Diabetes: Two Diseases in One

I don’t know how many times I’ve explained the difference between Type 1 and Type 2 diabetes -– to family, friends, colleagues, teachers, other mothers, you name it! I never really intended to write about it here, figuring I was addressing a primarily diabetic audience that’d be quite familiar with the distinction. But I’ve been implored to do so, and there’s also been some hot blog discussion on the topic of late.

So for those who aren’t familiar: Type 1 and Type 2 diabetes are essentially two different diseases. What they share is the central feature of elevated blood sugar (glucose) levels due to absolute or relative insufficiencies of insulin, a hormone produced by the pancreas. Insulin is a key regulator of the body's metabolism.

To paraphrase author and blogger Martha O’Connor:
Type 1 Diabetes, traditionally referred to as juvenile-onset diabetes, is a genetic, autoimmune disorder. The body's T-cells recognize the insulin-producing cells of the pancreas (islet cells) as foreign invaders and begin to destroy them. Eventually, all the islet cells are destroyed, and the patient must take insulin shots several times daily in order to sustain life.

Type 1 Diabetes is NEVER caused by unhealthy lifestyle or simply by eating too many sweets. Never.

Type 2 Diabetes, which usually hits adults but lately has been on the rise in children, is a disorder in which the body is no longer able to properly use the insulin being produced. Type 2 can be (and increasingly is) brought on by poor diet and sedentary lifestyle. Essentially, overloading the body with carbohydrates over time causes the system to “break down” such that insulin can no longer be absorbed. Type 2 can often be controlled with diet and exercise, and/or with oral medications.

Note that Type 1 diabetes can never be controlled with diet and requires frequent blood glucose monitoring and insulin shots to preserve the patient's life. Type 2 diabetes can be preventable if a pre-diabetic condition is caught early. Sadly, once the autoimmune reaction of Type 1 diabetes has begun, it cannot be reversed. There is no known way to prevent Type 1 diabetes, although researchers are working on it.

Two Camps?
Paul Chaney of The Diabetes Blog poses the question whether a rift exists between the two diabetic “camps.”

I cringe…

I like to stick to the mantra, “we’re all in this together.”  Because we are!! But… there is also the aspect that many Type 1s can’t help feeling resentful of healthy people (i.e. carrying no genetic defects) who “brought the disease on themselves” through overeating and sluggishness.

As Scott Reynen comments on The Diabetes Blog:
“I've had negative feelings about Type 2s for a while now. But I think it's sort of like watching rich people waste money. I'd probably do the same if I were rich, but as I'm not, it's annoying to see them waste something I'd love to have. In the case of Type 2s, that something is the opportunity to not be diabetic, which to me is more valuable than money…” (I added the italics, btw)

Also many Type 1s and parents of Type 1 diabetic children are offended by the fact that much of the world lumps all diabetics together -– typically assuming that we all brought the disease upon ourselves in some way.

Martha writes: “It's very demoralizing and disheartening for a child with a chronic, life-threatening and uncurable illness to be told he did something to cause this illness, when he did NOT.”

Again, Type 1 is a genetic weakness that usually strikes thin people, who then characteristically become ultra-health-conscious.

BUT THEN AGAIN, there are also many Type 2s who apparently have a natural propensity for insulin resistance, and some who cross the line, like Kathleen Weaver, a Type 2 who is on insulin therapy and therefore lives like a Type 1.

So from my perspective, once you’ve got diabetes -– whichever type -- what it boils down to is what you’re going to do about it. I am very bothered by people who do little or nothing, and let themselves slip away. My own father died FAR TOO YOUNG from the effects of neglected Type 2 diabetes. If you’ve gotten to a bad place by taking poor care of yourself, then stand up and act, before it’s too late! Remember, we Type 1s work VERY HARD 24 hours a day just to stay alive. So an improved diet and exercise routine has got to be manageable as well. 

Comments

[Tekakwitha]

Hi, I'm new to the world of diabetes blogs but I've been reading yours and others for a while (which I've really enjoyed). Thanks for all the effort you put into your site!

