Sweet Caroline: A Story of Diabetes- Part 1

By Dr. Latif Hamed, MD, FAAO, MBA
Former Tenured Professor of Ophthalmology, UF College of Medicine

This two-part article is about French fries, television and drugs. ll you do not use any of these, you may skip reading it. These three things militate to produce what is now a worldwide epidemic: diabetes, and specifically type 2 diabetes. In this article, the word diabetes refers to type 2. 

If you are in a rush, here is the Cliff Notes version: Diabetes, and many other chronic diseases for that matter, are a result of excess consumption of unhealthy food, sedentary lifestyle, and over-reliance on the drug industry and health care system to reverse the damage.

I will address diabetes through my personal approach to coaching two types of diabetic patients, but the principles apply to almost any chronic health problem one may encounter, e.g.. high blood pressure, heart disease, cancer, depression, dementia and Alzheimer's.

I will call one patient John, and the other Kermit, I chose the names for fun because each correspond with a popular song that conveys the eventual outcome of the patient as I will tell you later. These two patients represent the extremes of what diabetes escalates to: most patients fall in between. These two men started with similar diabetes parameters, but they were quite different in their mindset and had drastically different outcomes. I want the reader to reflect on why two seemingly similar people who started a journey with similar body weight, general health, family history, and blood work diverged drastically along the way, Only one reached the finish line. For the sake of brevity, I will focus on John, a fatalist who took very little initiative to improve his overeating and sedentary lifestyle, and who eventually succumbed to diabetes, and let you read between the lines how Kermit cured his diabetes by employing an "escape velocity" mindset.

More on that later.

John sat at my exam chair twenty some years ago, referred by endocrinology for a diabetic eye exam. He weighed 240 pounds, sixty of which he gained over the previous five years. After finishing his eye exam, I swung into my preachy mode and tried to motivate him to clean up his diet, exercise, and gradually dig himself out of the diabetic rubble. My sermon evolved over the years, and it changes from one patient to another based on the circumstances. Food, I would say. should be thought of as medicine and not as a form of entertainment. It makes no sense to continue to overeat and be sedentary, resigning oneself to take the pills that physicians dutifully prescribe often with variable mention of essential fundamental lifestyle changes. You, I tell my patient, are the owner of the building, and the doctor is just a maintenance guy who comes over every six months to fix a leak or change a light bulb. The day-to-day upkeep is up to you, the inhabitant.

With subsequent visits, I continue to try to encourage John to modify his eating (to excess) and exercise [lack of) habits. Sometimes I overplay my hand. I catch myself saying: Go ahead and enjoy playing the role of the victim if you like, John. The bag of potato chips and makers of insulin are the culprits. You are a helpless bystander, a marginal observer, shackled by a yearning for sugar, and glued to a chair watching through TV the world slipping away. I normally say these types of things while standing by the door in case i need to make a run for it.

John considers himself to be religious, In despair, I invoke the temptations that pressured Adam and Eve to eat from the forbidden tree, and asked john to think of this sin every time his hand reached for a sugar-laden desert. That seldom works, perhaps because it is in our nature to be seduced, absent our awareness of the methods employed by the seducer, a seducer which here on earth we are talking about the food and drug industry. I will get to that in a minute.

But first things first. Here is a brief medical definition of diabetes. 1 will skip the customary Latin derivations of the term (it's Greek to mel) and address the topic in my Ocala English. Deep breath. Diabetes is the leading cause of blindness in the industrial world. It starts with insulin resistance as a patient overeats, moves less, gains weight, and develops metabolic syndrome. Uncontrolled blood glucose wreaks havoc on the body. High blood sugar weakens and thickens the walls of blood vessels and leads to blood leakage and oxygen starvation of the retina which in turn leads to scarring and vision loss. It affects just about every organ in the body in a similar manner, particularly the highly vascularized organs like the kidneys and the retinas. The damage happens slowly and surreptitiously with no visible signs of damage during the first decade or so, during which the pathology occurs under the radar at the molecular and cellular levels.

But diabetes is not just high blood sugar. As the diabetic becomes progressively less sensitive to insulin, the islets of Langerhans of the pancreas secrete more insulin (hyperinsulinemia), which leads to further weight gain and worse insulin resistance. In addition to the damage caused by the high blood glucose, chronically high serum insulin levels are bad. Insulin signals fat deposition and acts as a growth factor that can promote illnesses and even cancer. The average diabetic progresses from diet-controlled, then oral-medication-controlled, followed by insulin-dependent. When your cells no longer respond to the elevated levels of your own insulin, insulin injections are administered to get the insulin levels even higher to normalize blood sugar levels. But is the diabetic patient on insulin and normal serum glucose normal? Far from it. in order to get the glucose levels to the normal range, the blood insulin concentration runs very high (in the face of insulin resistance), and the more you eat, the more insulin you have to chase the food with in order to lower blood glucose. The price of lowering your blood sugar is to raise your insulin, and it is a high price indeed. The fact that we focus on glucose levels (and glycated proteins like the hemoglobin A1C), and do not trac insulin levels reflect poor understanding of the pathophysiology of diabetes, "Successful" treatment under the current paradigm produces normal glucose and at the expense of high insulin levels, but hopefully you now understand that you want both glucose and insulin to be normal. This requires a change in the way you think about, and treat, diabetes. To be healthy, there is no escaping a proper diet and exercise.

One hurdle l encounter often with my diabetic patients is alcohol consumption. The wine industry has scored a resounding victory in convincing the public that a glass or two of red wine at dinner is healthful. I have extraordinarily successful and intelligent medical colleagues who are renowned in their field who drink a lot of wine for health benefits! One told me that he increased his wine intake after his heart stents to strengthen his heart. Yikes! Do not blame my kids for being cynical! The wine industry mouthpieces claim that the flavonoids and polyphenols in the grapes that went into the wine are great antioxidants. Please do not hate me but this is wrong, and doubly so for diabetics. Recent research has shown that even small quantities of alcohol are harmful. The liver metabolizes alcohol into a toxic compound called acetaldehyde, a known carcinogen.

Skip the wine and have a couple of grapes, but only a couple because of the fructose content.

Take Control of Your Health and Vision

Diabetes affects more than your blood sugar — it impacts your eyes and overall well-being. At Florida Eye Specialist Institute, Dr. Latif Hamed helps patients protect their sight and take charge of their health through education, prevention, and compassionate care.

Schedule your diabetic eye exam today. Call (352) 237-0090 or request an appointment online.

Small changes today can make a lifetime of difference for your eyes and your health.