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Excerpt from The Diabetes Answer Book: Some Questions Before We Start

Am I a diabetic, or do I have diabetes?
I have many patients who say to me, “I have been a diabetic for fifteen years…” and then go on to ask their question. But when I speak to them or to any audience about diabetes, I never refer to them as being “a diabetic.” I prefer to say “someone with diabetes.” You may think this is a trivial distinction, but I don’t. Many people, including me, are offended when they hear someone in crutches and leg braces being called “a spastic,” and someone who has occasional brain seizures being called “an epileptic.” As far as I am concerned, the diseases and problems that you have to deal with every day do not define who you are as a person. To me, the patients whom I try to help are all interesting and very different people with all sorts of jobs, families, hobbies, and stories to tell. They just happen to have diabetes as well. This is a significant burden to add to their lives, but it does not define who they are. Throughout this book I will try to give useful and practical answers to questions that you might have about having diabetes and living with diabetes, but I will not refer to you or anyone else as being a diabetic.

Should I say blood glucose or blood sugar?
This is a minor thing to make a fuss about. When patients say to me, “Why are my blood sugars so high in the morning, Dr. McCulloch?” they are being quite correct. But since I use the term so often throughout the book, I want to explain why I prefer to talk about blood glucose rather than blood sugar. Sugars are refined (or “simple”) forms of carbohydrate. The basic building block of carbohydrates is a molecule with six carbon atoms joined together in a ring. Glucose is one example of a simple six-carbon sugar molecule. This is the form of sugar that floats around in your blood and gives energy to your muscles and brain and other parts of your body. There are other six-carbon sugar molecules, like fructose and galactose. Table sugar is a larger molecule called sucrose, which is made up of joining a glucose and a fructose molecule together. Starches like bread, rice, potatoes, and pasta are more “complex” kinds of carbohydrate where hundreds of six-carbon sugar building blocks are joined together. Because I will be talking about different kinds of carbohydrates and sugars in answering questions about the food we eat, I am going to refer to the sugar that floats around in your blood (and causes so much frustration and stress to you!) by its proper name—blood glucose.

What is a hormone?
A hormone is a substance that is made in special cells in one part of your body and then gets pushed into the blood, where it travels to other parts of your body to have its effect. For example, special cells in the thyroid gland in your neck make thyroid hormones that get sent all over your body to help all your muscles and bones and nerves and other cells work properly. Groups of cells that make hormones are called endocrine glands, so your thyroid gland is an endocrine gland. Insulin is a hormone, so the pancreas is another endocrine gland. When your body does not make enough insulin or does not respond to it properly, it can lead to diabetes, so I will talk a lot about insulin in this book. I will also mention quite a few other hormones that affect your blood glucose.

What’s the difference between a dietitian and a nutritionist?
Both of these terms are used for people who have special training to help you eat food that is healthy for you. Many people think that a “diet” always means you are being told to eat less so that you lose weight. Because of that, they imagine that a dietitian is someone who always wants you to lose weight. In recent years, people have started using the term nutritionist more often because it suggests, correctly, that these are people who think about how healthy the food is that you eat, not just how to help you eat less. Instead of being “put on a diet,” you might be told that someone has been given a prescription for medical nutrition therapy. Whether I use the word nutritionist or dietitian, I am referring to people who can help you understand how to think about what you are eating and change it in ways that will keep you healthier and with blood glucose levels that are where you want them to be. When you are choosing a doctor, a nurse, or a nutritionist, there are two important things to look for. First, does this person really know a lot about diabetes? Second, is this person easy to get along with? Does he or she relate well to me and understand how to help me achieve my goals?

Can you make it understandable without dumbing it down?
That is definitely my plan in answering these questions. I have been talking to people with diabetes for over thirty years. Most of them are very smart and ask detailed and thoughtful questions. They deserve thoughtful answers that give as much detail as they need to understand it properly. Medical terminology can sound complicated and hard to understand. Lots of the words are really long and hard to pronounce. It is difficult to know what they mean unless you have a Latin dictionary! But it is usually easy to say the same thing in plain language. I have tried to do that as much as I can. Some people I work with are expert at talking in plain language and I have asked them to look over my answers and help me say it in a way that is easy to understand. That does not mean I will make an answer simpler than it really is. But I will try to use language that is easy to understand. If you looked up what causes type 2 diabetes in a big medical textbook, you might get a sentence like this: Type 2 diabetes occurs due to genetically determined amyloid deposition in the pancreatic islet cells, resulting in progressive deterioration in their capacity for insulin secretion. You might read that and think, “Huh? I must be dumb, because I don’t understand that.” That is not true. “Medical speak” makes it sound really complicated, but it is possible to say all that stuff using words that most people can understand: Insulin is a substance made in your pancreas in special cells called islet cells. When you inherit the genes for type 2 diabetes from your parents, these islet cells begin to fill up with strange stuff called amyloid. Over years, more and more amyloid clogs up the inside of your islet cells so that they make less and less insulin. Putting it like that is not dumbing down the meaning, just making it easier to understand. I hope that this approach makes the answers more useful to you.