As far as type 1 & 2: I was diagnosed with type 1 a year ago and since then have learned so much. I have a friend that is 26 and is a type 2. He's been overweight for years and still hasn't told many of his friends that he's a type 2 diabetic, yet many of us know anyway. I'm afraid that he won't come out in the open with it because of the stigma. I think that if he did just come out and tell people we'd be able to offer our support and he'd be in a better situation. I admit that it sometimes makes me angry that I have this disease and have always been healthy (exercise & eating healthy). It frustrates me to see some type 2s who have had a long family history of the disease yet up until they were diagnosed were sedentary and overweight. But in the end I think of my type 2 friend and realize that I've just been getting angry at the disease, not so much the people who have it (for one reason or another).

Hm. This got a little long! Maybe I'll talk about this more on my new blog!
Thanks - Tekakwitha

[ThePef]

Being a type I that was initially diagnosed as a type II, I find the most difficult thing to manage is a consistent state. The littlest things drive me down too low, or too high. I am envious of someone who is a type II, because they don't have the same state issues a type I must address.

You tend to be more in tune to the way your body feels, so that you can determine what you must do at that point in time. Do I need to be more active right now, consume carbs, take insulin, rest, etc etc.

You place that type of body management into our busy lifestyles i.e. business, family, friends, and it becomes overwhelming at times.

Sometimes I do find it offensive the way the press talks about diabetes, and the way it tends to oversimplify the root cause as diet, and lack of exercise. And perhaps we really do have to present some sort of seperation between the two camps, since the root is not the same. We may need venaculars that demonstrate the true differnces between type I and type II, afterall the cure is not going to be the same.

[AmyT]

Hi Tekakwitha:
Congrats on your new blog! I'm adding you to my blogroll. You sound like you have the right attitude, and you are going to be fine!

- Amy

[Dave]

As a Type 2...."Guilty" Yes, I was overweight. Did not workout. Like I said "Guilty". I have read this blog for a while and have learned and laughed with it's author who is a Type 1. I am now at my BMI and take no meds, workout daily, eat right. For now I'm in control. Type 1 people have my outright respect and prayers. It's the word "Diabetes" that gets everyone confused. It does me.

[Pearlsa]

Hi Amy,

I enjoy reading your blog and have been reading it daily for sometime now. I was re-diagnosed type 1 in 2000 after being diagnosed type 2 for two weeks. I was 120lbs at 5f 3. When the pills made me sicker, my doctor sent me to an endo who re-diagnosed me and placed me on insulin on the spot. I think the medical establishment is so confused themselves sometimes and I also think there might be more variations of diabetes out there than just the two boxes they try to fit us in.

I know type 2’s that do not fit the over weight category or have never been over weight and do well on pills. Then there is the media?

Keep on writing,

Pearlsa

[Nick]

It's not just type 1 (like me) and type 2. THere's also type 1.5 (don't ask me!) and IGT--impaired glucose tolerance, which was called "borderline diabetes" in decades past. These metabolic disorders all share the same symptom when left untreated--sugary blood. We all know sugary blood leads to deterioration of tissues and the body wearing out while the person is still alive (nasty!). Luckily, I think I've got a handle on controlling the sugary blood thanks to pioneer Dr. Bernstein. Now it only takes me 18 hours a day to manage: 24 hours less the 6 hours I sleep.

How old was your father?

[The LIVabetes! Glucose Goddess]

Just a thought from the Glucose Goddess-

What's it like to be a type I diabetic?

(actually, I can't type at all!)
I think managing my diabetes is kinda like trying to figure out how much air you need to breathe everyday.(so whenever I feel blue......I just start breathing again.)

Sometimes when my friends ask me what it's like- I tell them its kinda like driving around in your car without a gas guage!

There's really only 4 things that as diabetics, we try to do everday-

1. Prevent the Hi's
2. Prevent the Lo's
3. Hold back the tides
4. and scale Mt. Everest

I've come up with 4 things that really would make Managing diabetes ALOT easier-

1. If we didn't have it!
2. If we had a magic wand and a crystal
ball.
3. If we never had to eat again.
4. If we craved celery sticks instead of
chocolate!

Type I, type II, type 1.75....does it really matter?
I think the even greater challenge in life is to overcome our fears and do what we can to make peace with adversity in whatever form it comes.

"If I could find a way to be Happy about having diabetes....I wouldn't need cure."
- The LIVabetes Glucose Goddess

[Pem]

There are lots more types the doctors haven't figured out yet. I'm a type II who isn't insulin resistant. I also have high HDL and low triglycerides (in fact my HDL is higher than my triglycerides). I was overweight, though somewhat active, but losing weight has helped my control not at all. I've been diagnosed for a year and a half now without any deterioration in control, so it is unlikely that I am really a type I.

