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Diabetes War: Community TV

  • Richard Cohen:

    Dr. Robin Goland is co-director of the Naomi Berrie Diabetes Center at Columbia University. Father Andrew Fornal is a chaplain at Columbia University and has type 2 diabetes. Dr. Goland, explain to us the difference between type 1 and type 2 diabetes.

  • Robin Goland:

    Type 2 diabetes is an enormous problem in this country and all over the world. All forms of diabetes cause the blood sugar, the glucose, to be high. About 24 million people in the United States have diabetes. About 90% have type 2 where insulin, the primary hormone that moves the sugar into the cells for fuel, doesn’t work normally. The other 10%, they don’t make insulin normally, so they’re lacking insulin and that’s why their blood sugar is high.

  • Richard:

    Now the epidemic that we read about is really type 2, isn’t it?

  • Robin:

    Both type 1 and type 2 diabetes are increasing in incidence. Type 2 diabetes is really exploding. This is the form that’s most tied to growing older, growing heavier, and not doing enough activity or exercise.

  • Richard:

    Again, for those who don’t quite understand, what does the illness do to you?

  • Robin:

    Poorly controlled diabetes over years, even if the patient feels fine, poorly controlled blood sugars can lead to blindness, to amputation, to kidney failure, to heart attack, and to stroke. The good news, though, if you know you have diabetes, is that we can help people keep the blood sugar close to normal and prevent those complications.

  • Richard:

    Explode a myth for us. Is type 2 diabetes a lifestyle disease?

  • Robin:

    Both types of diabetes, type 1 and type 2 diabetes, start out by being genetic. If you don’t have the genes for those diseases, you don’t get diabetes. So there are several myths. One is that the patients brought it upon themselves. Not true. Although it is true that once you get it, there are a lot of things you can do just by changing how you eat and changing how you exercise to make it better. Another really important myth to explode is that type 2 diabetes is somehow the kinder and gentler form of diabetes, that “oh my goodness, thank goodness that I don’t have the juvenile type 1 dangerous form of the disease.” No form of diabetes is good. It would be really good to cure both types of diabetes, but type 2 diabetes is just as concerning as type 1 diabetes.

  • Richard:

    How does it correlate with the increase in obesity that we read about?

  • Robin:

    So the rise in obesity in this country and all over the world almost exactly parallels the rise in type 2 diabetes. We’ve estimated that if we can stop this epidemic of obesity, which is not easy to do, we could eliminate 60, 70, 80% of type 2 diabetes. Another really important statistic is if you find out that you are at very high risk for diabetes, if you have pre-diabetes -- your blood sugars are creeping up but not quite yet enough to give you a diagnosis of diabetes -- we know that if you exercise just a little and change your diet just a little, lose just a little weight, you reduce your risk by 60%. So that’s huge. It’s just really hard to do.

  • Richard:

    But why is it so hard to do?

  • Robin:

    Well, because people are pretty set in their ways. They develop their habits and I could give you some examples of people who have trouble putting themselves first. Often we take care of other people, we take care of our families, we take care of our parishioners, of our patients, and ...

  • Richard:

    Are you talking about anybody in particular?

    [LAUGHTER]

  • Robin:

    Perhaps ...

    [LAUGHTER]

  • Richard:

    Father Andrew?

  • Andrew:

    Yes?

  • Richard:

    What kind of a patient are you?

  • Andrew:

    I’m a terrible patient.

  • Richard:

    Why?

  • Andrew:

    There’s always in my mind that I should be for somebody else, and as a pastor of the church, as a priest, this inclination is very strong, and so sometimes I try to -- I’m neglecting myself and my health. It is in giving time to the other person. And so that’s why I’m the terrible patient.

  • Richard:

    What should Father Andrew be doing that he’s not doing?

  • Robin:

    Well, we try to meet people where they start, and that’s why in order to be a good caregiver for somebody with diabetes, it’s important that there be access to a whole team: the doctor, the nurse, the nutritionist, a psychologist, ‘cause it’s complicated. This is not going to be a five-minute office visit because how people eat and how they view illness, how they view their impact on preventing something that has no symptoms, that might not happen for 10 years. We have to get to know each other and we have to figure out what he can fit into his life and do what he loves doing and still remain healthy. And everybody’s different.

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