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Subject: [IP] Type 2 versus type 1
I don't have either kind of diabetes, but I treat patients with both Type 1
and Type 2. From my perspective, type 2 has less dramatic consequences, but
neither is easy. In Type 2, the risk of life-threatening emergencies, such
as DKA, is small to non-existant. Hypoglycemia is usually less common, as
the body still has more of its ability to compensate for such things. So,
when you don't have the risks of IMMEDIATE death, it's a tad less scary.
Since more Type 1's are diagnosed younger, they have the"opportunity" to
have all those diabetic complications at younger ages. Yes, it's not good
to lose your vision, or your kidneys, or your feet at any age, but if I had
to choose, I'd rather do it at 65 than 35.
The medications for Type 2 have come a long way. The new insulin
sensitizers (Rezulin, Avandia, Actos), and Glucophage have let me get a lot
of Type 2's off insulin or greatly reduce their doses, with good
improvements in Hb A-1-C's at the same time. They're expensive, but it's a
pill. And, with all our threads about checking sugars/ injecting in public,
there's just something to be said for not having to face that social battle.
Good education is something that's crucial for any type of diabetes. What's
discouraging to me is how few Type 2's will participate. Our hospital has a
3 day class (1.5 hours each session either at noon or early evening), and I
probably make 10 referrals to the class for every 1 patient who actually
goes. With Type 1, the lifestyle change is so abrupt, that education is
demanded. But, it's also frustrating to me how few of my adult Type 1's
want to go through re-education when something new and better comes up.
Lifestyle changes are hard, no matter what your lifestyle change is.
There seem to be a lot of people on this list who are really type 1 1/2's -
the adults who are type 1's, but in slow progression to total loss of
pancreatic function. That really is a different diabetes than a true Type 2
who still has generous insulin production but is insulin resistant. I think
that these Type 1's-in-evolution are definitely getting the short end of the
stick, as little is published in the medical literature about them and their
needs. But, usually, they're not insulin resistant, and the pancreas is
doing the best it can, so the oral meds really don't help much.
So, for my money, I'd rather have Type 2. But, I'm going to keep trying to
get all my patients Hb A-1-C's down, with a lifestyle that they can do. And
keep my Type 1 daughter healthy and active and pumping till something better
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