“That’s what people get when they eat too much sugar.”
A chance remark and nothing of note to the woman that said it. But to me, it stung.
This was overheard while waiting for my prescription in Lloyds Pharmacy. A little boy keen for knowledge asked his mother to explain what a poster concerning undiagnosed diabetes was about.
I have been irked by the campaign this poster is a part of for some time already. They were first displayed during diabetes awareness week back in June but have remained in stores, tacked to the front desks and to outside windows, ever since. They state that “11 million people have undiagnosed diabetes in the UK. It uses the word ‘diabetes’ as one sweeping, blanket label. If you squint you might notice a tiny little asterisk alongside the word, which denotes ‘type 2’ written in nondescript letters in the bottom right hand corner.
Within the diabetes online community the lumping together of Type 1 and Type 2 diabetes is often a hot topic. But it recently occurred to me that I’ve never addressed it myself in a blog despite having spoken a lot about it in offline conversations and on social media. After the incident in Lloyds Pharmacy it struck me that I needed to write that blog. This one.
Let me stress from the outset -this is not about attacking people with type 2 diabetes or waging a war of type 1 vs. type 2. That unpleasantness is something I hate. Diabetes is a pain in the arse for anyone that has it, and we all have the right to moan and vent if we need to. But there are differences here which must be made clear whenever the conditions are referred to.
So to the facts.
Type 1 diabetes is an autoimmune condition whereby a fault in the immune system triggers an attack to beta cells in the pancreas. When these beta cells are destroyed the body is unable to producing insulin which can lead to blood sugar levels rising to dangerous levels. Type 1 diabetes must be treated by insulin injections or use of an insulin pump. It diabetes cannot be reversed or prevented and is never a result of any kind of lifestyle choices.
Type 2 diabetes comes as a result of insulin resistance in that the body cannot use insulin as it should or from the pancreas being unable to produce enough insulin. It can usually be controlled by medication in the form of tablets alongside diet but in more advanced stages some people need to inject insulin.
A type 2 going onto an insulin regime does not mean they are a type 1. Type 2 diabetes is most commonly diagnosed in later life but is becoming more prevalent in young adults and even children. This is due to poor eating habits and lack of exercise which results in obesity. I must stress however that type 2 diabetes is certainly not always caused by poor lifestyle habits. There are a number of other factors that can be a trigger such ethnicity or genes as you’re two to six times more likely to become type 2 if you have a parent, brother, sister or child that has it.
Why is all this important? Why does it matter that people realise the difference between type 1 and type 2 diabetes? Essentially because they are separate diseases with very significant differences. Conflating the two is akin to believing breast cancer is the same as bowel cancer. Yet new research by healthcare provider Abbott into Britain’s views on diabetes recently found 43 per of UK adults can’t tell the two types apart.
This lack of comprehension can be upsetting to people with type 1 diabetes as it often can lead to ignorance and stigma. It is not uncommon for a type 1 diabetic to be faced with unwelcome views from the misinformed public that may believe they did something to contribute to the onset of their condition. Advice given on how to cure type 1 by way of various ridiculous remedies (okra, cinnamon, more sleep) can also be a frequent occurrence. It may be believed that type 1 is more easily controlled than it is which reduces acknowledgement of its severity and threat to life. All of these reactions can cause someone with type 1 diabetes to feel a misplaced sense of guilt or shame and lead to mental health problems.
I can envisage it now. A scenario has played out in my head repeatedly since I heard that exchange in the pharmacy: that little boy approaching a newly diagnosed type 1 in his class at school and asserting that they must have it because they eat too many sweets. It happened to me. It’s happened to so many of us. It’s not the boy’s fault, he knows no better, but the kid that he talks to will take it in, it will be remembered. For me those kinds of comments festered, and grew into paranoia about what people might think; that I was greedy and had brought my condition on myself, which led to a very damaging belief that I needed to remain a certain size as some kind of effort to challenge that.
Also, you know what? Lloyds focused entirely on type 2 in their coverage of Diabetes Awareness Week, which is just not right. They may have stuck some information on their website but I certainly saw no mention of type 1 diabetes in any of their publicity. One in ten of the diabetics in the UK are type 1, and we should not be marginalised. We deserve to be heard and have people made aware of what we go through everyday
It just keeps happening, again and again and again despite many people’s efforts to educate the press and repeated polite requests that media coverage become more mindful and stop presenting diabetes as just one illness. The roll call of Daily Express front pages that shout “Yoghurt is key to beating diabetes”, “Eat fruit to fight diabetes” or “Diabetes risk in red meat” (all genuine headlines) has become quite a joke, one that is a matter of laugh or you will cry.
In fact, the media has a lot to answer for when it comes to perpetuating misinformation about both types of diabetes. Not least when it comes to the reasons why someone could develop type 2. Given the way the relationship between eating habits and type 2 is covered in the media, it’s unsurprising that so many people think that the only cause is obesity.
Newspaper headlines are a case in point. 'Wonder cure for diabetes'” (The Express, again), 'Is there a natural cure for Diabetes' (Mail Online) and 'Eating potatoes before pregnancy increases risk of diabetes' (The Telegraph), to name just a few more., Sensationalist splashes like these only need one tiny word and a single digit number to become more accurate and less damaging. Is it so fucking hard to add 'Type 2' before the word diabetes? Or to stick in the word “some” when reporting on obesity and diabetes? When will they listen?
After the incident in Lloyds I spoke to a representative from their head office about my objections with their campaign. She was apologetic and seemed to be listening. She told me she would take my points forward and that Lloyds would endeavour take more care with such representation in the future. Time will only tell if that will be the case. All I know is that now, during Diabetes Month, those posters are still up and there are no amendments to the information displayed.
Fortunately in social media we have a powerful tool which is the growing strength and camaraderie of the online diabetes community. This blog will I hope serve to contribute to our endeavours to counter the ignorance and myths. I plan to retweet it far and wide. We need to reach out far beyond the parameters of just the #GBdoc bubble. There are people who need to read this, and that is why I needed to write it
I am trying to imagine that little boy from the chemist in 20 years time. Perhaps he will have his own curious son who will be interested to know what diabetes is all about. As a father the boy will be informed and have the right insight to relay. Without hesitation he’ll explain that diabetes is actually a term that is used for two distinctly separate conditions. This can be the reality if we continue to chip away at ignorance and collectively object to every myth and inaccuracy we come across. We are in this together and we need to keep shouting.
By Claire Kearns.