Is Type 2 Diabetes Your Fault?
I recently got an irate letter (yes, an actual letter that was delivered by a mail carrier) from a man who said his wife had recently been diagnosed with diabetes and it’s all her fault.
He said he’s been telling her for years that she had to lose weight and exercise more but she didn’t do what he told her to do, so getting diabetes is all her fault. And he complained that I said in my book The First Year: Type 2 Diabetes that getting diabetes is not your fault.
I tried to explain what I meant, to no avail. But just in case some other people are confused about this issue, let me explain.
First, it is true that losing weight and exercising more will reduce your risk of getting diabetes. But it’s no guarantee. Sometimes people who aren’t overweight and who exercise a lot still get type 2 diabetes. Other people can be very overweight, even obese, and not get any exercise and they’ll never get diabetes.
In order to get type 2 diabetes, you need two different things. First, you must have insulin resistance (IR). Second, you must have beta cells with a genetic defect that won’t allow them to overcome the IR.
Some of your IR is genetic, some people estimate up to 50%. It’s not your fault if you have a lot of genetic IR. But even if you inherit a lot of IR, if you have strong beta cells that are able to grind out a lot of insulin to compensate for the IR, you won’t become diabetic, although you may put on a lot of weight because of the IR.
(Whether weight gain causes IR or IR causes weight gain is controversial. I think both are true, causing a vicious circle. You put on a little weight and your IR increases. The increased IR makes you put on more weight, and this increases the IR even more.)
If you’ve inherited beta cells that can’t cope with increased IR, this is not your fault.
Finally, many people who have weight problems, especially lifelong weight problems, seem to have defects in their appetite controls. Normally, when you’ve eaten enough food, you feel full. Some people never feel full.
The most extreme examples of this are the few people in the world who don’t produce any leptin, a hormone that is supposed to turn off your appetite when you’ve eaten enough. Little babies and toddlers with this condition are constantly ravenously hungry and will eat anything they can get their hands on. They become grossly obese as toddlers.
But if you give these children leptin, they immediately stop eating a lot and lose weight with no effort. Clearly, their overeating was not caused by some kind of moral failure or low self-esteem. They inherited a biochemical defect.
Now, if you’ve inherited a milder form of a defective appetite control, it is true that if you ate less all your life, you wouldn’t gain as much weight. But you’d spend your life feeling as if you were starving. And not eating food that is available when you’re starving is considered a form of torture. In fact, it’s often used to torture people.
So when I say that getting diabetes is not your fault, I don’t mean that people who are prediabetic should not attempt to lose weight and get more exercise. That may help keep them from progressing to type 2 diabetes. Similarly, the same things may help people with early type 2 to reduce their IR to the point at which their wimpy beta cells are able to cope, so their blood glucose levels will remain in the normal ranges.
What I mean is that for people with inherited IR and inherited wimpy beta cells, overcoming those genetic defects may be an almost impossible task, especially in a world in which almost everyone else is overworking (no time to cook good food or to walk 5 miles a day), overeating, and underexercising.
It’s not your fault that you faced these extra challenges. Perhaps saintly people could overcome them. But most of us aren’t saints.
Telling someone that getting type 2 diabetes is their own fault is like telling a 4-foot-tall man that it’s his fault he didn’t make the basketball team. An extraordinary person that size might be able to make the team despite the handicap. But most of us aren’t extraordinary.
Do what you can to control this disease. But don’t listen to people who try to blame you for getting diabetes.
Gretchen wrote for HealthCentral as a patient expert for Diabetes.