Saturday, April 28, 2012

Diabetes as a Spectrum Disorder

I've really been thinking about the T1/T2 wars (and please don't deny that they exist!), and was contemplating how to reframe the question so as to help everyone understand each other. And I think the concept of diabetes as a spectrum disorder is a really helpful one.

In academic studies, they concentrate on insulin resistance and autoimmunity as an either/or in order to make the population they are studying as homogeneous as possible. But in real life, it's just not that simple. Think about it:

First of all, insulin resistance. The fact is that EVERYONE, not just diabetics, falls somewhere on the scale of insulin resistance, all the way from people who are extremely insulin sensitive to those who are extremely insulin resistant. The curve is actually skewed to the right, which means that most people are at least somewhat insulin resistant. Of course, if their pancreas is healthy and they don't have the genes for diabetes, their pancreas merrily churns out the exact amount of insulin they need. While it's true that obesity correlates to some extent with T2 diabetes, it's NOT the cause, because while 33.8% of the general population is obese, only about 8% have diabetes of ALL kinds, so there are far more obese people who DON'T have diabetes and never will, than those who do.

Then there is insulin production, which again falls on a scale from zero production to massive production. Autoimmunity is not the only cause of pancreatic failure: it could be surgery, it could be amyloidosis, or it could be another cause which has not yet been determined. But again, this is not an either/or criterion; it's a spectrum, and some people can be producing some of their own insulin, yet not enough to stay alive.

So if you visualize an axis, with insulin resistance on the x axis, and insulin production on the y axis, you would see that a person could fall anywhere in the quadrant, regardless of the cause of their diabetes. So you could have extremely insulin-resistant "T1's" and you could have insulin-sensitive, slender "T2's" and everything in between. And because of that, clinically and experientially, the either/or, T1/T2 distinction breaks down -- the whole point of diabetes treatment is to do what the individual needs. So there is really NO basis for anyone with diabetes to feel hostility toward anyone else, because we're all unique individuals, and not one group fighting against perceived blame or victimhood, or any other response from the other group.

The fact is, we're in it together, and we need to support each other, no matter where we fall on that graph!


  1. Great post, Natalie. And so true. Loud yays!

  2. I truly don't understand the type wars and I hope that we live to see the day they are just a memory from the past.

  3. I'm glad I read this! I never thought of diabetes this way. It's interesting to think about. I'm speechless.

  4. Bloody hell YEAH this is so well written considered and bang on. I'm gonna book mark this for future use hon thank you x x x