Fat And Diabetic (No Relation)
Our guest post today comes from the delightful Sara, who writes in with a question for all our readers:
I am fat. I have diabetes. The two are in no way related to one another. Interesting how that works, huh? I have type 1 diabetes, so my pancreas is going to be dead regardless of what the number on the scale says, regardless of what I eat or don’t eat, and regardless of whether or not I exercise. Being healthy is just as good for me as it is for anybody, but my diabetes is here to stay. Even if I was type 2, as Rachel points out, it probably wouldn’t be due to my weight, but to genetics.
Here’s where the problem comes in. I love reading all the blogs in the fatosphere, and they have helped me change my body image 100% over the last few months. I am also somewhat active in an online diabetes community, TuDiabetes. The two communities aren’t meshing well for me lately, and I often find threads on the discussion boards where people talk about how they need to lose X amount of weight, or posts where people beat themselves up for eating a bag of chips, or posts where people are told by a doctor to lose weight in order to cure their diabetes. It’s hard to talk about fat acceptance in a community that has been told by the medical establishment that losing weight will cure their diabetes will go away, and where people whole-heartedly believe that their success in managing their diabetes is related to how much weight they can lose.
This is especially disconcerting because weight gain is a side affect of good diabetic control. It also places the emphasis on managing weight, when that emphasis should be placed on learning to balance carbohydrates and insulin.
How do I respond to this misinformation and obesophobia?
Posted by mo pie
Filed under: Advocacy, Guest Post, Health, Personal, Question, Science
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This is a tricky subject because for some people, weight and diabetes are intertwined. You must inherit the genetic predisposition, but environment can act as a trigger for some people in the development of the disease.
I think many people see weight loss as code for healthy eating – if you eat healthy, you must be thin, right? Sigh. I think your emphasis should be on exactly what it is you write about in your last paragraph. And I really encourage you to promote Health at Every Size, which encourages an appreciation of body size diversity and intuitive eating.
There will continue to be people who believe in and promote weight loss, but maybe you might give at least a few people food for thought.
This is a difficult subject because so much of it is misunderstood.
I believe that there is a connection between obesity and diabetes, but the medical establishment has the connection backwards. I believe that the diabetes actually causes the weight gain.
We know that persons with insulin resistance produce less energy in their cells than non-insulin resistant persons long before they ever become symptomatic. While the doctors are telling us that the lifestyle is driving the disease, it’s much more likely that the disease is driving the lifestyle.
I must admit, though, to not knowing how this works in those with type 1 diabetes, as only one person in my family ever had that (a distant cousin). Type 2 is the disease of choice among both my extended families. I do know, though, that insulin is involved in burning fat, so it makes sense that if you have insulin issues, you are going to have problems with weight control.
The problem is getting this information to people whose only knowledge of their illness is what they get from their medical practitioners and the general media, which is that being obese causes diabetes.
I do encourage you, though, to speak out about what you know to be truth. Encourage people to live a healthy lifestyle and leave weight out of the equation. Fixating on weight will just bring down self esteem and cause an unhealthy relationship with food, which we all know is the worst thing that can happen to someone with diabetes.
It sounds to me that Sara should look for an online community aimed specifically at people with type I diabetes, as the two types of diabetes are very different in their etiologies and treatments, and type II is by far the more common type.
The problem is, although Type II is the one always associated with being fat, it seems the medical community as a whole is also beginning to lump Type 1 with fatness as well, and they give the old standbys of eating right (but eating right means different things to different people), and exercise.
Maritizia is right when she says you just have to educate people on living a healthy lifestyle without the focus on weight, which is health at every size basically. I’d also continue to challenge the medical community’s blind mindset on fat = diabetes. This is not always the case. Diabetes does not discriminate when it comes to weight.
My mom had Type 1 and while she was never obese, she certainly had ups and downs on the scale and I know weight was a topic of conversation at the doctor. I also suspect sometimes she eased off on the insulin to lose a few pounds, which you surely know is a dangerous thing to do.
I think it is possible to have both Type 1 and Type 2, to add insult to injury. But they really are two separate diseases, certainly with similar symptoms, but very different causes and treatments. As long and you and your doctors think you are doing well, you can’t let other people’s input wreck your mindset.
This is the long way of saying that I also think you should look for a diabetes support network that focuses more on Type 1. I know the ADA (diabetes.org) has some chat boards just for people with Type 1; I don’t know if they’re very helpful, but surely there are more out there, too.
Good luck– I suffer from some intractable back/hip pain caused by mild scoliosis and some past sports injuries (sustained when I was thinner!), and while losing weight would perhaps help, I get tired of hearing that it would just be a miracle cure for all my problems.
I’m sorry that some folks are responding to your post telling you to go away and join a type 1 diabetes community. From my reading of your post, you were asking how to respond to fatphobia among diabetics.
