home
RSS
With diabetes, don't focus on blame
April 15th, 2011
11:20 AM ET

With diabetes, don't focus on blame

David Kendall, M.D., is the chief scientific and medical officer of the American Diabetes Association

One of the most common misconceptions about diabetes is that the people who develop the chronic disease somehow brought it on themselves. Many believe that people develop type 1 diabetes because of eating too much sugar. Similarly, many believe that people develop type 2 diabetes as a result of overeating and being overweight or obese.

The simple fact is that both type 1 and type 2 diabetes develop as a result of both human factors (genetics and family history in particular) and environmental factors. Scientists have shown that certain genes predispose a person to develop diabetes, while a variety of environmental factors contribute to (or trigger) the development of diabetes.

Type 1 diabetes results when the body’s immune system destroys the insulin-producing cells in the pancreas. Type 2 diabetes develops when the cells of the body become resistant to the effect of insulin, and the insulin-producing cells ultimately make less insulin than is necessary.

In both type 1 and type 2 diabetes, scientists have determined that many genes are involved in setting the stage for the possibility that diabetes can develop. If those genes are present, diabetes only will develop if certain environmental factors come in to play, triggering the onset of the disease.

How do we know that environmental triggers are involved in causing diabetes, and not just genetics? One way we know this is by looking at diabetes in identical twins, who share identical genes.

In type 1 diabetes, the “concordance rate” for identical twins is no more than 25-50 percent, meaning that if one twin has diabetes, there is only a 50-50 chance (or less) that the other twin will develop it as well. In type 2 diabetes, the concordance rate approaches 90 percent for identical twins, but it doesn’t fully reach 100 percent. That tells us that in both types of diabetes, something in the person’s environment has to play a role in the development of the disease.

Scientists have been looking for both specific genes and the most common triggering mechanisms for many years. With type 1 diabetes, the search has been very frustrating, and while many factors have been studied over the years (including viruses, chemicals, and dietary components) there has been very little progress in identifying exactly what those factors might be. But one thing we are certain of is that sugar consumption is not one of the triggers for diabetes. Even if someone knows that they are at increased risk for type 1 diabetes due to a family history, there is no single behavior or treatment we know of that can alter that risk.

With type 2 diabetes, we do know that a major risk factor is being overweight or obese. Being overweight or obese also represents a complex interaction between genetics, environment, and behavior. But we do know that higher body weight is not the sole explanation since not all who become overweight or obese will develop type 2 diabetes. Indeed, most people who are overweight or obese do not develop type 2 diabetes. And many people who develop type 2 diabetes are of normal weight, which means that other environmental risk factors may be involved as well.

No one is to blame for their diabetes. We certainly cannot control the genes we inherit. And while certain environmental and behavior “triggers” have been identified, managing those risk factors can be challenging.

As noted, there is nothing specific yet to be done to prevent type 1 diabetes. Increased physical activity with modest weight loss can lower the risk of developing type 2 diabetes, but does not prevent all cases.

We do know that diabetes can be effectively managed and that by working to control blood glucose levels, people with diabetes can reduce their risk of developing complications. For people with type 2 diabetes, moderate weight loss can be helpful; for everyone with diabetes, eating a healthy diet, increasing physical activity, and using their medications as prescribed are all helpful in the management of this disease.

Post by:
Filed under: Diabetes

soundoff (131 Responses)
  1. pound

    Good grief, people. Seriously. Could everybody kind of calm down and stop throwing insults around? We all have our own faults. If you think you're immune, go take a long look in the mirror...

    April 17, 2011 at 22:03 | Report abuse | Reply
  2. Sarah

    I was diagnosed with type 2 diabetes at the age of 34 and I only weigh 115 pounds.I have always been very active all my life and watched what I ate. I have a family history as both my father & grandmother has it. My nurse said my illness was completely genetic and that my lifestyle had very little to do it. Even still, the ignorance regarding this disease is appalling even among certain health professionals. I am very careful about what I eat and I still have trouble controlling my blood sugar. There are still people who will assume I eat junk food all day & sit on the coach which could not be further from the truth.

    April 18, 2011 at 00:20 | Report abuse | Reply
  3. Anne S.

    I was diagosed with diabetes when I was 36 yrs. old. I battled with it for 20 yrs. trying to control it and having bouts of insulin reactions. Most primary doctors and such think they know everything about diabetes, but they don't. After the 20 yrs. I went to a endocrinologist and was diagnosed with both kinds. I was also put on a diet of carbs. I would be dead right now if I hadn't gone to him. All the misinformation that I had gotten from other doctors along the way didn't help me. The endocrinologist had me straightened out in a week's time. Anyone that has diabetes should be going to an endocrinologist not some primary doctor or such. I go to a diabetic center every 3 months and it's the best place to go as they know all the new techniques about diabetes and have the most up to date news.

