well, good for you. again a difference, most type 1's can't get their A1C's that low because we lack alpha cells, amylin (we digest food too quickly), etc...If you think T1 and T2 are similar, if you can look at a 14 - 18 month old child in a DKA coma - fighting to even breath or stay alive, deathly thin who never had 35 lbs to lose let alone high blood pressure and cholesterol, of course, then that's certainly your prerogative. It IS different!
I also digest food quickly. With Apidra, my glucose is back to pre meal level in 70 minutes. With novolog, it takes 100 minutes.
Amylin production decreases proportionately with insulin production, my c-peptide is 0.2, which puts it about 1/30 of normal.
"Can't" is a *very* long time!
Actually, my mom has a co-worker who's a type 2 who has had very adverse hyperglycemia and hypoglycemic events. She's had seizures at work and has gone unconscious at work. When she was having her treatment adjusted she'd swing between both, now she's a lot more stable but even then she's having stuff I don't think I'd have as a type 1. I haven't had any serious events(talking seizures, comas, etc) despite being a type 1 . Granted I haven't been one super duper long , I still don't have a lot of those things and I'm pretty sure I'm a type 1. I also have an a1c of 5.5% because I'm a very disciplined eater and try to dose my insulin the best I can (Lately I hypo though if I'm wrong at all on that dosing instead of hyper like before when I was new to insulin) . I'm pretty sure I'm no longer honeymooning because without the insulin I am screwed and sicker than a dog with ketones galore.
Basically, all diabetics are very different with certain reactions and whatnot. Not all type 2's have never had an experience like a type 1 has, insulin carries a very high hypo risk and when used in insulin sensitizing drugs it can still cause very severe hypoglycemia. Some type 2's also get DKA when very sick and it's definitely not hhs. There's also type 1's that don't have the serious awful things that can happen , at least not for a long time. Does not make them a type 2.
A topic like this can degenerate, unfortunately. But since I always advise "test, test, test" (as in test your BGs a lot per day), I would also say that we should live by "compassion, compassion, compassion." Lots of times per day. We are all in this together.
I think this is basically what the OP is getting at. We're all diabetic. We're all subject to highs, most of us to lows, as well. We're all aware of the dangers of complications, we all have a love/hate relationship with food, and we all have that day of diagnosis that changed our worlds. Why exclude people from the community because they have a different disease mechanism?
Even at our snarkiest here - which isn't very snarky in my experience - there is rarely if ever an effort to exclude based on type. But Jag's point is important. I never give insulin advice to a T2 because the amounts we use are so different. Lloyd uses 75 units of basal per day, I use around 12. If he were to give insulin adjustment advice to a T1 based on his own experience, he might kill the person. If I were to give insulin adjustment advice to a T2, the adjustments would probably be irrelevant.
It's important to know how we're alike and how we're different. And as Melitta said we must live by "compassion, compassion, compassion".
The amounts can be vastly different, as you said.
Many of the things other than amount are the same. A pump works the same way (though a T2 usually needs a 300 U cartridge). Carb counting is the same. In general, methods are the same or similar. Amounts are not.
so right, you are.
Hip Hip hooray. +++ We must be compassionate.
I agree 100%.
However, I think many many more T2's should be on insulin than are. Basically, as a rule of thumb, of chronically running an a1c over 7, they should be treating their condition with at least bolus insulin.
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.While I'm certain there was no malice in your paragraph above, it speaks to exactly the sort of T1/T2 division, borne from ignorance, that I'm talking about here.
The difference between the T1 and T2 diabetics in your discussion is not the origin of their disease, it is the manner of treatment. A T2 (such as myself) treating with insulin (I have a Dexcom and Omnipod) face precisely the same challenges concerning hypos, calculating, counting carbs, aware and dealing with this hour by hour. I submit that my behavior is no different than a T1 -- with the one exception that my BG will not go through the roof and me go into DKA if I don't have basal.
However, that, and my insulin quantities due to insulin resistance, are really the only practical differences. Heck, I had a hypo last night.
I've been pounding this drum since I started on this site: T2's are inadequately treated presently. Doctors, patients, and our society have developed a culture of acceptance of "treat enough to eliminate acute symptoms" for T2, rather than the proper strategy of "treat to normal blood sugars", when the body of evidence shows strongly that the latter is what constitutes really tackling this disease.
I'm not on insulin because I have to be. I am because I demanded to be. I can take a cocktail of metformin, glipizide, and januvia; combined with a rather rigid diet and exercise regimen, as well as a failrly inflexible diet and exercise schedule, and achieve "medically acceptable" results: <120 preprandial, <200 postprandial, a1c <8. And have my foot amputated when I'm 70, and maybe be going blind.
That is a pretty good description of the standards for T2 diabetes care.
I guess I need to modify my original complaint: T1's, and T2's treating their diabetes effectively (in my opinion) have far more in common than not.
