Do you assume diabetics with horrible complications are to blame?

[BlueberryIsMyFavourite]

I'm just curious about this. And as this is an anonymous forum I thought people would answer truthfully, whereas in person I think people at least sometimes want to be more gentle.

I have type 1 diabetes for a long time now, 28 years, since childhood. I have always been incredibly sensitive to insulin and for a long time in old fashioned terms would have been called "brittle" but doctors don't tend to use that term anymore.

I have very good diabetes management now thanks to new technology. However, plenty of damage was done early on.

There just seems to be a general sense that people think diabetes is quite simple to control, and if you are struggling it's because you aren't doing something right.

Whereas, there are so, so many factors that can cause blood sugar to rise or drop apart from food - as an example, brushing my teeth can cause me to start dropping quickly, which then needs some glucose or juice to treat and stabilise it, and try brushing teeth again later. Because of course, diabetes also can destroy oral health, so good oral hygiene is very important. This is obviously a small, mundane example.

It is relentless and there are no days off.

Do you just assume diabetics with complications are essentially irresponsible?

I’m Type 2 & my GP thinks it’s a genetic propensity. I was diagnosed exactly a month after my Dad died last year with Diabetes as a cause of death on his death certificate. And there’s a heap of type 1 on my maternal line.

But many thanks to PPs, it’s great to hear my diabetes and any visible complications are my fault 🙄.

Seeing someone dying, after amputations & vascular collapse in both legs leading to his last 5 years unable to walk, is horrific.

I went from fine (with blood tests every 6 months due to my mountain of medications for pain) & to an hbA1c reading of 78.

I think one of the big issues is that NICE guidelines do not allow for type 2s to have an NHS funded glucose monitor unless they start using insulin.

I’m lucky that I can afford £20 - £40 odd a month on lancets & glucose strips. Many can’t, especially if poor compliance has led to physical complications leading to being unable to work.

I have met so many older type 2s at clinics who don’t monitor, who think that Metformin makes it OK to eat cakes, sausage rolls, biscuits etc.! If you live by your monitor, you can see the consequences of your diet & adjust accordingly. Although I can feel if I’m low (I do have dips around & way under 4mmol), I will always confirm on my monitor.
And I have no symptoms if I’m high - I only know if I do a reading. So many type 2s have no idea day to day what their glucose level is.

I also have a plethora of spinal issues that cause extreme pain (diagnosed in my teens & twenties during spinal surgery, I’m an old moo of 50 now). Synovial cysts to help the now non existent degenerative discs, spinal bifida occulta leaving me with a chunk of vertebrae missing & deformed, and being in the small percentage of SBO people who have pain associated with it, plus osteoarthritis, bone spurs & tiny fracturing from T11 to S1, split nerve bundles that pinch as they go through too small exit holes (nerve root decompression ops on a deformed vertebrae 3 months after giving birth in my 20s, so much fun with a tiny baby you can’t pick up for weeks), continuous sciatica for 30 years… tl;dr, my back is a clusterfuck.

For me, there is a pattern between extreme pain and higher glucose readings. Pregabalin seems to raise my glucose too (and I have lower leg swelling on pregabalin too, just to add a cherry on the top of the whole shebang). If I’m high (without eating anything), I have to wait until the opiates kick in enough for my glucose to fall as the pain level does. Diabetic nurse has seen this phenomenon on other patients before too, but without monitoring I’d be none the wiser.

A year into my diagnosis, and pop! I have Chronic Kidney Disease stage 3a too (from zero to 3a in 6 months) despite monitoring & eating well only when in range. Again, Dad had CKD and the CKD team think there’s a genetic link. Obviously that has throttled my diet further. CKD is often a playmate of diabetes.

Sure, I was a little plump at diagnosis (not buns, various meds over the years) and I am losing weight due to my restricted diet and walking (I say walk, it’s a crutch using wobble) 6 miles a day to provide care for my elderly Mum & walking the dog. I also use weights and use a vibrating platform - it’s named the Wobbletron 3000 - and the usual stretching & OT exercises to get enough movement to move in the morning.

But it is comforting to know I have brought this upon myself & I will be judged for being a type 2 with co-morbid conditions.

Diabetes is shit.

Excuse the rambling, congratulations if you’ve made it here; bad pain night & pregabalin makes my brain work like a slug moving through lard.

can you show him this thread?

Type1? Of course not. It’s a serious autoimmune disease

Type2? Utterly failed by the NHS who seem to persist in ignoring Dr Unwin’s work

One of my friends is blind because of her diabetes. It's because they did laser treatment (I can't remember the details) which caused it.

Not at all with type 1. Type 2 a bit, mostly because I had relatives with it who were very unhealthy and made it all worse. I know it’s more complicated than that though.

