Five myths about diabetes

Yet despite its prevalence and severity, misconceptions about diabetes abound. Here are five of the most persistent.

Myth No. 1: Only kids get Type 1 diabetes.

One myth is reflected (if only residually) in the name of a major advocacy group combating diabetes: The stated goal of JDRF, formerly known as the Juvenile Diabetes Research Foundation, is to help find a cure for Type 1 diabetes - which is still often called "juvenile diabetes," pegging it as an affliction of children and teenagers. This myth persists even within the medical community. One woman who developed Type 1 diabetes in her 40s wrote on the blog of the Diabetic Journey website that her severe flulike symptoms, frequent urination and intense thirst initially led to a misdiagnosis by her doctors of Type 2 diabetes "because of my age." The mistake led to an emergency-room visit.

But of the approximately 64,000 Type 1 cases diagnosed in the United States each year, less than half - about 27,000 - occur in people under the age of 20, typically when they're between 10 and 14. The other 37,000 are adults between 20 and 65. And it's not unheard of for someone in their 70s or 80s to receive a new diagnosis. 

Type 1 diabetes is an autoimmune disease that causes a person's body to attack its pancreas, destroying its ability to produce insulin, a hormone that regulates the processing of glucose. The only way to treat it is with insulin injections or an insulin pump. (With Type 2 diabetes, patients generate insulin but are resistant to its effects.) If untreated, Type 1 can cause the sometimes-fatal condition diabetic ketoacidosis: The body can't use the sugar in the blood, so it breaks down fats for fuel, generating dangerous acid levels as a byproduct. 

We still have a lot to learn about who develops Type 1 and why. Genes are an important risk factor, yet environmental influences, such as a viral or bacterial infection, probably also play a role.

Myth No. 2: 'Walmart insulin' is just as good as the expensive kind.

The price of the most popular types of insulin has roughly tripled in the past decade, inspiring politicians to explore policy solutions and people with diabetes to search for cheaper options. A vial of Levemir, one of the newer insulins, retails for about $380, and many people need more than one vial per month. In September, Minnesota state Rep. Jeremy Munson posted a video to Facebook showing himself purchasing a vial of insulin at Walmart for $24.88. "There's affordable options out there," he said. A blogger for FDAReview, a project of the libertarian Independent Institute, similarly argued that Americans should "Trust Walmart's Insulin to Save Lives."

But the insulins sold at Walmart are not the same as the modern insulins that people with Type 1 or Type 2 diabetes rely on. They're not worthless, but they aren't a feasible option for many people. 

Over-the-counter insulin has been around since the 1980s, when scientists first learned to program bacteria to produce human insulin. And while they are far better than the insulins extracted from cow and pig pancreases that they replaced, using them safely requires an incredibly strict diet and exercise regimen. (Imagine planning all your meals and snacks to have the same number of calories, never missing a meal, and exercising at the same time and level of intensity every day.) 

There are more than a half-dozen brands of modern insulins introduced in the 1990s and 2000s. These allow patients to eat late or skip a meal with fewer episodes of dangerous - and potentially fatal - low blood sugar. They're infinitely more forgiving when you're trying to live a normal life. But for reasons the pharmaceutical companies can't adequately justify, these drugs have become fearsomely expensive.

Myth No. 3: Eating sugar gives you diabetes.

Eating lots of sugar is bad for your energy levels and weight,says a column posted on the website Best Health Guide, but "what it's absolutely worst for, is your risk of diabetes." Meanwhile, a writer for Healthline who has the disease wearily reported hearing a co-worker joke, "I just ate so many cupcakes, I got diabetes."

Because monitoring sugar levels plays such an important role in managing diabetes, many people assume that sugar is also its cause. But as an autoimmune disorder, Type 1 diabetes develops as a result of genetic risk and an unclear trigger; it's not caused by eating sugar - or anything else.

The story for Type 2 diabetes is a bit more complicated. Obesity and inactivity play huge roles in the risk for the disease, but genetics are also a factor, even more so than for Type 1. Many people eat diets laden with fat and sugar but never develop diabetes because their pancreases are able to produce large amounts of insulin on demand; others are not so lucky. Too much sugar, per se, won't give you diabetes. But it can make you overweight, increasing your risk for Type 2. 

Myth No. 4: You can't eat sweet foods if you have diabetes.

"Avoid doughnuts, toasted pastries, and other bakery sweets," a Health.com column advises people with diabetes - and take a pass on melons and bananas, too. "Skip sugary foods like sweets and soda," says Everyday Health. Misconceptions about which foods are completely off limits for people with the disease - especially sweets - are so common that the website The Mighty helpfully suggests 26 snappy comebacks for when others offer uninformed "advice."

Granted, eating too many sweets isn't a great idea for someone with diabetes - but it isn't good for someone without diabetes, either. 

People with Type 1 or Type 2 already pay close attention to their blood sugar levels, monitoring such things as sugar intake, carbohydrate content, total calories, exercise levels and insulin administration. When you're doing all that, the occasional large dessert is fine. If you take insulin, you'll take a bit more to offset the chocolate cake. If you take medication, like metformin, to manage Type 2, a walk around the block might suffice. 

It turns out that fat, not sugar, is what really makes blood sugars hard to control for many people with diabetes. In my clinic, when I see a high blood-sugar reading from a patient whose numbers are usually in the normal range, my first question is whether they had pizza or Chinese takeout the night before. 

Both are high-fat, high-carbohydrate meals that make for a challenging combination for someone with diabetes: Fat slows the absorption of the carbohydrates and increases the body's insulin resistance, raising blood sugars. The slow food absorption throws off normal insulin timing; the result is often low blood sugar levels (as the insulin kicks in before digestion) followed by high blood sugar levels (as the insulin wears off while the carbohydrates from the meal linger).

Myth No. 5: You can treat Type 1 diabetes without insulin.

There are endless dubious stories about people with Type 1 diabetes who manage, through some dietary trick, to avoid the need for insulin. In 2016, the website Diabetes.co.uk reported on the case of a 9-year-old Hungarian boy who supposedly avoided insulin injections for 24 months by following a "paleo" diet that "consisted only of animal meat, fat, offal and eggs." In 2007, there were reports that Halle Berry had reversed her Type 1 diabetes with a healthy diet ("I've managed to wean myself off insulin," the actress said).

But when you hear of someone with Type 1 who doesn't need insulin, invariably they've either just been diagnosed - or have been misdiagnosed or are confused about which type they have.

People with newly diagnosed Type 1 diabetes can sometimes come off insulin soon after their blood sugars are brought under control. This is what's known as a "honeymoon period," in which patients can keep their symptoms largely in check through diet, weight loss and exercise. In some cases, the honeymoon period can last months or (rarely) years. But this isn't a reversal of their condition: The patients have just reduced the burden placed on their weakened pancreas. Inevitably, they will end up back on insulin as their immune system continues to attack their pancreas.

The other "cured" group are the misdiagnosed. Berry, for instance, still says a keto diet helps her diabetes, but she has since clarified that, in fact, she has Type 2. Since people with Type 2 diabetes can produce insulin, it's not surprising if they don't need an external supply.