Diabetes vs. Cancer?

“I’d rather have my breast cancer than your Type 1.”  My friend said this recently after we had a conversion with someone who found out about my T1 and mentioned that a family member had diabetes but they didn’t know which type.  I told my friend that I’d rather have Type 1 than Type 2, which led to her quote above.  We joked about it, because choosing cancer over T1D sounds shocking.  Choose cancer? 

As someone who hasn’t had a cancer diagnosis, there’s no chance I’d elect to get one.  But I understand where she’s coming from.  For my friend, cancer was temporary.  She had surgery, then chemo, then radiation…and then the celebration of “ringing the bell” and being called a survivor.  She was done and we all celebrated!  Within a year of finding a lump, the cancer was gone.  But that’s not the end of the journey.  I’ve watched her go through multiple reconstruction surgeries, memory loss, neuropathy taking away feeling in her feet, and the fear of a recurrence or secondary cancer.  Cancer isn’t just here, treated and done.  It’s gone and my friend is fortunately well.  But it wasn’t just one year and done.

My friend’s perspective is that cancer came and went, but Type 1 goes on forever.  Each year she celebrates the day she became a cancer survivor.  I celebrate my “diaversary,” the day that I was diagnosed and my life changed permanently.  There’s no escape, there’s no day where this ends.  And it could kill me, just like cancer could.  That’s the comparison my friend sees.  She fought, she won, and I…I’m going to have T1 for the rest of my life unless medical science pulls off something I’m hoping for but not expecting.  Type 1 is the gift that keeps on giving…and taking…and could take me out.

Another factor is one that same friend and I have discussed in the past – it’s much easier in many cases to be the patient than the observer.  She barely remembers what she went through with cancer because she was in the middle of it.  The rest of us remember watching her suffer.  Living with T1D is just “what I do” every day because this is my life.  But she sees me stabbing my fingers, shaking from lows and waking up to alarms at 2 AM and constantly monitoring every tiny detail, and she doesn’t want any part of it. 

Does my friend’s statement make sense?  It’s all about perspective.  I understand why she feels the way she does.  But this is a great example of choosing the evil you know.  I wouldn’t pick cancer over T1, and she wouldn’t pick T1 over cancer.  Given the chance nobody would choose either of these.  But she survived cancer and I’m doing pretty well with Type 1, so it makes sense we’d both pick our own disease.  It’s too bad we’re in a place where we could have this conversation, but I’m grateful we’re both here to have it at all.

Food Wars

When I was diagnosed with Type 1 I spent a lot of time reading message boards on the internet because in my experience the best way to learn about a disease is from the people who live with that condition.  One of the first things I saw, repeatedly, was the insistence that people with T1 can eat anything they want.  Want a piece of cake?  Figure out the carb count, take the appropriate dose of insulin and you’re good to go.  I found this information fascinating because I’d been eating a low carb diet for years and knew well that carbohydrates raise blood sugar.  If my body no longer made the insulin I needed to remove sugar from my blood, why would it be OK to eat any carbs I wanted?

One of the earliest blog posts I wrote was called “Yes, I Can Eat That.”  I discussed my typical low carb way of eating but I also responded unequivocally to the “can you eat that” question that well-meaning friends and family sometimes ask.  The reality is that the diet debate is a regular one in the Type 1 community and people on either site can be quite passionate about their perspectives.  Many doctors encourage their patients or the parents of patients to continue living “normally” after a diagnosis.  After all, insulin can be used to account for the sugar in meals, so why should anyone be denied their favorite foods?  But here’s the catch:  the insulin I’m injecting before or after a meal isn’t the same insulin my body used to make.  It doesn’t work the same as what your body makes.  A healthy pancreas produces the necessary insulin quickly, and it rapidly escorts sugar out of the blood stream.  The synthetic insulin I inject takes effect more slowly and works its magic over several hours.  That means that even if I give myself exactly the right amount of insulin for whatever I’m about to eat, my blood sugar is going to go up.  Maybe up and then up some more depending on the food, before the insulin brings me back down hours later.  The more time I spend with my blood sugar running high, the more chance there is for damage…to my vision, my nervous system, etc.  I’m trying to avoid that damage.

For me, the way to do that is to skip the carbs in the first place.  If I minimize the food I’m eating that messes with my blood sugar, the easier it is for me to keep that sugar in healthy place.  I still need to inject insulin for pretty much everything I eat because protein raises blood sugar, but it’s a lot less insulin and food that has a lot less impact on me in the first place.  I see people online who say they can eat “normally” and maintain good blood sugar and a fairly low a1c.  I’m not saying it isn’t possible; it just isn’t possible for me.  It’s similar for me to any debate about approaches to dieting for weight loss.  I know people who’ve had great success with Weight Watchers, but it’s not for me.  Within the first day or two, I’d likely be awaiting trial for homicide.  Finding what works for you makes the most sense whatever the context.  For me what works is eating a high fat diet with minimal carbohydrate from any source, and I’ve got the Dexcom trends and a1c to prove it.

The problem that happens online when people discuss their dietary choices is that people tend to be convinced that their way is the only right way.  There are those that think low carb is a horrifying way to live, those who believe that high fat is dangerous, and those that believe strongly that a "normal" diet is their right as a Type 1.  On the flip side there are people like me who believe low carb is the easiest choice...but even within that community there are debates about whether high fat or high protein are the way to go.  I believe there's no one answer for everyone, but I wish everyone knew there were options.  After all, if Weight Watchers doesn't work there's always South Beach, or the Mediterranean diet, or any number of other choices.  The same is true with Type 1.