A lot has been said and written about the best way to live with diabetes. But how much of what you think you know is actually true? Chances are you have never even heard that there is a cure for the disease.

This article is not another of the thousands of alternative treatments which claim to cure all ailments known to man once you sign up for a monthly package and sell it to your increasingly annoyed friends. The conventional wisdom about diabetes will be challenged to see how wrong we are about this all too common disease.

False: Diabetes is caused by too much sugar in the blood

Yes, you test your blood sugar levels to see if you are diabetic or are at risk of developing the disease. But is this what is causing the disease, or is it only a symptom of the underlying problem? There is a story about a Russian czar who found out that the province with the highest rate of disease also had the highest numbers of doctors. His simple solution: kill all the doctors since they must be the root of the problem.

Too often we tend to think like the czar in looking at diseases. We know that the high levels of blood sugar cause the problems associated with diabetes, so we target the sugar instead of trying to fix what caused the high sugar in the first place. But what causes that high sugar? Easy. Your parents and your food. And since we can't target our parents, then we should address our food. Problem solved.

There are two types of diabetes mellitus — type one is insulin dependent seen in younger patients, and type two is the more common adult onset diabetes which is caused by a combination of decreased response to insulin by the tissues and a loss of insulin production in our insulin factory, the pancreas.

Obesity has been shown to be a risk factor for the development of type two diabetes mellitus. The exact mechanism is unclear, but one newer theory is that it's not the carbs, it's the fat that's the problem. This theory suggests that type two diabetes is caused more by abnormal lipid metabolism (fat breakdown by the body) rather than abnormal carbohydrate metabolism. So if the problem is too much fat, then hyperglycemia should be corrected by a reversal of fat overload, ie weight loss. In fact, this has been shown to occur with improvement in the blood sugar levels with diet and exercise leading to weight loss.

False: There is no cure for diabetes

The field of bariatric surgery uses surgical procedures to limit the amount of food ingested and absorbed by obese patients. The current gold-standard and most commonly performed bariatric procedure today is the Roux-en-Y gastric bypass (RYGB).

The RYGB involves the construction of a small stomach pouch and attaching a limb of small intestine to the pouch thus bypassing a segment of the gut and restoring intestinal continuity. The procedure is safe and highly effective in terms of excess weight loss. With the shedding of excess pounds, patients see a marked improvement in their hypertension, cholesterol levels, and glucose control, etc.

Recent studies have shown the superiority of surgery over standard medical therapy in curing and improving diabetes. When two groups of patients were treated with either surgery or standard medical treatment, the group treated by surgery had far better control of their disease. Significantly, many of those who had surgery were cured whilst those who received medical therapy, as expected, required more medication to control their blood sugar levels as time went by.

Somewhat true: Lifestyle changes, oral medication and insulin effectively treat diabetes

Traditional treatment for diabetes focuses on medication and telling patients to eat better every time they visit the doctor, and patients exaggerating their efforts at doing so (be honest now!)

However, despite all the advances in pharmaceuticals, there is no decline in the number of diabetic patients or complications of the disease. In fact, there has been a steady increase. So drugs can't be the answer. The new outlook on diabetes places greater importance on lifestyle changes as a treatment option. Unfortunately, most people still look at medication as the only way to treat their diabetes.

Until we take weight loss as a tool in the fight against diabetes, we will continue to have increasing numbers of patients with diabetes and its dreaded complications.

Dr Alfred Dawes is a consultant general, laparoscopic and obesity surgeon at Premier Heart and Surgery Centre, and managing director, Mahogany Health and Fitness.

Obesity has been shown to be a risk factor for the development of type two diabetes mellitus.