Type 2 diabetes is not a mild form of diabetes
While I was reading the news of the hostage taking in Sloviansk, two descriptions of diabetes caught my eye. Although the statements may not influence the alarming events in Ukraine, they reflect a common misconception of diabetes. In separate reports on the hostages:
- A Swedish national, who was first to be released because he was “suffering” from diabetes, was described as having “a mild form of diabetes”.
- A soldier, also a hostage, was described as suffering from diabetes “but it is not a serious condition, he is on tablets”.
Mild form of diabetes? Not a serious condition? What?
Given the common perception of diabetes, I can only conclude that these statements referred to Type 2 diabetes.
They reminded me of Tom Hank’s pronouncements on his Type 2 diabetes diagnosis last year. His tweet said “Type 1 is VERY SERIOUS! Type 2 I can manage with good habits. I shall!” While I admire Mr. Hank’s resolution to manage his diabetes, his view that Type 2 diabetes, unlike Type 1, is not serious or very serious is a concern for several reasons. One, as a respected celebrity, his statements will be remembered by a lot of folks. Two, if he, who presumably can afford a decent doctor who should have told him differently, has that basic misconception of Type 2 diabetes, then we can’t expect ordinary folks, many of whom probably cannot afford doctors at all, to know better. Three, his statements underscore how much work we need to do to change the image of Type 2 diabetes, including among the medical and diabetes communities.
On an online diabetes board, a member wrote that his doctor and endocrinologist told him that he has “a little bit of diabetes”. A little bit of diabetes? As opposed to what? A large bit? How exactly does one have a little bit of diabetes or a lot of it? What did his doctor mean in real, actual, factual and practical terms?
As far as I know, the forms of diabetes are Type 1, Type 2, Type 1.5, LADA, MODY, to name the more common ones. Type 1 is not the serious or very serious type, and Type 2 and the other types are not the mild types. Injecting insulin does not make one’s diabetes serious, no more than taking medication indicates a more serious form of Type 2 diabetes compared to those who choose to control diabetes only with diet and exercise.
Each type of diabetes is serious in and of itself. Let me repeat: Diabetes is a serious condition.
There are no mild Type 2 diabetes and serious Type 2 diabetes
On the same online diabetes board, there are members who believe that within each type of diabetes, there is a mild form, a serious form, and a very serious form. Their reasoning stems from the fact that diabetics respond differently to diabetes, not all suffer the same kind or level of complications, and treatment differs from person to person.
But the perceived differences are not due to having mild and serious diabetes. If you meet the criteria for say Type 2 diabetes then you have Type 2 diabetes. You do not have a mild Type 2 or a serious Type 2. Type 2 diabetes only has one form, the serious one.
Yes, each diabetic deals with his own diabetes differently from others, for various reasons. We are not all created equal, do not have the same genes, and do not live our lives in exactly the same manner or encounter exactly the same circumstances. Some may have a higher level of insulin resistance than others. Many people with Type 2 diabetes do not even exhibit any symptom at all. Does the lack of symptom imply that one’s diabetes is mild? Unfortunately, many symptomless diabetics first discover their diabetes when they seek medical treatment from diabetes complications. The differences among diabetics within the same type are likely due to genes, lifestyle choices, fitness levels, predisposition to medical conditions which, although not related to diabetes, affect one’s health and immune system, environment (smoggy places? unclean water? dusty environment?), and many other factors.
Take me as an example. I may be able to indulge in a few more grams of carbs than other Type 2 diabetics. But that’s not because I have the mild form but most likely because I run and exercise regularly (known to lower insulin resistance), I take metformin (while others do not take medication at all), and I avoid simple carbs such as pasta, noodles and supermarket frankenfood. But those few grams of extra carbs, though crucial to my sanity, are nothing in the larger scheme of things. The fact remains that I cannot ingest carbs the way my non-diabetic husband or even a pre-diabetic friend can. If I don’t control my diabetes as I do now, I’ll be on more pills than you can count, I cannot even have those extra grams of carbs that I enjoy now, and my BG will always be high. No, I am not delusional to think that my diabetes is the not-so-serious kind. It is serious and I take it very seriously.
I’m not being pessimistic. I’m just being realistic. I believe that to address one’s problem properly, one should first acknowledge that a problem exists and then face that problem squarely.
In Part 2: Why I resist the mild versus serious dichotomy, and Note to doctors.