Diabetes Mellitus Type 2 (2DM) accounts for over 90% of diabetes worldwide, with about 1 in 10 Americans having the condition. One might say it’s endemic. So as healthcare workers, we not only need to understand the disease and know how to identify early risk factors, but we also need to be aware of the myriad of misconceptions and myths surrounding the condition of which many healthcare workers practice medicine. So before you slap that pancake and maple syrup out of your patient’s hand and make an angry phone call to dietary, sit back and read through some of the common myths, learn the counter truth to those myths, and recognize ways nurses and other healthcare workers can bring awareness to the condition and help.
Type 2 diabetes, the short and sweet.
Need a crash course? 2DM is caused by insulin resistance. Let’s break it down. When you eat food, your body digests it and converts it to sugar. Sugar enters the bloodstream, where it hollers at your pancreas to make some insulin so that the sugar in your blood can drive over to the cells needed for energy. Insulin can even help your liver store sugar for later, like when you miss lunch working a 12-hour shift.
Insulin resistance occurs when you have so much circulating sugar in your blood, and the pancreas tries to keep up by making more insulin. And just like an overworked nurse after 4 shifts in a row, the pancreas makes terrible decisions. It produces insulin that is not top-of-the-line, so your cells ignore it. Your blood sugar continues to rise as well as the levels of insulin in your blood. Lots of circulating sugar is terrible for your body and needs to go somewhere, so your body stores it as fat.
2DM is diagnosed with the glycated hemoglobin test, known as hemoglobin A1C. A hemoglobin A1C measures the amount of glucose attached to A1C in your red blood cells. Remember, blood sugar levels rise with insulin resistance, which means more blood sugar will be attached to the A1C molecules. Fasting blood sugars are ok but can overlook a diabetes diagnosis if someone decreases their intake over a few days. A1C gives providers and nurses a better picture of a patient’s day-to-day blood sugar levels. Here are the diagnosis guidelines for a hemoglobin A1C,
- Below 5.7% is normal.
- 5.7% to 6.4% are diagnosed as prediabetes.
- 6.5% or higher on two separate tests indicates diabetes.
So now that we’ve reviewed 2DM basics let’s look at some of the myths and misconceptions we as healthcare professionals have. I asked my network for the top 5 most common misbeliefs regarding 2DM and curated the myths and the truth, so we can better educate and care for our patients.
Pour some sugar on me.
Let’s start with the most common misconception: sugar is bad. A patient has 2DM, so they must refrain from all sugar intake. We are nearing the holiday season where (at least in my house) candies and cookies abound. When I put myself in my patient’s proverbial shoes, how bummed would I be if I couldn’t have a Christmas cookie? The answer is super bummed, and even more, I would probably disregard the instructions and eat all the cookies and candy.
So what is the truth? Thankfully scientists are making huge advancements in what we know about sugar and its effect on diabetes. And what they’ve discovered is that it’s really about the carbs. Mayo Clinic gives two simple recommendations for diabetes when it comes to making room for dessert:
- Replace some of the carbohydrates in your meal with sweets. So skip the potatoes so you can have a slice of pumpkin pie.
- Replace a high-carb food with something with fewer carbs so you can account for the sweetness. Having a slice of bread and fresh fruit? Remove those from your meal, eat more leafy greens and protein, and enjoy your dessert.
It’s all about balance. Sugar is not bad and, in moderation, can be enjoyed if you have 2DM. Let’s not sugar-shame our patients this holiday season but give them practical tips to have their cake and eat it too.
Just say “no” to carbs.
Similar to sugar, western society tends to be carb haters. Numerous fad diets are centered around removing all carbs from your diet – yeah, I’m talking to you, keto. Carbs are either complex or simple (like my husband and me; I am complex, and he is simple). As humans, we tend to err on simplicity, yet when it comes to carbs, it’s all about complexity.
