Letters to the Editor

Feb 1, 2002

"Fat and Lazy?" Editorial

Your guest editorial by Jan Chait ("Fat and Lazy?" November 2001, p. 11) has opened the floodgates to my own feelings. I, too, went through a period of reduced energy and weight gain before my diagnosis. My reduced energy was made worse by a sleep disorder called sleep apnea. I have another problem called attention deficit disorder. One of my coping mechanisms for that was to drink a lot of coffee. It went undiagnosed for 58 years. I don't know how to craft a survey or how to tabulate the results, but I think there is an important prevention thread here.

Thank you for the great magazine. The response from Dr. Bernstein about frozen shoulder ("Ask the Expert," p. 45) hits home as well. I have read Diabetes Health for about three years.

Jim Friberg
Camas, Washington

I want to convey my thanks to you for your magazine and its valuable information and tone. I get many diabetes magazines, and most of them have a shaking-finger, patronizing, judgmental attitude, much like the attitude most medical professionals in the field have toward their patients. Diabetes Health, however, tells it like it is. It has an empowering, activist, empathetic tone, which I greatly appreciate. The guest editorial by Jan Chait ("Fat and Lazy?" November 2001, p. 11) resonated with me, as my experience and reactions are nearly identical to the ones she had. I am not controlling my weight well. I have always been "fat," and now I am bigger than ever. I am also depressed and have no energy for anything. I cried when I read the article and feel the pain she feels. I have maintained for years there is more to me than my fat or my diabetes.

Gail Trenhaile
Ohama, Nebraska

I have type 2 diabetes and was diagnosed at the end of December 1999. My problem is my know-it-all daughter. She claims I am overweight and that's why I got diabetes. I have ancestors with type 2 diabetes. I exercise diligently. Even before being diagnosed, I cooked without sugars and watched my weight—always keeping it in control and going to a nutritionist. So I have always been following a regimen to keep weight off. When I developed diabetes, I was almost always hypoglycemic. I learned that I should have six small meals to avoid going too high or low. Although I have done all of these things—not to mention walking a mile twice a day and working in a library putting up books and teaching—I still gained weight that wouldn't come off.

Margaret Caloroso
Hayward, California

I just finished reading the guest editorial entitled "Fat and Lazy?" (November 2001, p. 11). I have to say that I am tired of listening to people with type 2 diabetes whine about how it is not their fault that they have diabetes and then try to give us the impression that we are all supposed to feel sorry for them. If you want a good editorial, why don't you have someone write about a child with type 1 diabetes—someone who must live every day with this disease and who wears an insulin pump around the clock and gets 10 blood-glucose checks a day? I am the mother of a 5-year-old girl named Emily with type 1 diabetes.

Or maybe you could write an article about the parents of a child with type 1 diabetes—parents who haven't slept through an entire night since their child's diagnosis; who must constantly explain why their child has this disease; who have to deal with rude comments from waitresses when they order diet sodas for their child.

I am not interested in hearing another story about someone who must take a pill and then complains because they can't eat another piece of cheesecake. I would give anything to be able to give my daughter a pill, set up a special diet and exercise program and make everything better. I invite all of these type 2s to spend one day as a type 1 child and then maybe they won't feel so sorry for themselves anymore.

Rebecca Wiseman
Stewartstown, Pennsylvania

Editor's note: Thank you for your comments. We received a wide variety of responses—both positive and negative—to the argument that people with type 2 diabetes are unfairly stereotyped as "fat and lazy." We encourage you to continue writing to us expressing your opinions, and we will continue to be sympathetic toward the concerns of all people with diabetes.

Not Sure About Alternate-Site Testing

We can argue the merits and technological accuracy of alternate-site testing for years. But the overriding consideration is consistency, not only accuracy. Each device has a different level of accuracy, as does each site. None are as accurate as a lab test. The purpose of the tests is to give you a good approximation of your blood-glucose levels so you can adjust your regimen to achieve relative normalcy. Any change of devices or sites will disrupt what consistency is available through these tests.

Caution here is the prudent path.

