Thursday, 21 January 2010

Mild or Severe?

There used to be a time when there was only one kind of diabetes. In the pre-insulin days, diabetes would manifest itself as acute, usually in young people who lost weight rapidly and slipped into coma, or age-onset, which was generally perceived as milder since survival might endure for many years. At that time the different causes of the disease were not clearly known – lack of insulin would cause the acute symptoms, whereas a gradual decline would be due to resistance to insulin action.

Somewhere along the line, the descriptive terms ‘mild’ and ‘severe’ crept in. These terms distinguished those who were in DKA, coma, going blind, kidney failure, amputations from those who showed few outer signs of the disease and were able to manage their condition to some extent by dietary and other lifestyle modifications. These latter cases would succumb eventually to the more dreadful complications, just as their ‘severe’ counterparts had.

In recent times, the adjectives have been used to describe a distinction between Type 1 and Type 2 – with Type 2 often falling into the ‘mild’ category as it may be treated by diet and lifestyle changes in many cases, or with tablets rather than insulin injections. This is nonsense – both types require vigilance and present different and, in my view, equally difficult challenges.

The terms ‘severe’ and ‘mild’ persist to this day in some medical practises or publications, but I think they are very misleading. People with diabetes have diabetes. All forms of diabetes are ‘severe’, since all can lead to awful consequences if they are not properly treated and managed. This is a life, limb and sight threatening,disease and no-one diagnosed with it should be misled into complacency by being told that theirs is ‘not so bad’. Nor, in my opinion, should people be told they don’t need to test, to find out how dietary and activity changes affect their levels so that they can achieve the best possible control. There’s an argument used that knowing how things are going might lead to depression at the sight of an occasional high reading – what nonsense! People need to be able to learn how to use these readings to adapt and enhance their chances of staying free of complications. It is criminal to deny anyone who wishes to test the means to do so – once a year HbA1c tests are an additional tool, not a substitute!

Whatever your Type of diabetes, and whatever your stage, you must never think that it needs little consideration because ‘yours is not so bad’.

Now, calm down, you’ve no need to worry my dear,
I can tell you right now that you’ve little to fear,
For you’re much better off than a lot of them here,
Diabetes for some folk can be classed as severe!

What then is the difference, for I see you have filed
My details and blood test under ‘Diabetes, mild’?
I was wondering if maybe you might have compiled
Some simple distinctions – pretend I’m a child…

Well, if it’s mild, then we’ll see you perhaps once a year,
To see if you’ve gone blind, and that your urine is clear,
But if it’s severe, and if you were to cough,
Then there’s every chance that your foot might fall off!

Thank goodness it’s mild then, and I won’t need to test,
For knowing my levels might make me distressed…
I’m happier not knowing, until the day that I’m here
And you tell me I’ve caught the type that’s severe!

1 comment:

  1. Peter C would say that Type 1 is mild compared to Type 2 ;)

    Great post as ever Northe x