Sunday, November 29, 2015


It was actually, at least, what I thought, a very simple question..."In a patient diagnosed with type 1 diabetes, the first step of treatment must be: a)  Diet and exercise or b) Medication

A 24 hour Twitter poll came back with the result that of a total of 1064 people who kindly put their opinion, 27% or about 287 people went for option 1. Or translated about a quarter of folks went for diet and exercise as a first step of treatment.
Now before I go into any analysis of that result..2 salient caveats to make ..firstly this is NOT a scientific survey, so apologies for how question could have been framed etc and secondly, this is NOT a blog to mock, make fun of or berate anyone who have chosen option 1.  This is an opportunity to educate and raise awareness and I would be grateful if this analysis is read in that light.

So for starters, the correct answer is - simply- option 2. For someone diagnosed with type 1 diabetes, insulin keeps you alive. Yes, education, discussions about diet nd exercise is all important but without making any bones about it, if you don't give them Insulin, there there is no person around to teach them all that. So yes, education is important and in fact paramount, but that does not supersede the need to give someone diagnosed with type 1 diabetes the medication they need to keep alive.

Let's look at the group who chose "Medications". Again, to emphasise, it's Insulin, not anything else, but insulin. If you have someone with type 1 diabetes, they have a total insulin deficiency, and without that, they won't survive. So no, don't try anything else, if in doubt, use Insulin or please ask a specialist.
Now to the 27%...the important question..who are they..and there is no way of knowing that. It could indeed be a mixture of HCPs, Jo public or folks who work in the NHS but not involved directly with patients. Or it could be a question ( as confirmed by some) of reading the question wrong.
It does open up a few areas to look at..firstly ones who are simply part of Jo Public..does it reflect the amalgamation of type 2 and type 1 diabetes into 1 amorphous mass? The buzzword is all about diet and exercise and with celebrity chefs leading the charge, diabetes it all now the same? Without any hesitation, for type 2 diabetes, diet and exercise should be the first step...but is that what the public thinks when type 1 diabetes is mentioned?
If so, then that MUST be our responsibility as specialists to keep raising the flag in all forums. No, it isn't the responsibility of charities, policy makers, but us,as specialists, to be the voice for patients who have type 1 diabetes. Ideally, you would want patients to lead that charge themselves, but I suspect we all know how far we are from that yet.  Thus, for those who are Jo Public etc - my appeal? If you have voted, use this as an opportunity to understand the difference between type 1 and type 2 diabetes. It isn't the same by any stretch of imagination or science.

Finally, to the group which would worry a lot of parents, carers apart from patients themselves. If even 1 in that group who answered is an HCP ( and hadn't read the question right)..again..thank you for answering but here lies an opportunity for learning. In the future, if you have someone who has type 1 diabetes, there is NO other option...the only one is to give them the medication which will keep them alive. If you read that as Type 2...then use it as a learning exercise to make the distinction for the next patient you review.

It indeed has been a fascinating exercise...and I must admit to not being despaired at the outcome. It surely shows the work that needs to be done but also shows the willingness of many to engage and learn. Thereby lies the power of social media..thereby lies it's side which can indeed be used for improving care.

Thank you to all who contributed and hope this can spark some discussion as well as act as a learning exercise. To be honest, if this helps in even 1 patient being given the right treatment, being saved from being admitted in ketoacidosis or even lower the stigma a tiny bit, that Twitter poll was worth the time.

As Mr Mandela said.."Education is the most powerful weapon we can use to change the world". Amen Madiba


  1. Type 1 and Tupe 2 diabetes are relatively recent names for the conditions. It's not surprising that some of the public is confused.

  2. Thank-you very much for this. It is a relief to see that at least one person in the health industry understands the frustrations, and potential danger, that goes along with the misunderstanding of the lack of differentiation between type 1 and type 2. We in the T1D community know that our words are seen as simply those of naughty children who wish to have their voice heard. But you seem to understand that it goes a lot further than that. There is real danger involved in the lack of differentiation between T1 and T2 diabetes. People have already died and more will in the future if the media and health industry don't understand that there needs to be a clear and recognised distinction between the two.