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Admit it, Type 1s. In weaker moments, you look down your noses at the Type 2 diabetics. You know that their disease can result from poor lifestyle choices. You know that their treatment regimen, compared with yours, is simple.
And you're really tired of folks telling you: "Oh, my grandfather had diabetes, too!"
"It's almost like sibling rivalry," says diabetes educator and author Constance Brown-Riggs. "People with Type 1 diabetes feel that those with Type 2 get all the attention. People with Type 2 feel that Type 1 diabetes is 'really bad diabetes.' "
But clinicians such as Brown-Riggs and diabetics themselves point out that both types hold similar challenges and consequences. As a matter of fact, Type 2 diabetics sometimes outperform their Type 1 brethren.
Impossible? Far from it. The best-controlled, most-motivated Type 2s have lessons for all of us - Type 1s and even other Type 2s. Here are a few.
Taking a wake-up call
Type 1s know their disease isn't their fault. Type 2s don't have that reassurance. But that means some take their diagnosis as a serious motivator.
Brown-Riggs told me, "I have one women in my practice that was diagnosed with type 2 about eight years ago. She absolutely took her diagnosis as a wake-up call. She carefully plans her meals, counts carbs, exercises, monitors blood glucose and maintains regular contact with her health care team."
With that work, the woman is able to manage her illness without medication.
Brown-Riggs's patient understood that she got herself into this situation and it was now her job to get herself out of it. For Type 1s, the diagnosis is permanent. But that doesn't mean they can't learn from the best Type 2s and realize that the key to success isn't a particular device or nutrition plan. It's their own willpower.
To the treadmill
You can rededicate yourself to the basics, but where do you start? Why not diet and physical activity?
For Type 1s, diet lessons can fade into the background after years or decades with the disease. Why not take some extra insulin and eat an extra doughnut? Brown-Riggs has seen the direct consequences of this thinking: fatter Type 1s.
"I just saw someone in the office today - type 1 and obese," Brown-Riggs said. "So clearly the conversation revolved around weight and lifestyle."
Type 2 diabetic and stock car racer Richard Palasik finds himself routinely checking nutritional information on packages at the grocery store. He points to obesity as a challenge not just for diabetics, but for our culture.
"Obesity is almost the norm," he said. "Not the rarity."
For Type 2s, connections between weight, exercise and their illness are crystal clear. They can't afford to discount them. So if you're a Type 1 who manages fairly well with insulin but sticks to the sofa -- get a move on! Those pounds aren't going to lose themselves.
No change is too small
Type 2 patient Barbara DiRisio exercises at least five days a week and takes her oral medication faithfully. Since her diagnosis in 2001, she said, "I have only missed my pills perhaps twice a year."
But DiRisio offers another tip, one that might be easy for Type 1s to dismiss: "I never drink fruit juices or colas," she said. "Only diet cola."
Type 1 diabetics surely know not to drink sugared sodas. But how many other small changes do we miss? DiRisio, a Type 2 diabetic since 2001, has improved her health in a simple, direct way.
Do we take the stairs at work rather than the elevator? Do we remember to check our blood sugar that extra time when we're unsure? Do we, like stock car racer Palasik, make sure to inspect the labels on food we buy?
When when we make these small things habits, we can improve overall diabetes control and health.
Head back to class
Type 2 diabetics may not have dealt with their disease as long as many Type 1s, but that means they can have an educational advantage. Once diagnosed, many Type 2s go to sessions with a diabetic educator. They learn about healthy practices. They get handouts.
Depending on a Type 1's level of engagement, years may have passed since a session with a diabetic specialist. And like most areas of medicine, the diabetes field doesn't stand still. Brown-Riggs said she often has to bring Type 1s up to date with the latest research and information - if they even had the knowledge to begin with.
"Many that have had diabetes for years have had no formal education," she said, "particularly when it comes to nutrition."
Ultimately, extra communication with professionals can only help your control. Having to explain yourself to someone can be a powerful motivator.
Catch some Zs
Author John Hedtke connects his Type 2 diabetes diagnosis with a lack of sleep. "I was working a full-time job and writing books in the evenings, shorting myself on sleep pretty constantly for years at a time," he says.
According to the National Sleep Foundation, more and more research makes the same connection. Lack of sleep equals high blood pressure, obesity and Type 2 diabetes risk.
Type 1s already have their diagnosis, but the applications are clear nonetheless. High blood pressure and obesity complicate diabetes management. Reducing or preventing both improve blood sugars and overall health.
Hedtke has also found, firsthand, that no change is too small. "I'm actually napping more and working only one full-time job at a time," he said.
-- Don't let it slow you down
Yes, managing insulin-dependent diabetes takes time, energy and effort. But Type 2 diabetics have something else to teach: Don't let the disease become your life. Make it another part of who you are
That's what Palasik has done. He's the crew chief with California's Desert Dingo Racing, which runs the official World Diabetes Day off-road race car and competes in the Baja 1000. He's taken the wheel of the team's stock Volkswagen Beetle.
"I don't let the disease stop me doing what I want to do or hamper me in any way," Palasik said. The strenuous effort of desert driving makes his blood sugar rise, so he makes adjustments before each race, often giving himself extra insulin.
"You don't have to let it define you," he said. "Just follow the rules."
Type 1 and Type 2 diabetics may never be on exactly the same page. The difference are real and profound. The average age of diagnosis. The treatment regimen. The long-term prognosis.
But the epidemic of Type 2 diabetes means that more people than ever are learning about the disease and that more education and treatment is available now than ever before. Not everything can work for both groups. But much can.
"It's just not as cut and dry as it use to be," Brown-Riggs said. "Which is actually good news."
Dietician and certified diabetes educator Constance Brown-Riggs' new book, The African American Guide to Living Well with Diabetes, comes out in July. She points out that despite the big differences between Type 1s and Type 2s, "self-care behaviors are the same regardless of what type of diabetes an individual has." She lists seven categories:
37 comments - Apr 19, 2010
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