The only way I have found to respond to fatphobia among any people is to keep pointing out the flaws and misinformation in what they say, exactly as you do here, and to point out assumptions that people make that aren’t well supported by science, as you do here.
And although I think doing this is very important, it’s hard because generally you get a lot of criticism heaped on what you say, and you don’t really see direct results of your work.
I think there are results, but they are more of the variety that Mahatma Gandhi talked about when he said “First they ignore you, then they laugh at you, then they fight you, then you win.”
[Note, I am not comparing fat oppression with the struggle of Gandhi and his followers. I just think that particular quote is relevant to both.]
I am also a Type 1 diabetic involved in the online type 1 community. I am not fat, but I find FA fascinating, and so it’s interesting to see a post on the intersection of the two communities.
Diabetes advocacy and fat advocacy have a lot in common. I think there is a general effort to let go of the “good” and “bad” labels food gets in a diabetic world (sugar free jello = good, cake = bad; those are completely meaningless and generally psychologically harmful labels). There is a lot of guilt associated with food as a Type 1 diabetic, not because of a food’s impact on weight, but because of a food’s impact on blood sugar. This is psychologically unhealthy for the same reasons diet- and fatness-related food guilt is unhealthy. There is a lot of misinformation among the population at large, particularly about T1 diabetes, and people have very little compunction when it comes to sharing their opinion on what you’re supposed to eat (“…shouldn’t you not eat that? You have diabetes!” — this phrase sends me into frothing fits of rage). It doesn’t help that 90% or so of the diabetic world has Type 2 diabetes, meaning that the population at large and doctors in particular try to share an opinion on your disease (…which is none of their business) that is based on questionable knowledge about a completely different disease (Medical anecdote: very few large-scale studies are done for Type 1 diabetics. Most doctors will tell their T1 patients that they should get their LDL under 100, thus requiring medication, even though the only study that has every indicated any potential benefit to anyone on statins was done on Type 2 men in their 50s who have already had heart attacks. In other words, a different age bracket of people who are a different gender than I am who have a COMPLETELY DIFFERENT DISEASE were helped by a medication, and thus I should take it. Right. That’s science, right there). It is very hard to get good medical care as a T1 diabetic. Our concerns thus overlap in certain important respects.
That said.
I think you’d be hard-pressed to disassociate Type 1 diabetes and food. Type 1 diabetes lends itself to food pathology more than any other condition/state of being, including “overweight.” The blood sugar and the A1C are the end all, be all, and the food (more specifically, the carb content of the food) is what makes the blood sugar change. So just about any Type 1 diabetic can either rattle off the carb content and serving size of basically any food out there or can intuitively avoid foods with carbohydrates in them (…my approach) to avoid having to know the carb content or insulin/carb ratio. It’s a disease whose care revolves around careful control and understanding of every bite of food that goes into one’s mouth. Whether or not weight is a concern for a type 1 diabetic, food always is, and always will be. Insulin, of course, is known to increase weight, so weight can’t be removed from the picture in terms of understanding a T1’s relationship with food, but I think, more than weight, control is what modulates a T1’s food obsession. In my mind, this goes a long way to explaining why the percentage of T1 women with anorexia is so much higher than in the general population: when all your life revolves around controlling your food intake, it can kind of take on a mind of its own.
My verdict, depressing though it may be, is that I don’t know if it’s possible to be a controlled type 1 diabetic and also have a classically healthy (by the intuitive eating standard) relationship with food. I don’t think it’s possible to control T1 diabetes without considering the implications of weight gains or losses on diabetes care (I lost a bunch o’ weight when I took control of my blood sugar: my insulin sensitivity sky-rocketed. I had to think about this in my daily life so as to not take a truckload of insulin and accidentally kill myself with hypoglycemia). I also think that the concerns of the T1 population and the FA population have a lot of overlap, but I don’t know if it’s possible to get as far in changing attitudes towards food in the T1 community, because they are so intertwined with diabetes care.
I don’t think that the community is as miserable as you describe it, though: most of the T1 blogs I read tend to focus on blood sugar control and not weight. I have noticed the trend you mention on TuDiabetes specifically, but it’s worth mentioning that TD seems largely dominated by T2’s, who have a whole different can of pathologies dumped on their brains by the obesophobic medical community. I think focusing in your discussions on blood sugar control is the best way to go about addressing the misinformation that exists, but I really don’t think you’re alone in your focus on glucose control.
Anyway, I’m just kind of musing aloud. Sorry if this comment is a bit disjointed.
While I think gaining weight may add a little to insulin resistance, genetics is the basic cause. IME high glucose and insulin levels in the blood can add more resistance than gaining weight does.