When I talk to thin people who had reasons to worry about diabetes I suggest they insist at least that their doctors check their blood glucose when they have other lab tests. I tell them thin people aren't usually diagnosed until they have serious complications because doctors are so prejudiced against fat people that they fall into the assumption that only fat people get diabetes.

[birdwoman]

Seems like diabetes is a term for the SYMPTOM, not the disease... if you know what I mean?

Kind of like Cancer. Cancer really seems to describe the result, not the cause. There are so many types of cancer and they run the gamut in treatability and toxicity... yet they're all called cancer.

what do I know about medicine? I just flunked a couple of kids trying to become doctors out of organic chem, that's all.

(*)>

[AmyT]

Nick:
My dad was barely 71. He should've had 20 more good years in him!

-AmyT

[Milissa]

I think this is great that you are having this information on the internet. My son who is eight years old was just recently diagnosed with Type 1 Diabetes.

I didn't know much about Diabetes until he was diagnosed. Well meaning friends and family keep telling Brendan that he can outgrow his diabetes with his diet and if he takes herbal medication(I said no to this). We know they mean well but it does get frustrating.

Thanks for posting this information.

[A.J.]

Hello everyone, this is my first time reading any type of diabetes blog, and I have really enjoyed it. I can relate to everything that is being said. One thing I was wondering was if anyone has enjoyed the switch from syringes to an insulin pump as much as I have. I was diagnosed with Type 1 diabetes two years ago, I am now 24 years old. I refused to get on the pump in fear that it would be too weird to have something connected to me at all times. After taking 7-10 shots a day for a year plus and feeling tired throughout the day, I decided to see if the pump could improve the way I felt. So far I have been on it for a month, and I can't believe how much I love it, and I was very skeptical. If anyone is thinking about making the change and has any questions or comments I would love to discuss it or just hear thoughts.

[AmyT]

Hello A.J., welcome!
I'm curious: which pump did you choose?

Also, the best way to to get folks' attention here is to post a comment on one of the brand new entries, so that your input is in the "forefront."

Take care!
- Amy

[Rachel]

I've been reading through your blog today (and leaving comments as I see fit).

My doctor said that I "got the short end of the genetic stick" with respect to type 2 happening in my late 20's. I never had an obese BMI, but yeah, stayed a little overweight for a little too long (6 years) for my genetic background - probably due to undiagnosed hypothyroidism. Very frustrating for someone who was underweight for much of her life. Very frustrating for someone whose parents both have smoked for 45 years (with heart disease and diabetes on mom's side) and who are just now seeing diabetes hit them in their 60's.

thank you again for this wonderful blog. I write about my type 2 experience more in my livejournal: http://www.livejournal.com/~ramaba for now, but I'm looking to move most stuff over to the URL indicated.

[mytime79]

It looks like I'm pretty late to respond, but this is a very interesting topic and I really do respect everyone's opinion.

I've been a Type 1 diabetic since I was 14 years old and I'm now 26. Over the past couple of years I've become sensative to the TYPE 1 vs. TYPE 2 discussion. If someone finds out I'm diabetic, most common response is, "My grandma, father, uncle, etc... is diabetic." My first reaction always is to try and clarify, well do they have type 1 or type 2. One of my biggest fears, as it turns out, is to be considered a Type 2 diabetic. It hurts me to even write that down, but it is also the truth. At 26, I don't want people to start assuming things about me regarding the diabetes when the disease for me is a genetic disease, and NOTHING I could've done in my life could've prevented getting it.

[Jeanette Pizarro]

I can understand the frustration of people with type 1 diabetes. However, there are other reasons too for getting type 2. When your mother was an alcoholic while pregnent and then did not feed you just gave you sugar water for meals, that can lead to type 2 in adults, no nutritions. I was not overweight and always active with work and sports and now I have type 2. We all have to deal with this desease and keep informed of new treatments. I believe that no one should suffer. I have many friends and know many young kids with diabetes and it hurts me to see the struggles. I rather help them as much as I can instead of seperating the types and why they got it. God bless

[Nancy]

My brother is using his diabetes to commit suicide and we can't seem to help him. He is 52 and is refusing treatment. He only weights 150 or less and is having leg and hand pain at night. What will it be like for him to die? I can't seem to find any information on what it is like to die from diabetes. He absolutely refuses to particiate in his care. It this time we are just trying to cope.

