The standards for care do start with lifestyle changes. An adult in the US who presents with pre-diabetes will be given counseling on diet, exercise and stress management. Depending on the insurance situation, they will be referred to a whole host of specialists.
The reality is that the vast majority of people fail to make the necessary changes and will ultimately require insulin therapy in some form.
This is the correct answer. And the conspiracy baiting on this is Shameless. A lot of people simply don’t or won’t change their lifestyle. And that in large part means lots of carbohydrates. I have people in my family who’ve largely cut out carbohydrates. It’s very hard and very inconvenient. There’s very few places we can go fast food wise that they can actually eat much of any of it. Cooking at home means cooking a small separate carbless version for them. It’s a massive disruption to most people’s lifestyle and not at all easy. Everyone whether on insulin or not would benefit from eating less carbs. It’s damned hard though.
That counseling on diet, exercise, and stress management is usually pretty low impact or expensive. My coworker who was trying to handle pre-diabetes mostly got a few pamphlets and brochures before being referred to specialists.
And those folks were expensive too. He spent months following various strategies from the specialists. One had him eating small amounts of carbs all day long, so he was munching on corn chips all day everyday. Not sure it helped. But that was the kind of support and help the US medical system was providing a proactive pre-diabetic: an expensive one that pushed corn chips.
Also the boss was diabetic too and they’d discuss things. One phenomena the boss had was when he went to Europe for a few weeks every few years his diabetes mostly self regulated and didn’t need insulin. Stress was his #1 but also tended to accept his diet was way better on the Mediterranean.
The Guardian published a few stories this week about the ADAs preference for insulin rather than lifestyle changes to treat type 2 diabetes. They’re a really interesting read.
I just read the one about people getting fired for refusing to approve recipes with a bunch of unnecessary Splenda. Splenda gives the ADA a ton of money, so now they’re pushing salads with added sweetener. Some kind of potato lobby gives the ADA money, and shocker, suddenly they’re recommending potatoes to people who shouldn’t eat excess carbs. It’s pretty fucking shameful.
Wait why would you even put a sweetener on salad out of all things?
I’m not sure. Salad dressing, maybe? But the Guardian article was talking about recipes having like, 1/4 cup of Splenda, which sounds insane for salad no matter where you put it.
I mean maybe it’s a culture difference but I can’t imagine salad having sweet stuff in it. It just doesn’t make sense.
American food tends to be way sweeter than anywhere else I’ve ever been, so yeah, probably cultural.
The answer as always: money
This is the best summary I could come up with:
It is also ruinously expensive, as doctors visits, hospital stays, insulin, blood test strips, leg amputations, continuous glucose monitors and numerous glucose-lowering drugs add up to about $400bn a year.
“The ingenious author of the work now before us,” a 1797 article in the Edinburgh review Annals of Medicine said, “recommends a mode of treatment, which in some cases, has been decidedly productive of remarkable benefit.”
As I previously wrote about in the Guardian, I was diagnosed with type 2 diabetes three years ago and prescribed insulin shots and metformin, but was able to get off all medication by adhering to a strict low-carbohydrate diet.
Or why the ADA’s huge educational campaigns soft-pedaled the diet, and preferred to let millions of people with type 2 diabetes take numerous medications or shoot themselves up with insulin instead.
“The reality is that if you want to treat type 2 diabetes effectively, the first thing you have to do is throw out the ADA’s dietary guidelines,” Sami Inkinen told me.
The losers are the millions of people with diabetes who suffer amputations, blindness, neuropathy, often daily shoot themselves with insulin and eat carbohydrate-rich foods because they simply are not informed about their healthier options.
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