This Hacker News discussion primarily revolves around Type 2 Diabetes (T2D), its causes, reversibility, and treatment, and contrasts it with Type 1 Diabetes (T1D) and emerging treatments. A secondary theme is the effectiveness and perception of lifestyle changes (diet and exercise) versus medical interventions.
Reversibility and Causes of Type 2 Diabetes
A strong consensus emerges that early-stage Type 2 Diabetes is often reversible through lifestyle changes, particularly diet and exercise. However, the discussion also highlights that T2D is not solely a lifestyle disease and has genetic and other non-lifestyle factors. Some users expressed frustration with the oversimplification of T2D as purely a result of being overweight or eating poorly, citing personal experiences where these interventions were insufficient.
- "Type 2, they need to solve type 2." (m3kw9)
- "Yes, but even lifestyle changes (like a diet low in glycemic load and building muscle) can help reduce many of the harmful effects of type 2 diabetes, even sending it into remission for some people in early stages." (javchz)
- "I just want to make clear what the other commenter said: type 2 is completely reversible in its early stages. Lose weight, eat a more healthy diet, and you should see your body return to normal." (kulahan)
- "Why? Type 2 can be mostly prevented and if caught early enough treated with diet and exercise. If you solve type 2 they’ll just eat themselves into a new episode again" (moi2388)
- "But for 50 years they've been told "carbs and whole grains are good for you"." (fhdkweig) This was countered by: "Carbs have replaced fats as the conventional wisdom thing to religiously minimize for a couple of decades now; this is like reading a canned rant that was found in a time capsule from the 1990s." (dragonwriter)
- "This is a highly questionable statement. There are myriad reasons for the kinds of DNA copying errors that cause cancer(s), and few are mono-causal. Type-II diabetes is mainly a lifestyle disease and barely existed 50 years ago." (ch4s3)
- "Your misplaced confidence that Type II diabetes is a lifestyle disease for which you can just judge the victim is questionable. I have never been overweight, I eat healthy (mostly plants, very little refined carbs), and I am active and run 5k regularly. That didn't prevent me from inheriting T2 from both my parents by the time I turned 60." (bregma)
- "If your read carefully, you'll note that I said largely. There is clearly a genetic component and non-lifestyle environmental factors. You don't need to go back to the 1970s even. In 1990 fewer than 5% of Americans had Type II diabetes and now that number probably exceeds 15%." (ch4s3)
- "We tend to think of type 2 diabetes as a disease that afflicts people who are overweight. But it can also appear in people with perfectly healthy weights—and be more deadly in them." (RHSeeger)
- "type 2 is more closely associated with genetics than type 1" (chips_not_fries)
The Role and Efficacy of GLP-1 Drugs and Medical Interventions
GLP-1 agonist drugs like Ozempic are highlighted as critical for some individuals in achieving blood sugar control when diet and exercise alone were insufficient. This leads to a discussion about whether these drugs primarily aid weight loss by managing appetite, effectively helping individuals stick to a diet. The conversation also touches on other potential medical interventions like Duodenum Resurfacing (DMR).
- "It wasn't until I started taking a GLP-1 drug that my sugar came under control. So medication (ozempic) was critical to me getting my blood sugar under control. Diet didn't fix it. Exercise didn't help." (UI_at_80x24)
- "Ozempic helped you lose weight primarily by making you stick to a diet, due to its suppressing effects on appetite." (borroka)
- "One promising technique is duodenum resurfacing (DMR). This helps reset some of the insulin sensitivity issues. The one problem we have is that this is a one time low risk procedure compared to selling insulin or GLP-1. Like all of our problems in healthcare, we have a major misalignment in incentives." (snarf21)
The Nuance of Diet and Exercise Effectiveness
There's a significant thread discussing the role and perception of diet and exercise. Some argue that "calories in/calories out" is the fundamental principle for weight management and that exercise alone is often insufficient to offset poor dietary habits. Others defend the importance of exercise, not just for weight loss but for overall health, and lament the "fat and diet shaming" that can arise from oversimplified advice. The calorie expenditure of exercise, like cycling, is debated, with some suggesting it's less impactful than commonly perceived in the context of compensating for high caloric intake.
