There are few things more misunderstood than diabetes. It’s a disease that can seem simple from a casual distance (oh, it means you can’t have sugar, and you’d probably be just fine if you lost a few pounds), while in truth it is a very complex condition — actually, several fairly different complex conditions that all happen to be called “diabetes.” It seems like it’s a disease that’s mentioned all over the place, but it’s still rare enough that relatively few people ever really learn what it really is.
So today I’m going to offer this column anyone who finds themselves in the social orbit of someone living with diabetes. Consider this your Diabetes 101: Intro to ‘betes.
1. There are two main types of diabetes, and they’re not the same.
OK, this is an important one. Diabetes is really several different diseases. Both main types involve the body’s ability to metabolize sugar, but the causes are very different. And the treatments can be very different. Some of my most irritating experiences as a Type 1 diabetic have been when someone who knows someone with Type 2 decides to start giving me advice or telling me I shouldn’t be eating something. And I’m not alone here — everyone I’ve talked to with Type 1 has had the same experience, and it drives them crazy, too.
There is one important physiological distinction you should understand. In Type 1 diabetes, the immune system mistakenly attacks the body’s beta cells, which produce insulin. Insulin is what the body needs to transfer sugar from the bloodstream to the body’s many cells (which use that sugar for food). Without the insulin, the sugar backs up in the blood, which causes severely elevated glucose levels and eventually loss of consciousness if not treated. (Chronically high blood glucose levels can also cause a variety of complications such as eye and heart conditions.)
Type 2 diabetes is a different issue. In Type 2 diabetes, two things can happen. The cells in the body can develop insulin resistance — that is, the cells are unable to properly make use of the insulin, and therefore extra amounts of insulin are required to keep moving the glucose out of the bloodstream into the cells. In addition, the insulin-producing beta cells can produce insufficient amounts of insulin. This is similar to the issue for people with Type 1, but here the issue isn’t about LOSING the insulin-producing cells, but rather about the their under-production of insulin.
2. The types of diabetes are treated differently.
Because the physiology is different, the treatments are different. People with Type 1 diabetes, like me, have no options but to take insulin, either through multiple daily injections or with an insulin pump, which delivers a constant drip of insulin through a small, plastic cannula. Both sound way worse than they are — the needles I use are so thin you can’t even feel them (the average mosquito bite hurts much more than my shots ever do), and the cannulas used by pumps are very small, flexible, plastic tubes that go just beneath the surface of the skin.
Whatever the delivery method, the goals are the same: We take a certain amount of insulin for our “basal dose.” This is a relatively small amount of insulin that needs to always be in the bloodstream. You see, the liver will put sugar into the blood most of the time, and with no insulin that sugar alone could send us sky high. The other doses we take are “bolus doses.” These are given when we eat, and the amount must be matched to the amount of food we’re about to consume. I won’t go into too much detail here, except to say one very important thing: Yes, we can eat some dessert! We can have reasonable amounts of sugar, as long as we have taken the appropriate amount of insulin to cover it. In addition, because we are matching insulin to food, it’s also possible for us to take too much insulin, and then actually need something sugary to avoid having our blood sugar go so low that we pass out. The moral here is that for people with Type 1 diabetes, consuming sugar is not an automatic “no-no,” and sometimes, it’s actually a medical necessity (for more on that, see a piece I wrote about what friends and family need to know about hypoglycemia).
Type 2 diabetes, as I said earlier, is about the cells resistance and/or a sub-par insulin production from the beta cells. The first line of treatment for Type 2 diabetes is medication aimed at helping the cells become less insulin resistant. Now, because of this, people with Type 2 diabetes do need to be more careful about their sugar intake. Someone with Type 2 doesn’t have the “luxury” (as if anything about diabetes is a luxury…) of simply taking extra insulin to match the extra sugar. Now, eventually some people with Type 2 will start taking insulin — if their body’s production falls too low, it becomes a necessity.
3. There are things people with diabetes have in common.
Finally, let’s look at what these two disease do have in common. First, neither one should be dismissed as a “lifestyle disease” brought on by lazy habits. Type 1 diabetes is the result of a fluke immune system malfunction. And while Type 2 is often pinned on “being overweight,” that is a wild oversimplification. Two people could have identical weight, diet, and exercise routines, and one will develop Type 2 diabetes and the other will not. Losing weight does often help with lowering insulin resistance, but weight does not cause diabetes. In fact, one of the strongest predictors is genetics — again, nothing an individual has any control over.
Lastly, it’s important for you (as a friend, relative or other) to understand that living with diabetes is hard, but we know what we’re doing. Support us, help us when we ask for it, and if you’re concerned, talk to us. But respect us, and remember we’re the ones in charge of our lives.
Want more information for loved ones of people with diabetes? Read “Hypoglycemia — What Your Inner Circle Needs to Know” and “A Guide for the Friends of People With Diabetes.”