A challenge: T1 be a T2 for a day

Type 2
1

EDIT: I just reread this again after some hours away from the discussion and frankly I was surprised at the sharp tone and taunting sort of rhetoric. I think I was probably ticked off about some of the things said in that other discussion.

I sincerely apologize to the many fellow diabetics, T1 or 2, that I offended. I vented when I shouldn't have.
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I started quit some controversy over comparing T1 and T2 to be far more similar than not in another thread. Several T1's have taken issue with my statements in that thread.

I stand by them. Indeed, I think there is a great deal of ignorance among T1's regarding T2, and I see many of the same "common sense" nonsense about T2 that afflicts the general non-diabetes population in some of the statements in that discussion.

Frankly, I think active, engaged T2's understand T1, the challenges T1's face, the treatment regimens and options much better than most T1's understand about T2. The following is what drives it home for me:

Does a responsible T1 test, have a BG of 200, and then do nothing about it? Or do they inject a correction bolus?

Do they then test again say, an hour later, and adjust again if they think it's necessary?

T1's, would you accept a prescribed treatment plan that said take your TDD in long-acting, then adjust your quantity and timing of diet and excercise to keep yourself from getting hypo, and well, just live with watching that BG after eating take 6 hours to get back down below say, 140?

You too can be a T2 for a day. Just do it! Double up on your basal injection for the day, and do not bolus with any fast-acting. If on a pump, just do a temp basal increase, and don't bolus.

You will then have a much better idea of what it's like to be a T2. You'll also probably think it's an insane way to treat your diabetes, and maybe start pondering, why aren't T2's -- most of them -- bolusing too?

I'm an insulin dependent T2 because I want to be, not because my "team" wanted me to. I have enough beta cell function that, with a pill cocktail and restrictive life, I can achieve an a1c of 7-8.

And hate it.

Instead, I demanded the same high-resolution tools (insulin, CGM) that T1's have, with which many achieve normal BG control and a1c's 4-6. Why shouldn't I be able to be that healthy too?

2

Of course the pill cocktail does not act like slow acting insulin or a pump. The metformin I took shot my BG way down after 5-6 hours, and way up after 8-9. Then most doctors wont give you anything but a pill cocktail unless your A1C is approaching 8. Even once I got on basal and bolus insulin, my GP was suggesting that I get off it and try a combination of meds.

Fortunately, I tested positive for all the T1 antibody tests and don't have to be treated like a T2 anymore. Additionally, getting a T1 diagnosis opened the door for me to receive a reasonable amount of test strips, a Dexcom, and a pump(which I don't use). I'm kind of surprised that being an T2 you were able to get a CGM.

Anyway, no thanks on the T2 living. Been there, done that, had the metformin headaches, vitamin deficiency, and puking.

3

Who in the other discussion disagreed with you?

I really am curious.

I didn't see anyone post there saying T2s shouldn't be encouraged to use insulin and the other tools T1s use or should be expected to put up with ridiculous levels of (non-)control.

All this talk about T1 ignorance, yet I honestly didn't see it in the other thread save for possibly one or two posts out of the dozens of replies. I saw a few T1s (myself included) posting that the diseases are not identical. There are some very real differences between the two that, although seemingly minor, can have a big impact (especially psychologically). But also that yes, in general there are very similar day-to-day management issues and overall challenges and goals.

Overall, I think no type can really fully understand the other because we are talking about life experiences. Maybe this is the problem. Do we really have to fully understand one another and be living identical experiences to respect and cooperate? I don't think so.

Or perhaps I am one of the ignorant ones and just don't realize it? In which case ... I'd still be curious to know.

4

I'd try it but if I did not have insulin for the day I would be in the ICU with DKA long before the 24 hours are up. Could possibly even die in that 24 hours.

5

I wasn't referring to you, Jen.

I'm referring to those that seem to think T2, when not on insulin, is easier to manage effectively.

It's not.

It's easier to manage ineffectively.

6

But ... who in the previous thread said that? No one, from what I saw.

7

What the??? I do not want to be a T2 for a day. Suggesting a T1 "Double up on your basal injection for the day, and do not bolus with any fast-acting. If on a pump, just do a temp basal increase, and don't bolus." is dangerous and shameful. What if someone were to try this and suffered consequence? Your idea is offensive, and is the epitome of ignorance Your other discussion is just beating a dead horse and serves no purpose in supporting each other or understanding each other. I'd rather play battle ball!

