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For starters, let’s establish how the term diabetes came to be:
The term diabetes is the shortened version of the full name diabetes mellitus. Diabetes mellitus is derived from the Greek word diabetes meaning siphon – to pass through [ed: pee] and the Latin word mellitus meaning honeyed or sweet. This is because in diabetes excess sugar is found in blood as well as the urine. [source]
On the face of it, the medical community has assigned a term to a series of conditions based on a common symptom: untreated diabetics urinate (pee) a lot. I suppose to confirm diagnosis in the good ol’ days, tasting the pee was required to confirm if it was honeyed or sweet. Good times.
Overstaying the Terminology Welcome?
We started calling it diabetes because, untreated, it makes you pee a lot (I get it. You gotta start somewhere, right?). Yet, here we are, thousands of years later, and we’ve evolved the term diabetes from describing a symptom to describing a plethora of chronic conditions unified by the symptom.
Another issue created by this shift is that we have transposed the term diabetes as a way to describe symptoms into a term that connotes a chronic condition.
Why is this a problem? People who are currently managing their diabetes are called diabetics (i.e., “those who pee a lot”). Yet, if they are effective in treating and managing their condition, they no longer pee a lot. Houston, we have a problem.
A troubling aspect of the current lexicon is that we have no common language to discern between people who have the underlying conditions that create glucose toxicity and people who are experiencing glucose toxicity.
If I’m diagnosed with diabetes, it’s because I have some problem in my physiology that’s leading to dangerous glucose levels. But if I am able to resolve the glucose level problem (through diet, exercise, medication, insulin), I’m currently still considered to have diabetes, even though, when measured, my body would report back that there is no diabetic state (at least from a glucose perspective). This has real consequences in the type and cost of care, and (as you’ll read later) in how the healthcare system rations care.
As a relatively small example of this dynamic in action, I’ve been instructed to now have eye exams every year because I was diagnosed with diabetes. Yet, my glucose levels are at normal levels due to my Type A Diabetic management techniques. As a result, I have no distinguishing physiological features that would mandate spending more healthcare dollars on additional eye exams. Yet, it is now an expected behavior because “diabetics tend to experience retinopathy as a diabetic complication.” Take this example and extrapolate it to every extra doctor visit, quarterly blood test, and all the other “expected” additional interactions with the healthcare system for every well-managed diabetic who simply do not require this level of treatment due to the real world evidence that they are no longer in a diabetic state.
Should We Retire the Term Diabetes?
Diabetes is an ugly, outdated term that does a poor job describing a variety of underlying conditions and should be retired.
For starters, as a word (devoid of meaning), diabetes is, subjectively, unattractive. It sounds bad, and not just to me. Phonaesthetics is the study of beauty and pleasantness associated with the sounds of certain words or parts of words. In this field of study, there are some general guidelines around what makes words sound attractive and unattractive. Suffice it to say that the word diabetes shares more unattractive aesthetic traits than attractive traits (side note: the same applies to cancer, another branded term that is phoneaesthetically ugly and has outlived its utility). But being unattractive is not a good enough reason to retire a word.
As outlined above, the meaning of the term diabetes has expanded so far from its initial utilization that it’s showing its stretch marks. We’re just asking a single term to do too much as the science expands the complexity of this polyetiological condition. We would be far better served by using descriptive terms that aided understanding of the condition when being used.
Most importantly, the term diabetes is far over-extended in its utility. What used to be a term to describe symptoms of someone who was experiencing the effects of falling out of glucose homeostasis is now being used to describe anyone who has any kind of underlying insulin disorder for the rest of their lives. While diabetes isn’t the only disease term that is utilized this way, it seems inappropriate given the vast array of disorders and the varying ways to addressing or mitigating them.
To throw my point here in sharp relief, consider the following examples where other conditions aren’t tied to the person’s identity as a life-long adjective:
- A lot of people get depressed. Some of these people have chronic depression, while many have situational depression. The people with chronic depression may consider themselves stricken with depression as a chronic disease state as a part of their identity, but many will not – especially if it’s treated and managed well. And those who suffer from situational depression would certainly not consider themselves “depressed” years after having a bout with depression (even though the underlying conditions that created that situational depressed state still exist in their system).
- A lot of people have high cholesterol. Even though for many having high cholesterol is based on genetics and not lifestyle choice, we don’t go around saying that those with high cholesterol are hypercholesterolemic the rest of their lives just because they happen to have a physiological condition that creates a cholesterol imbalance. If the person who has high cholesterol brings it down through a lifestyle change, do we still consider them hypercholesterolemics? (No, we do not.)
- A lot of people have high blood pressure. Some due to lifestyle; some due to genetic make-up. Are these people called hypertensives in general conversation? Of course not. These people say “I suffer from high blood pressure” or “I have hypertension.” And if they get their blood pressure under control (by natural or prescription pathways), are they branded the rest of their lives, even though the natural homeostatic state no longer works as expected? (No, we do not.)
Why, pray tell, must diabetes be so different from these other medical conditions?
The lesson to be learned here is straightforward: If you are able to manage an underlying condition through lifestyle change and/or therapies, the Type A Diabetic credo states that you do not need to identify as someone with a chronic condition. Instead, you can identify as someone who has taken control of the underlying condition so that your body is unaware that there is a problem.