@CentrifugalBumblePuppy I’m sorry, your health sounds so unlucky and crap. 💐at least this thread shows the majority of people don’t judge and that more people are being educated further.

I wish you all the best with your health.

Ps @CentrifugalBumblePuppy stupid question - why do you have to pay for lancets and strips?

This is from DIabetes.org

"low-carb diets position statement for professionals (may 2021)

This article is for professionals. If you would like to read information on low-carb diets for people with diabetes, you can find this on our low-carb diet and meal plan page.

Here at Diabetes UK, we have put together this position statement to explain how low carb diets might be used to help manage diabetes. We used the best level of evidence to inform the recommendations and conclusions.

Together with the Scientific Advisory Committee on Nutrition (SACN) we have released a report which recommends lower carb diets as a short-term effective option for adults with type 2 diabetes who have obesity or overweight. This includes low carb diets providing 50 – 130g of carbs a day. These diets can help with weight loss, glucose management and reduce the risk factors associated with cardiovascular disease. So, we can recommend them for some adults with type 2 diabetes. But, there is no consistent evidence that a low carb diet is any more effective than other approaches in the long term. So it shouldn’t be seen as the diet for everyone.

At the moment, there is no strong evidence to say that a low carb diet is safe or effective for people with type 1 diabetes. Because of this, we do not recommend low carb diets to people with type 1 diabetes.

Evidence for low carb diets in children reports adverse effects such as poor growth, a greater risk of cardiovascular disease and psychological problems. So, we don’t recommend low carb diets for children with diabetes.

People should be encouraged to eat more vegetables, fruits, wholegrains, pulses, seafood, nuts, and to eat less red meat and processed meat, sugar sweetened drinks, sugar sweetened foods, and refined grains such as white bread."

Note this is from Diabetes.org which is an advocate and research charity for DIabetes
There is another website called Diabetes.co.uk which is a commercial company that makes it's money from selling low carb diets! so best be avoided

This why the NHS do not recommend diets such as Unwins
Any weight loss works whether its from low carbing or any other diet. Low carbing or keto are the least sustainable diets, so may work short term but not effective in the long run. Low carb is a quick fix, but no evidence that it is healthy in the long term. There is evidence now that keto diets double your risk of heart attacks.

Type 1 Diabetes is a much more complicated disease than a lot of people think. Bad management of glucose levels do often mean seeing the longer term complications earlier, however there are a whole host of reasons why some people may struggle with glucose management to start with.
Living with diabetes can be emotionally and physically draining, as it's a long term illness which needs managing daily (more than daily actually).

I'm lucky I'm genetically slim, have been raised to understand nutrition (to some degree), don't suffer food addiction or disorder, have a medium appetite and like healthy food

Same as above - apart from the lucky part, As despite always being slim, I'm bordering on type 2 diabetes, probably genetics as my dad was type 2 diabetic in his later years despite being slim and exercising, eating well thoughout his life.

Just to point out that type 2 diabetics aren't always overweight. I guess I'm lucky I asked for an HBA1c blood to be done, and have acted on the results, as best I can.

In answer to the OP - no - I don't judge anyone with complications from type 1
(or 2 for that matter) as sometimes shit happens despite our best efforts.

{I've got rheumatoid arthritis as well - since the age of 33 - which can also predispose me to getting type 2 diabetes}

Because most people with T2 don't need to regularly test their blood sugar, hence the lancets and strips would not be prescribed for her.

How would that help him?! @WilmaWonka could you request that he is considered for a pump? There should be more access now for children and it could make a big difference.

No. I know a few people with T1D. The amount of faff and hassle they go through just to try and live a “normal” life is massive. And, even when they do everything “right” things can and do go wrong. It’s a complicated and difficult disease to manage, definitely not my place to judge.

@sorrynotathome why do most type 2 diabetics not need to test??

I would whole heartedly disagree - as if you don't know what your blood sugar is - you could be spiking each and every day - and getting to the point where you need insulin etc etc.

Just to add - I work on a dialysis unit and at least 30% of our patients are type 2 diabetics.

I don’t know enough about Type 2 diabetes, admittedly, but I don’t think it’s ever helpful to ‘blame’ people for health issues. What good does judgement do?

Type 1 - certainly not. My adult son has it, and it is a difficult condition to manage.

Too many people define "health" as synonymous with good moral character. Same with weight. It's a dangerous ignorance.

T2 has a strong genetic component, weight and diet management is not always enough. And there has been a massive rise in T1 in young people after covid infections.

Shame (or shaming others) never helps with behaviour change. It's pointless so why do it?

It's bloody hard to have a long term condition. You never get a rest.

