Friday, May 2, 2008

Which type of diabetes is worse? Part 1

Last night I blogged about Jay Cutler's diagnosis of type 1 diabetes. The article in the Denver Post reveals a breathtaking mix of scientific fact and popular misunderstandings about diabetes.

Take, for example, the statement that type 1 is "the most serious type of diabetes." Actually, judging from everything I've read and been told by my doctors, I'd actually say that type 1 diabetics actually have it better.

Consider the facts:

* Only 10 percent of all diabetics are type 1. You know those headlines that talk about how diabetes is becoming this epidemic, that more and more people are becoming diabetic all the time? That's type 2 they're talking about. Type 2 is the epidemic.

* Type 1 diabetes is an autoimmune disease, which means my immune system attacked and killed the insulin-producing cells in my pancreas. Compare this to type 2 diabetics, whose condition typically is caused by poor diet, lack of exercise, and obesity. (Not always, mind you, but again -- the epidemic certainly is due to these factors.)

* Type 1 diabetics are typically diagnosed young, many even younger than I was. This usually means that they are more willing to adapt to their condition in order to ensure tight control. Type 2 diabetics, on the other hand, often are unwilling to change their diet or exercise more. They're usually older, so they have had many years to become set in their ways.

All of this begs the question: Which type of diabetes is really worse?

Imagine you have two people with liver problems. One of them has problems that stem from a naturally occurring disease, perhaps a childhood condition. The other is steadily drinking his liver to death, and although his condition is perhaps not as far advanced, it's quickly getting worse — and he shows no signs of letting up. Which one would you consider to be worse off?

Of course, this isn't a perfect analogy, as type 1 and type 2 diabetes are actually dramatically different diseases. As I already mentioned, type 1 diabetes is an autoimmune disease that basically kills off most or all of the insulin-producing cells in the pancreas.

In type 2 diabetes, however, the body actually becomes resistant to its own insulin. It is unable to use the insulin correctly, so it continues to make more and more insulin, which only increases the body's insulin resistance. I believe obesity also contributes to increased insulin resistance.

In any case, my point is that type 1 is usually more treatable, because the patient is generally more willing to manage their diabetes. On the other hand, type 2 diabetics (according to my doctors) tend to be more stubborn and set in their ways, refusing to take the steps that could virtually cure them of their condition.


Anonymous said...

i had to laugh. your logic and thinking is surely blinded.

Katharine Swan said...

Welcome to my blog, Anonymous! Please feel free to add some detail to why you disagree with me.

Anonymous said...

Wow. I just stumbled upon this. Having been diagnosed at the age of 7 I suppose I should be THANKFUL in my mid-20s that I am developing neuropathy, despite never having an A1c over 8 (my last one was 5.9 mind you) because obviously I have adapted.

I guess it's better that instead of a normal childhood, I was in and out of hospitals, unable to go on field trips to water parks and Disney world. While all of my peers in college were worrying about how to buy beer, I was worrying about how to buy $150 bottles of insulin.... That I NEED to survive. I use 3 per month. And yet you can get generic metformin for type 2 for considerably less. Where is the fucking decency in that???

Your logic, as the previous anonymous commenter stated, is completely flawed and offensive. Just because there are less of us who have Type 1, it does not make it acceptable to keep spreading misinformation about this disorder/disease.

I would KILL to be able to simply change my diet and not have to deal with this hell. I didn't give myself this disease by being overweight, lazy and consuming too much coca cola, and some type 2's didn't either, but most of them did and if they don't want to change their sedentary lifestyles, they deserve much worse than neuropathy.

Katharine Swan said...

Anonymous, I am very sorry for the late response, but your comment sat in my spam box for a long time before I found it.

I am not sure you understood my post. I was saying that as a whole, type 2 diabetes sounds worse to me. Not your particular case, just the disease itself. It's often caused by people's habits of not taking care of themselves, and by the time it sets in their habits are ingrained, and most are extremely resentful and reluctant to change their ways.

Type 1, on the other hand -- particularly for diabetics diagnosed since Lantus was first released a little over 10 years ago -- is easier to control when you are diagnosed young, when you are still forming your habits.

It sounds like you are very angry about the unfairness of having such a bad case of type 1 while people with type 2 don't take of themselves. I don't disagree with you, and like I said, I wasn't saying anything about individual cases of the disease. And I agree with you that it's horrible how expensive insulin is. I just get tired of being told that I've "got it bad" because I have to take insulin, especially when I'm being told that by a type 2 diabetic who rarely checks their blood sugar and refuses to exercise or eat right. People who say type 1 is worse because it requires insulin usually don't understand that they are two completely different diseases.

I'm sorry you've had such a rotten experience with diabetes, but I think you and I actually agree on most stuff. I think the only place we differ is because I said I think type 2 -- which is the epidemic -- is worse, and you've had such a horrible experience with type 1 that you disagree. But please realize that I wasn't making a comment on YOUR experience, but on the implications of overeating and the growing numbers of type 2 in America.