About that T1/T2 division

Community
#1

...I really don't get it. Why do people do this?

There are posts now and then that leave me with the bad taste that some T1's think they are better, or "more legitimate" than T2's.

Then there's the whole "fault" thing -- some T1's seem to view T2 as something T2's brought on themselves. We all know that's a common misconception in the general public; it stings all the more when a fellow diabetic throws it at you.

Here's my view on this whole stupid controversy: There is vastly more that T1's and T2's have in common with this illness than not. We face exactly the same health risks, the same alterations to our lifestyle with the exception of insulin therapy, and even that isn't a bright line separating us. We face the same burdens of management, record-keeping, etc.

And for some T2's -- many of us would argue it should be vastly more -- we manage our BG with insulin too.

Often with disease there are multiple paths to getting there, but once you arrive, the disease is basically the same. That is how it is with diabetes. T1 or T2, we are brothers and sisters, not cousins. We really need to keep that in mind and act like it, folks.

#2

Amen!

#3

I have to say I agree. I don't like any of the hostility that type 2's get. I can't say I see it on here, at least as much as everywhere else (particularly on the comment section of news articles about type 2) . This gave me a toooon of problems when I was in diagnosis limbo after being diagnosed with diabetes and being told I had 2 and going through lots of self loathing and dealing with shame that I never would of deserved even if I was a type 2. It ain't worth it, no one should feel bad because they have diabetes, regardless of what type. No one should feel like it's self inflicted either, because even type 2 can happen to the healthiest of people.

#4

Maybe some of that sense might be because the JDRF excludes T2 by referring to JUVENILE diabetes. The same sort of goes for "the cure" and the sort of stream of "curism" that permeates places like Facebook and sometimes spills over here. Sure a cure for T1 would be great but 1) it leaves T2 out and, given the complexity of the multiple components of T2, it seems, at least to me, rather less likely to be cured any time soon.

Perhaps the biggest problem facing people with T2 is how the "prevent diabetes with diet and exercise" meme has captured the public mind. Soundbites from Drew Carey or Michelle Obama misstate how T2 can be managed with diet and exercise (e.g. BadMoonT2, I know there's many of you here!) in the context of a public health plan. I for one would like to read through Drew Carey's medical records before I will believe that, if had diabetes, he is actually "cured". Diet and exercise are good for everyone. T2 is a very complex disease (cf. The Ralph DiFronzo article explaining this in detail: "From the Triumvirate to the Ominous Octet") and fixing the various elements of it, which may perhaps be as curable as T1, doesn't seem to generate the marketing "buzz" of Tour de Cure or the gazillions of JDRF walks and other events that shovel money at T1. In general diabetes receives much less funding for research than other diseases like cancer and heart disease however I suspect that T2 gets the least amount of research dollars/ patient of any of them.

#5

I agree, in general I think we have far more commonalities than differences.

Ten years ago, before I started hanging out in online diabetes communities (and particularly this community), I probably would have disagreed. It's largely because of hanging out online and interacting with all types and reading about the incredible effort we all put into our diabetes, whatever our treatment regiment or duration of diabetes or level of control or diabetes type, that changed my thinking.

I do, however, believe T1 and T2 are still different. I don't believe they are exactly the same experiences or that the treatments are exactly identical. Each Type has their own issues and struggles. I don't think pointing out those differences is a bad thing. But, as you pointed out, no one should be blamed for diabetes, and no Type is harder or easier or better or worse than the other.

#6

As a T2 managing on oral meds/diet/exercise, I perceive that there is a tangible line between those who are on insulin & those who aren't. To wit, that T1s & T2s on insulin share alot of the same challenges in their D management.
Thoughts?

#7

The reason they do this is because that is the perception given by the medical community. The focus of the medical community has been prevention, as it should be, but where they fail is they have not made the distinction between prevention of the disease and prevention of symptoms. If you have T2 it could not be prevented but you can in some cases prevent the onset of symptoms.

If one wishes to lay blame it is possible with either type of D. If one is facing complications, be they T1 or T2, a narrow minded person could lay blame on past behavior. I for one refuse to go there for I have no way of knowing if the blame is warranted.

I am reminded of a biblical saying. He who is without sin among you, let him be the first to throw a stone.

#8

+1

#9

I agree with you completely Dave. That trend, which I see in forums like these as well as throughout the rest of the world, is not in anyone’s best interest, and its just fairly obnoxious

#10

I do so much agree.