8

I got a pump and CGM for two reasons, both critically important: I had gone way off the reservation for a year+, and my a1c shot up to 11.

Second, I have an endo that shares my philosophy on this, so she wrote letters, made calls, and advocated hard. We won.

I now have BG through the day that, when I behave myself gastronimically, looks like a non-diabetic. My a1c is now under 6.

Regardless, a bowl of 3 scoops of ice cream still sends me soaring, despite all my carb counting, pre-bolusing, etc. Was my b-day yesterday, so I threw caution to the wind and ate half a pint of my favorite, coffee Häagen-Dazs.

I was delighted that I peaked at 175, and was back under 140 within 2 hours. I was expecting and prepared for 250, and all the ill feeling that goes with it.

As a T2, I simply couldn't have enjoyed that indulgence, AT ALL, if I weren't treating my diabetes like it should be treated, but instead was half-treating it like most diabetics.

And I'm certainly not advocating being irresponsible as a diabetic and eating like a Sumo Wrestler with poor nutritional choices. However, I do think it is entirely appropriate to be able to treat oneself on special occasions, and with the right treatment tools, I CAN.

And should be able to.

9

Once again I am in complete agreement with Jen, and complete disagreement with you. Really, thanks for accusing T1's of being "ignorant". That will REALLY do a lot to improve relations between us.

10

Suggesting a T1 "Double up on your basal injection for the day, and do not bolus with any fast-acting. If on a pump, just do a temp basal increase, and don't bolus." is dangerous and shameful.

His point was that for most T2s who have lost the bulk of their insulin response, this is effectively the treatment regimen they receive.

11

i didnt respond to the other thread about t1/2 divide. i havent read it all, either.

when i was first diagnosed, i had the polys-the thirst, constant peeing and hunger, and had lost 3 or four kilos. i went in to the doc and said my dad is t2, my sister is insulin resistant, lots of t2 everywhere in the family, and thought i had diabetes. i thought i had t2 of course, with all that and being in my thirties. it didnt occur to me that i could be t1, but here i am.

i cannot imagine being any kind of diabetic and not having insulin available and recommended to me. its not like i feel like im luckier being t1, but sometimes i kind of do, considering the fact that i would have to live like many t2s do-on pills, testing (maybe) once a day and no exogenous insulin. i have watched many relatives suffer through it. i cannot imagine how hard it must be to do this without insulin.

12

Hopefully there will soon come a time when all Type 2s who would benefit from insulin as a primary treatment will be able to have it prescribed and covered by insurance without a fight. The same goes for an adequate number of test strips for both types and CGMs for all who are willing to put in the extra work. But the suggestion that anyone with Type 1 "double up" on basal injections or especially try a temporary basal rate of 200% on their pump for a day does not, in my opinion, show a clear understanding of the treatment and challenges of Type 1. With the recent weather changes, I find my Dexcom readings slipping into the 50s overnight. Doubling my basal rates would be a disaster in the making, and a risk that I don't believe any of us should be willing to make. But I do understand your point about not being prescribed a fast acting insulin to bolus. I have to say that I have several Type 2 friends who bolus prior to meals, and their A1cs are much lower than mine.

13

Instead, I demanded the same high-resolution tools (insulin, CGM) that T1's have, with which many achieve normal BG control and a1c's 4-6.

Even with these tools and try as hard as possible, I've never heard of "many" T1's achieving normal BG control and A1c's 4-6. That's not correct. The average T1 person has an A1c in the 7's.

My T2 relatives have no clue how hard it is to control T1D and how dangerous it is to be on insulin. The ambulance rides are the best part.

14

I wondered about that as well. My endo, who has a huge practice and has Type 1 himself, has not been happy on the occasions my A1c has dropped below 6.0, mostly because I have difficulty achieving a low A1c without inadvertently having a lot of lows.

