Pauperization assistant navigating life with diabetes? You can always Ask D'Mine! Welcome once again to our weekly Q&A column, hosted by veteran type 1, diabetes author and pedagogue Wil Dubois. This week, Wil tackles that universal proposition question of "who has it worse?" when it comes to diabetes. We never like to compare conditions, but this call into question does keep popping up, and as usual, Wil has through with his homework. So, understand happening!

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Amy, type 1 from Wisconsin, asks: What are the findings on which 'brand' of diabetes — type 1 or type 2 — has many complications, or has serious complications many ofttimes? Is on that point some inquiry out there that monitored complications for each type on an individual basi? I have looked and found nothing…but you are the overcome; if information technology is KO'd there, I am sure you can get your hands on that!

Wil@Ask D'Mine answers: You're letter-perfect that angelical research is firmly to come by on this subject, and passions about information technology run very high. Nothing seems to get type 1s and type 2s at each others' throats more quickly than the "who has it worse" question.

In real time, all other things organism equal, sugar in the blood current is equally toxic for T1s and T2s. We know IT can trash your eyes, kidneys, nerve endings, and pretty much everything other in your body. And in either type 1 or type 2, if you can normalize your blood glucose, you are largely immune from these toxic effects (yes, I know that this is easier said than done). So, in theory, the 2 types of diabetes should glucinium on quits footing.

But they are not. More on it in a narrow. Simply first I require to talk a bit more close to who has IT worse.

Being type 1 myself, and working with a fair figure of other type 1s, and a quite a little many type 2s for many years now, I think I'm qualified to state which is "worse." At the risk of being flamed alive—a grassroots circumstances for columnists—I'd have to vote for T2 being the nastier variety. Hold on, now! Hear me out. And then let's attend at what little knowledge base evidence we have, and see if it backs me up or not.

I make out all the arguments for why typewrite 1 is "worse." DKA stool putting to death you nowadays. A hypo can stamp out you now. It's implacable in its direction responsibilities, etcetera, etcetera, etcetera. But those are all fear and effort bound up — really more life-style issues than actual biological risk factors. They are real in that they impact our lives, I'm not discounting that. But for whatever reason, type 2 seems to accompany a greater range of comorbidities that collectively become a greater challenge to manage, and seem to lead to worsened outcomes.

Case 2s suffer greater levels of corpulency, hypertension, hyperlipidemia, depression, and assorted rubor than we type 1s make out. In fact, new evidence suggests typewrite 2 is really an incendiary disease, sort o than simply insulin impedance syndrome as previously intellection. If this proves trustworthy, it may explain typewrite 2 diabetes' wider-ranging effects on its victims' bodies.

But you asked me to identify "findings" and research, not to reasonable give an opinion. And you were specifically interested in complications, non management difficulty—although there is believable a connection between the deuce.

What backside scientific discipline really secern us? Well, it's complicated, course. Simply Hera we go…

When it comes to sheer fatality rate, type 2 is the big killer. Annually it fells Thomas More than 3,060,000 populate world-wide (the equivalent of euthanizing the integral population of the state of Iowa annually), spell type 1  takes out roughly 340,000 of us. Of course, you bear to remember that we type 1s are a minority universe in the diabetes universe. Where on Earth did I get those numbers? From the World Health Organization's Diabetes fact sheet. Merely we need to look back at more than just the total act of fatalities to see which diabetes is more dangerous. We also require to look to lifespans, it's widely publicised that we character 1s take over much shorter lifespans than type 2s.

But do we?

Type 2s, according to enquiry by Diabetes Britain, can expect a decade reduction in life expectancy over "sugar normals." The Lapp report states that type 1s "traditionally" had a 20-year reduction in lifespan, but that this Crataegus laevigata induce lengthened with modern improvements in diabetes care (this assumes changes in government policy and health policy doesn't wipeout these newly recognized gains).

Wherefore is the lifespan gap closing for character 1s yet stable for type 2s? I think it comes depressed to the medical qualifications of the docs who treat U.S.A. Most type 1s in the developed world are under the forethought of specialists, and often have access to a team: endos, heart docs, nutritionists, educators, and to a greater extent. Most eccentric 2s are under the care of a single primary care doc. Nothing against primary attention common people, but they just don't have the time and resources that the peculiarity practices do.

But wait. It's not that simple either.

Where you get your diabetes matters to how deplorable your complications become as well, unheeding of type. Some where in the world you unfilmed, and where you are on your area's socioeconomic run greatly affects your diabetes outcomes. Diabetes is a friendly disease—but that's a subject for another day.

Course: if you don't stimulate access to medications, you leave do worse. If you are also poor to see a doctor, you will do worsened. If your doc doesn't have it away what he is doing, you will do worse. If you don't ever have the opportunity to visualise an educator, how can you memorise how to take care of yourself? But those grim relationships between environment and outcomes don't glitter a light on the rudimentary biota of the two primary flavors of diabetes.

But this does: Kids WHO set about type 2 have more complex complications than kids of the same age with type 1—even when the type 2 kids have had diabetes for a shorter period. How untold more complex, and how much shorter time span? A classical study showed that type 2 kids, after having diabetes a mere 1.3 old age on the average, had to a greater extent than double the rates of microalbuminuria and hypertension than type 1 kids who'd been members of the club more than five times longer. For those of you who forgot, microalbuminuria is the canary in the coal mine when it comes to kidney nonstarter. That study showed similar rates of neuropathy betwixt the two types, and the but complication that was more park in type 1 kids was eye damage.

So, at to the lowest degree in youth, type 2 is clearly more invasive in the short run.

More recently, a early study that looked at long-term outcomes (defined as 25 years) between type 1 and type 2 youthfulness WHO got diabetes at the same age finished with a doom so scientifically chilling that I have to quotation it, "Young-onset type 2 diabetes has greater mortality and lethality when compared to type 1 diabetes in like-minded ages of attack."

Something unique whitethorn be happening to youth. Maybe mixing diabetes with puberty supersizes the type 2. This is one of the a couple of areas where I could regain something close to a head-to-head comparison between the two flavors, and it is very bring in that the character 2 is the more severe of the pair: Both in the short and eight-day runs.

We don't yet experience studies comparing outcomes between adult dx'd type 1s and type 2s, or if we do, I wasn't able to find them. Still, given that complications happen faster in type 2s than types 1s of the same age, even though the type 1 kids had diabetes longer; and given that we understand to a greater extent type 2s dying compared to character 1s who got diabetes at the synoptic senesce, I think we arse say the complications (I'm sure you will agree that death is the ultimate complicatedness) are worse for type 2s than for type 1s.

So there's the evidence, as we have it. High blood glucose is toxic, atomic number 102 affair how you catch on. The poorer you are, the more likely it is that you won't have the resources and access needed to control it. Both types are herculean to control. Looking to studies of young people seems to be the uncomparable way to remove the more layers of social, profession, economic, and lifestyle issues that can confuse the data. Unless youth confers some additionally wicked factor to type 2 that doesn't befall in adults (a hypothesis), it's jolly clear that type 2 is the more complicating disease: it generates complications more rapidly than type 1, and information technology shortens lifespans more.

But really, the bottom line is that either type sucks, and we arse't discount the emotional, psychological, and financial strains of living with diabetes. What's the rack up type of diabetes?

I think out the inferior type of diabetes is the type you have.

Whatever type that is.

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 Pyrus communis trees. Bottom line: we are only a little part of your total prescription. You still need the professional advice, treatment, and care of a licenced health chec professional.