For a disease that strikes close to two million Americans a year and affects more than 20 million, diabetes is surprisingly misunderstood. And this lack of understanding is having tragic consequences; according to projections by the Centers for Disease Control (CDC), as many as one in three American adults could have diabetes by 2050. So how do we get the facts straight? Let's start with correcting the most common mistakes. Here are eight common beliefs about diabetes that are just plain wrong.
Lie: Only Overweight People Get Diabetes
Truth: Most experts now believe that diabetes is primarily genetic in origin, and it can happen to anyone at any weight. In addition to family history, risk factors include ethnicity and age. Diabetes occurs when cells become resistant to the action of insulin, a hormone secreted by the pancreas. The pancreas can't make enough insulin to keep up, causing sugar to build up in your bloodstream. Eating unhealthy food or being overweight can lead to insulin resistance and trigger the onset of diabetes, says Eliot LeBow, a licensed clinical social worker (LCSW) health and wellness advisor for the American Diabetes Association. But diabetes doesn't require that particular trigger to develop. "People who are very thin get type 2 diabetes as well as people who are carrying extra weight," says LeBow. Meanwhile, most overweight people never develop type 2 diabetes.
Lie: You Get Diabetes From Eating Too Much Sugar
Truth: It's not that simple. A candy habit itself doesn't cause diabetes, experts say. If you're thin, exercise regularly, and eat a generally healthy diet (in other words, if your diabetes risk is low), then the occasional M&Ms binge isn't something to worry about. But many people who eat a lot of sugar are overweight, and that does increase your risk for type 2 diabetes. And once you're significantly overweight or obese, your cells can become resistant to insulin, so that when you eat candy or other sweets your body can't process the sugar efficiently.
Sugary drinks like soda pop, however, do pose a diabetes risk, according to recent studies, though experts don't yet know whether the culprit is the highly concentrated sugars in these drinks or the empty calories. The American Heart Association now recommends limiting your intake of sugary drinks to 450 calories per week.
Lie: Diabetes Isn't That Serious
Truth: This is the most dangerous misconception of all, experts say. According to the American Diabetes Association, type 2 diabetes kills more people each year than breast cancer and AIDS combined. And two out of three people with diabetes die from heart disease or stroke. The good news, though, is that diabetes is a manageable condition, and with good blood sugar control you can hold off diabetes complications or prevent them entirely. Keep on top of your heart health by getting regular blood pressure and lipid screenings and any other tests recommended by your doctor. If your blood pressure, cholesterol, or lipid levels are above the normal range, or your HDL (good cholesterol) is too low, talk to your doctor about the best treatment options, which may include going on medications to lower your blood pressure and cholesterol.
Lie: If You Lose Weight and Eat Right, Diabetes Will Be "Cured"
Truth: Losing weight, changing your diet, and exercising more are definitely the first steps to controlling your diabetes, because these actions decrease insulin resistance, making your body's cells respond better to insulin. And if you have mild or prediabetes, taking these steps might in fact cause your diabetes to go "dormant," says diabetes educator Eliot LeBow. But that doesn't mean your diabetes is "cured" and you can stop worrying -- it can come back at any time, given an opportunity. "And that's really important to know," says LeBow, "because it keeps you focused on monitoring where that diabetes is at."
Lie: Once You Have Diabetes, You're Going to Have Serious Health Problems
Truth: There's no question that diabetes can lead to a host of health problems. In addition to heart disease and stroke, diabetes can damage your vision and cause circulation and nerve problems that can damage your feet. However, if you keep a tight rein on your blood sugar and don't allow it to spike and drop, you can prevent these types of damage. Keeping glucose levels, blood pressure, and cholesterol on target also helps prevent heart attack and stroke, the two diabetes complications most likely to be fatal.
Lie: You Can't Eat Carbs If You Have Diabetes
Truth: Counting carbohydrates is important for people with diabetes, yes, but that doesn't mean eliminating them altogether. In fact, avoiding carbs can be unsafe for diabetics, says Jessica Crandall of the Academy of Nutrition and Dietetics. The brain needs carbohydrates, which it converts to glucose, as its energy source. The best plan: Figure out with your doctor how many 15-gram servings of carbohydrates you can eat a day. For many people with diabetes, it works out to about four times a day. It's best to prioritize carbs from whole grains, fruits, and vegetables and limit carbs from refined or processed sugar. Try to follow a set meal schedule, and eat approximately the same amount of carbs with each meal. The best trick is to choose carbs containing fiber (an orange rather than orange juice) and pair carbohydrates with protein (peanut butter with an apple, sardines with crackers). Both these strategies keep blood sugar from spiking.
Lie: Going on Insulin Means You've Failed
Truth: Because of the misplaced stigma about insulin therapy, many people with type 2 diabetes hold off taking insulin for far too long, when doing so would actually be the true sign of success. The goal when you have diabetes is tight blood sugar control, because high blood sugar is what leads to symptoms and long-term complications like vision loss, heart disease, and loss of circulation in the legs and feet. And if you aren't able to keep your blood sugar stable with diet and exercise alone, or with diet, exercise and oral diabetes medications, then you're doing your health a big favor by starting insulin. Diabetes is a progressive disease, and over time most people with diabetes will need to take insulin.
Lie: You Have to Eat a Special Diet If You Have Diabetes
Truth: One of the most common misconceptions about diabetes, this is also one of the furthest from reality. And experts worry about this myth, because it prevents people from seeking treatment for diabetes because they fear giving up their favorite foods. Here's the reality: The recommended diet for someone with prediabetes or diabetes is pretty much the same diet experts recommend for everyone. It features healthy fats like olive oil, plenty of vegetables (and some fruit), whole grains, lean meat, and nonfat dairy products. In fact, it's almost identical to the "Mediterranean" diet you've heard so much about.
But -- and it's a big but -- you'll need to monitor the amount of carbs you eat at one time to avoid glucose overload. (Furthermore, sugar allowances vary depending on the stage of your diabetes.) According to the American Diabetes Association, sweets aren't off-limits for most people with type 2 diabetes. If you have dessert, take away another high-carbohydrate food, such as bread with dinner. Same with alcohol: If you must have a drink, stick to a small glass of beer or wine, and cut carbohydrates from your meal to balance things out. Portion control is important -- a small slice of cake and no seconds, one small beer but no more Oktoberfest.
It's also not true that people with diabetes have to eat less. Actually, you want to eat regularly throughout the day -- at least three meals and several snacks -- to prevent blood sugar spikes and drops. Experts recommend eating at least every four hours, and that includes having a bedtime snack with staying power (like a handful of nuts or whole-wheat toast with peanut butter) to tide you over until morning.