"#iwishthatpeopleknewdiabetes means something different to everyone and took the time to listen. #doc #diabetes #Type1 #type2 #health"

I posted this tweet this week, and it seems like there’s room to expand on the thought, particularly in the wake of ‘diabetes’ being bandied around the internet lately. I’m thinking about CrossFit here and their somewhat terrible ad:

People (mostly Type 1s) got quite angry that CrossFit were blurring the boundaries between their disease and Type 2 diabetes. This is common and, on the face of it, mildly annoying. It goes hand-in-hand with all those (occasionally well-meaning but always ignorant) things that TypeZeros ask or say:

“Did you eat too much sugar when you were young?”

“Have you got bad diabetes? / Is your diabetes severe?”

“Diabetes, that’s diet-related, right? / Can you eat any sugar? / You shouldn’t eat that, it's sweet.”

Of course, it’s a bit worse when instead of a friend or acquaintance who you can easily educate, it’s a popular fitness company that’s saying it. Not only have they got more reach thanks to their marketing budget, but the whole philosophy of such companies is about taking control of your body. Their message implies that, as a diabetic, you have failed.

Not only is this a fairly terrible judgemental stance to take – who the hell CrossFit to say whether I am OK or not?* - but it is also wrong on two scientific counts, and another on a more human level.

One – There are two different types of diabetes. Type 1 is when you can’t produce insulin, and Type 2 is when you become resistant to insulin. They are quite different diseases, with often quite starkly different treatments. For example, Type 1s can’t survive without injecting insulin whereas a lot of Type 2s can, and treat their disease with diet, exercise and pills.

On top of this, you just get Type 1. It’s got nothing to do with diet at all; it’s an auto-immune disease, and no-one quite knows what triggers it. By using the catch-all term ‘diabetes’, CrossFit seem to be implying that Type 1s have “brought it on themselves”.

That’s true for Type 2s though, isn’t it?

No.  

Two – Type 2 diabetes is a diet-related disease, but it is not necessarily caused by being obese. Being overweight is a risk factor. Much like doing CrossFit is a risk factor for severe kidney problems – there is a much higher incidence of rhabdomyolysis for CrossFitters than in the general population. However, rather than exercising too much to cause yourself potentially lasting and expensive damage, Type 2s often haven’t ‘only got themselves to blame’. The nature of being Type 2 or pre-Type 2 (having impaired glucose tolerance), means you are actually likely to put on weight; having insulin resistance makes you tired and liable to eat more. By implying that drinking Coca-Cola will make you fat and so diabetic, CrossFit are putting the cart before the horse. Perhaps that’s a new kind of exercise CrossFit are developing…

In any case, scientifically, CrossFit are out on an over-developed limb.

But as I say, live and let live. I know I’d prefer to have a fully-functioning mind and slightly dodgy pancreas, rather than the other way around...

But CrossFit have also failed on a more human level. Quel ruddy surprise you might say. True, but it is a failing that healthcare professionals often make as well, which is detrimental to diabetics everywhere and this was the real thrust of my tweet.

Diabetes is different for everyone. Not only different as in Type 1 and Type 2, but different within those groups for the daily and extraordinary challenges those diabetics face. Life for a Type 1 in rural Peru, where they have one insulin injection a week (if they’re lucky) is quite different from an urban Western Type 1 with all of modern healthcare to help them.

But even in less extreme circumstances, people face different challenges: one person’s blood sugars might be high all the time because they’ve looking after a new-born baby and don’t have enough time to sleep. Another may face eviction. Someone else may struggle to fit in at school. A child's parents may have divorced. Or, yes, a person might have a problem with their weight. Treating diabetes, of whatever type, is complicated by all these issues, and barking out slogans only helps to depress people who already face difficulties leading a life with a long-term condition. There is no catch-all answer to the problems of diabetes.  

I wrote Joe’s Rough Guide to Diabetes to face this truth. The book teaches through encouragement. It doesn’t tell you what to do; it tells you what I did so you can learn from my mistakes. Only you can learn to manage diabetes in your own situation. It’s something that a lot of people don’t seem to understand.

The same broad-use idea underpins the design of the Small-in-one: everything you need for a day, any brand of meter or insulin pen, in a handy little case. Hopefully, it’s enough for what you need, and gives you enough flexibility to live the life you want. 

I’m not going to claim my products are the only answer, they’re not. But they are part of an answer to improving diabetes care that starts when people in positions of authority stop telling and start to listen.

*At the risk of going over-board, ‘fascist’ actually seems an apt description of their position.