Happy Saturday, and welcome back to our weekly advice column, Ask D'Mine, hosted by veteran type 1, diabetes author and educator Wil Dubois.Ask-DMine_button

We're quickly approaching Veteran's Day 2014 on Nov. 11, and today Wil is tackling that topic a bit early (given that November brings a frenzy of diabetes advocacy news and of course World Diabetes Day on Nov.14). So this week, Wil takes a look at the available data on diabetes in the military and how that might effect the future of D-drafts.

{Got your own questions? Email us at AskDMine@diabetesmine.com}


Jim, type 2 himself and father of a T1D daughter, from Michigan, writes: Recently while out walking, and after having read a book about WW2, I was wondering if there are diabetics in the military and how they manage to maintain their blood sugar levels under the extreme conditions they find themselves in, since it is not all that easy in "normal" life? How about during World War 2 and on the front lines? Just thinking, with as much as the number of diabetics seems to have grown over past years, how would we fare if another world war broke out -- would we have a sufficient pool of those able to serve in the military to support the effort? Just curious, or maybe it was the hot sun that day?  :-}

Wil@Ask D'Mine answers: What a great question. We've covered diabetes in the modern day military a couple of times. Mike wrote a piece about how wanting to serve often requires fighting the brass before you fight the enemy; and we ran this dLife vid on an active duty T1. But I too just read a book on World War 2, so that part of your question really caught my curiosity.

Of course, back in the 1940s even in civilian life, diabetes was pretty much don't-ask don't-tell, so finding any info on serving D-folks in that era is a hard task. I suspect that there were virtually zero type 1s in the trenches. It's not like the old days where a girl could dress like a man and join the Navy. Or a pirate ship. Don't-ask don't-tell don't work with insulin and syringes, so I suspect there weren't any undercover type 1s in WW2 combat. Type 2s, however, are another subject altogether. And believe it or not, we actually know more about them than you'd think.

I found an article on the subject of diabetes and war service at the U.S. Army Medical Department's Office of Medical History (who knew such an office even existed?). The article's autArmy Medical Corphor, Dr. Alexander Marble, looked at historical data in the Army's archives for both WW1 and WW2, but the data-rich article gets complex because the 'War to End all Wars' (That would be the First World War) was fought before insulin. Right. New onset type 1 would kill a soldier as surely as a Hun's bullet. But just focusing on the WW2 part of Dr. Marble's article, he states that the number of fightin' diabetics was quite low, and his thesis is that there are two reasons for this:

  1. First, the bulk of the troops in WW2 were drawn from the 18-37 year-old range, below the typical diagnosis age for type 2 at the time.
  2. And secondly, induction stations actually screened for diabetes via urine tests, and rejected anyone with elevated sugar.

Did any patriotic diabetics sneak in a bottle of someone else's urine to beat the test and serve his country? I doubt it, but now I know the subject of my next novel. Actually, the records indicate that the vast majority of the rejected inductees had no clue they had diabetes before the screening.

How many men were rejected for service because of diabetes? A lot.

The records lump all endocrine issues together, leaving the data open to squabbling amongst historians, but it looks like somewhere between 19,300-23,500 American men were rejected for military service during WW2 because of diabetes, or officially: "manifestly disqualifying defects." Wow. And some of our kind think the word "diabetic" is rude. How would you like to be saddled with the label of manifestly defective? Personally, I think I'd have a hard time displaying my manifestly defective alert tattoo with pride.

Meanwhile, this manifestly disqualifying defect finally became a subject of public conversation in an era when manpower was sorely needed by the country. Some military experts felt diabetics could serve stateside and "perform useful duty" to support the war effort, but none other than the legendary endocrinologist Elliott Joslin himself disagreed. He said: "The diabetic quota useful for military service is relatively so insignificant, the hazards which both the diabetic and the Government would undergo if they were inducted are so great, and the need for their services in civilian occupations where they would be less exposed to complications so apparent, that the present rule to omit them from the draft appears proper."

