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.