In the taste confounds the appetite

Last night's class was presented by another first-time mini-med speaker. Unlike last week's presenter, however, this one stuck pretty well to the order of slides as distributed in the class packet (thank you, sir) and had left himself enough time to get through all the material and still have a decent Q&A. He also seemed more at ease, connecting with the audience and answering questions without being brusque. If his manner during the class is indicative of his interactions with patients, his practice must do well.

God knows it's probably growing, because he's an endocrinologist specializing in diabetes, the topic of last night's lecture and an, er, expanding field in its own right. The doc covered the clinical and therapeutic differences between Type 1 and Type 2 diabetes (the first involving complete and apparently spontaneous failure of the insulin-producing beta cells; the second, once known as adult-onset diabetes, involving a slower progression from insulin resistance to complete beta-cell failure, and strongly statistically correlated with weight gain), the definitions of prediabetes versus full diabetes, how the disease rates have changed over time, what therapies are available, and how regimens have been adapted to cope with shifting disease patterns. He emphasized that most of the increase in Type 2 is lifestyle driven, and although I was a smidge disappointed that he didn't mention our borked-up food distribution system, which IMO is responsible for many of our dysfunctional eating patterns, he did advocate much wider access to gyms and nutritional counseling. Questions from the audience included whether Lipitor is associated with weight gain, because everyone in the questioner's family who has taken it has also put on pounds (response: sorry, this is a case where correlation != causality); why some physicians worry that insulin is associated with cardiovascular disease (response: incorrect data were presented by a high-profile physician, and although the numbers have since been refuted, not everybody got the news); and why fatty fat fatties don't just stop being so fat (from, of course, That One Guy, who needs to shut up so hard; formal response: it takes a lot of work and commitment that many of us find difficult to maintain).

My only quibble, come to think, is that the presenter was so pleasant and positive that the scale of the problem may not have come through. Unless our health care system, food network, and overall cultural attitude toward exercise change drastically, the number of people with diabetes is going to continue to rise. Pharma companies can make stupid money off treating diabetes—it is largely a disease of wealthy societies, after all, although genetic predisposition plays a significant role—so while we may see increased funding for medicating diabetes, coordinating efforts for preventing the disease from ever developing are tricky. It's a lot easier to fund a drug than it is to make a city's layout safe and accessible for bicyclists and pedestrians and to make fresh food more affordable and appealing than preservative-laden packaged stuff.

It was a cool spring night when we stepped out of class, so I walked the two miles back to Dupont rather than waiting for a bus. Truncal obesity begone! Integrating exercise into daily life, yay! Today my hip registers a protest at all that strolling in nonsupportive shoes. Damn, it's always something.