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[Lene Petite]

Hello, I read all this blog very carefully and found a lot of very useful advices! I would recommend you to come to www.pharmamedics.com and find their a lot of medicaments of High European Quality which will help you in the fight with your deseases!Do not give up!

[karen]

how dare some of you type 1s condem type 2s. how many of us wont come out of the closet because of the way people think that we are just fat people that gave ourselves this disease. i come to read a post to find comfort and am more upset than i was. to act as though only type 1s struggle with this diease. as a type 2 i take 4 shots a day and go thru highs and lows all day long and have a endo that tells me i cant lose weight because i inject insulin. i cant except that and i am going to a new dietician tomorrow and i wish myself luck. i wish some of you an attitude adjustment. do you really think we deserve to get a disease and you dont because of life style choices. how sad.

[Bclark]

I am kind of frustrated with a comment I read here. It said type 1 diabetes is never caused by eating sweets. That is true. However, type 2 diabetes is never caused by eating to many sweets either. Please do not be so quick to assume type 2 diabetics are massive people who do nothing but eat candy all the time. With so much knowledge of diabetes I would hope you would know diabetes type one or two is not caused by eating sweets. The carbohydrates found in sugary foods cause blood glucose levels to rise. That is why sweets are often off limits or a least strictly limited for diabetics. I am a type 2 diabetic. I am not overweight nor have I ever been. Please type 2's don't let this person's blog make you feel bad. Keep your sugar under control and just disreguard the negative things people say. We'll be alright.

[Kari]

I was diagnosed one year ago, at the age of 47, with Type II diabetes.
My mother has Type II; my great-grandfather lost a limb, experienced blindness and died because of some form of diabetes. It seems to be genetic, not due to poor lifestyle choices.
I am fit, exercise heavily and eat very responsibly.
I also take a high dosage of two separate medications...the combination of these three efforts keep my sugars close to normal...most of the time.
Stress seems to be the variable that is difficult to control and that can throw the natural body chemistry off.
I personally would not mind if the medical community changed the name of Type II Diabetes...if for the reason that it offends people living with Type I or for other valid reasons.
It seems to me that what is needed and would be very much appreciated is more research, funding, education, quality medications and support.
I trust all people living with any form of diabetes or people living with those who have diabetes, would agree, at least in part.

As a matter of note, I have found that the American Diabetes Society website has far more practical information that their Canadian counterpart...hopefully, something else that will change over time.

[AK]

There are some groups where genetic susceptibility to Type 2 is so enhanced that they can develop insulin resistance, early onset heart disease and Type 2 despite being quite thin.

This condition is so commonly met with amongst Asian Indians (actualy the entire Indian subcontinent and Pakistan/Afghanistan as well)
that it has been termed 'The Indian Paradox'.
http://www.littleindia.com/news/139/ARTICLE/1390/2006-11-12.html

This article is very informative--except it may give slightly inaccurate info on how to measure waist hip ratio. They say to measure the belly at navel level--other sources advise measuring ones waist at the narrowest point which for many of us is just above the belly button.

What it adds up to is if you are from an ethnic group that is from a part of the world visited by frequent and severe famine conditions, you may have inherited a body that gets the equivalent of 200 miles to a gallon.

This is excellent for surviving harsh conditions, but the inhabitant of such a body at accelerated risk of Type 2 if he or she moves to a part of the world where stress runs high, there's little opportunity for exercise and where unhealthy food is cheaper and more readily available than healthy food.

My father, uncle and grandmother all survived starvation in Russia following the Bolshevik revolution.

All three of them later developed Type 2, and neither my father nor uncle was overweight at time of diagnosis.

One can have the 'Indian Paradox' and not necessarily be Indian--just be descended from ancestors who lived in areas where famine was frequent.

[Jen]

How dare those of you with type 1 diabetes act like you are better than those of us with type 2. Grow the hell up and get over it. I am 32 years old and type 2. I am in shape, eat right and work out 4 times a week. Pretty much everyone on my mother's side of the family is diabetic. My diabetes is a result of genetics not a result of anything I did or did not do. So, get off your high horse and stop acting like all people with type 2 brought it on themselves. Your pure ignorance astounds me.

[suede]

Jen,

I'm 37 and in the same boat...
I have to admit I feel better to have seen your post here.

Thanks