It's almost a cliche to say that the most annoying response people make to learning your child has Type 1 diabetes is to say, "Is that the bad kind?" To everyone in the know, that level of ignorance is bothersome on many levels, which we can summarize via the various responses that pop into my head (and sometimes out my mouth, depending on how annoying the questioner seems):
• "Well, there IS no 'good' kind of diabetes."
• "If you mean, does he need to take insulin for the rest of his life, then yes, it is. But there are worse things."
• "It is what it is."
So I was not terribly enthused when I spotted a Medscape article entitled, "Young Onset Type 1 or Type 2 diabetes: Which is Worse?"
After reading it, however, I found a number of encouraging points. For instance:
Nevertheless, the clear message is that not all forms of diabetes are equivalent. Despite the common manifestation of hyperglycemia, the disease takes many forms, the differentiation of which will improve our ability to care for all patients with diabetes.
YES! YEEEEEESSS! Get that message out to GPs everywhere. They are different diseases. The expectations and prognosis for treatment of T1 and T2 are not the same. You cannot look at a patient in her late teens who is thirsty and losing weight and peeing all the time and feeling fatigued and say to yourself, "She's too old for Type 1, so it must be Type 2 — I'll give her a script for metformin and send her on her way with an admonition to eat less sugar and get more exercise."* You have to do the due diligence. Test for ketones, my friends. Test for autoantibodies. Assume nothing in your diagnosis! And do not treat the one as you treat the other.
*Actual response of a physician to a distant relative — whose aunt, a nurse, fortunately refused to accept that, which is good because the girl was in DKA.
I hope my T2 friends will forgive me, but I was also pleased to see this:
Despite a statistically shorter duration of diabetes and similar glycemic exposure, macrovascular complications were much more common in the type 2 diabetes cohort (ischemic heart disease and stroke), but there was no difference in retinopathy or renal function. Death was also more common among patients with type 2 diabetes, and it occurred after shorter disease duration.
Now, I would not wish vascular complications of diabetes on my worst enemy. But I also have a T1 child who is about to turn 7, and who has now lived with diabetes for 5 1/2 of his 7-years-to-date lifetime. Do I fear those complications? DAMN RIGHT, I DO. Is there a part of me that also fears I may bury this sweet boy of mine someday, long before he reaches what would otherwise be the end of his life? (Do I really need to answer that?)
Am I therefore a tiny bit relieved to know that, all other things being equal, he has less likelihood of developing those complications than he would be if he had T2? I confess that I am. I know that relief to be somewhat illusory — there's nothing in this article to identify whether the T2s on average had better or worse compliance than the T1s, what the two populations' overall Hba1c values were, etc. — and those things do make a difference. But I feel it nonetheless, particularly given that I have had good luck in keeping Eric's a1c within close reach of the ideal. I take whatever encouragement I can get wherever I can get it.
Consider the social and media garbage that surrounds T2 — the not-so-subtle hints that T2D represents a failure of "self-control" or "willpower", the messages of faux reassurance that you "can beat this disease" accompanied as they are by the underlying caveat, IF ONLY YOU TURN YOURSELF INTO SOMEONE ELSE THROUGH HEROIC MASOCHISM (Yes, Biggest Loser, I'm looking at YOU, with your in-the-title slam that you only win if you slice yourself in half, and if you don't, well...). All with a side of scorn — how many of us have seen the "math problem" meme below?
I go freaking BALLISTIC when I see this. And yet deep down I am very glad that if someone gives me the "what did you do, feed him straight sugar in his bottle?" line, I can hit back with the (true) response that Eric's diabetes is autoimmune, has nothing whatsoever to do with what he eats, and in fact he was still breastfeeding when he got sick. I usually try to make the point, as well, that even T2 isn't "caused by sugar"/carbs given the strong genetic component involved... but for those ignorami who have been put in their place when I enlighten them as to the nature of Eric's T1, any additional info I would like to impart is drowned out by the beat of their hasty retreat.
When you look at stuff like that, how can you honestly call T1 "the bad kind"? Yes, it sucks. Yes, it causes anxiety and sleepless nights, and no, I don't mind people elevating me to the status of WonderMom when they hear what a routine day with diabetes is like, because there are days it brings me down so low that any boost, deserved or otherwise, is welcome. But if I had to manage a child with T2, I should think it would be infinitely worse.
Think about it: The needs of T1 are quite simple and clear-cut. Food? give insulin. Exercise? give food. Test, and test again. The math used to calculate basal and bolus ratios is beautifully simple, even during growth spurts. And underlying all of it is social support: you're not to blame for your child's illness, what a tragedy it is, you must be an incredibly strong/smart/patient person to be able to deal with all that day in and day out. For the rest, you do what any good parent would do, and on it goes.
Now imagine attempting to accomplish the same goals when you have to motivate your child to eat healthy foods and take medicines that it's quite possible he or she does not want anything to do with. Heck, I spent 2 years in a constant battle with Eric to let me give him Tylenol, just because he did not like the medicine's color. Eventually I found a store that sold the dye-free stuff, but still... if I had to give him oral hypoglycemics, I think I'd just want to cry all the time. Imagine attempting to promote a daily exercise program when you yourself *ahem* are not on that wagon and really don't want to be given cranky knees, weak ankles, a wee bit of asthma, and an abhorrence of feeling sticky. "Do as I say, not as I do" has never cut the mustard with Eric.
Imagine, too, trying to manage your child's diabetes and assess his or her blood sugar levels when your insurer thinks a single test daily — or no testing — is appropriate, yet your kid's pediatrician bitches you out because the a1c comes back at 8.5%. (Pediatric endocrinologist? You don't need that, he's "only" got T2D, and we know how to manage that in primary care.)
Imagine doing all this in the context of social messaging that derides T2s as "fatties" (regardless of their actual BMI) who "lack self-control" and are "lazy" and therefore undeserving of sympathy.
Yeah. I know which one I think of as being "the bad one"...