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June 11, 2003

Behavior, Daily Care

Question from Jacksonville, Florida, USA:

About two years ago, my dad was diagnosed with type 2 diabetes and started on Avandia. He was supposed to change his diet, but he didn't and kept eating lots of starches (including sweets) in huge portions. He is not overweight, and he gets a lot of exercise. A week ago, the doctor did more tests and now says my dad has type 1 diabetes, and he has to give himself a shot of Lantus every morning. My dad is still eating what he wants including the big portions and sweets. What will happen if he does not change his diet and eats all these sugary things?


First, I am not sure of the criteria used to diagnose type 1 diabetes. Often, what happens is that anytime someone is treated with insulin, they are [erroneously] described as having type 1 diabetes. The Avandia [rosiglitazone] is a good medication, but it does not have a rapid onset of action. Your father’s physician may have started Lantus in an attempt to more rapidly lower the blood sugars.

It is true that eating poorly can really set him back. In some patients, medications are used when a change in diet may be all that is required. Poor control carries the risks of complications. Those that control blood sugars are more healthy and have a healthier future. It is often difficult to convince people of that. I hope your father listens to you.


[Editor’s comment: Perhaps it would be worthwhile to suggest to your dad that he ask for a referral to a diabetes team that includes a dietitian, as well as an endocrinologist, diabetes nurse educator, and exercise specialist.