#11

You are just jealous cause we are better lookin'. lol

#12

I agree with you that T2's are unfairly blamed for their condition. I believe we don't know what things are causing the increase in cases. I'm not convinced that obesity causes diabetes, rather both being a result of some type of metabolic disorder.
But I don't agree that we face the same burdens, risks, and lifestyle alterations. As a T1 I'm concerned about hypoglycemia every day of my life. Intensive management for a T1 requires more testing, adjusting, calculating, and decision-making on an hour-by-hour basis than a conscientious T2. Some things we have better. I can have a big piece of cake (hopefully only on occasion), cover it with insulin, and only see a short-lived spike in my BG.
It's very important that medical personnel understand the differences, which they often don't. Get a group of T1's together and have them talk about hospital experiences. It's very common for us to get an overdose of insulin because the doctor is used to dosing T2's, who generally need a lot more insulin. One man I know refused his insulin shot before bed in the hospital because it was far too much for him. The nurse refused to ask the doctor to lower it, and he went without. He woke up with a BG of 600.
One (kind of) funny story. I was referred several years ago to a Carb Counting class by my doctor. I showed up with two other gentlemen, who were recently diagnosed with T2 and were not on any kind of medication. Their doctors didn't know that Carb Counting refers to a method used to calculate insulin doses. The CDE went through all the information, using me as her sole example. The two men just looked bewildered.
We do face the same types of complications, and some of the same restrictions to our lifestyles. We should always support each other. But sometimes we must point out the differences, for our own health and safety.

#13

I'm not convinced; I think there are big differences, especially when it comes to management advice. That's why I typically post here only on threads relevant to T1's. If I post advice here to a T2 I try to always be careful to point out that I'm a T1 and that my experience may not be relevant. I wish more people here would do that, since I think otherwise the advice can be very misleading.

I disagree with your statement that the health risks, alterations to lifestyle, burdens of management, and record-keeping are all the same. I think you'll find big differences in all of these areas if you think about it.

I think Jen is exactly right by pointing out the one thing that really DOES bind us together - that no matter what type of diabetes you have it takes lots of EFFORT to manage it.

#14

Hmmm. You may be overlooking the fact that thousands of T2s control their diabetes with insulin, and are just as much at risk of hypos as anyone else. Furthermore, it is MUCH MUCH more difficult for a T2 to get a pump authorized.

#15

I'm a T2 on insulin, c-peptide 0.2
Hypoglycemia check
carb counting check
Testing 6 times, check
Calculating check
DKA unlikely
Limit my carbs to 80 a day, YES
Insulin Pump, check
Remembering to take my metformin, priceless

I used to tease a very good T1 friend of mine. I told him he took metformin with his insulin. I on the other hand, took insulin with my metformin.

-Lloyd

#16

Everyone who uses insulin is at risk of hypoglycemia. It's my understanding that T1s are at increased risk of *severe* hypoglycemia, particularly overnight, because their counter-regulatory system is compromised and doesn't respond as vigorously as it should (if at all) to lows.

#17

I agree. They are vastly different. Type 1 is an autoimmune disease and the attack on the pancreas, i.e., islet cells destroys not only insulin and our ability to produce amilyn (beta cells) but the alpha cells are also destroyed. this also leaves T1's prone to other autoimmune diseases. T1's sensitivity to insulin is very different and we produce ketones and go DKA. I've talked to T2's who let their blood sugars soar...we, as type 1's cannot because we'll go DKA. We also have no ability to just manage this with an oral, diet or exercise and unless and until there is a cure, we'll forever be on insulin. Frankly, if my basal isn't correct, i could exercise forever and my blood sugars really won't come down. I don't think I've ever posted advice for a type 2, maybe only if it was insulin related (or possible late onset type 1) cause I have no clue about type 2. just because a type 2 is on insulin, that doesn't make them insulin dependent. they're two different things. no one says it's type 2's fault, it's not about fault, it's just different. Type 2's have metabolic issues as well. I've discussed this with my Endo (many, really) and been told to never compare my type 1 with type 2 diabetes because they are entirely different and have nothing in common other than managing blood sugars...which, for all of us...sucks. just sayin'. I think if a type 2 ever had the awful experience of DKA (or the constant fear) and severe hypoglycemia; seizures, passing out, paramedics called, etc...they might realize the vast difference(s).

#18

I have no ability do manage my diabetes with diet, though cutting my carbohydrates back to 80 a day helps. If I ate no carbohydrates at all, I would still need 50 units a day of basal insulin. Exercise affects my glucose very little.

I agree with your statement above, you have no clue about type 2.

-Lloyd

#19

well, have you tried to lose weight - maybe it's too late for you to do that. however, i never had that chance to even try. I've been extremely healthy, very active, athletic my entire life and weigh 105 lbs and about 90 lbs. when I was diagnosed. there's a huge difference. forget it, these types of conversations tend to get heated so I won't list the facts about type 2.

#20

Cutting my carbohydrates back by 100 carbs a day, allowed me to lose 35 pounds in 8 months, and keep it off for more than 6 years now.

Losing weight made no difference in my insulin needs. During the 6 years since I lost the weight, my TDD has gone up from 55 U to 75. However, all 28 A1c's have been between 4.9 and 5.4. That takes hard work and knowing what you are doing.

-Lloyd