Often times I start diabetes education classes with my own story and share how my daughter was diagnosed with diabetes at 7 years old. Inevitably, I get the question, “Is that the ‘bad’ diabetes?”. I suppose, for many ,the need for insulin determines if diabetes is “bad”. The stories of insulin users and the loss of extremities are rampant. Insulin users are judged as “not taking care of themselves” and the idea of a “bad diabetic” is perpetuated. Being a mom of a T1D kiddo, I kind of love insulin! It saved my girl’s life and many others. In my book, there is no “good” or “bad” diabetes. There is just a complicated medical condition that requires attention every day, no matter what kind of diabetes a person has.
Diabetes is more common than you may know. Over 38million, or 1:10 Americans live with this challenging condition. About 90% are type 2 and around 10% are type 1. Digging a bit deeper, I must mention gestational diabetes which affects up to 10% of pregnant women. This diabetes develops between the 24th and 28th week of gestation and usually resolves after delivery. Furthermore, LADA (Latent Autoimmune Diabetes of Adulthood) or Type 1.5 diabetes can get misdiagnosed initially as Type 2. Up to 10% of newly diagnosed Type 2’s are actually making antibodies and fall into this category. Type 3c Diabetes is a category that refers to a type of diabetes that develops due to re-occurring pancreatitis, cystic fibrosis, pancreatic cancer and other things that damage insulin producing cells. MODY, or Maturity-Onset Diabetes of the Young is a rare kind of diabetes brought on by a mutation in a gene. It tends to run in families and reaches across more than one generation despite lifestyle or environmental factors. For the purposes of this blog, I will focus on type 1 and type 2 diabetes, but regardless of the diagnosis there is no denying the challenges each face on a daily basis.
The perception is that a person can cure themselves of type 2 through lifestyle changes, whereas, type 1 is not influenced by lifestyle. More sinister yet, is that a person “gave” themselves diabetes due strictly to weight gain, inactivity, and poor food choices. Oh the guilt! In reality, it’s all about insulin production. Both types of diabetes are dealing with insulin deficiency. Dr. Ralph A DeFronzo, author of the Ominous Octet and world renown diabetes researcher from UT San Antonio, found that at diagnosis of T2D a person has lost 80% of beta cell function. Recent efforts to stage type 1 indicates that beta cell destruction is progressive as well. Typically, T1D progresses quicker, but at the end of the day both battle with sufficient insulin production.
Newsflash! After we eat a meal blood sugar rises whether you have diabetes or not. We need insulin to do its job so that elevation does not linger. This is the daily battle that both T1D and T2D deal with at each meal or any time food enters the GI tract! Both need their insulin to escort glucose into cells. Whether that insulin is given by injection or released by a pancreas, both are trying to find that right “dose” that sets their body up for success. When I say “dose” I’m referring to the delicate balancing act of food, movement, and insulin action.
All people with diabetes benefit from regular exercise, moderate carb consumption, and achieving a healthy weight. Though T2D may be managed initially by lifestyle changes, most will need medication at some point, including insulin. Both need to learn how their medications work and the causes, symptoms, and treatment for hyper/hypoglycemia. Diabetes is full of nuances and does not look the same every day adding an extra degree of difficulty. It is influenced by sleep, illness, stress, hormone fluctuations, time of day, and the list goes on. No individual is capable of controlling these variables perfectly regardless of type of diabetes. Chasing that target A1c of less than 7%, managing dysglycemia, and the rigorous work it takes to reduce the risk of complications is on the radar of both T1 and T2 folks. Both are huge users of healthcare often seeing their health care providers multiple times per year, obtaining regular lab work, eye exams, foot exams, and engaging specialists as needed. Diabetes technology is exploding requiring time, attention, and money to utilize. Challenges that impact not only T1D’s but also T2D’s as the use of Continuous Glucose Monitors expand. Developing a sick day plan, staying on top of vaccinations, and knowing when to call in the help of a doctor is important for those living with diabetes. Planning ahead for activities like travel, exercise, and holidays is a shared talent that both benefit from when given their time and attention. Grab a One2One upscale bag to solve the travel dilemma! With all these demands it’s not surprising that feelings of frustration, burn out, and uncertainty can plague a person living with any kind of diabetes.
As a diabetes educator I am quick to define differences and slow to express the many similarities. I understand each have unique traits, but how awesome would it be if we could be mouthpieces for each other and recognize that diabetes as a whole is challenging for all and a condition that lasts a lifetime. That would be 38 million voices supporting and advocating for one another. Let’s get rid of the “good and bad” labels and replace the “us vs them” mentality with a more powerful way. Think of the possibilities. What can happen if we strive to increase empathy and understanding in America through our shared experiences? E pluribus unum!
By Stacey Fox, BSN, RN
UCHealth Diabetes Nurse Educator
Proud mom of Leah Healey, Founder of One2OneDiabetes
References:
Centers for Disease Control and Prevention
www.cdc.gov>diabetes>about
NIH National Library of Medicine
PMC Pub Med Central
From the Triumverate to the Ominous Octet: A New Paradigm for the Treatment of Type 2 Diabetes Mellitus/2009