Parents of children with T1DM would love for their children's disease to be called by another name so it isn't confused with type 2 diabetes (or T2DM). Although T1DM and T2DM share some of the same characteristics, they are hardly the same disease. They differ in the following ways:
il The cause of T1DM is a genetic tendency plus a virus. The cause of T2DM is heredity plus obesity plus a sedentary lifestyle.
i Patients with T1DM have an absolute lack of insulin when the disease strikes. Patients with T2DM may actually have too much measurable insulin when the disease strikes; they have insulin resistance.
i Most cases of T1DM occur in childhood. Most cases of T2DM occur after age 35.
I T2DM can be controlled with diet and exercise alone. T1DM can't be controlled in that way.
I Diabetic ketoacidosis (see Chapter 4) is often the first complaint in T1DM. It doesn't occur in patients with T2DM.
i Most patients with T1DM are thin. Patients with T2DM are generally (but not always) fat.
T1DM and T2DM are similar in the following ways:
i The clinical problem in both begins when the blood glucose rises too high.
I High blood glucose acts as a toxin in both forms.
See Chapter 3 for more about the differences between T1DM and T2DM.
You Can't Eat Sugar with Type 1 Diabetes
This myth goes back to the time before insulin became available in 1921. At that time, there was nothing that could force glucose into the cells of the body where insulin was required, so the treatment was the elimination of all carbohydrates. The reasoning was that, if a patient didn't consume carbohydrates, then the blood glucose couldn't rise to the high levels that resulted in excessive urination, thirst, confusion, coma, and death. That approach worked for a time, but the liver is fully capable of making glucose from protein despite the fact that the glucose can't get into liver cells to be stored as glycogen once it's made.
Today, there are probably more types of insulin available than are needed. A little injected insulin can take care of lots of sugar or other carbohydrates.
A corollary to this myth is that T1DM is caused by consuming too many sweets. Doctors have a pretty good idea of the cause of T1DM, and sweets have nothing to do with it. As I explain in Chapter 2, the cause of T1DM is believed to be a combination of a hereditary tendency and infection with a virus that has characteristics similar to insulin-producing beta cells. As the body destroys the virus, it mistakenly destroys the beta cells as well.
All in all, some glucose as part of a good overall diet is definitely acceptable. Let your child enjoy a little sugar. Just don't let him overdo it. Eating anything in excess is discouraged, whether it's carbohydrate, protein, or fat. See Chapter 8 for the full details on eating a healthy, sensible diet.
You Have to Eat Special Foods When You Have Type 1 Diabetes
With T1DM, there's no advantage to eating special diabetic foods. It's difficult enough to deal with all the requirements for good diabetes care to have to eat boring tasteless foods! Food is one of life's great pleasures, and your child can have excellent glucose control with regular food so long as you account for the carbohydrate in it. Need some help?
1 I provide resources for great recipes in Appendix B.
1 In my book Diabetes Cookbook For Dummies, 2nd Edition (Wiley), I offer page after page of recipes for delicious meals that fit into a nutritional plan for patients with T1DM. These recipes come from some of the best restaurants in America.
1 Books that feature good, nutritious food for children with T1DM fill the shelves of many bookstores.
Show your child that he can eat delicious meals and still follow his nutritional plan. Prepare meals that the whole family can eat. With food this good, there's no reason that everyone in the family shouldn't eat the same meals as your child with T1DM.
If You Take Insulin, You Must Have Type 1 Diabetes
In T1DM, insulin is an essential part of diabetes care because the disease is characterized by a total lack of insulin in the body. On the other hand, in T2DM, insulin is a tool to get the blood glucose to a level at which diet and exercise can work. T2DM is a lifestyle disease, not a disease of lack of insulin When someone with T2DM improves his diet, exercise regimen, and weight, he can manage T2DM without insulin.
So how do patients with T2DM wind up on insulin? They initially have resistance to their own insulin. As time passes, many of them also seem to lose the ability to make enough insulin to control their blood glucose at their current weight. Then they must be put on insulin.
Many of those patients with T2DM could come off the insulin with proper diet and exercise. The diagnosis remains T2DM whether they are on insulin or not.
In my practice, I've seen many patients with T2DM who have been put on insulin by other doctors and still have poor control of their diabetes. When I successfully get them to lose 5 to 10 percent of their body weight, their need for insulin diminishes and sometimes even goes away. My patients can hardly believe that they can get off the insulin and have even better control of their blood glucose than they did when they were on it. These aren't true T1DM patients — they actually have T2DM. Their own bodies' insulin does a much better job of regulating their metabolism than any insulin shot I could give them.
I go over the basics of insulin for folks with T1DM in Chapters 10 and 11. To find out much more about the basics and treatment of T2DM, check out my book Diabetes For Dummies, 2nd Edition (Wiley).
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