Diabetes' civil war

Laura Fitzgerald, 21, was diagnosed with Type 1 diabetes when she was 6 years old. She must inject herself with insulin daily. (E. Jason Wambsgans / Tribune)


"I'm sorry, but I hate Type 2. I call it the wuss version," Hashemi-Rad, 34, wrote on diabetesdaily.com in response to an online article headlined: "Which is worse: Type 1 or Type 2 diabetes?"


As rates of Type 2 diabetes soar, tempers are flaring in the diabetes blogosphere, where many people with Type 1 diabetes are lobbying for a new, distinct name for their condition in hopes of clearing up misconceptions and securing more resources to put toward a cure.

With Type 2 diabetes — formerly known as "adult-onset diabetes"— people have trouble putting insulin to use in the body to metabolize dietary sugars. Obesity is a major risk factor, and diet, exercise and medication can help prevent the condition in people at risk or treat the disease once it develops.

Type 1, by contrast, used to be called "juvenile diabetes" because it is often present from childhood. People with the condition produce no insulin and will die unless they regularly dose themselves with the hormone.

Many people don't understand those differences, and because Type 2 diabetes is far more common it receives most of the attention. Type 1's often hear "You don't look like a diabetic!" or are assumed to have caused their illness by overeating.

"Typically, people have no idea what diabetes is or how it works," said Chicago's Laura Fitzgerald, 21, who was diagnosed at age 6. "They assume I did it to myself."

Diabetes educator Riva Greenberg has repeatedly advocated for a name change, hoping that greater recognition will lead to more stem cell research.

"When the two types are lumped together, it's hard for organizations committed to finding a cure to Type 1 to really get funded," said Greenberg, author of "50 Diabetes Myths That Can Ruin Your Life." "If policymakers don't understand the difference between the two — they are thinking people need to move more and eat less — it's going to be hard to help cure Type 1."

Some people with Type 2 diabetes say they are being unfairly stigmatized for developing a disease that has a strong genetic component. Those who exercise regularly are often shocked to be diagnosed, because they assume only overweight people are at risk. At the same time, controlling diabetes with lifestyle changes and medication isn't as easy one might think.

Susan Amati, of Chicago, who has Type 2 diabetes, said people shouldn't be quick to judge.

"Bad behavior may contribute to the cause," she said, "but many people may not behave any differently than the average person, but get diabetes. I ate and dieted very carefully, but until I got the proper medicines, my blood sugar control wasn't good."

However, gaps in communication, lifestyle and differences in the treatment plans for the two types can make it difficult for the two sides to understand each other.

"Type 2 diabetics are 'blamed' while Type 1 diabetics are 'ignored' and really it isn't fair to anyone," said diabetes blogger Allison Blass (lemonadelife.com), who is based in New York City and has Type 1.

While all people with diabetes are characterized by elevated blood sugar, Type 1 and Type 2 are essentially two distinct diseases.

Type 1, which is considered more devastating, is an autoimmune disorder; the body has attacked itself and permanently destroyed the cells in the pancreas that make insulin. Insulin is needed to transport sugar into the cells where it can be metabolized and used for energy. If too much sugar (or glucose) stays in the blood, it can lead to serious damage to the tissues, eyes, nerves, heart, gums and teeth.

People with this condition need insulin to live. They receive it either by injecting themselves with a syringe or receiving infusions through a pump attached to their body.

Type 2's, on the other hand, produce some insulin. The problem is the insulin can't do its job. When the body resists insulin, sugar builds up in the blood, causing the same negative effects as Type 1. The condition often goes undiagnosed for years — it's estimated that a third of the cases of high blood sugar are untreated in the U.S. — which means Type 2's can have more complications, including high blood pressure, high cholesterol, heart disease and stroke.