Myths and Misconceptions about Diabetes

By Zeke Trence, as told to Dace L. Trence, MD, FACE

I have been asked to share my story and to help shed some light on a few of the myths about human diabetes that I’ve learned on my journey living with the condition. While it’s an honor to be asked to tell my story, it’s not without some embarrassment.

I moved with a fellow feline from the Midwest to the Pacific Northwest about two years ago. Not a comfortable journey being stashed away in a carrier in the “animal hold.” And to add to my stress, no flight attendant offered any treats or even water on my trip, just some medicine to supposedly calm me – indeed – and my companion fared no better.

Settling into a new home that now had to be shared with a not-so-welcoming resident feline, as well as a resident dog, was traumatic. I tried to do my best to behave. Unfortunately, I began to “think (and other things!) outside the box,” so to speak. Yes, this was embarrassing and drove my human family crazy, particular my female caretaker. I tried a lot of finger (paw) pointing to pin my “accidents” on the others, to no avail. Soon, I was discovered and off to the vet clinic I was taken. And that’s when we first learned… diagnosis: Diabetes!

My reaction:

Once we came to grips with my “new normal,” I began to study up on the disease. I learned that, while uncommon in cats, diabetes is more and more prevalent with humans. And as with many things in the people world, there is a lot of information out there on diabetes, including some unfortunate myths. So, with computer mouse in paw, I proceeded to click around the internet to learn the truths about some of these diabetes myths:

Myth No. 1: Diabetes is easy.

For those who think diabetes is easy, think again. With both felines and my human friends, managing diabetes on a daily basis is important. For me, it was insulin twice a day, low-carbohydrate special cat food and ear pricks to check glucose. Both cats and people often initially wonder, “How do I pay for the insulin and the blood sugar testing equipment?” As a kitty, I’m not able to apply for affordable care insurance, and my job skills are limited to laying around in the sun. I haven’t caught a mouse in years, so no employer-sponsored insurance is possible. And the vet bills, ouch! And, how do I tell people about any low blood sugars I may be experiencing? Humans experience a lot of the same issues, what with checking blood sugar levels several times per day, decisions on which methods of insulin infusion and cost questions. No way is this disease easy.

Myth No.2: A1C is the absolute standard for measuring overall blood sugar control.

A1C is a blood test that is generally considered the gold standard for measurement of blood sugar control in the previous three months. The test does serve as a marker for the risk of developing eye, kidney and blood vessel complications. I can lick my ear and maybe fudge the pinprick sugar, but the A1C test is checked through blood work. I have learned it is a test that can be affected by many conditions, as well as drugs. For example, anemia, pregnancy, even age can make the A1C falsely lower or higher. Medications such as iron will decrease the A1C, as will drinking alcohol, taking aspirin, or vitamin C and vitamin E. It can be affected by ethnicity as well. African-Americans may have a higher A1C for a blood sugar average than Caucasians. High triglycerides (sugar fats), abnormal heart valves, even a low thyroid state can impact the accuracy of A1C.

And did you know that there is a considerable range of “average” associated with the A1C? So, if your human physician tells you your A1C is 7.0 percent – a rather good value – your average blood sugar over the previous three months could be anywhere from 123 to 185 (measured as mg/dL, or milligrams per deciliter). If your A1C is 8.0 (and this definitely means you need to refocus your attention on your blood sugar control), the average could be anywhere from 147 to 217, meaning that an average blood sugar of 150 in one person could win them kitty treats with an A1C of 7.0, but in another it would mean an A1C of 8.0 and a trip to visit their diabetes care team. In my case, a trip to the dreaded vet clinic, again.

Myth No. 3: An ACE or ARB drug is absolutely necessary for every person that has diabetes.

As I learn more about my condition by listening to my doctor and researching on my own, I’ve learned that there are certain requirements pertaining to specific medications. One such class of drugs included the ACEs (angiotensin converting enzyme) and the ARBs (angiotensin receptor blocker). Examples of these are lisinopril, enalapril, prinivil, captopril, candesartan, telmisartan and losartan. These are very common drugs recommended for blood pressure control. In humans with type 1 diabetes (the diabetes that comes from antibodies destroying the ability of the pancreas to produce insulin), taking these drugs to protect against the development of kidney disease is not supported by studies that I read in the medical literature.

In an article from The New England Journal of Medicine, 285 patients with type 1 diabetes with normal blood pressure and normal urine protein were followed for five years. They were on losartan (100 mg daily), enalapril (20 mg daily), or a placebo (a fake pill with no medicine in it). They were evaluated using kidney biopsy specimens and eye exams. There was no significant difference between the groups in the development of diabetes-associated kidney disease, although there was a decrease in the development of diabetes-associated eye disease. But as with all drugs, there are potential side effects, including lightheadedness, dizziness and a possible increase in blood potassium, which can interfere with normal heart function. Just wait until the vet brings up this topic. Am I ever ready to discuss “pros” and “cons.”

Myth No.4: Supplements will cure me.

It may not be entirely surprising that this is a myth, but what about prevention of the development of diabetes? I have undergone a certain operation that allows me to, *ahem*, decline any claim to being the instigator of more cats in this world, but what about preventing any risk of developing diabetes in my existing family members, knowing that they could be at risk? Where to start? There is so much information out there, and it’s all so confusing my little kitty head is beginning to spin.

Let’s look at just one supplement that caught my eye: nicotinamide. Nicotinamide is in the B vitamin family, closely similar to niacin (vitamin B3). In animals that develop either spontaneous or induced diabetes (induced occurs in studies where a toxic substance is given to destroy pancreas cells producing insulin), nicotinamide has been shown to increase insulin production and prevent development of diabetes if administered before onset of the disease. Since 1947, nicotinamide was shown to inhibit development of diabetes in rats and mice (Yum! You can see why this caught my eye). Two large, multi-center clinical trials evaluated the effects of nicotinamide in at-risk relatives of those with type 1 diabetes. A German study (named DENIS) identified siblings (age 3–12 years) of patients with type 1 diabetes thought to be of risk of developing type 1 diabetes within three years. The study participants were randomized to receive either high-dose nicotinamide or a placebo. But the results were disappointing. Alas, the rate of developing type 1 diabetes was similar in both groups and showed no protection in using the nicotinamide supplement.

Myth No. 5: You are alone in your struggle with diabetes.

There are many support systems and groups out there to help throughout this journey – your healthcare team can be a great resource in finding them.

For you humans, the American Association of Clinical Endocrinologists (AACE), the American Diabetes Association (ADA) and the Juvenile Diabetes Research Foundation (JDRF) are all purrrrific resources for information, finding the right physician healthcare team and the best healthcare management. There are also local support groups in many communities, some associated with hospitals, some independent, that your endocrinology team can tell you about.

There are even support groups for pet lovers whose companion animals have diabetes! If dogs are your preference (Really? Are you kidding me????), try visiting this site for help: If cats are your favorite pet (and you know they are), here’s a website that’s chock full of helpful information: http://www.felinediabetes. com/FDMB/.

As far as my health, my blood sugar is down from 370 to 149 on glargine insulin 2 units twice daily. I eat a low-glycemic index dry food and DM cat food every day (of course, I do have a few special treats now and then). Most importantly, I think inside the box and my thirst is back to normal. Meow!