My Friend’s Eye View of Diabetes

I have a friend I pal around with for a day every few months. We’ll go into town with some sort of grown-up, goal-oriented theme, such as visiting rooftop parks or checking out produce markets in Chinatown—anything to make us feel less guilty about the fact that we’re really out just to goof off.

He knows I have diabetes, and sometimes our conversations touch on it. He is an educated, well-read man, but even so, he doesn’t really understand what diabetes is all about or what it is I’m supposed to be doing about it.

Talking to him about diabetes is a way for me to see how most people who don’t have the disease view it. I’m pretty sure that most of us type 2s run into the same misconceptions that my friend has:   

Misception #1: You can’t have any sugar, period.

This is probably the greatest misconception. I tell whomever asks that any carbohydrate—refined sugar is only one among many—is converted into glucose in the bloodstream. The question for somebody with type 2 diabetes is how much sugar are you ingesting and how fast will your body convert it into too high a level of glucose? So, no, I don’t have to give up sugar. But I do have to take into account what it will do to me if I consume too much of it at one sitting.

Misconception #2: All diabetics have to take insulin.

This is where non-diabetics are most open to a discussion of type 1 and type 2 diabetes. Yes, virtually all type 1s must take insulin. No, type 2 does not require insulin to manage it, although a significant percentage of type 2s begin using insulin when diet, exercise, and drugs combined lose their efficacy.

Misconception #3: There’s only one kind of diabetes.

The news that there are two—perhaps even more—types of diabetes is often a revelation to non-diabetics. While the expressions “juvenile diabetes” and “adult onset diabetes” are perfectly clear to those of us who have the disease, they’re often meaningless to people who don’t.

That’s why other terms are helpful to the conversation: “auto-immune disease” and “genetic predisposition” when discussing type 1; and “lifestyle consequences,” “prediabetes,” and “metabolic syndrome” when discussing the path to type 2.

Misconception #4: Diabetes is a genetic disease/Diabetes is not a genetic disease.

Yes, it is. No, it’s not. The difference, of course, is that type 1s are the recipients of a genetic endowment that destines them to an autoimmune attack on their ability to produce insulin. It is the luck of the draw for them, and there is nothing they can do to stop it. The jury is very much out on whether there’s a genetic component to type 2. There may be a genetic predisposition, but for now type 2 seems to be more the consequence of lifestyle choices that build up over time.

Misconception #5: I could go into a seizure at any moment.

Although hypoglycemia is an ever-present threat to many people with diabetes, it isn’t for all. This is a good point in the conversation to tell a friend that you know what steps to take if you feel hypoglycemia coming on (test kit and glucose tabs or candy bar at the ready; medical ID somewhere on your body). It’s also an opportunity to teach your friend what to do if and when you feel hypoglycemica coming on.

Misconception #6: You look perfectly fine. Why is diabetes such a big deal?

Because its effects are cumulative and unfold over time, the same way a brooklet can eventually undermine a cliff. “Beware a disease that plays the long game,” I tell them.