What’s in a name? A rose by any other name would smell as sweet. But when we are talking about diabetes, we should choose names that make sense. The French do. They use the term “thin diabetes” (diabète maigre) to refer to a catastrophic disease that results from failure of the pancreas. They use the term “fat diabetes” (diabète gras) to refer to a milder, curable cause of high blood sugar. Fat diabetes tends to occur in overweight people, and it’s made worse by fat in the diet.
When people talk about diabetes, they almost always mean diabetes mellitus, which is sometimes called sugar diabetes or just plain sugar. Diabetes insipidus is an unrelated condition in which the body can’t conserve water.
The most obvious symptom of untreated diabetes mellitus is excessive thirst and frequent urination. The word diabetes came from the Greek word for siphon, because water seemed to pass right through these patients. Their urine was loaded with sugar. Because they were losing calories through their urine, they tended to lose weight.
By the 1870s, doctors in France divided diabetes mellitus into two categories. Thin diabetes was a relatively rare but catastrophic, incurable disease that tended to happen in children and young adults who tended to be thin to begin with. These patients rapidly went into a coma and died, regardless of treatment. At autopsy, it was often clear that something had gone wrong with their pancreas. In contrast, fat diabetes was a common, relatively mild condition that tended to happen in middle-aged to elderly adults. It could be cured if the patient ate less and exercised more.
English-speaking doctors didn’t like the terms thin diabetes and fat diabetes. Instead, they used the terms juvenile diabetes and adult-onset diabetes. These terms are misleading because “juvenile” diabetes can strike adults, and “adult-onset” diabetes can occur in an overweight child. After the discovery of insulin in the 1920s, English-speaking doctors started to refer to thin diabetes as insulin-dependent diabetes mellitus and fat diabetes as non–insulin-dependent diabetes mellitus. People with thin diabetes would die without insulin therapy. In contrast, patients with fat diabetes often responded poorly to insulin therapy.
Now that so many people with fat diabetes are taking insulin, it’s confusing to refer to their condition as non–insulin-dependent. Instead, American and British doctors now refer to thin diabetes as type 1 diabetes. Fat diabetes is called type 2 diabetes. Unfortunately, these names are meaningless to the layman.
In the 1930s, a British researcher named H.P. Himsworth found that he could induce a condition that resembled fat diabetes in healthy volunteers by feeding them a high-fat diet for only a week. After a week of eating a high-fat diet, the volunteers were given a glucose tolerance test. This meant that they were given a dose of glucose in water and had their blood sugar measured every 15 minutes for several hours. When the volunteers had been eating a fatty diet for a week, they got a huge spike in blood sugar after drinking the glucose; but when they’d been eating a starchy, low-fat diet for a week, their blood sugar levels stayed low and stable after they drank the glucose. Himsworth’s review of these experiments was published in the British Medical Journal in 1940 .
When I talk to people who have fat diabetes, they typically don’t remember whether their diabetes is type 1 or type 2. Some of them have been taking insulin at least occasionally, so the term non–insulin-dependent makes no sense to them. Most of them have been told that they have to cut back on eating carbohydrates. Unfortunately, that means eating lots of protein and fat instead. Tragically, that also means that they are injuring their already damaged kidneys with the overload of waste products that come from burning protein for energy. It also means that they are probably making their insulin resistance worse, by eating too much fat.
One solution to this madness is to start using the term fat diabetes to refer to type 2 diabetes. The second solution is to shift the focus in the management of type 2 diabetes. Instead of telling patients to avoid eating carbohydrates to avoid blood sugar spikes, shouldn’t doctors be teaching their patients to shift to a low-fat, high-carbohydrate diet to restore their natural sensitivity to insulin? As the results of Himsworth’s studies suggested, clinical studies of a high-carbohydrate, low-fat diet have shown great success in helping people with fat diabetes shed pounds, control their blood sugar, and reduce or eliminate their need for prescription drugs [2,3].
One warning: If you have diabetes or any other health problem or are taking prescription medication, talk to a diabetes educator, registered dietitian, and your prescriber before making any major change in diet.
1. Himsworth HP. Insulin deficiency and insulin inefficiency. Br Med J 1940;1:719-722. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2177399/pdf/brmedj04143-0003.pdf
2. Barnard ND, Cohen J, Jenkins DJ et al. A low-fat vegan diet improves glycemic control and cardiovascular risk factors in a randomized clinical trial in individuals with type 2 diabetes. Diabetes Care 2006;29:1777-1783. http://care.diabetesjournals.org/content/29/8/1777.long
3. Barnard RJ, Jung T, Inkeles SB. Diet and exercise in the treatment of NIDDM. The need for early emphasis. Diabetes Care 1994;17:1469-1472. http://www.ncbi.nlm.nih.gov/pubmed/7882819?dopt=Citation