    April 18, 2011 at 05:51 | Report abuse | Reply
  4. happen

    The vast majority of Type II diabetics are at fault for eating themselves to the size of a house. They refuse to show any restraint and just let a hospital reign them in when they crash, complaining all the while that they can't have another can of soda with every meal and chomping down KFC that their mutually obese family brings to them during visiting hours. Their same total lack of motivation combines with morbid obesity generally leaves them unemployed and ignorant, uninsured and never paying their medical bills. They are so defensive about their right to over eat they lie about their condition, play the victim, and go online and say that they or people they know are Type II diabetics who aren't overweight. Then they finally check into the hospital one more time as their morbid obesity cofactors combine to lead them into a horrible, very long, painful and humiliating drawn out death. Seen it a hundred times.

    April 18, 2011 at 06:28 | Report abuse | Reply
    • Natalie

      You didn't read the article you are replying to, and you are just showing your bias against Type 2 diabetics. Type 2's come in all sizes, and while some of them are morbidly obese, the vast majority are somewhere between normal weight and obese, but not morbidly obese. And you don't know anything about the eating habits of all Type 2's - you are picking out people who conform to your biased preconceived notions, and ignoring the majority who eat just about like everyone else, including the slim. And you also ignore the morbidly obese who DON'T have diabetes - what sets them apart? Do you like them better than normal-weight Type 2's?

      April 20, 2011 at 16:17 | Report abuse |
    • Andrew

      Your post is misleading and ungenerous. I doubt that anyone will deny that lifestyle is a major risk factor. But, for each of the last 10 years, I have been super-active – cycling over 3000 miles each year. I ate a reasonably healthy diet And I have never been close to being obese. And yet I have high blood sugar. So please be careful with your generalizations.

      August 30, 2011 at 10:32 | Report abuse |
  5. Peggy

    I have Type 2 Diabetes, and I readily admit that I am overweight, however, there is some genetic component, since my dad, who was never overweight also developed Type 2 Diabetes. My mom, who has always been underweight, also developed the condition, due to the steroids she has had to take for her rheumatoid arthritis and lung disease. So there are a lot of factors in developing the disease.

    April 18, 2011 at 06:41 | Report abuse | Reply
  6. R

    Gentics plays a role in D2 absolutely. But it is not the end all be all. For most individuals with D2 (not all mind you) excessive weight and unhealthly lifestlye became the triggers that set of D2.

    I fully support those that have developed D2. When they make the choice to get healthier, manage their D2 and some even are able to reverse it. What gets me are individuals who do nothing about it. They put it out there that they have it, but turn around and eat the same bad food, don't try to even exersize and do nothing to help try to lessen it. I have a hard time sitting around supporting someone who does nothing to support themselves.

    Not all people do that, but some do. It's not a blaming thing. I don't blame them for getting D2 but I do think people need to be accountable for their own actions. It's hard watching a friend or loved one die and do nothing about it.

    April 18, 2011 at 09:08 | Report abuse | Reply
  7. ...k

    one cannot be fat without calorie providing food. if all you can eat is a piece of bread a day to not be fat then so be it

    April 18, 2011 at 09:15 | Report abuse | Reply
    • Betsy G

      would you be willing to eat only a piece of bread a day?

      April 20, 2011 at 09:38 | Report abuse |
  8. REALIST

    What we need to do is compare other countries risk of diabetes across race/gender and determine why their is a difference. The difference is very telling. Americans are just too fat and do not eat properly!!! Yes some will develop regardless of their efforts, however some will be able to stay off the genetics. We do have a major problem in this country and that is bleeding heart liberals that throw individual responsiblity out the window. If you are fat and overweight and they tell me you have diabetes because of genetic factors, dont expect my healthcare tax dollers to pay for your fat butt!!!

    April 18, 2011 at 16:01 | Report abuse | Reply
  9. REALIST

    Another thing I work in a healthcare clinic that sees close to 600 patient visits a month. 70% of whom are diabetic. As a courtesy we offer water,soda and snacks to all our patients. 9 times out of 10 the diabetic patients will not dirnk the diet soda or even choose the water. They demand the regular sodas. Often when we stress the water or the sugar free drinks they state they will just not drink anything. We are dealing with a population of ignorant bafoons. We educate them over and over and over. Please do not tell me because its due to poverty. We as Americans are surrounded by health choices and even with the vast amount of education many of continue to make impulsive choices. some groups of people make impuslive choices far more than others. However, we can talk about the reasons for that. The excuse always is poverty. Last time I checked the poverty stricken in other countries are skinny and malnourished. Our improvished are fat and diabetic. CNN needs to focus on the epidemic of the lack of individual responsibilty in this country. That is the root of the problem in this country. Instead of Black in America, or Asian in America or Mexican in America. How about a segment on irriesponsible in America.

