Wil Dubois

Got questions about navigating life with diabetes? Well, here's your chance to Ask D'Mine! Our weekly advice column, that is — hosted by veteran type 1, diabetes author and educator Wil Dubois.

This week, Wil answers a question from a concerned diabetes mom who like many of us, is frustrated with outsiders who have "so much to say" about this illness.

If you have additional thoughts about how to respond to unsolicited advice, definitely share those below!

{Got your own questions? Email us at [email protected]}

Karen, “parent of kid with T1” from North Carolina, writes: Hi Wil, my 11-year-old son was diagnosed with T1 diabetes about a little over a month ago. I’ve been frustrated with well-meaning people who hear the news and try to reassure my son by saying that he can just start eating better and then he can stop taking insulin. It’s like hearing someone tell your kid not to worry about learning to swim because with just a little practice he can learn how to breathe underwater: Thanks for the advice that will kill my kid if he follows it! Anyway, I’m somewhat fruitlessly trying to explain to people what the T1/T2 differences are, but I keep running into the same question: If the problem with T2 is not insulin production but insulin sensitivity, why do people with T2 sometimes need to inject/pump insulin? I’ve asked several people, including two super smart dudes with T2, and no one really seems to know anything less vague than “because the body can’t regulate blood sugar on its own anymore.” Can you help me out?

[email protected] D’Mine answers: First, to your son, welcome to the family. Second, to you, I’m so glad you found us. Third, you bet I can help you out! And more. I think I can explain the “why do some T2s need insulin” question so that you can understand it, and then I’m going to raise the bar and try to come up with an elevator speech version you can deploy in the field to help you with those well-meaning (but ignorant) people you keep encountering.

Why? Because I’m more worried about your blood pressure than your kid’s diabetes.

But for our new Healthline readers (Hello, and thanks for dropping by!) let me start by recapping the facts about the two major classifications of diabetes: Type 1 and Type 2. These are commonly abbreviated either T1 and T2, or T1D and T2D by the community. [There’s also a pregnancy version called Gestational Diabetes, but that’s too far off topic for today.]

WhatDTypeSometimes you’ll also hear us talk about type 3, which for years has been slang for someone who loves a T1 or T2. We use this term to acknowledge the fact that diabetes doesn’t just affect the individual who has it, but also the entire family. A type 3 could be a spouse, sibling, parent, child, grandparent, aunt or uncle, niece or nephew, cousin, cohabitating spousal equivalent, same-sex partner, in-law, step-person, adopted family member, honorary family member, roommate, or even a family pet. Yep, basically anyone in the family tree, or in the person with diabetes’ domicile or ecosystem. Trust me on this, if you live in close contact with a person with diabetes, that person’s diabetes will have an impact on your life!

Of course, the term Type 3 Diabetes has started becoming more commonly aligned with the Diabetes-Alzheimer's Disease connection, so many have started referring to spouses, D-parents and other caregivers by the umbrella term of "Type Awesome."

Since parents like yourself are often called D-moms or D-dads, here are a couple choices you might consider printing on your new D-businesses cards:

Karen, Type Awesome …or… Karen, D-Mom

At your son’s diagnosis, did the doctors remember to tell you how much fun this whole diabetes thing was going to be?

Oh, and while we’re on the subject of labels, as both you and many of our readers are new to the diabetes space, I should talk about your son’s D-businesses card, too. I could fill a whole column talking about this, and maybe I will in the future, but quickly, some people with diabetes feel the term “diabetic” is somehow vulgar and they’ve been advocating for “person with diabetes” (or PWD for short) instead. They’ve made enough noise over the last few years that we D-journalists have pretty much standardized on that term.

Whew! So much for the linguistics lesson. Now, let’s dig into what you really wanted to know in the first place: The pathophysiology of the various flavors of diabetes. Type 1, arguably the hardest type to live with, is the easiest type to explain. It’s an autoimmune disease in which the immune system freaks out and kills the insulin-producing beta cells in the pancreas. The immune system, working right or short-circuited, is an amazing weapon to behold. It’s very good at its job. In short order, people with type 1 have no insulin left in their bodies, and simply put, without insulin death follows closely. Luckily for all of us with type 1 today, for almost a hundred years we’ve been able to medically replace the insulin our bodies lack by taking daily injections of insulin.

Type 2, on the other hand, ain’t so simple. A T2’s body produces insulin, but cannot use it well. The insulin sensitivity you talked about is actually a form of insulin resistance. A T2’s body just isn't able to properly process the insulin present. This allows the blood sugar level to begin to climb, and that in turn triggers signals for yet more insulin. Most early-stage type 2s are literally flooded with insulin. For a time, the body can over-produce insulin in large enough quantities to overwhelm the insulin resistance, but like a water pump in a well left on night and day with no rest, the pancreas eventually burns out and insulin production sputters to a stop. At this point, from a practical strandpoint, there’s no real difference between a T1 and a T2 except for the path they followed to get to the same point.

In type 2s, this insulin production burnout is a slow-motion process that can take decades to complete. Prior to total pancreatic burnout there are any number of therapies that can help -- all of those oral drugs you hear about -- but any type 2 who lives with the disease long enough will become dependent on insulin eventually. In some cases, doctors and patients hold out till the last second. A more enlightened approach is to add some supplemental insulin earlier on in the process to take a load off the poor pancreas and put off the total burnout thing. So there you go: Type 2s need insulin when their disease gets to the point where their bodies can no longer produce enough insulin to keep the blood sugar in control.

ElevatorPitchNow, to that elevator speech I promised you. You know, now that I think about it—and I know I’ll get some heat about this—I think all of us T1s, T2s, and T3s should give up on trying to educate the general public. It’s futile, and our energy is better spent elsewhere. Let’s face the facts, Folks: Even many people with diabetes don’t understand the differences between the types, so why should we expect the general public to be able to understand? In general, people only have the time (and the need) to understand the diseases that directly affect them or their loved ones. So Karen, instead of trying to educate the masses one well-intended ignoramus at a time, I think you just need a quick way to get people off your back. For that, I recommend:

“Oh, thank you for that suggestion, but my son has the other kind of diabetes. No matter what he eats, his body doesn’t produce any insulin at all, and without insulin injections he’ll die.”

After all, trying to educate everyone on the differences between T1 and T2 diabetes is like trying to learn to breathe underwater.

Disclaimer: 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.

Disclaimer: Content created by the Diabetes Mine team. For more details click here.


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.