Saturday, July 31, 2010

Easier or harder?

This afternoon I put out on Twitter a request for Type 1s to make suggestions about anything they might like to see a Type 2 address. My friend Scott Johnson responded, "I often think you guys have it harder - depending more on willpower & dietary choices for BG control. Do you feel that way?"

It's a complicated question, or a simple question with a complicated answer. I've often thought about it, and I've been hesitant to address it. My basic reaction is "absolutely not!" However, I've rarely been angrier than the time I was listening to a podcast panel of Type 1 PWDs, and someone said that "Type 2 is easy!"

The first thing to remember, and I'll mention it again, is that Type 2 is a progressive disease. Type 2 covers people in many different situations: diet and exercise alone; a dizzying array of oral and injectable medication options, each with its own set of consequences; a combination of oral medication and basal insulin injections; and full insulin dependency. A Type 2 may be as healthy as a horse or a very sick individual indeed. A Type 2 may be dealing with the effects not only of diabetes itself but any or all the other conditions that tend to cluster with it: hypertension, elevated cholesterol, heart disease, apnea, and others.

I have to say that in my mind, it's the manner of treatment and how well it's working that affects what life is like far more than the disease mechanism. For the purpose of this discussion, by "Type 2" I'll be referring to someone on the diet/exercise regimen or oral medications.

I also want to note that my knowledge of what Type 1 is like to deal with is all second hand. I think I know more about it than most people, but I'm sure there are important things I don't understand. So, I hope my friends will forgive me if I'm missing something important.

I have some academic background in political philosophy, and it often helps me to go Aristotelian on the bit and break things down into parts. I see four areas to compare lifestyles for the two types: immediate health impact, daily management, complication avoidance, and the complications themselves.

Immediate health impact -- As I noted above, a Type 2 diabetic may be at many different places on the scale between healthy and sick on a day to day basis. In my own case, because I'm so fortunate in how well my medications work at present, I don't experience anything like the rollercoasters I see many of my T1 friends experiencing. I've never had a low, as I've noted elsewhere, and anything like reasonable choices in what I eat keeps me from getting too high to feel poorly in that respect. I do have days in which I feel ill because my metabolism hates me in general.

Daily management -- There are sort of two sides to this coin. There's absolutely nothing I currently have to do that's as intrusive as the daily routine of shots/pump management, diabetes arithmetic, many daily blood tests, etc. On the other hand, many of the folks that manage Type 2 without medication work vary hard, with very significant dietary restrictions and exercise routines that would make Richard Simmons blush. On the third hand (can you believe I'm not a lawyer?), Type 1's are not necessarily immune to the same genetic, lifestyle, and environmental factors that produce insulin resistance in Type 2 folks, and thus diet and exercise become critical for some of them, too. So, this one is kind of a toss-up to me, and depends on the individual's situation.

Some Type 2s feel a bit of envy for folks on basal/bolus regimens who "can just push a button" or "just take a shot" to prepare for a special meal or to treat a high. I'm not one who feels that way - I think it's way more complicated than that, and I don't want to minimize the difficulty and discomfort of managing boluses. Yes, it would be nice to have a tool (other than patience) to deal with a high that's beyond exercise being a safe option. But that might yet be down the road for me.

Complication avoidance

For people with all types of diabetes, the best chance of fending off the complications we can all list consists in good long-term control of blood sugar levels. (And, of course, complications may show up even when control has been good.) But, in order to achieve that control over the long term, many Type 2s must do their best to make very significant changes in their dietary and exercise choices. Most often, Type 2 is diagnosed in middle age or later, and habits have been built up over decades, and making those changes is very difficult. Plus, for those of us who are truly obese, there are often psychological issues that must be either addressed or somehow sidestepped for meaningful changes to occur. So, the challenges are considerable, and I for one am not even out of the foothills at the basis of this particular mountain. For most (I think) Type 1 PWDs, this is a set of issues that's not part of the equation. Again, however, Type 1 PWDs are not immune to this set of issues and may deal with them as much as anybody else.

(Mini-rant: I just about lost my temper during last week's #dsma session. A number of folks talked offhandedly about lifestyle choices, as if it was a simple thing, like upgrading your wardrobe and grooming yourself a little more carefully to get a better job. If losing weight is so freaking easy to do, how come millions of Americans (and countless others) are unable to do it? Do you really believe all of those people are stupid, or have deeply flawed personalities? Or, just based on your own experience with blood sugar management, don't you think that human metabolism is way more complicated than we currently comprehend, and that we simply don't yet know how to actually help people rather than just lecture them? *ahem* Sorry.)

The Complications Themselves -- I think it's important to note that the long term effects of diabetes do not much vary between the two major types. The organs of our bodies that rely on intricate networks of tiny blood vessels don't care why they've been assaulted by excess blood sugar for many years. They're not concerned about antibodies, or insulin resistance, or beta cells, or artificial ingredients, or even cheeseburger consumption.

So, in summary, my answer to Scott is no, I don't think that Type 2 is harder, although distinctions between the two types fade as Type 2 advances. On the other hand, that's not to say that Type 2 is "easy", and involves issues and complications not common to most of my Type 1 friends. All diabetes is hard, all diabetes sucks, all diabetes needs to be cured.


  1. karend18:05 PM

    excellent post

  2. Great post Bob. You have a real gift of carefully making your points while carefully not downplaying or hurting anyones feelings. This is a sensitive subject you talked about, and did so in a very excellent way.

    I appreciate the thought and consideration you put into each and every sentence. I just wish I would have made time to read it sooner! :-)


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T Minus Two by Bob Pedersen is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.