires regular injections that are self-administered because the body fails to produce enough, if any, insulin. This form generally develops before the age of 30 and affects about 10 percent of all diabetics. 

Wrong.  There are more than two types of diabetes - actually, there are at least four (type 1, type 2, LADA, and gestational).  In addition, it should be noted that EVERY person is dependent on insulin - diabetic or not.  Insulin is a naturally occurring digestive hormone in the human body.  Perhaps this is what he meant, but it could have been better expressed.

Type 2, on the other hand, signifies insulin resistance. These people produce adequate insulin levels, but the body is unable to use it properly. Some may even need insulin injections in order to stimulate the pancreas. This form can occur in people of all ages and is more prevalent in obese people, Hispanics and Native Americans. Some cases of Type 2 diabetes have a strong genetic basis while others do not. 

The last sentence pertains to type 1 diabetes as well - while some of us "inherited" the gene from a family member, others have no family history of the condition.

Prevention is key with the disorder to prevent your diabetes from progressing to Type 1. If appropriate, try to lose weight, since excess weight can keep your body from making and using insulin properly. Reduce your salt and alcohol intake. Make better choices when grocery shopping. 

Wow.  This paragraph is so many kinds of wrong, that I'm really not sure where to begin.  First off, type 2 does not progress to type 1.  Type 1 is an auto-immune disease.  Type 2 is a metabolic disease.  Type 1's can acquire insulin resistance, which is a hallmark of Type 2, while Type 2's can become insulin-dependent, which is a hallmark of Type 1.  (You can see why this gets confusing for people who aren't living with or working with this every day - but, c'mon, he's a doctor!)  What he most likely (at least, I hope) meant to say here was "insulin-dependent" instead of "Type 1".  However, it needs to be clear that the need to inject or infuse insulin does not, in itself, justify a diagnosis of Type 1.

Secondly, excess weight has nothing to do with developing Type 1, and is only a trigger (not a CAUSE) for Type 2.  Salt and alcohol intake also have no bearing on the likelihood of developing Type 1.

It's exactly this kind of misinformation that leads to the general public not really knowing what Type 1 is.  So, in an effort to balance the injustice of Dr. Gott's response, here's what Type 1 Diabetes is (taken from http://www.jdrf.org/):

Type 1 diabetes is a chronic, debilitating disease affecting every organ system that strikes children and adults suddenly, and lasts a lifetime. Type 1 diabetes is an autoimmune disease in which a person's pancreas stops producing insulin, a hormone that enables people to get energy from food. (Type 1 diabetes occurs when the body's immune system attacks and destroys certain cells in the pancreas, an organ about the size of a hand that is located behind the lower part of the stomach. These cells -- called beta cells -- are contained, along with other types of cells, within small islands of endocrine cells called the pancreatic islets. Beta cells normally produce insulin, a hormone that helps the body move the glucose contained in food into cells throughout the body, which use it for energy. But when the beta cells are destroyed, no insulin can be produced, and the glucose stays in the blood instead, where it can cause serious damage to all the organ systems of the body.) People with type 1 diabetes must take multiple injections of insulin daily or continuous infusion of insulin through a pump just to survive. Taking insulin does not cure any type of diabetes nor prevent the possibility of its eventual and devastating effects: kidney failure, blindness, nerve damage, amputation, heart attack, and stroke. Unlike type 1 diabetes, type 2 diabetes is a metabolic disorder that is often diagnosed in adulthood in which a person's body still produces insulin but is unable to use it effectively.

Okay, back to Dr. Gott.

Keep fresh vegetables such as carrot and celery sticks readily available to snack on while watching television. Eat properly and coordinate a program of regular exercise, such as riding a bicycle or golfing. A simple walk around the block daily is good.  Ask your physician or endocrinologist if referral to a dietitian would help. If you have a community center nearby, sign up for swimming or aerobics classes. Get a friend to join you. There's more incentive if you have company.  

That's good advice for anyone.  However, this is given in the context of "preventing" Type 2 from turning into Type 1.  There is no cure for Type 1, and there is also no prevention for it.  Doesn't Dr. Gott know what JDRF does?

If medication is appropriate, take it according to your physician's directions. Follow my No Flour, No Sugar diet. I have received countless communications from readers stating they have brought their diabetes, cholesterol levels and hypertension under control and have been able to discontinue their medication while on my diet. 

Again, it needs to be specified what sort of diabetes we're talking about here.  He's directing this advice towards a reader with type 2 - because, believe me, if a simple change in diet could suddenly kick-start my pancreas into producing insulin again, and could stop my immune system from killing off my beta cells, don't you think I would have done it by now?

For those interested, here is a link to an online version of the article:  http://www.pasadenastarnews.com/ci_15571806 .  If you want to write Dr. Gott, he can be reached at Dr. Gott c/o United Media, 200 Madison Ave., Fourth Floor, New York, NY 10016.

Do it!