My dad and grandad both had T2 diabetes. Both slim, took part in competitive sports, both South Asian heritage. Both late diagnosis leading to sight loss. From the moment of diagnosis my dad followed all the guidance and was on Metformin for 20 years until kidney damage and other complications meant he had to switch to insulin. His weight and BMI were always well within the healthy range.

At my over 40s health check they put me at potentially 4 times higher risk of T2 diabetes, albeit no sign of heading that way currently.

The T1 / T2 'debate' sometimes comes across to me (in an incredibly crass way) as "good" diabetes and "bad" diabetes. Born with it / self-inflicted. I think it's common for there to be over simplification of this and other diseases in order to get certain messages out to the public and it can lead to conscious and sub-conscious judgement.

For example there's more of a push on messaging about some links between obesity and cancer in recent years. When a friend returned to work after breast cancer treatment she was about to take a bite of some birthday cake in the office when a colleague patted her on the arm and said "shouldn't you be watching what you eat now you've had the warning?". Someone else chipped in that she might have the BRCA gene. Good cancer / bad cancer?!

I think we would all need to undergo a lot of scientific and medical training before we could get close to understanding the complexities of these blanket terms.

They only prescribe monitors and strips for T2 if they are on medications that cause Hypos ie insulin.
If @CentrifugalBumblePuppy can prove she is constantly having hypos then maybe they can make a case for getting a nhs monitor and strips.

As a type 2, I don’t qualify for a standard glucose monitor, as told by my diabetic nurse on diagnosis last year. Whether that’s a local Clinical Commissioning Group decision or a NICE one, I’d have to investigate.

Bless her, she did try to see if the strips she had would fit my monitor (a Sinocare Safe AQ, recommended by a friends with type 2 who do test & supposedly better than the NHS recommended ones). Nurse said the situation is ridiculous, she sees patients who rely on the 3-6 monthly hbA1C alone.

It stands to reason that type 2s who don’t receive an NHS monitor (like my Dad, he never controlled his) or cannot afford to buy their own will have more difficulty controlling their levels; when you have the glucose reading in front of you, it brings into sharp relief the consequences of your actions (saying that as someone who had anorexia & binge eating disorder along the years)!

Son’s DDad is a type 2, he too didn’t have a monitor until his health declined & he started needing insulin; his CCG doesn’t give glucose monitors to type 2 either unless they rely on insulin, and ex now has an NHS continuous glucose monitor, a Libre 2 maybe?

(Not weird, son’s DDad & my DH & I are friends, we had an open door policy at the start so son - then 2 - could feel happy & secure going between homes, we’ve had many happy meals with his partners over the years at theirs and ours, son is in his 30s now but we still all chat. No jealousy at all, and DH knows if his Dad and I were the last 2 people on earth, we wouldn’t repopulate it 😂).

My T2D was caused by pregnancy. Maybe that’s a lifestyle factor. I was very fit, played a lot of sport, wasn’t overweight, ate healthily etc. As several PP have said, managing it is a lengthy learning process because so many things can affect glucose levels, from the weather to stress or insomnia. Managing diabetes requires robust mental health and excellent social support. Lots of people don’t have that. The ignorance on this thread saddens me.

I'm type 2 and take metformin. I've got a Glucose Monitor (finger prick thing) and get the strips and lancets on prescription. The nurse told me the NHS don't like prescribing them but they will if you want one.

Well societies attitude to smoking helped cut smoking. Along with some pretty firm law. “We” all judge a smoker.
I don’t think it means we don’t worry and love our friends and family who have heart attacks and lung disease because of smoking.

Its all well and good saying T2 is just one of those things but clearly its explosion in cases world wide means it’s lifestyle more than genetics. Just because a percentage of people have it due to other factors the majority rise is down to lifestyle.
In the same way skin cancer rapidly rose with cheap holidays abroad and sun beds. Where of course T1 skin ( those with pale skin ginger or blonde hair) need to take more care because genetics say they have greater risk. All the people with skin cancer I know take the responsibility for getting it, even if childhood sun burn was down to parents or lack of knowledge.

“We” all judge a smoker.

No, “we” don’t.

Type 2 isn't just lifestyle though. Genetics play a strong part. As does ethnicity, age, gender etc..

It's patently ridiculous to judge a stranger for such a complex disease when you have no knowledge of what factor/factors contributed to it.

@GrumpyOldCrone The “we” is as a society. Clearly we do. Go to France or Spain, the contrast is amazing.

I’m a social smoker btw. Me and my middle aged friends having a sneaky fag at the pub. I wouldn’t have one near children, people eating or really anywhere that wasn’t a smoking area because I’m conscious of glares, tuts and eye rolls.