Is There a Civil War?

** There’s been a lot of conversation about the Civil war: Diabetes vs. diabetes article by Julie Deardorff that originally appeared in the Chicago Tribune.   One of the contributor’s was David Edelman and his post on Diabetes Daily, Which Is Worse? My personal reply to that thread was “The worst kind? That’s an easy one. It’s whichever type affects you or a loved one.”  So here’s my take on the whole thing…

Is there a Civil War? Yes and no.

The basis of the rift is the same as any bias or prejudice:  Ignorance.

While T1 and T2 both have the same basic symptoms and long-term prognosis if not controlled, the treatment regimens can be vastly different between the two types.

Most people learn about diabetes from the media (news, entertainment, opinion) and what they learn is very stereotypical. Diabetics are fat and lazy and it is their own fault.

When someone gets a diabetes diagnosis, either Type 1 or Type 2, that is pretty much all they know. They can easily end up feeling guilty for doing this to themselves and the stigma that the stereotype causes can make them isolated, not wanting to talk about it.

And that stereotype is totally incorrect. The cellular changes that cause insulin resistance in T2 can be detected years before the diabetes presents itself. The insulin resistance causes weight gain, so obesity is a symptom, not a cause. The general public doesn’t understand that just because there is a correlation between two things, that doesn’t mean that one causes the other.

And T1 is an auto-immune disease where their own body destroys the insulin producing cells in the pancreas.  Eating too much didn’t cause that type either.

With the stereotypes so firmly in place, any diabetic may feel stigmatized.  And a newly Dxd T1 may feel unfairly grouped with those “fat and lazy” T2s.  Wars have probably been started over less.

What a T1 may not know about a T2 is that controlling T2 requires lifestyle changes to exercise and diet, which are extremely difficult to accomplish (especially if you are not getting support), along with medication.  Seriously, how many New Year’s resolutions did you just recall reading that?

What the T1 sees is a T2 taking a pill or being very upset that their fasting glucose level was 140 this morning. To a T1, a pill is much easier than insulin and a lot of us are plenty happy with waking to a 140. However, what the T1 doesn’t see is that 140 IS a big deal to that person.  They don’t see the effort it takes to change diet and exercise habits.  Working so hard and then seeing a higher than normal number.

Coming from the other direction, a T2 may see T1s talking about counting carbs and just dosing correctly; i.e. T1s can eat anything they want. What the T2 doesn’t see is that is an ongoing juggling act that will never end.  And while T1s can adjust doses for food, there are risks associated with that.  A T1 can miscount or just calculate their dosage wrong; ending up in a potentially dangerous low (hypoglycemic) or high (hyperglycemic) episode.

When talking about meds, if a T2 skips a dose for a day or two, their numbers run a bit higher than normal.  For a T1, skipping meds for a day or two is FATAL. I’d probably be dead by this time tomorrow if left untreated.

So the T1 doesn’t see the same urgency in the T2 world. What the T1 may not see is that many T2s are only diagnosed after complications have already begun and, since there is not that same urgency as in the T1 world, it can become even harder to make those already difficult lifestyle changes.   The complications may not be evident yet, “I’m not having any problems. I’ll worry about it later”.   And then later arrives with irreversible damage done.

There are a large number of T2s who do take insulin, usually large amounts due to insulin resistance. It is usually a long acting version and since their bodies are still functioning “somewhat normally”,  low blood sugar incidents are relatively rare, but they are know to happen.

Blood testing is another area where there are differences. As a T1, intensive insulin treatment requires intensive glucose monitoring to be successful; i.e. avoiding both low and high glucose levels. So testing 6 or more times daily is not unusual.  A T2 may not require that much, and probably doesn’t. Testing first thing in the morning and a couple of hours after a random meal is probably good enough on a daily basis, but I’m not a doc so don’t quote me on that!

I’ve witnessed several of these spats and used to be a “T2 bigot” myself. Once I understood the differences AND the similarities between the two groups, I was able to put that prejudice to rest.

I do believe that it was a grave disservice to all diabetics when both conditions were called diabetes.  And while I see the logic in renaming Type 1, I wonder if that wouldn’t make things more confusing.  Someone at a higher pay-grade than me is going to have to make that call.

As I’m finishing this up, I bet 99.9% of the folks who read it already know this and I’m just preaching to the choir again.  (hmmm… seems I do that a lot).  I hope that Julie’s article can lead to more media awareness.  Media education is an area that I would like to see more activity from the national organizations.

But even if the JDRF and ADA both put out press release after press release,  write letters to the editor of every myth published, you have to wonder how much good that would actually do.  You can lead a publisher to a story, but you can’t make them print it.

It may just be that correct articles about the similarities and differences between T1 and T2 just isn’t “sexy” enough unless the horrible complications are the topic.  “If it bleeds, it leads” seems to be the mantra.

You don’t see many stories about people who have lived decades with T1 or T2.  They don’t have articles that show the incredible effort and dedication that it takes to survive.   They don’t show all the balls being juggled on a daily basis for the rest of our lives.

I sometimes wonder if we should just forget about what myths are still being pushed.  Maybe turn our attention to the vastly growing audience of diabetics and make sure that they understand the differences.

Make sure that they understand what diabetes is and isn’t, helping them overcome their fears and guilt that have been spawned by the myths and a diagnosis.  Empower them to take their local media outlet to task when some senseless drivel is spewed forth.

Perhaps then enough attention can be drawn to the harm these myths do and thereby lay them to rest.

© 2010 Scott Strange, Strangely Diabetic and http://StrangelyDiabetic.com