It's diabetes awareness month. Let's tell the world what resilience really means.
What is diabetes?
Diabetes means different things to different people. For some, it's a lifestyle disease brought on by consuming excess food, in particular, sugar. To the layman, the word insulin may never be mentioned, despite it being the contributing cause. Due to the vast bulk of people suffering this 'type' (90%), it's easy to see why the media is preoccupied with it. However, our knowledge of insulin resistance is growing and the stigma surrounding people with type 2 diabetes is changing.
For others, it could be a way of life as they may have been diagnosed as a baby or child. Pricking fingers, counting carbs, weighing food, hypos, hypers, stigma, missed school, 3 am blood sugar checks, thousands upon thousands of injections, unsightly 'lumps' after insulin injections (lipohypertrophy), countless medical appointments and navigating contradictory advice on how to manage this insidious disease. All whilst living in hope that they won't suffer a 'complication' which could alter their lives with type 1 diabetes more than it already is.
Diabetes can also strike fear in the hearts of expectant mothers. The fastest-growing 'type' impacts pregnancy and can have devastating effects on the baby and mother's health. It throws danger at the expectant family from two angles: 1) the immediate consequences to both mother and baby during pregnancy and 2) It raises the risk of developing type 2 diabetes in both their futures. To add insult to injury, this type of gestational diabetes raises the risk of the baby being born premature, via c-section, and suffering a range of other complications.
Then there are the types that even diabetics find mysterious. LADA - Latent Autoimmune Diabetes of Adulthood is typically characterised as a form of type 1 diabetes but develops later and slower. Many doctors misdiagnose this as type 2 due to these traits. Commonly referred to as 'type 1.5', LADA patients may be prescribed incorrect or inappropriate treatments resulting in an acceleration of destruction of their insulin-producing beta cells. Like type 2 diabetics, people with LADA may be able to control their disease initially with diet and exercise alone, but over time and with continued exposure to high blood sugars (hyperglycemia), they will be forced to inject insulin and adopt the lifestyle management of type 1. Starting on insulin therapy earlier may well prove beneficial as it can preserve beta cell function and delay potential complications.
We're now getting into rare diabetes territory, with a type that is caused by a mutation in a single gene. Experts estimate that just 1-2% of people with diabetes will have MODY or maturity onset diabetes of the young. A form whereby the parent who has the genetic mutation has a 50% chance of passing it down to their child. The child will then go on to develop diabetes before the age of 25 regardless of lifestyle, ethnicity, or weight.
As we’ve explored in previous articles, there is also a type of diabetes that increases the risk of complications for type 1 diabetics. Double diabetes is when a person with type 1 also has insulin resistance - a typical trait of type 2. Essentially, when a type 1 is sedentary and eats a diet rich in carbohydrates, they require excessive amounts of insulin to cover the food (which results in visceral fat storage), and over time the body struggles to use insulin properly (insulin resistance). It’s a slippery slope and the risk of developing complications is increased.
Not to be outdone, we have another ’type’ that is perhaps the scariest of them all. Imagine having to live life managing diabetes the same as type 1, but the insulin has no consistent effect. Imagine when you eat food your blood sugars sky-rocket to dangerous levels, but upon remedying this with insulin it plunges you into severe hypoglycemia. Now imagine this happening every day, with the constant fear of hypos or even diabetic ketoacidosis (DKA) The impact is severe. People with brittle diabetes are faced with this very real struggle and if there ever was a cure on the horizon, they would be at the front of the cue.
To the medical profession, diabetes is a progressive chronic disease that is clogging up our health systems. There is mounting evidence that ‘insulin resistance’ is the primary driver of heart disease, and if this turns out to be accurate diabetes will overshadow every disease on the planet. Despite type 1 and type 2 being very different in what is generally considered the cause (autoimmune - type 1: metabolic - type 2), the management is strikingly similar, and the complications which can present themselves are identical. Understanding Insulin is the key regardless of what type you have.
To the people who live with diabetes, it is a constant source of stress. "Am I making the right diet choices? Am I exercising the right way or enough? Am I giving myself too much or too little insulin? Am I checking my blood sugars enough? Am I going to the doctor enough? Am I getting enough sleep?"
Is there anything else I can do to help me manage this disease and hopefully live a long, complication-free life?
No-one chooses to be sick. No-one chooses to live every day in fear. People with diabetes are strong because they must be strong. We endure a daily struggle that for us is ‘normal’, but for others is an alien world away far from their bubble of comfort - and to live in ignorance is bliss.
If you’re not a diabetic, don’t look at every insulin injection in public as something that should be done behind closed doors. Don’t look at every overweight or obese person as though they have no self-control. Don’t look at every child who has a cannula sticking out of their belly and tilt your head and feel pity. Don’t ask every diabetic “should you be eating that”, because the answer is, you shouldn’t be eating it either.
People who live with and endure diabetes are incredibly resilient, courageous, and brave. Every day is a storm and they weather potentially catastrophic conditions with dignity and pride.
We all have our own battles to fight. Some are obvious and others are hidden. But for people with diabetes, it’s both.