    April 18, 2011 at 16:08 | Report abuse | Reply
    • Blogson

      What sort of "healthcare clinic" supposedly offers such unhealthy "refreshments" to its clientele? If such a place exists it should be banned from practicing "healthcare" until it cleans up its act.

      April 19, 2011 at 19:47 | Report abuse |
    • pd

      It is spelled "buffoon". You should not be working in a clinic which cares for people with diabetes. They are not their disease.

      April 20, 2011 at 19:37 | Report abuse |
    • Pete of Maine

      Well Realist, it seems you have all the answers. Not only do you believe in what you say, but the things you write are blatantly false. If, as you say ,all overweight people are irresponsible and that only "liberals" allow irresonsibility. Then why haven't "conservative" thinkers- like yourself- cured any disease or problem. This " so called" clinic you work at must be in a very poor and southern region- where ignorance is bliss. Otherwise, why would this clinic have an idiot like you working there. It is obvious that you have absolutely no idea about the disease. So you should stop writing on a subject matter that is beyond your intelligence. Bonehead, I'm a type I who can be sure that I'm in better shape then you. I 'd bet good money on it.

      April 25, 2011 at 09:22 | Report abuse |
    • Bored Science Homework Do-er

      I don't care about your completely deluded conclusion on type 2 diabetics, but, if you plan to complain about ignorant people, perhaps you should look at your own spelling and grammar, I'm sure you are educated enough to have learnt how to spell, considering you supposedly, have a job, and leave the diabetes to people who know what they are talking about.

      Here is my correction of your post, the brackets are my additions to your post. Usually the first word will replace your word then the explanation.

      What w e (we- It doesn’t need a space, it’s one word.) need to do is compare other countries (countrys’- too hard to explain so I’m not going to bother.) risk of diabetes across race/gender and determine why their (there- ‘There’ indicates a place as in, "I live here not there," whereas ‘Their’ is the possessive of "they", as in "They live there but is isn't their house.") is a difference. The difference is very telling. Americans are just too fat and do not eat properly!!! (Congratulations this is the first sentence that makes sense.) Yes some will develop regardless of their efforts,(;- Semicolon time.) however some will be able to stay off the genetics. We do have a major problem in this country and that is bleeding heart liberals that throw individual responsiblity (responsibility- re-spon-si-bil-i-ty, 6 syllables.) out the window. If you are fat and overweight and they tell me you have diabetes because of genetic factors, don’t(don’t- It is the shortened version of do not and the ‘ represents the missing letter.) expect my healthcare tax dollars(dollars- Please say that was a typo.) to pay for your fat butt!!! Another thing (,-Here is a nice place for a pause.) I work in a healthcare clinic that sees close to 600 patient visits a month. 70% of whom are diabetic. As a courtesy we offer water,soda(water, soda- Need a space between two words.) and snacks to all our patients. 9 times out of 10 the diabetic patients will not dirnk (drink- More! This is disappointing spelling.) the diet soda or even choose the water. They demand the regular sodas. Often when we stress the water or the sugar free drinks they state (that.) they will just not drink anything. We are dealing with a population of ignorant bafoons (buffoons.). We educate them over and over and over. Please do not tell me because its due to poverty (Please do not tell me that it’s due to poverty- Simply didn’t make sense.). We as Americans are surrounded by health choices and even with the vast amount of education many of (us- Would fit quite well in here.) continue to make impulsive choices. Some (Some- Capitals go at the start of sentences.) groups of people make impuslive (impulsive- I’ll let you off on that one as a typo.) choices far more than others. However, we can talk about the reasons for that. The excuse (is.) always is (- no is) poverty. Last time I checked the poverty stricken in other countries (Correct use of countries.) are skinny and malnourished. Our improvished (What is this word?) are fat and diabetic. CNN needs to focus on the epidemic of the lack of individual responsibility (responsibility- Really, again?) in this country. That is the root of the problem in this country. Instead of Black in America, or Asian in America or Mexican in America. (,- You can’t end a sentence like that) How (how- because of my new comma) about a segment on irriesponsible (irresponsible- Let’s hope that was a typo) in America.

