Why does the American Diabetes Association push insulin? | Hacker News Reader

Why does the American Diabetes Association push insulin?

theguardian.com

6 pointsoneseven13 comments

When my dad told me he had type 2 diabetes, I told him to go on a paleo diet, basically low carb. He gave me a bunch of reasons why that was a bad idea, and had already read some books recommended by the ADA, which he felt backed him up. He spent over 6 years trying all kinds of stuff (everything except low carb and no sugar). Eventually he found a doctor doing a program that puts type 2 diabetics on an extreme elimination diet, no solid food at all for several months… way more extreme, and way less sustainable, than what I suggested. He eventually kicked it with that, but it took a long time, a lot of money, and an extreme intervention.

During that period my dad was fighting with this, my mom was also diagnosed with type 2. I told her the exact same thing. She did it, and 3 months later she was fine, for the cost of some meat and vegetables.

The ADA is a joke. I’ve found books from over 100 years ago talking about avoiding carbs/sugar to fix diabetes. This isn’t new stuff, there’s just no money in it I guess.

Could you please add references to the > 100 years old books? Genuinely asking.

Google: Banting Diet

I think it was this book, but I think there was another I saw in the past as well.

The Treatment of Diabetes Mellitus, published in 1923

https://archive.org/details/treatmentofdiabee3josl/mode/1up

> (pg 427) 2. Carbohydrate.— The total carbohydrate in the diet of diabetic patients is almost invariably restricted, and even with insulin the quantity prescribed seldom exceeds 100 grams

There is more stuff, but I’m on my phone now, so it’s hard to go through.

I also ran across this:

https://www.wfmp.ca/post/diabetes-a-short-history

>In the 1700s & 1800s, physicians began to realize that dietary changes could help manage diabetes. Patients were advised to do things like eat only the fat and meat of animals. During the Franco-Prussian war, Dr. Apollinaire noted that his diabetic patients' symptoms improved due to war rationing.

People also wouldn't be willing to do it. Trying to fix obesity with diet has been a disaster at the population level.

My dad was willing to do stuff, he went vegan for 6+ months and various other things. Pretty much anything a popular diabetes book would tell him. He could be compliant, he just needed the advice to come from an accredited medical professional.

I get that most people won’t make lifestyle changes, so a big part of the medical system is about medicating people so they can not die, while living something close to the life they had before… but that should not be the assumed course for every patient.

Doctors should be presenting and pushing for the lifestyle changes they can lead to what is effectively a cure. It should not be assumed the patient knows all this stuff. If the patient is unwilling or unable to make those changes, then other courses of action should be used.

Type 2 is caused by having chronically high blood sugar levels. It would stand to reason that removing the sugar would allow the body to return to normal function. Continuing to eat sugar, using insulin to handle the levels, is just going to make things worse and worse over time, it will never get better. It makes 0 sense for this to be the default way to handle it, without even mentioning the lifestyle change and why it would work to get a person’s system back to normal functioning (assuming they aren’t too far gone and don’t have something else going on).

I don't have diabetes but I know that when it comes to diet, it's very hard for people to change what they eat. Insulin seems to be the easier solution.

Changing to a strict low-carb diet might be the best solution but an injection a day is probably easier.

We see it constantly. Obesity can be fixed by diet and addiction is fixed by abstaining. But people aren't always able to change. Sometimes what's possible is better than what should be done. In this case, injecting insulin is better, in general, than a change in diet since most people are just not able or willing to change their diets. I've known people that have diabetes and I know for a fact that the first suggestion by the doctor was to change their diet. But ultimately insulin was used since their blood sugar level didn't change.

When I was diagnosed with diabetes type 2 my doctor pushed the standard drugs on me without mentioning the alternative. When I found out about low carb, tried it and succeeded with it, my doctor just smiled and nodded. He wasn't surprised. But he was entirely unwilling to deviate from the standard of care dictated by the tablet he carried around. He was a very experience well trained doctor ... acting like a clerk performing a script.

I wonder why there is such a widespread distrust of authority in this country?

I imagine for the same reason that Ozempic will become standard of care for obesity compared to "diet and exercise."

It doesn't work. It scientifically works, but it is not something most people are willing to implement.

Sure, if you eat a low-carb diet, you can reverse type 2 diabeties, but virtually nobody is going to be willing to do that. You would kill a lot of people with that advice.

When a patient shows up with a blood glucose >300 mg/dl it is mystifying why a doctor would not simply give them a pamphlet about konjac noodles and a coupon for $3 off cauliflower crust pizza.

Surely it must be a conspiracy when you hear things like “treating acute hyperglycemia” and “preventing imminent kidney failure, coma and death” as opposed to “have you heard of keto tik tok?” Perhaps the ADA should encourage prolonged high blood glucose and focus on making sure their diet cookbooks are printed in braille so that the patients they let go blind on purpose can use them?

How many people are willing to eat cauliflower crust pizza?

Dietary changes have utterly failed in practice at treating any other condition within the population at large outside of perhaps avoiding nuts.

Exactly not me I like food too much. I would just not eat pizza as opposed to eating some trash that pretends to be Pizza.

That being said most of the time dietary changes fail isn't because the suggested diet doesn't work it's because the people are just unwilling to follow it.

That's also no reason to not take a multi-pronged approach of recommending dietary changes and pharmaceutical interventions.

Surprisingly, cauliflower crust pizza is actually pretty good if you are ok with thin crust pizza.

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