Hello, my name is Anastasia. It’s been 32 days since my last nutrition rant. I thought I had everything under control. I was calmly writing a huge post on polyunsaturated fatty acids. It came out of the blue. I walked into a scheduled lecture on major clinical concepts surrounding diabetes naively believing I had the willpower. Those of you watching me implode on Twitter know just how wrong I was.
The endocrinologist who was standing in front of us is probably a fantastic doctor. He was just asked to help some medical students revise the clinical approach to Type I and Type II diabetes. I cannot judge his level of knowledge or his expertise based on a few slides. But maybe you can.
After briefly recapping the definitions of Type 1, Type 2 and LADA (late onset autoimmune), he got my attention by declaring that Type 2 Diabetes was a genetic condition. I was a bit flummoxed. Sure, I know of the studies isolating the genes involved. I also know of the popular quoted statistic that the identical twin of a diabetic patient has 90% chances of getting the disease. Still I think of Marfan’s or hemophilia as a typical genetic condition: a known mutation of a certain gene causing a problem.
The next important fact to be addressed was the increase in the prevalence of diabetes. I thought you had to have spent some serious time under a rock not to have noticed that but nevertheless I observed many students scribbling furiously.
At this point I was getting a little confused: why would a genetic condition increase in prevalence in such a short period of time? The answer was on the next slide.
Causes of increasing prevalence of T2D:
– increasing gene pool
– high fat and high GI diets
– less physical activity
“Increasing gene pool” had me slide down my chair in a fit of silent giggles as I was mentally fighting off in a image of all those sex-crazed diabetics hellbent on spreading their defective genes.
And you all know how the obesity story goes: being a glutton and a sloth makes you fat. Being fat makes you a diabetic. Hang on, wasn’t it genetic? I’m lost.
This disease is so horrible that if you are thin then it’s your genes, and if you are fat then it’s your fault!
So is there any hope???
Here is a long awaited lifestyle slide:
1. Refer to a dietician for diet advice.
Good to know that we as doctors are prepared to admit that we are totally inept in giving diet advice.
2. Lose weight.
If only somebody ever told a fat diabetic that all they have to do is to lose weight! They wouldn’t have had years of silent small vessel damage destroying their retina, eyes and kidneys.
3. Maintain physical fitness, eg walking 30 minutes a day 5 times a week.
My sarcasm has actually failed me at this point. I honestly have nothing.
The discussion on the lifestyle changes for diabetes was pessimistically concluded with: it’s too hard to convince patients to change their diet and increase their physical activity. The lecturer sounded genuinely upset about this fact, lamenting that most lifestyle changes tend to fail, at which point all diabetics inevitably progress to medication.
Ah, yes, the medication. Quick rundown on the drugs: from metformin (“a fantastic drug which assists with weight loss and improves the liver insulin sensitivity”) to sulphonylureas (“fantastic drugs with a proven safety record which increase the insulin output from the pancreas”) to glitazones (“recent drugs exciting some cautious optimism, still associated with some unfortunate side effects, like HEART FAILURE”) and so on. Until, finally, insulin. All roads lead to Rome, all drains lead to the ocean. All diabetics end up with insulin.
Apparently, the trick with insulin is not to forget to increase the dose when you know that you are about to shock your system with a gargantuan serving of pasta with a low fat sauce. Silly me, I would have thought it sensible to reduce your requirements for insulin in the first place.
And of course as any medical student knows, a discussion on diabetes has to be wrapped up with some happy snaps of gangrenous toes. That will drive the message home!
I know that many of you are reading this with a mixture of exasperation and amusement. And a shadow of superiority. Surely any intelligent person would critically appraise the information given, research the best sources, analyse primary studies, draw their own conclusions and use their own brain???
What if you are a medical student? You have 5 months till people call you “Doctor”. You need to be able to deal with trauma, haemorrhage, heart attack, delirium, burns, sepsis, anaphylaxis, organ failure, psychotic episode, dislocated shoulder, meningitis, testicular torsion and a spider bite.
Senior doctors inspire our admiration with their wealth of knowledge, confidence in dealing with the unexpected, their people skills (not always) and the sheer fact that they have been through what we are going through and survived! Even if you were crazy enough to start a nutrition blog in your last year of med school, do own research on the train to the hospital and write angry posts instead of studying for exams… would you question an esteemed professor during his lecture?
Everything we know is just what we have been told. Based on that, the future of medicine has me worried.
I am eagerly awaiting your comments.