Tension Between Type One and Type Two Diabetics
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.
However, the researchers reported that the treatment also reduced insulin resistance in the beta cells and postulated that insulin resistance may play a large part in type 1 as well as type 2 diabetes.
And inflammation apparently plays a large part in causing type 1 as well. This same study showed that the treatment that reduced inflammation and normalized blood sugar levels in NOD (type 1 analogues) mice also reduced insulin resistance.
In other words, work done with mice that are analogous to type 1 human patients has produced results that may help type 2s as well as type 1s. And work on inflammation aimed at type 2s has produced results that may help type 1s.
I personally think that we all have the same disease, with some autoimmune destruction of beta cells and some insulin resistance. In type 1s, there's more immune dysfunction and little insulin resistance. In type 2s, there only a little immune dysfunction, not enough to show up on tests for GAD antibody, but a lot of insulin resistance.
I have no evidence for this. It's just intuition. So don't take my theory too seriously.
But I do think type 1s and type 2s should support each other instead of quibbling about where most of the research money is going or pointing a finger at one type and suggesting that those patients don't deserve as much help.
Diabetes stinks. No one understands it like the people who live with it 24/7, and we need all the support we can get. This year, let's all make New Year's resolutions to try to understand the types of diabetes we don't have and to support each other instead of throwing barbs.