      Okay I don’t think I missed anything.

      October 3, 2011 at 01:00 | Report abuse |
    • Hakou

      I will agree with you that the ADA does not claim type 2 diabetes is a acburle disease. However, the fact was I had to cure my dependence of insulin and pills counter to ADA’s own guidelines. However, one could acknowledge my cure was only from the dependence I had on insulin and pills, not on my predisposition of type 2 diabetes that was in my genes from birth.In fact, I had admitted to this way thinking many times in the content I had published; but the point nevertheless remains that it is acburle…no matter how you get there. To me, my simple way of thinking compares it to people who are drunks, and if they stop drinking…they aren’t drunks. In other words, quit eating wrong and type 2 diabetes will disappear. Can I say that for everyone? No! But I did prove it to myself and I now have evidence from other like kind people.What I disagree with as far as ADA is concerned are their guidelines and lack of direction by encouraging diabetic patients to eat heavy carbohydrate meals and not exposing how the dramatic affects (insulin stimulation) glycemic loads have with regard to the food we eat.

      March 5, 2012 at 22:36 | Report abuse |
  10. Pam

    I get so irritated by the stereotypes and rude jargon that people post in blogs.

    April 19, 2011 at 18:13 | Report abuse | Reply
  11. Jim

    With some comments it appears that the writers did not even bother to read the article and instead post ignorant and unthinking stereotyped comments. I know several people who have Type 2 diabetes who live healthy lifestyles and follow the rules and still have Type 2 diabetes. Perhaps such idiotic comments typify part of what is wrong with many Americans – shoot from the hip verbally and have little or no intelligence about what they are writing.

    April 19, 2011 at 19:42 | Report abuse | Reply
  12. CHOPPERGIRL

    This is BS, we know exactly who to BLAME, the giant soft drink corporations that grow filthy rich off of poisoning the world's population with no warning stickers on their products whatsoever. Indeed, people need to start BLAMING MORE.

    I became type 2 diabetic at an early age in high school, not because I was obese or genetically disposed to (which I'm not), but because I drank a lot of soft drinks not having any idea what devastating myriad of effects they have on the human body.

    April 20, 2011 at 01:07 | Report abuse | Reply
  13. schua1

    I'm glad this Dr. works with diabetes...seeing as diabetes is NOT genetic and yet his says it is. Remind me to never go to him if I become ill.

    April 20, 2011 at 01:24 | Report abuse | Reply
  14. Melanie Thompson

    Knock it off with the weight comments. Diabetes is a tragedy, for whatever reason. The blame game does not work here. There is more involved than what many people think. Shut your mouths

    April 23, 2011 at 04:53 | Report abuse | Reply
    • Saori

      People with type 1 diabetes CANNOT prucode insulin which brings the blood sugar down so just about everything they eat causes their blood sugar to rise. They have to inject insulin to compensate for the lack of it. The diet they should follow should be low fat and low carb and sugar. Basically they should follow a normal healthy diet. When insulin is administed because it was not natrually prucoded in the body in response to the foods we eat, sometimes to much insulin is given and the blood sugar is brought down to low. Low to the point the person can die which is why someone who uses insulin needs to have some sugar or sugar pills, candy on hand just in case the sugar drops really low.Type 2 diabetics basically have a pancreas that has pooped out and cannot prucode adequate amount of insulin to keep blood sugars within normal range. They also should follow a low fat, low carb diet but they don't have to worry so much about the sugar dropping really low because most type 2 diabetics take pills to control their condition which don't drop the sugar quite so much. If the pills aren't working well enough they also might need insulin.Pretty much the diets are the same for both types.References : RN

      March 5, 2012 at 23:24 | Report abuse |
  15. Bebee

    hi guys. i got tested for mupiltle things i have a new dr. anyway i have 3 dr's total. I got a test recently that says that 1. My Triglycerides are at 790. Now I never heard of having them high before, but then.. 2. My Cholesterol was high like this for the first time at 264. My insulin/glucose was 90. Could I have insulin resistance, or diabetes? Could this be a fluke thing? Can I keep warding it off by eating vegies and fruits, fish, and taking vitamins and stuff? Next part 2..

    August 1, 2012 at 20:39 | Report abuse | Reply
1 2

Post a comment


 

CNN welcomes a lively and courteous discussion as long as you follow the Rules of Conduct set forth in our Terms of Service. Comments are not pre-screened before they post. You agree that anything you post may be used, along with your name and profile picture, in accordance with our Privacy Policy and the license you have granted pursuant to our Terms of Service.

Advertisement
About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.