Type one, Type Two and the Crossfit Furore

Over the past couple of days there has been a bit of a shit-storm on Twitter centred around the Crossfit account. At the heart of the furore was an image.

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This is many things. Without a doubt it was incredibly ill judged. It’s inaccurate at worst, vastly over simplistic at very best. It perpetuates stereotypes that do nothing to support any of us living with diabetes. It also has the potential to be offensive. But get this: it’s offensive to all people with diabetes, whether that is type 1 or type 2.

As Allison tweeted, poking fun at any chronic condition, at any type of diabetes, is simply not ok. The development of type 2 diabetes in particular is not as straight forward as even many in the type 1 camp would believe. But interestingly it was the type 1 community getting riled up.

http://twitter.com/AMNimlos/status/615894384580517889

http://twitter.com/AMNimlos/status/615907636693766145

And this persisted, even when Crossfit clarified that they meant type 2. To be fair to Crossfit, the character limit on Twitter doesn’t always help these things. But as noted above, whether type one or type two shouldn’t matter. What we should have been attacking Crossfit for was their overall lack of courtesy and inconsideration and the fact that making jokes about anyone with a health is not a nice thing to do. And of course pointing out that the relationship between sugar and diabetes is very weak.

But this thing had legs. And looking at it from the outside it seemed that a lot of type ones were saying “It’s okay for you to make that joke just as long as you are clear that type 1 and type 2 are different things.” And that is not helpful at all. Because like it or not, all types of diabetes tend to be lumped together by those without intimate knowledge, and if you want to improve people’s understanding and perceptions of what we go through, we need to stick together. If type ones perpetuate the myths surrounding type two, we’re only harming ourselves in the long run. It’s not okay for Crossfit to perpetuate those myths, and it’s not okay for us to use the guise of  “defending our own interestes” to do it either.

There was a lot of misinterpretation, too. Quite a few tweets I read came from people who seemed to think that Crossfit were saying type 1 could turn in to type 2. Clearly that is impossible. We don’t need to re-hash the Halle Berry issue here. But what was being said about people with type 1 diabetes developing type 2 in addition is actually factually correct.

The development of clinical features of type 2 diabetes (insulin resistance and associated body composition factors) in people with type 1 diabetes has been recognised for well over twenty years. What you have to remember is that type 2 diabetes is not something for which there is a test that flashes up saying “Yes, you have it.” It is a collection of clinical features and a diagnosis made by the meeting of certain criteria. One of these is elevated blood glucose, which people with type one already have as a result of that condition. Another is insulin resistance, but that alone is not enough either. People with type 1 can have insulin resistance for other reasons. Women with Polycystic Ovarian Syndrome can have insulin resistance without having any type of diabetes. But if the other diagnostic criteria are also present in a person with pre-existing type 1, then it is reasonable to assume that even if the patient did not already have type 1, they would, at this point, have developed type 2. The widely used clinical term for this is “double diabetes”. It may be a horrible term, but it is scattered throughout the literature and defines the specific situation of having characteristics, beyond just insulin deficiency and resistance, of both types of diabetes.

I’m really not sure why so many type ones are offended by the statement of this fact. Or want to insist that it is not possible. That you can only have one or the other.

Consider the alternative scenario. Are you saying that it would be impossible for someone with type 2 diabetes (positive c-peptide, no auto-antibodies, so definitely not a misdiagnosis) to develop type 1? If they developed auto-immune destruction of beta cells (distinct from beta cell exhaustion common in long term insulin resistance) would you instantly say their type 2 had gone away? Yes, this scenario is unlikely, as type 1 would usually manifest first. But it illustrates the point that it is not – cannot be – impossible for the two conditions to co-exist.

I’m not defending Crossfit. As per my earlier paragraph, they are still guilty of perpetuating unhelpful stereotypes and misinformation. The heart of their original argument was that “sugar causes diabetes” and they chose to back this up by citing a couple of individual studies that show a correlation between consumption of sugary beverages and the development of diabetes. In actual fact, the evidence for the association, and certainly for causation, still appears rather weak. And there are so many confounding factors in diabetes. Thus, it will almost certainly never be as simple as saying that a single thing causes it, because it requires the perfect storm of factors to come together.

What is not helpful is to keep defending this stance using infographics culled from the internet that cite no sources. If you want people to listen to, and appreciate, your argument, you need to make sure that it is properly backed up. As a community, we do better when, instead of attacking those that spread misinformation, or poorly worded statements that imply untruths, we focus simply on spreading the correct information. Sugar does not “cause” diabetes, but healthy lifestyles can help to minimise the risks if you happen to be pre-disposed.

The bottom line, however, is that it is not okay to make jokes about any type of diabetes, or any other condition, be that cancer, mental health issues or physical disabilities. But that message to Crossfit was lost in a war between diabetes types and you can bet that is why the message is so often lost on the general public. By focusing on the distinction between types, all people have done is given Crossfit a way to try and argue back, as their consitent responses that they meant type 2 have shown.

What we should have been telling them loud and clear is that “Picking on people’s health vulnerabilities is an abhorrent thing to do.”

I for one would have liked to see them argue their way out of that one.

Because it it.

I don’t understand how anyone can argue with that. So as a type 1 diabetic, please make sure that you aren’t inadvertently doing it too.

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