I know reducing my glucose and insulin levels reduced my resistance a great deal. The substantial weight loss (~70lbs) following that seemed to make no difference at all.
Also, no matter how high your insulin resistance or how fat you get, you can’t develop diabetes of any type unless your pancreas is compromised in some way, usually genetically.
For anyone who wants to read more about Type 2 diabetes.
http://www.phlaunt.com/diabetes/index.php
“I’m sorry that some folks are responding to your post telling you to go away and join a type 1 diabetes community.”
I don’t think anyone said that, Stef, and I think that interpretation is kind of inflammatory. Just in case Sara interpreted anything said above that way, I for one welcome her to the comments (the only place I can stake a claim at BFD) and encourage her to seek meaningful peer support anywhere she can find it and especially here.
Sara, speak out and provide information. You have every right to share an opinion, especially if you have the research to back it up.
Thanks, everybody, for some great ideas.
@Rachel – Any particular HAES site you would recommend linking to in some of the forums?
@ Maritzia – I think C hit it right on the head by mentioning that diabetics (especially young type 1 women) have a much higher rate of ED than the rest of the population. We are pretty much forced to have such an intimate relationship with food that it often turns sour. There are still things I refuse to eat flat out because of my diabetes (pancake syrup being one of them).
@ La Wade – I do read some blogs of T1s, but most of the communities are open to both T1s and T2s. The two get conflated so much that we end up inhabiting the same online spaces. Also, some of us share a lot in terms of treatment (especially the insulin-using T2s), which is why some of the comradery makes sense. We know the differences between our diseases, even if the news media lumps us together constantly.
@Bree – I have been lucky enough that most of my doctors (and I see a lot of them) focus on my blood sugar numbers rather than my weight. But I fear the day when they start hounding me to lose a few (or many) pounds.
@Andrea – It’s very possible your mom used insulin to manipulate her weight. The most common ED among T1s is to stop taking insulin, which in essence starves the body (and does all kinds of nasty things to your vital organs).
@Stef – I think the others meant leave TuDiabetes, not the FA community. Just to clear that up…
@C – I agree with most of what you said, and thank you for clearing up the studies on T1 and cholesterol. My doc just put me on a statin as a “preventative measure” since my numbers are high “for being a diabetic,” and at the age of 22 I refuse to start taking one more goddamned pill that I will have to take for the rest of my life. In regards to T1 web sources, the blogs that I read are mostly written by women, which means that they stress about weight in female-typical ways, especially when it comes to fitting into wedding gowns and such. The main focus is blood sugar control, but fear of gaining tons of weight is definitely a present theme.
@ginger – Thanks for offering support your support! It’s FA’ers like you that have contributed to me feeling so much better about myself since I made a New Year’s resolution to not lose weight. :-)
To continue the (completely tangential) cholesterol discussion: I’m 23, and told my doctor the exact same thing about the statin. “High for a (type 2!) diabetic” means an LDL above 100. “Perfect” for everyone else is below 130. IT IS IMPOSSIBLE TO GET AN LDL BELOW 100 without medication.
I’m not a doctor, obvs, but I raised my eyebrows through the roof at that one. And said “Thank you, but no thank you.”
I told her that when she found me a study on Type 1 diabetics that showed a statistically significant effect of 40 some-odd years of taking a statin on my life expectancy, then we could talk.
I think doctors think I have an attitude problem.
My LDL hasn’t been over 70 and they still want me to take a statin, no thanks.
I write a blog about my life with Type 1 diabetes (see link), and I’m a fellow fattie!
I think when diabetes comes into play, you are guaranteed to have people freaking out over their weight, especially type 2’s who have been told their weight is the only reason they have the disease. I have seen people on different message boards who were so determined that their type 2 could be controlled with diet alone, they were pretty much obsessed. Honestly, sometimes you just NEED medication, whether you eat well or not.
And because of the way diabetes is talked about in the media, those of us with Type 1 (which is an autoimmune disease) face even MORE weight discrimination, I think. If you tell someone you have diabetes, it sometimes becomes a daily dialog of “can you eat that? maybe if you stopped eating that your diabetes would go away. my aunt ethel cut out sweets and she’s cured! how many pills do you take every day? I’ll bet if you lost 20 pounds…” Those of us with diabetes KNOW that’s wrong, but the media plays up diabetes as such a “fat person’s disease”…really, it could be any person’s disease.
Try starting a fat acceptance thread (or threads) on TuDiabetes. Talk about what concerns you regarding the way others talk about their diabetes. You can’t change any minds if you just watch others talk about their food obsessions, though it is a little difficult to NOT obsess over food when you have to worry about how much insulin you need for every other morsel you feel like popping in your mouth, whether that’s a healthy salad or a giant brownie.
Note to the BFD crew: I am linking to this post at my own blog today for a related post! :)