I have witnessed some heated discussions lately on social media about the differences between type 1 and type 2 diabetes. Unkind comments from unempathetic type 1 diabetics about type 2 diabetes being avoidable are unnecessary and often inaccurate. These comments have been around for some time and are, in my opinion misguided because they attack the victims instead of the perpetrators of the blaming and shaming of diabetics.
I have also seen a rise in people with type 2 diabetes accusing type 1s of stigmatising type 2 and excluding them from support activities. The terminology “type-shaming” is something I have heard bandied around. Again I believe these accusations are, also generally misguided and a misdirection of anger. Type 1s don’t write newspaper articles about “diabesity” or pay for campaigns telling people to lose weight or exercise to avoid diabetes.
We are as disgusted by the lack of nuance, the oversimplification and the blaming as you are. My post on diabetes advocacy I know exactly how it feels, the same thing happens to anyone with diabetes who suffers complications even after many decades of battling with this damn disease. The blame and recriminations certainly don’t make living with diabetes easier and add to the psychosocial distress and depression that is common amongst people with all types of diabetes.
I stand against stigma and blame.
I do however, strongly believe that the distinction between type 1 and type 2 diabetes needs to be made clear and that this can be achieved without denigrating people with other forms of diabetes. The differences in type of diabetes need to be clear because:
Type 1s will die without insulin. If we are confused with type 2, as we often are it can have deadly consequences. Type 2s generally don’t need insulin if they are fasting and will not die for lack of exogenous insulin. We however, do and many health care professionals let alone the general public don’t realise this. I’ve heard many, many stories of serious health consequences as a result of type 1s being treated as type 2s.
There is often a significant (and life-threatening) delay between the onset of symptoms of type 1 diabetes and an accurate diagnosis. This is because both the general public and GPs are very well educated about “diabetes” risk factors and the non-urgent nature of a type 2 diagnosis without realising these factors don’t apply to type 1. So when a young, lean, caucasian person presents to a GP with fatigue, blurred vision and reported thirst they’re likely to be tested for Glandular fever (mono) or something other than diabetes because they don’t fit the risk profile for [type 2] diabetes. That is annoying because they are showing all the symptoms of type 1 diabetes but this is ignored because of confusion between diabetes types.
As a minority group, our needs for peer support can’t be met through generic “diabetes” support. I have been quite frustrated by well-meaning type 2s trying to be supportive in a discussion about exercise or weight loss but they just don’t understand what hypos or heaven forbid, dka are like or the fine line that is insulin dependence combined with insulin sensitivity. It’s not their fault, it’s just that our conditions are different. Unless it is specified that a group is for type 1s, the greater population of type 2s will dominate and type 1’s needs will get lost. All the t1 support groups of which I’m aware have been initiated by type 1s for type 1s so it’s a self-help thing that can easily be replicated if other groups wish to do so.
This brings me to my final point. Many type 1s have fought long and hard in the battle to promote understanding of our disease, it’s not fair to claim we are discriminating against type 2s simply because we advocate for ourselves. We were blamed and shamed by the diabetes messages too, but we took a stand and lobbied our supposed representative organisations and the mainstream media. Diabetics were denied pump funding but again, despite the deafening silence on pumps from Diabetes Australia at the time, type 1 groups like JDRF and the Type 1 Diabetes Network mobilised their members to advocate for subsidised supplies. I don’t say this to pat type 1s on the back or claim that we are superior in any way but to show that actions by individuals and small groups can make a difference and you’ve got to be part of the change you want to see. if you don’t like the stigma around type 2, perhaps the place to start is lobbying the supposedly member-based organisations that promote these messages.
There are many things that people with “diabetes” have in common but some important differences too. Making sure the differences are understood is life-saving for type 1s and does not demean or belittle the very real needs of people with type 2, or the seriousness of type 2 diabetes. There are many opportunities for mutual support and co-operation in making things better for everyone affected by diabetes but type 1 is different from type 2 and it is neither discriminatory nor shaming to point this out.
What do you think? Is the distinction necessary or discriminatory? Could it be done better or do you have ideas for how diabetics can speak with a more unified voice? Please feel free to comment.Tweet