Complex carbs have more fiber and are nutrient-dense. They are also recommended for weight loss because the slower digestion process keeps you feeling fuller for longer. A few examples of complex carbs are quinoa, whole grain bread, oatmeal, legumes and beans, and high-fiber vegetables and fruits (fact: any fruit that starts with a P has lots of fiber. Get it? P for poop). Simple carbs are processed and refined foods like sodas, sweets, chips, and fruit juices. These are easy to digest and cause a quick burst of energy followed by a dramatic drop, which might entice you to eat more.
Remember, carbs are an essential part of a healthy diet; regardless of diabetic status, humans need them. Encourage patients to eat complex carbs and help them identify which carbs are complex. Teach them tricks to swap out simple carbs for more complex ones. For example, high-fiber multigrain pancakes are ok and actually good for you. You can also teach them how to count their carbs. Here is an excellent refresher from the CDC. So whether you’re a bedside nurse, provider, or nurse aide, it’s important to remember that all carbs are not created equally.
Losing weight is easy.
Being overweight or obese can be controversial as it relates to diabetes. Since being overweight or obese is a risk factor for 2DM, the assumption is that patients can simply lose weight, and their diabetes will go away. In fact, have you ever had a patient swear to you they are monitoring their calories and exercising, but they just can’t lose weight? Well, there is some merit to what they are saying, and it can be a frustrating negative feedback loop patients become stuck in.
Let’s go back to the basics. Remember, 2DM is caused by large amounts of circulating sugar and overproduction of insulin resistant to being used. So what happens when large amounts of insulin circulate in your body over a long period? Lots of things, but one is weight gain. If you’ve ever worked with newborns, you probably know that mothers with gestational diabetes tend to give birth to large babies, and that is because insulin is a growth hormone. If your patient is newly diagnosed with 2DM or their 2DM is uncontrolled, losing weight can be a struggle. So if you have a patient struggling to lose weight, ensure they’ve been screened and tested for 2DM.
The hesitation with gestation.
Gestational diabetes (GDM) occurs during pregnancy and is believed to follow similar pathophysiology as 2DM, occurring in almost 10% of all pregnancies in the US. GDM is technically not 2DM, but it is a variation, and many healthcare professionals wrongly believe that once the mother delivers the baby, there is nothing to worry about. But this is simply not the case. Patients with GDM have a higher risk for 2DM later in life. In fact, pregnancy is thought to be a futuristic window into the health of our patient’s future. Not only should patients with a history of GDM be tested every three years, but they also need to know the risk doesn’t end after delivery. A systematic review and meta-analysis from July 2021 found that rates of 2DM after GDM are as high as 70% up to 28 years after delivery. It’s essential that healthcare professionals not only screen patients after delivery, but we also need to ensure patients know their long-term risks.
Many clinicians fall prey to the myth that 2DM is reversible, so treatment isn’t urgent. A friend of mine, a Family Practice NP, recently counseled a patient with prediabetes who had a hemoglobin A1C of 6.1. As she discussed the patient’s status, she discovered the patient was hesitant to take medication. My friend agreed that the patient could give her body time to reverse her pre-diabetic state with diet and exercise.
While diet and exercise are great, my friend’s sponsoring physician reminded her of the importance of preserving the pancreatic cells in prediabetes. He informed her we must be more aggressive in treatment, even with prediabetes. 2DM is not reversible; unless you are morbidly obese, the lifestyle changes made with diet and exercise are not likely enough, and eventually, 2DM will manifest. Medications like Metformin are integral in treating pre-diabetics and preserving the beta-cell function of the pancreas.
Giving patients time to adjust their diet and incorporate exercise is always a good care plan. The main takeaway and learning point is that for many patients (some research says most), lifestyle changes will not be enough, nor will they be sustainable.
Type 2 diabetes is highly prevalent and regardless of what area of healthcare you work in, you will interact with patients living with or at risk for 2DM. It’s important to not only educate yourself but also to know how to share that information with patients in a way they will understand. For American Diabetes Month, make a commitment to stay informed and to share accurate information, and maybe one day, we will live in a world with less diabetes.