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.Awesome, Lloyd!
I'm glad to have you here as a fellow T2 IDPDS, especially a fellow pumper. Some T1's attitudes about this are, ironically, based in the same ignorance that afflicts the general non-diabetic population.
What I find most disturbing about the issue that prompted this discussion is the tone that comes through in some posts by T1's about T2's that it's more serious.
It's not.
All I can say is the argument between Lloyd and Sarah is the poster-child for the reason for this discussion.
Sarah, I say this with nothing but friendliness: Your ignorance about real T2's is the problem here, not a failure by Lloyd, myself, and other T2's to understand the academic literature about the differences between the two conditions.
I say ignorance because, as you saw in the exchange, with the exception of DKA, pretty much every difference you "thought" existed between an insulin using T2 and T1's turns out to be mistaken.
And that's my point. There are many T2's like Lloyd and me out there. There should be vastly more, and that's my point. The fact that we inadequately treat T2's (many if not most) simply masks the similarities, making it seem that there are big differences.
However, you're missing the forest for the trees. You, and other T1's could back way off your treatment protocol, and not get close to risking death. We read here regularly of T1 youth who do eactly that. We read of a new eating disorder among T1 young women, going without insulin to lose weight. Are they carb counting? Calculating insulin ratios? Testing? Worrying about managing their diabetes hour to hour?
No.
Are they dead?
No.
The point is, as I said in the original post, yes, there are differences, but much much more is similar.
Of course, the two paths to diabetes are not the same, but no one said they are. What was said is they have far more in common than not once you get there. It is my contention that in fact we deliberately blind ourselves to this and knowingly undertreat T2's.
I disagree. Type 1s who skip insulin *are* risking their lives by doing so. Those who die don't post online, after all. Only the survivors post. If you do any amount of research on the issue at all, you will find many accounts of young people who repeatedly put themselves into DKA trying to skip insulin. To say that skipping insulin for a Type 1 is not really life-threatening is just wrong. And I do not say this to say that Type 1 is "worse" than Type 2—but this is one of the differences.
This is an illustration, I think, of where these types of discussions go awry and get very emotional. I see it repeatedly where Type 2s post saying that the conditions are identical, and Type 1s post saying that they are very different. My original response to this post is a compromise: the conditions *are* different, but they are similar enough that we should all be supporting one another because we all have the same goals in the end.
I find this post extremely offensive. "Are they dead?" Dave, some folks here have lost friends to T1 related issues such as the eating disorder you describe sarcastically above. Yes, Dave, there unfortunately is a consequence of death with unaddressed diabulimia. I am astounded that you would post such a thing. This type of exchange is not helpful for our community.
I don't think anyone here has said T2 is less serious than T1.
But T1 does have some risk of immediate consequences (DKA and severe hypoglycemia) that T2s, even those who use insulin, do not have. Of course, there are always exceptions to the rule. But in general terms, those are important differences.
Well type 2's still have the risk of something that is like a sister emergency to DKA and it's called HHS (Hyperglycemic hyperosmolar syndrome) . It's like DKA without the extreme ketones. I read about it in a diabetes pamphlet I got on diagnosis day (as I got mostly type 2 info). It has like a very similar set of symptoms (consciousness issues mostly) and often comes with sickness or if they forget or don't use enough medicine. The only difference is that it has less to do with ketones than dehydration whereas dehydration can come with DKA but that's more of a ketone thing. My mom's coworker with type 2 experiences it a lot. I know she's one person but she's had it quite a bit and it makes an impact on me where I think type 2 can be easily just as dangerous as type 1 under similar or even the same circumstances.
Dave, in my opinion it isn't Sarah who is displaying her ignorance. Lloyd in a post on another forum noted that only 27% of T2's take any insulin at all. So the overwhelming majority of T2's take NO insulin. Some like you and Lloyd take insulin, but did you not have at least several years of diabetes before you needed to take any insulin?
Surely you will agree that there are huge differences in treatment, management, health risks, alterations to lifestyle, burdens of management, and record-keeping between a population that needs to take insulin every day to survive and a population most of whose members survive by taking no insulin at all. That is the gist of what Sarah was saying, and I don't understand why you want to avoid this fact.
This topic has been debated everywhere in the DOC again and again and again and again and again and again and again and again and again and again and again and again and again and again and again and again. I am sick unto death of it.
The "differences" between types, real or imagined, are a straw man. Every case of diabetes is different. No two T1s react identically to a given protocol, and the same is true for T2s. At the end of the day, I don't care whether I am T1, T2, or T56. I care about regulating my BG. Proper treatment is what matters. Control is what matters. Without it we are all dead, either quickly or slowly.
Until the PWD community learns to speak with one voice, there is no hope of changing public or institutional attitudes. None.
The house is on fire and we are arguing about who owns which piece of furniture.