Diabetes Self-Management Blog

Saturday afternoon I was lying on the bed, reading a book, when it began. I got a pain here…then another one there…and then I began to sweat. Profusely. Next came the shakes, a fuzzy head and, finally, a bit of nausea.

Appendix? Gall bladder? Hypoglycemia? Whatever it was, it was definitely scary. And odd. Usually if my glucose goes too low, I might sweat a little bit, but experience none of the other symptoms. Some juice took care of the sweats, etc., but the pain was still there. As it turns out, it was a urinary tract infection. It wasn’t severely low blood glucose, either: It was a very fast drop of about 40 points, as shown when I looked at the graph on my continuous glucose monitor.

Ain’t diabetes fun?

Some people with Type 1 diabetes get irked because the general population confuses their condition with Type 2 diabetes.

Me? I have Type 2 diabetes. I get irked because I feel as if many people with Type 1 diabetes look down on me because I have it easier/brought it on myself/don’t know anything about diabetes/could get rid of diabetes if I’d just take care of myself. Stuff like that.

Oh, yeah: Some health-care professionals have the same attitude. Don’tcha just hate it when a health-care professional thinks he knows more than you?

It got me to thinking about the Type 1 versus Type 2 “wars,” highlighted in David Spero’s blog entry on April 28, in which he referred to an article in Diabetes Health. I have several friends with Type 1 diabetes and one of them, Liz, had once said she had changed her mind about Type 2.

One of the misconceptions she mentioned was that Type 2s didn’t have to take insulin and didn’t experience hypoglycemia. See the first paragraph.

One of my favorites was that “the Type 2 diet essentially involved nothing more than avoiding sugary things like candy, cake, cookies, pie, and other dessert-type things.” (Oh, how I wish!)

That, in turn, reminded me of a comment I got on something I wrote in 2001 about my belief that diabetes precedes the “fat and lazy.” The comment was from a mother who said that her daughter “has to use an insulin pump” and also that she wished her daughter “only had to take a pill and not eat cheesecake.”

I had mentioned in the article that I used an insulin pump. I guess that was overlooked. But I do eat cheesecake — only if it’s one I made. And I only make cheesecake when I’m taking it to a function where I get one thin slice and the other people take care of the “leftovers” for me.

Moving on: “Type 2 was easy to manage,” Liz wrote. “Shoot, you could just get rid of it with a little effort.” And, “Type 2 was a much less severe form of diabetes than Type 1, more like a choice or an inconvenience, really.”

I’ll admit to gritting my teeth every time I hear that Type 1 is the “more severe” form of diabetes. I think it’s all severe. All of us — all types — are at risk for getting the same complications if we don’t work to maintain decent blood glucose levels as often as possible. Also, I’m reminded of the fact that many people with Type 2 diabetes don’t even find out they have it until after a complication has occurred.

It also telegraphs to those with Type 2 diabetes that they don’t have a “serious” form of the condition. I was in that camp for several years after being diagnosed with Type 2 diabetes. I didn’t really have to take care of myself because I didn’t have the “real” form of diabetes.

What if the doctor had told me Type 2 was “real” diabetes. Or what if he had sent me to a diabetes educator? I believe that, in many cases, a lack of knowledge and a belief that Type 2 isn’t a “serious” form of diabetes contributes to the lack of attention to the disorder — and that would be both on the part of the health-care professional and the person with diabetes. If you don’t learn about it, and if you believe it’s not a serious condition, you’re not going to take care of it.

Yes, I know: Type 1s don’t like to be associated with us clueless, fat, lazy Type 2s. Even 40 years ago, Liz didn’t like it, either, including having people tell her she caused her own diabetes by eating too much sugar.

That was “especially annoying for me to hear as my mother, the organic health-food freak, had never let us eat sugary foods. I never even tasted a Twinkie until I was a teenager,” she said.

And then there were the tales of gloom and doom about a grandmother, an aunt, a cousin who had lost a leg, a kidney, her eyesight… And those who said they knew somebody who had gotten rid of their diabetes by losing weight.

It’s a wonder Liz puts up with me. It must be hell hanging out with somebody who pigs out on sugar, pays no attention to her diabetes, and is dumber that a box of rocks about the condition.

Actually, I count my carbohydrates, know about the interaction among insulin, food, and exercise, and really know how surgeries and infections influence blood glucose levels. (She says as she continues to try and avoid hypoglycemia by lowering her basal rates and adjusts her insulin-to-carb ratio and correction factor.) Plus, I finally got some darned good diabetes self-management education. Something a lot of people with diabetes — all types — could use.