OK, so we were effectively weeded out at the sign-up stage in WW2. But what about those servicemen who developed diabetes while serving? According to Marble's article, in WW2, Army hospitals treated on average 1,600 or so men each year of the war for diabetes that developed during service. Many presented with gangrene, others went into comas. Each year about 1% of the patients died. After treatment, more than three-quarters of them were "separated for disability," but the other quarter were returned to service. The author doesn't know why, but speculates that either their diabetes was "mild" or that the PWDs were "key personnel." In other words, the Army will keep you if it needs you badly enough.

During the war, 60 soldiers who developed type 1 perished under Army care. Thirty-three were from the Army, one was a sailor, one was a marine, three were retired military personnel, five were beneficiaries, and two were with the Civilian Conservation Corps. Of those who died, most perished within 48 hours of admission to the hospital. BG levels on admission in a third of the servicemen were greater than 500 mg/dL. Marble notes that those diagnosed on the home front fared much better than those diagnosed in the theaters of operation, largely due to the transport time involved.

Interestingly, to me, recent studies of the Army's historical data show that the diabetes "disqualification" rates for whites were much higher than for blacks. Like more than three times higher, suggesting that the diabetes rate for Caucasians was three times higher at the time. But today, blacks have a diabetes rate nearly double that of whites. This tells me there have been some major social upheavals over the ensuing decades that have tipped the scales on who has more diabetes.

Meanwhile, the side effects of the war seemed to have lowered the already modest diabetes rates at the time. In some countries this was due to rationing and in others due to shortages. But in the long run, the war itself may have served as an accelerant to the growth of diabetes. Some researchers now believe that experiencing the war—even as a civilian—increased diabetes risk decades later.

As to your musings about would we have enough manpower to fill the ranks if there were another big war, I don't see a World War 2 type of megUncleSamIWantYoua-war with massive armies ever happening again. You'd only need that kind of troop strength if China and Russia got together and decided to rule the world, and what are the odds of that?

Come to think of it, maybe we'd better take a second look at our readiness, after all.

Actually, I think we'd be fine. Well, not fine. Sending a whole generation off to war is never "fine," but I think we could get enough able-bodied people to fill the ranks. Here's how I see it: Soldiering is still a young man's job, and even with the rise of diabetes in all ages, the prevalence in the key age group is still low enough that we could field a pretty impressive army. The latest data from the Feds shows that diabetes in the under-20 crowd (T1 and T2 combined) makes up only one-quarter of one percent of the population in that age range, suggesting that 99.75% of 18-20 year olds are draftable. And in the 20-44 year old range, the diabetes rate is 4.1%, suggesting that 95.9% are draftable. Stay put, Putin. We're not so fat and lazy as you imagine we are.

And we have one other thing on our side that we didn't have in very great numbers in WW2, and that's girl power. Today's military is 14.5% female. We could always deploy a greater number of fighting females if we needed to. And of course the nature of war has changed, too. An aging type 1 like myself could fly a drone from an air-conditioned office in Maryland just as well as the buffest 18-year-old jarhead. If the nation got desperate in repelling the northern hordes, any of us D-folks that might not be combat-ready could ignore Joslin's advice and still fill all the gazillion support roles for the frontline troops.

And for what it's worth, I think we D-folk would make good soldiers, frontlines or backlines. Because if there's one thing we know how to do, it's that we sure know how to fight.

Thanks for the great historical question, and don't forget Veteran's Day next month!


This is not a medical advice column. We are PWDs freely and openly sharing the wisdom of our collected experiences — our been-there-done-that knowledge from the trenches. But we are not MDs, RNs, NPs, PAs, CDEs, or partridges in pear trees. Bottom line: we are only a small part of your total prescription. You still need the professional advice, treatment, and care of a licensed medical professional.

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This content is created for Diabetes Mine, a consumer health blog focused on the diabetes community. The content is not medically reviewed and doesn't adhere to Healthline's editorial guidelines. For more information about Healthline's partnership with Diabetes Mine, please click here.