July 17, 2007

Type 1s Hating Type 2s

This post is about one of the dirty little not-so-secrets of the online diabetes community. Type 1s often complain of how much they hate the way that the general public confuses them--innocent victims of an autoimmune attack--with those disgusting, fat, lazy type 2s who caused their own disease.

But despite what you read in the media, the science is very clear on the fact that most Type 2s did not "cause" their diabetes any more than the Type 1s did. Like Type 1s, Type 2s start out with a genetic make up that predisposes them to develop their form of Diabetes. This genetic make up causes them to develop insulin resistance long before they are overweight, and is instrumental in their subsequent weight gain. It may also result in errors in the way that their mitochondria work--the cell's fat burning organelles--so that their bodies deposit fat rather than burning it as a normal person would.

Studies of thin relatives of people with Type 2 show that they show abnormal insulin response decades before they themselves develop either obesity OR diabetes. Twin studies also show that 80% of identical twins of a Type 2 diabetic ALSO become diabetic while fraternal twins do NOT show this concurrence. This is considered very strong proof of a genetic origin for a disease by the scientific community.

New genes strongly associated with Type 2 diabetes are being identified every year. Most recently, for example, Type 2 diabetes has been strongly associated with defects in PTPN1, found in 20% of white Type 2 diabetics, Calpain-10 in 17% of Mexicans, HNF4-a which raises risk 30% in Finns and is more common in people with Diabetes who are of Ashkenazi Jewish descent, and TCF7L2 which was found to double the risk of developing Type 2 diabetes in an English population.

Another point that gets lost in the simplistic media coverage of Type 2 diabetes, is that while 80% of Type 2s are fat, most obese people do not have diabetes. In fact, two out of three obese people do NOT develop diabetes,

Indeed, here is good reason to believe that many of those people with Type 2 diabetes who are obese are obese because the widely fluctuating blood sugars caused by eating a high carb diet cause intolerable hunger and alterations in the other hormones, besides insulin, that the body uses to maintain weight homeostasis.

The effect that GLP-1 supplementation with Byetta has on the eating patterns some people with diabetes is very telling here, since GLP-1 crosses the blood-brain barrier and impacts on feeding behavior in all kinds of mammals. When we look at intense hunger as a symptom rather than a moral failing, and when we realize that flattening blood sugar swings usually eliminates that hunger, we get a whole new understanding of the relationship of diabetes to weight that has little to do with the "you caused your disease you lazy slob" approach Type 1s buy into when thinking about Type 2s.

Even more relevant to the anger of Type 1s against Type 2s, is the recent research has found that, depending on the study, between 4 and 30% of "Type 2s" in various studies have been found to have GAD antibodies--the same markers of autoimmune attack as Type 1s. The difference appears to be that the autoimmune attack is not as total as that the type 1s experience. This should not be a surprise. Many people with Type 2 also have thyroid disease, which is often due to autoimmune attack.

There's a lot more research along these lines. You can read about some of it, with links to the original research papers at You Did Not Cause Your Diabetes with Reckless Overeating.

Gina Kolata's new book, Rethinking Thin, does a great job of summarizing the research that proves that normal people do not become permanently obese by overeating and that there needs to be an underlying disorder for a person to pack on and retain large amounts of weight.

Did Type 1s Cause Their Disease?

There's some interesting research floating around that seems to show that the upsurge in autoimmune disorders of all types in children growing up in Western society may be an unintended consequence of our obsession with cleanliness.

This theory argues that children who don't spend hours each day getting filthy outside, where their immune systems meet and conquer a host of microorganisms, are more likely to develop antibodies against their own bodies. A growing immune system that isn't presented with playmates will attack whatever it finds, often the body's own cells or foods--hence the huge growth in food allergies in the young. The growing use of anti-microbial soaps in the home also contributes to this lack of traditional playmates for the developing immune system.

But no one takes this kind of data and uses it to blame the Type 1 or their family for "causing" their disease, because cleanliness is considered a virtue in our society! If it were the other way around, and the kids who were raised in less cleanly homes were more likely to develop Type 1, you would probably see that kind of blame that you see loaded on Type 2s.

The fact is, people love to be able to pin moral blame on those who get a terrible disease, because if we can blame those people for their disease and attribute it to failings we personally don't have, we can feel safe. The alternative is to see innocent people just like us struck down by nasty diseases and feel fear.

But the fact is, the body is an insanely complex mechanism, and we are living in environments that are completely different--biochemically--from those we evolved to fill over many millions of years.

And it is not beyond belief that the many forms of genetic damage that cause Type 2--and the RISE in the incidence of Type 2 Diabetes--may well be a caused by damage to our DNA caused by the chemicals outgassing from the plastics that surround us, from the toxic Teflon that lines our cooking pans, from the petrochemicals we breathe in our air, from the smokestack emissions that contain significant amounts of toxic metals and toxic organic compounds, or even from early life exposure the hormones found in public water supplies, thanks to the huge amount of birth control pills half the population takes, a good amount of which is going down the sewers.

So next time you are tempted to distinguish yourself from those fat slobs with Type 2 diabetes, take a deep breath and use it as a teaching moment. When people with all kinds of diabetes band together, we can make advances for all of us. We can ensure that there is health coverage for all kinds of people with diabetes, no matter where employed, we can get rid of discrimination against people with diabetes, we can do something about the lousy care so many of us receive from doctors who don't keep up with the research, and we can demand that our institutions support the basic research that might free us from the stop gap drugs and devices that are what we have to deal with now.


Rachel... said...

Excellent thoughts & facts.

Anonymous said...

You're on a roll -- it's just one terrific post after another. Thanks!

Anonymous said...

Very interesting and informative post!! As a T1, I do have anger at the T2's...but I think it is more because T2's can USUALLY achieve decent control with diet and exercise. I don't think that most T2's caused their disease, but I think they are given far better a far easier and better way to control it once they have it. And most T2's that I know don't do what can benefit them the best. They are more willing to trust a pill than go for a walk. That's frustrating to me.

Jenny said...

Re Type 2 control being "easier". The point you raise deserves it's own blog posting and will get it!