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Sunday, December 21, 2014
Does diabetes skip a generation
I have been told that diabetes skips a generation. Both my father and his brother died of heart complications from Type 1 diabetes in their early 40`s. I am paranoid about what foods my kids consume for fear of them contracting this disease (at birthday parties I scrape the icing off the cake before they can eat it...) Am I being overly cautious?
Your question raises several issues that many people are concerned about. Let me try to take them one-by-one:
I have to take your word for whether your father and brother both had type 1 as opposed to type 2 diabetes. Many people are labelled as having type 1 diabetes because they are treated with insulin but not everyone who is insulin-treated has type 1 diabetes. Type 1 diabetes represents the form characterized primarily by destruction of the cells that produce insulin. Type 2 diabetes usually results from a combination of resistance to insulin of the cells that usually respond to insulin with an inadequacy of the insulin producing cells to be able to keep up with the demand for insulin. Type 1 absolutely requires insulin for survival. Type 2 commonly improves early on with treatments that improve the body's ability to respond to its own insulin but progresses over time to the point where insulin treatment is needed.
The distinction is important to your question because the inheritance of Type 1 and Type 2 are different. In both cases, what is inherited is a predisposition to diabetes, which means that not everyone who inherits the genes will get it. A family history of type 2 diabetes means a much greater chance of inheriting the diabetes than a family history of type 1 diabetes. The genetics of both are complex - even though genes play a role, most people with Type 1 diabetes do not have a family history of diabetes.
In Type 2 diabetes, the interaction between genes and environment is very much at the level of lifestyle factors: diet and exercise can make a big difference in whether an individual will actually develop diabetes. In Type 1 diabetes, we think the genes and environment interaction is really at the level of whether the individual who inherits the risk for the disease is exposed to triggers which lead to the destruction of the insulin-producing cells. Food and exercise don't make much difference in whether the disease develops, but once one has the disease, they make a difference how well the disease is controlled and in the chances of developing complications.
Generally, the recommendations we make about diet for everybody are to be moderate in dietary intake and encourage a healthy balanced diet. That should be accompanied by encouraging an active lifestyle and a healthy level of physical activity.
Your choice of words (paranoid, overly cautious) is very telling about how you perceive the situation and is probably an important clue. You want to be positive.
Robert M Cohen, MD
Professor of Clinical Medicine
College of Medicine
University of Cincinnati