I am writing this in response to a post on The Art of Healthy Living about preventing pre-diabetes. While there was nothing factually incorrect in the article, the picture that accompanied it irritated me. It was a picture of a woman pursing her lips in front of a brightly coloured macaron, presumably not then eating it, along with the title ‘Tips for Preventing Pre-Diabetes’. To me it seems this image merely serves to perpetuate some of the worst pre-conceptions about diabetes as a whole – that the two types are one and the same disease.
The article was more accurately aimed at how to prevent Type 2 diabetes, a much more commonly occurring illness than Type 1 diabetes. What is difficult is that they are not one and the same disease and it is frustrating, particularly for those of us who live with Type 1, to have all diabetes thought of as one and the same illness. It is true that controlling diet and exercise may well, and in some but not all cases, prevent or at least slow down the onset of pre-Type 2 diabetes. Diet and exercise levels however have nothing to do with prevention of Type 1 diabetes – there is no way, that we know of yet, to prevent Type 1.
Type 2 Diabetes
Type 2 diabetes is much more commonly occurring than Type 1. Of the 3.5 million people in the UK, who either have diabetes or are likely to have diabetes, 90% of them have Type 2 (that’s 3.15 million people). The remaining people with diabetes have Type 1 (that’s 350,000 people). Type 2 arises when for some reason, the body’s insulin-producing cells (beta cells found in the pancreas) are hindered from producing enough insulin, or the sufferer loses sensitivity to the insulin produced. One of the factors that can hinder insulin production is weight gain, either from being overweight or sometimes from pregnancy, and the beta cells function is compromised. It is literally that the beta cells are being squashed by the extra weight, or by the baby, and they can’t function normally. However, Type 2 also occurs in people who are not overweight nor pregnant, though we don’t yet know why. There appears to be a genetic link to this – if one or both of your parents had Type 2 diabetes, then you are more likely to suffer from it as well. Therefore, controlling what you eat, exercising regularly, and even the daily intake of anti-diabetes supplements such as Berberine which can help your body to function better overall, are important in Type 2 diabetes management.
Type 1 Diabetes
In Type 1 diabetes, the beta cells that produce insulin have been destroyed by the body’s immune response. At some point, and for a reason we do not yet fully understand, the body recognises the beta cells as an enemy and destroys them. The beta cells no longer exist, so they cannot produce the hormone. Therefore, insulin has to be brought into the body from an outside source (injections of insulin). Some Type 2 diabetics have to have insulin injections, too, when their insulin production is so compromised that the drugs they are usually initially prescribed to stimulate their own insulin production aren’t sufficient to cope with their needs. All Type 1 diabetics must take insulin, either via multiple daily injections or via an insulin pump, because their bodies simply do not produce it. Because insulin is essential to survival, if a person does not receive it, they will die, usually within a matter of weeks. It is also why in the numbers quoted here about the prevalence of diabetes in the UK, the numbers of people who are ‘likely to have’ diabetes includes mainly people with undiagnosed Type 2. It is possible to live with compromised insulin production for a time, sometimes years or decades. There are no Type 1 diabetics who survive indefinitely without insulin.
So, coming back to what initiated this contribution was the irritation I experienced as a result of lumping the two diseases together under one banner.
They are similar, it is true.
They are not, however, the same.
Caroline Nairn is a psychotherapist, runner and diabetic advocate who has had Type 1 diabetes for 48 years.