- "Calories in/out is the only reliable way (short of surgery or drugs anyway) to reliably change the size of your body in either direction." (ToucanLoucan)
- "m3kw9: Type 2, they need to solve type 2." (kingkawn)
- "But it should help temper the fat and diet shaming that exists in society. Why would it? Factually, if Ozempic and similar solved your weight issues, it directly means you were eating "too much" food. People who see that as a personal failing will continue to do so, and will see Ozempic as enabling "weak willed" people, or a crutch for "lesser" people." (mrguyorama)
- "somenameforme: A bit of a tangent, but the biking stuff is not relevant. What matters is your caloric consumption. Biking 25 miles, depending on your weight, is going to burn something like 1300 calories. For some contrast, a 2L bottle of coke has about 800 calories. So treat yourself to a big serving of Coke after (or during) the biking, maybe a fast food burger or whatever, and it's like you're not even biking at all in terms of caloric effect." (somenameforme)
- "Exercise, especially using efficient means like biking or running or walking, just isn't that effective. You need caloric restriction to make any ground for the majority of people." (mrguyorama)
- "Even if you are overweight... it's NOT easy to lose weight.. especially if you've lost a significant amount of weight in your life. You may well have a really dysfunctional metabolism, and most advice is just bad for this case. Many people actually have to eat more of a reduced menu in order to lose weight." (tracker1)
Type 1 Diabetes vs. Type 2 Diabetes and the Future of Treatment
The discussion frequently differentiates between Type 1 and Type 2 Diabetes, emphasizing that T1D involves a lack of insulin production and is not influenced by lifestyle changes. There's excitement about the exploration of new treatments for diabetes, including gene editing and cell therapies, with caution expressed regarding the early stages of research and the potential for media hype to create unrealistic expectations. The complexity of T1D and the need for advanced treatments are implicitly acknowledged. Mention is also made of "Type 1.5" diabetes, where diagnosis can be complex.
- "Type 1 is a different story. It’s the lack of natural insulin production (due to a damaged pancreas, autoimmune or other causes), basically the opposite problem to type 2, and no amount of lifestyle changes will replace of need of insulin doses." (javchz)
- "This is great news. Any type of pancreatic function restoration is also potentially good for Type 1.5 (which constitute a sizable chunk of misdiagnosed T2Ds) where the body attacks more slowly (over the course of years) instead of acutely like traditional T1D and so doctors assume it's insulin resistance instead of pancreatic function decline since they both present with the same symptom - hyperglycemia." (umvi)
- "To gene-edit these cells, they had to use a lentivirus vector -- a (limited form of a) class of viruses that notably includes HIV. These viral vectors work by splicing themselves into random places in the host cell's DNA. Which is fine, except that there's a non-zero chance that in the process, the virus will initiate a cancer." (gwerbret)
- "N=1 study should not have made it into headlines." (JackeJR)
- "I’ve had T1D for decades and have seen every headline under the sun with a “cure” always sometime in the next 5 years, so my expectations are properly tempered. Still excited by it but a long way from clinics handing this out as a solution (if it’s viable)." (thecosas)
- "The harms of hyping this up is that readers will get their hopes up and then be disappointed when things don't pan out as do most scientific endeavours. Overtime, readers will learn to distrust anything that is being reported because 90% of which do not translate to real world impact." (JackeJR)
Misinformation and Societal Perceptions
A recurring concern is the prevalence of misinformation and the societal tendency to blame individuals for their health conditions. Users express frustration with simplistic narratives and the shaming that often accompanies discussions about weight, diet, and diabetes. The need for more nuanced understanding and empathy is evident.
- "My anecdote does not contradict wide-spread science and medically derived knowledge. But it should help temper the fat and diet shaming that exists in society." (UI_at_80x24)
- "RHSeeger: Because it has been commented over and over "oh, type 2 is because you are overweight"... It's wrong and it's insulting." (RHSeeger)
- "Even if you are overweight... it's NOT easy to lose weight.. especially if you've lost a significant amount of weight in your life. You may well have a really dysfunctional metabolism, and most advice is just bad for this case. Many people actually have to eat more of a reduced menu in order to lose weight. [...] And even then, you may still need some level of supplemental insulin for a long while. That isn't to say I support general gluttony and laziness... but it isn't that easy, and its even harder when people just assume you aren't even trying or have negativity towards you in general." (tracker1)