4 Questions and Answers about Managing Rheumatoid Arthritis and Diabetesby Lawrence 'Rick' Phillips Patient Advocate
People with rheumatoid arthritis (RA) are approximately 50 percent more likely to develop diabetes than the general population. I was diagnosed with type 1 diabetes in 1974 and rheumatoid arthritis (RA) in 2000. Today I’d like to share some questions I am commonly asked about living with RA and diabetes and my answers.
Answer: The next question I am often asked is if RA and diabetes are related. My answer is yes and no. Both RA and type 1 diabetes are autoimmune diseases. In both cases my autoimmune system has chosen or been triggered to attack essential functions of my body. With RA it is my joints and organs, and with Type 1 diabetes it is the insulin-producing Beta cells of my pancreas. Since I was diagnosed with RA, I have been very interested in the prevalence of RA among people with type 1 diabetes, but we don’t yet know the number of people with both type 1 and RA.
Type 2 diabetes is usually characterized by insulin resistance. Which means that a person with the condition makes insulin but is unable to use their own insulin correctly. This is sometimes, but not always, associated with obesity, age, physical inactivity, and previous history of gestational diabetes. Type 2 diabetes is usually treated with diet restrictions and oral, or specialized injected medications, followed by the use of insulin.
Answer: People sometimes ask me if I have the “bad kind” of diabetes. I do not know any “good” diabetes. I think of diabetes like a major airport. People become diabetic via different routes. But regardless of how you get there, diabetes is still the inability to properly use carbohydrates.
Some people with diabetes have insulin resistance. Meaning their bodies cannot use the insulin they produce to deal with carbohydrates; this is usually referred to as type 2 or gestational diabetes. But other people, such as myself, have bodies that no longer produce insulin. This condition is called type 1 diabetes. But regardless of what we call the various types of diabetes (Diabetes Quebec reports six types), we all arrive at the same point. We need intervention to help our bodies process carbohydrates.
RA is similar to diabetes in this regard. We arrive at the RA airport from different paths. However, unlike diabetes, we have much less understanding of what causes rheumatoid arthritis. Also with RA, we have much less understanding of what works or not. Whereas with diabetes, we know that with a few exceptions, there is one medication that works to help us process carbohydrates: insulin. But with RA, there is not one overall treatment that works for most of us. In that regard, RA is much more frustrating.
Answer: When people hear I have both RA and diabetes, they always ask me which is worse. I almost always answer curtly: both.
But if one peels back my blunt answer, I will say that RA is much worse for me. It’s worse because I have more control over my diabetes. I have devices that help me correct the discomfort I experience when my blood sugar is high and glucose to correct my blood sugar when it is low. I do not have immediate control over RA. With RA when I feel awful it is two to nine months (if ever) before I can feel better. With diabetes, I might have 48 hours of discomfort but ultimately there is a mechanism to correct it.
Answer: The final thing I tell people is that I am lucky. This usually draws the biggest surprise. How can you feel lucky to have RA and diabetes? The answer is simple. When I was diagnosed with diabetes, I felt my life would be relatively short and fraught with many medical complications. My mother, also a type 1, passed away at age 46 due to complications related to diabetes. So for me, being diagnosed with diabetes at age 17 meant a short life.
What I did not count on were the advances in medical understanding about diabetes and its treatments. So when I was diagnosed with RA at 42, I came to the realization that I am a blessed person. I lived long enough to have a second autoimmune disease. Such a life span was far from assured in 1974. In 2000, I had to say thank God I have lived long enough to have RA. The result is I try hard to celebrate each day and remember this is a day I did not think I would have in 1974.
I need to make the best of my gift.