Ted Martin
Iselin, New Jersey

Being Screened at Airports Since September 11

I wear an insulin pump and have flown a number of times since September 2001. Every time I've gone through security, I've been patted down and scanned with the wand. When I flew from Washington, D.C., to Chicago, the female screener patting me down was very suspicious of my pump. I explained that it was an insulin pump and that I have diabetes, but she didn't understand. Finally, I gave up trying to explain it. I pulled down the waistband of my pants and showed her the insertion site. Needless to say, she didn't give me any more trouble. But then again, my biggest worry while flying is whether my knitting needles will be confiscated. And, so far, I've knitted on every flight!

Keep up the good work.

Kari Larson
Washington, D.C.

Compliments About Lantus

Using Lantus takes the guesswork out of blood-glucose control and has lowered my A1C 1.3 percentage points. My doctor tells me to expect my A1C to lower even more as I continue to use Lantus.

Mary G. Gibbs
Raeford, North Carolina

I started taking Lantus at bedtime two months ago, and it has been great in reducing all my former middle-of-the night lows (which occurred when I was using NPH insulin). Lantus also seems to slightly reduce the number of Humalog units I need to take for my mealtime injections.

Marcyl Seidscher
San Mateo, California

Can Type 2 Diabetes Really Progress to Type 1 Diabetes?

In the "Ask the Expert" section of the November 2001 issue (p. 50), a reader asks, "Is the logical prognosis that type 2 [diabetes] eventually progresses into insulin-dependent type 1?"

Daniel Einhorn, MD, addresses the reader's question but does not explain that people with type 2 diabetes cannot simply get type 1 diabetes and that the two types are different. His response leaves open the assumption that type 1 is somehow the result of not properly managing your diabetes through lifestyle changes or a type 2 medication.

As the parent of a 5-year-old who has type 1 diabetes, I am well aware of the fact that type 1s have no choice but to take insulin. They do not have the option of simply changing their diet or exercise program to lower their blood glucose. I am often asked whether my child must take insulin because she doesn't eat properly or why she cannot take a pill to control her blood glucose. Dr. Einhorn has done a great disservice by not explaining the differences between type 1 and type 2 diabetes.

Rebecca Wiseman
Stewartstown, Pennsylvania

Although I agree with the information in the response provided by Daniel Einhorn, MD (November 2001), I regret he did not emphasize that type 1 and type 2 diabetes are two different diseases, involving either autoimmune destruction of beta cells or primarily insulin resistance. Requiring insulin does not make someone with type 2 a type 1; such a person is simply a type 2 treated with insulin.

Thanks for your interesting articles. We frequently discuss them at my VA clinic support group.

Diane Schell, RN, BSN, CDE
VA Outpatient Clinic
Peoria, Illinois

I take umbrage with the answer to the question of whether type 2 diabetes progresses into insulin-dependent type 1 (November 2001).

Daniel Einhorn, MD, did not answer the question correctly. Type 2 diabetes will never develop into type 1 diabetes, unless it was misdiagnosed to begin with. When a person with type 2 diabetes needs to begin taking insulin to control diabetes, he or she does not become a type 1. The two types are different diseases, despite being similar in some ways. Most people—including some doctors and too many people with diabetes—do not understand the difference between the two types.

It should be pointed out that people with type 1 diabetes can—and do—live full lives up until old age with minimal complications. Type 1s make up 5 to 10 percent of people with diabetes. It takes a lot of time, self-discipline and determination to stay in good control. I have had type 1 diabetes for 39 years with minimal complications.

Pat Shermer
Rapid City, South Dakota

Editor's note: We asked Dr. Einhorn to reply.

I read the question as asking whether type 2 diabetes inevitably deteriorates into the need for insulin around the clock like type 1 diabetes and all the complications that go with it.

My answer is no, based on the information we have today. Type 1 and type 2 diabetes are distinct, and one does not develop into the other. However, some people with type 1 diabetes have insulin resistance (like people with type 2), and some people with type 2 diabetes go on to complete insulin dependence with no endogenous insulin production, like those with type 1—although the mechanism may be different.

Daniel Einhorn, MD, FACP, FACE
Diabetes and Endocrine Associates
La Jolla, California

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