15

Guys I don't think he was actually saying to do that, more or less to give people a hint of what the difference is. You don't wanna change your insulin regimen without a doctor's approval and I think he realizes that, right? He's upset with how type 2's are treated in comparison to type 1's , and it's completely understandable to be angry about that. I'd say it's pretty easily to know when you want to have insulin and all of the tools that a diabetic can have, except type 2's are often restricted by insurance to not be allowed as many test strips, cgms, pumps, etc. I understand type 2 anger, especially who want more out of their diabetes treatment and don't get it. Insurance companies in particular almost punish type 2's. Some type 1's even get this, but it's often more type 2's . Sometimes even doctors are really cruel towards type 2's and expect them to lose weight (when they're already slim or at least of a non-overweight size) and expect them to have a very rigid diet and lifestyle that is REALLY HARD to maintain to even just get the 7% a1c, and leave it at 7% when they could do better with more tools. Besides that? Insulin is PROBABLY safer for you than any type 2 drug (see Victoza for some scary crap, that commercial talks about the scary stuff more than anything) but they still get told to try all of these potentially dangerous drugs instead of insulin which might work best and be safest? I don't fully understand that part. I mean I was originally diagnosed type 2 and I HAVE NO IDEA how the doctor expected me to maintain a good a1c let alone my kidneys and general health with just one pill of metformin and 2 test strips a day. Even if I ended up on some other type 2 drug I don't see how I'd survive with 2 strips a day. Especially when the doctor legitimately called me CRAZY for wanting to test more and being concerned that I was a type 1 and she did nothing about it. I get there's better doctors out there (I have one now) but some people don't have access to doctors that don't treat them like crap.

While I would say there's not that much if any type 1 ignorance towards type 2's here (there's been one thread though where I saw it... not the one Dave's talkin' about though) BUT I have seen it in places, particularly where type 1's blame type 2's for "changing the definition of diabetes" and giving us a hard time and people associating the disease with people who are "fat" and "do it to themselves." when that's not always the case, and it's becoming more common for slim otherwise healthy people to be type 2 and it's nothing they really did. I think we can agree people don't do anything to deserve their diabetes, if they got it from their diet , then so be it. No one deserves it, and no one also deserves inadequate treatment for it, regardless of type. No one also deserves to be shamed for something that they have and now have to deal with no matter what for the rest of their life instead of being encouraged to get better. I'm glad most people here seem to be pretty cool about the types and don't do this crap to people but I've seen it literally everywhere else and it's really awful.

16

My endo's a type 1 as well, he doesn't seem too concerned about my 5.5% a1c. He asks me how many lows I have (I'd say about 1-2 a month? ) and it's almost always because I give myself too much so I'm trying to reduce it and play on the safe side, that's why I'm trying to get a pump lol. He's totally on board with the idea of me getting a pump and particularly a CGM as now I've left the "hyperglycemia all of the time' club. I'm kinda reluctant due to the cost for the cgm and the abdominal space it'll take up but I'm pretty sure I'll end up with one afterall as my a1c is the lowest I wanna go.

17

Do you think T1s don't lead a restricted life? I'm on MDI not because I want to lead an unrestricted life, but I want to live! My insulin regime is not the only way I am healthy, I'm very careful about what I eat and how I exercise. My eating and exercise have to be planned out, no real spontaneity in my life. Asking if a T1 would accept a T2 treatment is nonsense. I do sense a bit of T1 ignorance in your comments. I admit I don't know much about T2 but I would never judge someone or tell them how to live with it. This may over simplify things but why do you care what others think? If you are eating well, exercising and a healthy weight feel good about yourself. If a T2 needs insulin to achieve this then they should have it. The end result for all of us should be a long and healthy life.
Dawn

18

I'm honestly confused... you said several things in your posting. Not sure what your curious about: That no one disagreed with me? Plenty did, on a variety of points.

No one said that T2's shouldn't use insulin therapy? I agree, no one did. But I didn't claim they did.

Help me out here, Jen. What is it you think I'm claiming that you don't feel occurred?

19

Thank your for understanding the point I'm making. I've always thought I was a careful and precise communicator, especially with the written word. I'm at a loss to understand where the miscommunication is occurring.

I've certainly made some enemies though, and I'm quite sad about that.

20
Guys I don't think he was actually saying to do that, more or less to give people a hint of what the difference is. You don't wanna change your insulin regimen without a doctor's approval and I think he realizes that, right?
Spot on.