Wednesday, October 19, 2016

Type 1 vs Type 2: the dumbest fight ever!

There are many memes in the T1D online communities, but one of the most irritating is the one that resurfaces whenever Type 1 Diabetics feel offended to be compared to Type 2 Diabetics. It basically goes a bit like this
"Don't confuse me with those ugly, fat and lazy Type 2 diabetics - I am really sick and, in my case it is not self inflicted."
That type of comments infuriates me in a major way. For four reasons
    1. that is profoundly simplistic, dumb, uninformed and plainly stupid.
    2. it often ends up in mob style behavior from the T1D community, versus other patients, versus corporations, small businesses, versus politicians, etc...
    3. T1Ds constantly whine about the fact that the non T1D community doesn't understand their problems, are always the first in line whenever they can claim some advantages - "play the diabetes card" as they say. While this is understandable in the context of a very heavy chronic disease, why can't they at least show a bit empathy for other chronic sufferers? 
    4. the fact that Type 2 Diabetes is much more frequent than Type 1 diabetes drives research and funding. While it is true that you often can't directly transpose research, results and therapies from T2D to T1D, the most dim witted Type 1 Diabetic could at least try to understand that research in, for example, Insulin signaling could be beneficial in those two different diseases. Or that having huge budgets devoted to diabetology creates an eco-system that is favorable to progress in general. For all we know, a young post-doc who finds a reasearch job today in a metabolic lab focusing on TD2 diabetes could be the one who makes a major discovery applicable to T1D tomorrow. At least, he is definitely more likely to contribute than an orthopedic surgeon or a psychiatrist.
Let's quickly look at the genetic inheritance aspect of T1D and T2D as it is often seen as the ultimate "responsibility" test... this will be quick.
Type 2 diabetes concordance in dizygotic twins 40%
Type 2 diabetes concordance in monozygotic twins 70%
Source:Genetic Screening for Type 2 Diabetes

Type 1 diabetes concordance in dizygotic twins 3.1%
Type 1 diabetes concordance in monozygotic twins 27.3%

Just in case you don't know = dizygotic twins are standard brothers and sisters, with different genomes. monozygotic twins have mostly the same genome.
You can present the data both ways:

T2Ds are the ones who should complain because...
... the genetic factors play a much bigger role in Type 2 diabetes than in Type 1 - if you have a monozygotic twin with Type 2, there is a 70% chance you will be type 2 as well. In the case of Type 1, only 27.3%. (please do note that the lifestyle choice issues are mostly excluded by the comparison with dizygotic)

or, you could say

T1Ds are the ones who should complain because...
... the genetic factors play a much bigger role in Type 1 diabetes, having a T1D monozygotic twin multiplies your risk by 9, in T2D your risk is only multiplied by 1.7.
And that is only scratching the surface. Going back to the above points
  1. if you don't have the time to educate yourself, just shut up. Or, at the very least, learn to shut up when you are going to say mean stupid things. A statement such as "these are two different diseases" is enough, no need to badmouth others.
  2. don't join mobs, mobs are never a good idea.
  3. other people have diseases too. There is no "good" or "bad" patient. Show empathy, just as you would like others to have empathy for you.
  4. be thankful that a larger part of the population creates an environment that is favorable for research in general. No one knows where or when the eventual breakthrough will occur.

And, to some extent, I agree with there are, in many cases, a "self inflicted" part in T2D, but that doesn't change the above points: educate yourself, don't join mobs, show empathy, be thankful.
That "self inflicted" part - which again doesn't concern the whole T2D "class" of patients, by far - is not easy to solve. Are you going to remove kids from their families on "lifestyle" choices? Sterilize parts of the population? Invest in education so people know what a good diet or exercise regimen is? (even experts can't agree on many things). Shake up the food industry so the eventual trigger factors (we don't really know precisely which ones) are excluded? Yeah, that could be a good idea, but, get real, it won't be implemented any time soon.

Again,
educate yourself, don't join mobs, show empathy, be thankful

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