I’ll continue this thread next week, with some comments on how Liz changed her mind about people with Type 2 diabetes.

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Comments
  1. Jan,

    My Type 2 diagnosis was five and a half years ago, 21 December 2004. The nurse, as she took me into the exam room said, “So you’re here to talk to the doctor about your diabetes, right?”

    “I am now!”

    The doctor followed us into the room said, “Merry Christmas, you have diabetes. Here’s the prescription. See you in three months.

    After trying to educate myself on the implications and treatments I found out I should have a health care team: doctor, endocrinologist, diabetes educator, dietitian, ophthalmologist, podiatrist. I asked my doctor about meeting the rest of “my team”. She grudgingly told me it was my right and made the necessary referrals. At our last conversation, before I changed doctors, she told me it was *her* job to control *my* blood glucose and the only time she would consult the team would be if she was having difficulty!

    It is my life, my disease, I will look after myself with the assistance of the appropriate professionals - something my current doctor and I agree on.

    Posted by Garth |
  2. Jan,

    If you don’t believe that Type 1 is more severe than Type 2, consider the following thought experiment. Let’s imagine a Type 1 and a Type 2 lost on a desert island with no medications of any kind, and with limited amounts of food (but enough to live on) that would require physical effort and time to gather and prepare.

    Where would they be in a year (or less). The Type 1 (Liz) would be dead (due to DKA and starvation from a complete lack of insulin). But the Type 2 (you) would be alive, and probably healthier than you were when you landed on the island (due to weight loss and exercise).

    Its true that in the upside down world we live in now, where healthy living is hard to achieve and unhealthy junk food is virtually forced down our throats, that you two can have similar outcomes - assuming of course that you both have access to decent medical care.

    But do you understand why Type 1’s instinctively and understandably believe that they have “worse” diabetes than Type 2’s? And why the medical literature is written to reflect that fact?

    Posted by Jeff G |
  3. And just how does surgery affect blood glucose?

    I had out-patient surgery this morning. My fasting blood glucose (diet and exercise controlled) was 98 at 7:00 am. Following surgery, I had a light meal (around 2:00) of grilled eggplant & cheese. Two hours after the meal, my reading was 208. Normally, I would expect a reading of 120-140.

    Does the stress of surgery cause an increase in blood sugar level? Could I have been given glucose in my IV even though I told the anesthesiologist
    that I was a diet/exercise controlled diabetic? After surgery I had only water to drink.

    Posted by Ruthie |
  4. Apparenttly type 1s don’t read very well. Type 2s also encounter the exact same difficulties with lack of pancreatic function as type 1s. My team has informed me that such function ranges in scale from 1.1 to 4. Mine’s at 1.3. Guess who’s on insulin shots. Difference is mine started in my mid 40s, not from birth or early teens.

    Posted by Dave K |
  5. Dave,

    By definition T2’s are insulin-resistant, NOT insulin-negative. A T1 makes NO insulin, which is why the blood sugar of a T1 with no insulin to inject will go up until they will die on a desert island, regardless of how much or how little they eat or exercise.

    A T2 makes insulin, but it isn’t enough to keep their blood sugar normal because of their insulin-resistance. An overweight T2 can decrease their insulin-resistance by losing weight and increasing their exercise. They will survive to get off the island.

    “Being on” insulin is not the same thing as “requiring” insulin. If you are not overweight, and if you require insulin, then you should be checked for C-peptide - maybe you are actually a late onset T1.

    Posted by Jeff G |
  6. Jeff G, while what you say about a Type 1 may be true, your depiction of what will happen to a Type 2 doesn’t necessarily hold true. Type 2 also consists of beta cell dysfunction and can include insulin insufficiency. Type 2s can experience a loss of functioning beta cells over the years that can result in producing about as much insulin as a Type 1. Therefore, Type 2s can also “require” insulin. We also can go into DKA and can experience Hyperosmolar Hyperglycemic State (HHS), which is like DKA only usually without ketones. Fortunately HHS is very rare: While DKA has a death rate of less than 5%, that figure reaches 15% for HHS.

    I still believe all types of diabetes are severe.

    Jan

    Posted by Jan Chait |
  7. Ruthie, you could have been given an IV with sugar in it, but the surgery itself can stress your body out and blood glucose levels tend to rise with stress.

    Welcome to the wonderful world of diabetes!

    Jan
    (now hungry for eggplant)

    Posted by Jan Chait |

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