Andrew Sullivan has been hosting an ongoing series of emails from readers on the differences between Type II and Type I diabetes.
The reader who kicked off the topic wanted to draw a line between II, which results from a drop in insulin effectiveness in the body, and is often correlated with old age and/or obesity, and I, also often referred to as juvenile diabetes, often caused by an auto-immune reaction in which the body’s insulin producing cells are destroyed. While all of us probably know someone who suffers from Type II (I know several), Type I is more rare.
My brother was diagnosed with it around age four though. One day he just started guzzling apple juice and peeing constantly. When it was brought up to my mom, a nurse, she brought back testing equipment from work. Surely enough his blood sugar was sky high and his pee was full of glucose.
The interesting part came next though. While at the hospital to receive the official diagnosis and have his condition monitored for a little bit, it became quite clear that none of the doctors or nurses involved had any idea how to manage it.
One of Sullivan’s readers mentions something similar,
I’m 6’0?, and was down to 150. My doctor wanted me to try to gain 10 pounds! In the meantime, I was asking a question that confounded every doctor, dietitian, and American Diabetes Association hotline expert I talked to: What should I eat for breakfast? If I needed to lose weight, they had answers. If I was on insulin, they had answers. But if I was at an appropriate weight, and just wanted to find a plate of foods that my weakened insulin system could handle without unhealthy blood-glucose spikes, breakfast was a stumper.
My parents encountered a similar lack of information. Even in the hospital they were serving my little brother chicken nuggets, pudding, and other junk. That kind of food would be unhealthy for anyone, but completely understandable in a circumstance where trying to make the child feel better emotionally, psychologically, is taking precedence over long term health risks.
In my brother’s situation though, these were short term health risks. The mantra then (this was in the mid 90s) was just go back to having a normal life and pump yourself full of insulin as the need arises. Literally: have your cake and eat it to.
My suspicion is that most of us interact with medical professionals so rarely, and know for a fact how much they’ve studied and how much information they do have, that we nevertheless trick ourselves into thinking they know a lot more than they actually do. I don’t want to generalize too much from anecdotal evidence. But even given my own experiences with the field (various knee surgeries), I’ve observed a level of disagreement between different physicians that left me much less confident in their opinions than I would have otherwise been.
One orthopedic doctor would recommend one course of action, while a second and third suggested different things (repair the cartilage, remove it, or just try physical therapy).
Perhaps this is just part of how we practice medicine in this country. That is, we got to people when we need to get fixed rather than having health experts guiding us all along. I’m sure I’m not the only one whose been to a doctor for a check up only to realize he or she wasn’t much interested in my diet, sleep habits, or other day to day activities.
Which might explain why, when it comes to things like diet and physical activity, so many of us feel on our own. With my brother, my parents lucked out in that a variation on the Atkins diet worked wonders for him, keeping his blood sugar well regulated and helping him ace his tests at the endocrinologist. But that was only after much trial and error with little to no guidance from the health professionals available–either because of a lack of information or of interest.