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Thursday, July, 24, 2008

Two Types

by  Gretchen Becker
Wednesday, December 05, 2007
Gretchen Becker
Gretchen Becker
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Gretchen Becker studied biology for 8 years at Radcliffe/Harvard, w...

Gretchen Becker

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One sad aspect of the diabetes world is the way people with the two major types of diabetes -- type 1 and type 2 -- sometimes seem more adversarial than supportive of each other.

 

Whenever there's an article about the "epidemic" of type 2 diabetes, there's apt to be a flurry of comments by parents of children with type 1 saying their children are innocent victims of a genetic disease and shouldn't be confused with those type 2s who have a "preventable disease" that they "brought on themselves" with their gluttonous and slothful lifestyles.

 

In fact, the genetic link to type 2 diabetes is stronger than that to type 1. And many type 1s have no understanding of how difficult it is when you're ravenously hungry all day and put on weight even when you eat very little.

 

Conversely, type 2s tend to complain that they have to follow severely restricted diets and can't pig out on carbohydrates and just cover the carbs by pushing a button on a pump, like the type 1s can.

 

They have no understanding of how difficult it is having to count every carb you eat and calculate how much insulin to inject to cover those carbs, how difficult it is to go low without warning, always worried about going into DKA, or how difficult it is to be the parent of a toddler dealing with this disease.

 

Some misunderstanding among patients is understandable. But it's upsetting when even endocrinologists spout this kind of thing. A recent article in the New York Times concerned a trial to prevent type 1 diabetes.

 

"It's not the kind of condition where you just take a pill and sort of forget about it," said Dr. Natasha Leibel, Ali's endocrinologist at Columbia University's Naomi Berrie Diabetes Center in Manhattan. "Managing Type 1 is an incredibly intensive life change."

"The key to preventing Type 1 is genetics."


"Where you just take a pill and sort of forget about it?" Is this what Dr. Berrie advises her type 2 patients to do? Does she have any conception of how much effort and dedication it takes to follow a rigid diet and exercise plan?

 

Doesn't she know that type 2 diabetes is genetic too? That the genetic link with type 2 is even stronger than that of type 1?

 

The sad thing about this adversarial approach --- "My diabetes is more serious than your diabetes" --- is that we all have so much in common. Science is learning that there are more similarities between the two types than we used to think. Research aimed at type 2 may benefit type 1, and research aimed at type 1 may benefit type 2.

 

For example, in fall 2006, researchers in Toronto made the surprising report that they could cure diabetic mice by manipulating the nerves to the pancreas. The mice used in the experiments, called NOD for nonobese diabetic, were analogous to type 1 human patients and had autoimmune destruction of their beta cells.

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