Diabetes: Myths And Realities

Dr Sarita Bajaj,
MD(Medicine),
DM(Endocrinology, AIIMS),
Associate Prof Medicine,
MLN Medical College, Allahabad.

Many myths exist regarding all aspects of diabetes and they are very important from the point of view of treatment as they often come in the way of compliance.

1. Excessive intake of sugar and sweets causes diabetes. Not So
No scientific data supports this statement. However overeating (of especially sweets) may lead to obesity which can certainly unmask diabetes in those who have a tendency to develop it. So those with a strong family history should try to maintain their ideal body weight by good wholesome diet and regular exercise.
2. Presence of urine sugar confirms diabetes. No
Blood glucose testing is mandatory for diagnosis, never urine glucose alone. Diabetes may be diagnosed by (1) symptoms of diabetes plus a casual plasma glucose concentration of 200mg/dl or greater (2) fasting plasma glucose of 126mg/dl or greater. These criteria should be confirmed by repeat testing on a different day.
3. Hyperglycemia is invariably symptomatic. No
Patients with very high blood glucose values may be totally asymptomatic. Diagnosed diabetics represent only the tip of an iceberg. The majority are undiagnosed. So have your blood glucose tested at regular intervals irrespective of whether you have any complaints or not.
4. Diabetes is infectious. Not true at all.
It is multifactorial in origin.
5. Rice is prohibited in diabetes. No
Rice and wheat are similar types of carbohydrate and they can easily be interchanged.
6. All carbohydrates are to be avoided in diabetes. No
This is not only incorrect but dangerous too. Glucose is required for energy production by all, including diabetics. In case carbohydrates are completely curtailed energy production will be carried out from fats and this will result in production of ketones (Ketosis) which are toxic to the body. Ketosis may be fatal.
7. Fasting is useful in diabetes. Wrong
Fasting is prohibited in diabetics especially those on medication (Insulin or tablets). Fasting, if coupled with anti-diabetic treatment may lead to hypoglycemia- a state of low blood glucose. In case one keeps a fast without antidiabetic treatment blood glucose is liable to rise and if the fast is prolonged ketosis may result.
8. Honey cures diabetes. Not So
Honey, jaggery (gur) and sugar are prohibited in diabetes.
9. Fruits are harmful in diabetes. Incorrect
In fact fresh fruits are always recommeded in diabetics. The rule is one fruit a day on an exchangeable basis. As far as possible fruits should be taken whole (with peel) which will increase the fiber content and thereby keep diabetes in check.
10.Walking barefoot is good for diabetes. No
Walking is the best exercise for a diabetic, but never barefoot. Diabetics are prone to loss of sensation of feet and ulceration which takes a long time to heal. Gangrene may result resulting in amputation.
11. Oral hypoglycemic agents (drugs used to treat diabetes) are habit forming. No
Drugs should be prescribed once diet and exercise therapy together are not enough to control diabetes. They are given in addition and not as replacement for diet and exercise. They may be mandatory and required for lifetime in certain diabetics, while others may need them intermittently.
12. All the oral hypoglycemic tablets are the same and may be interchanged. Never
Many patients change their tablet if a particular tablet is not available for any reason. This too is not only incorrect but may be dangerous as most medicines have different onset and duration of action and are prescribed under different sets of conditions.
13. Additional tablets/insulin may do after a dietary indiscretion. Never
Many patients take an extra half to one tablet with a feast hoping that the irregularly committed during the party may be covered. However this will lead to erratic sugar control with swings of hypoglycemia and hyperglycemia.
14. Drugs should be stopped during illness. Incorrect
Drugs and diet should be continued during an ailment. As a matter of fact requirement of drugs during any other disease may actually increase. Depending on the severity of illness one may have to be switched over to insulin for a short period.
15. Once on insulin always on insulin. Incorrect
Insulin is mandatory in type 1 diabetes (also known as insulin dependent diabetes) and has to be taken for life. Type 2 diabetics, however (or non insulin dependent) do well on oral hypoglycemic agents, but require insulin temporarly during surgery, trauma, pregnancy or any major illness. They may however need insulin on a long term basis if they develop drug failure in the absence of any of the above condition.
16. Insulin is available in the form of tablets. Not Yet
Insulin delivery has improved, but it has to be taken by injection.
17. Insulin induces hypoglycemia which may be fatal. Yes and No
Once insulin is started patient education is mandatory. If the patient is informed about hypoglycemia he will learn to recognize it and manage himself. Hypoglycemia may be serious that is why insulin should be started under supervision and increased gradually with regular blood glucose monitoring to achieve euglycemia. The patients relatives are also informed and they should not get worried in this situation as it is rarely fatal if recognized in time and can be easily treated. Fatal hypoglycemia is known to occur with oral hypoglycemic agents too, which patients are bissfully unaware of.
18. Cure of diabetes is possible in other pathies. No
Diabetes is incurable in any pathy. Patients should not accept any tall claims without scientific evidence otherwise they may harm only themselves. The mainstay of treatment is diet control and regular exercise. Blood glucose levels may stay normal for an indefinite period by this regimen. That does not mean that diabetes is "cured" because it is a life long disease. It can only be conquered not decimated.