Classification Confusion
If sticking too long with a two-thousand-year-old symptom-based label isn’t a good enough reason to rethink how we talk about this condition, let’s explore another avenue that creates unnecessary problems: types. The different types of diabetes are so unrelated in terms of cause and therapies that it likely does more harm than good to lump people together based on a label that was designed to describe how much they pee before diagnosis, instead of focusing on what’s actually causing the problem.
I’m just going to say it as plain as I can:
It’s patently ridiculous that type 1 diabetes — an autoimmune condition which has more in common with rheumatoid arthritis and multiple sclerosis than it does with type 2 diabetes — shares the same disease label as type 2 diabetes, a metabolic condition that has more in common with Gastroparesis than type 1 diabetes.
The upshot: By combining type 1 and type 2 (and other types) together under the umbrella term diabetes, the medical community has created unnecessary confusion — and conflation — in the world of diabetes.
The Type A Diabetic says: Simplicity is your friend; if you have distinct diseases, use distinct labels. And, specifically in medicine, be descriptive with your labels.
Branding 101
You may be wondering what branding has to do with diabetes. You might be surprised how much branding and labels impact thinking. People, in general, stop studying something once they’ve labeled it. A label is a kind of comprehension status signal – an indicator that whatever has been labeled has been more-or-less figured out so that you can move onto the next thing to be figured out. It’s also well established that brands attract certain emotional attributes that convey meaning around a brand.
In the naming aspect of branding, there are two primary types of names: descriptive and coined. Descriptive labels aim to describe what the object does, whereas coined labels that are new terms added to the lexicon to describe something in a new way that’s not a word in the dictionary. An example of a descriptive label is “loudspeaker” – the name of the object actually attempts to describe (albeit in a very old-fashioned way) what the object actually does – it “speaks” to you. Perhaps a better example is the “toothbrush” – so descriptive that I don’t even have to explain what it is!
Coined labels are more associated with branding, because coined labels indicate something new or novel, which tends to lead to more sales because a coined name insinuates something special and different. Examples of coined labels: frisbees, podcasts, coke.
Which brings us to diabetes. Diabetes is a coined term. It’s become a brand. It’s such a brand, in fact, that people who suffer from this condition readily call themselves diabetics — like they’re part of some kind of cult following. The idea that people with an insulin disorder of some sort think of themselves as diabetics indicates just how strong the brand is – people readily identify with it.
Recalling the etymology of diabetes, isn’t it a bit ridiculous that people willingly label themselves diabetics, which is to say that they are the “people who pee far too much sweet urine”?
Yes, of course it’s ridiculous.
When you break it down based on how diabetes as a term came to be, it’s pretty simple: If you’re peeing too much, and you’re untreated, you are in a diabetic state and have diabetes. If you’ve identified the nature of your insulin disorder and are now managing your glucose equilibrium effectively, you will no longer pee too much, and you are no longer in a diabetic state… and, consequently, are no longer diabetic.
Diabetes is a coined term, which is a brand. As such, it acts as a cognitive shortcut to the point where it’s doing everyone a disservice.
It would be far better if we used descriptive labels to describe the different physiological conditions that lead to the imbalance of glucose in the blood of untreated diabetics. We’ll dig deeper into this in the next chapter.
Should We Even Have Diabetic Types?
There’s another issue that should be explored before we apply descriptive labels. We seem to be right in the midst of learning that there are more gradations of insulin issues (both in production and in resistance) than previously recognized. Studies are revealing that some type 1 diabetics also experience insulin resistance and that many type 2 diabetics can increasingly over time develop insulin production problems.
Given this overlap of dynamics between type 1 and type 2 diabetes, perhaps it’s time to move away from describing types of diabetes and start describing conditions based on the underlying causes for these insulin issues: production and resistance.
From Numbers to Descriptors
For decades, type 1 diabetes was referred to as juvenile diabetes, and type 2 diabetes was referred to adult-onset diabetes. We now know that this distinction is so inaccurate that misdiagnosing adults as type 2 likely has led to tens of thousands of people developing unnecessary complications – or even dying – as a result.
So, that’s a problem.
But it gets far more complicated: Not only is the age/type correlation dead in the water, but the current assumptions in many doctor offices that type 1 correlates with insulin production and type 2 correlates with insulin resistance aren’t accurate either.
- Most type 1s don’t produce any insulin (yet many adult-onset Type 1s do), and some type 2s produce too much insulin, and some type 2s don’t produce enough insulin. These situations, independent of type, are insulin production problems.
- All type 2s, and some type 1s, are no longer able to efficiently store glucose due to a resistance to insulin, and alpha-cells in the pancreas become resistant to insulin as well (which leads to impaired regulation of glucose releases from the liver), which points to insulin resistance problems.
More knowledge, more problems.
The original idea in the land of diabetes was that this would be a clean, distinct way to label the different conditions, but as you can see, with additional science, we now know there is no clean break between type 1 and type 2. The result? These labels are increasingly less helpful – and even harmful. To this end, I suggest we blow up all the nomenclature and look at it as a single, unified system.