Diabetes, Genetics and Shidduchim

It’s time for Part X in a series on dating and marriage in the religious Zionist community.

Last week’s edition of Torah Tidbits contained an article entitled “Diabetics and Shidduchim” by the Puah Institute for Fertility and Gynecology in Halacha. The article strongly discourages marriage to a person with diabetes. [Edited to add: As Rabbi Weitzman points out, the article doesn’t say what to do. However,  I read the article as strongly discouraging such a marriage.]

After pointing out the difficulties of living with someone who has a serious chronic illness, the author continues:

“. . . one of the risk factors for getting diabetes is that it is hereditary. Therefore someone who has diabetes is likely to pass it on to at least some of his offspring.”

The friend who sent me the article has a child with diabetes. She felt that the attitude in the article could destroy her daughter’s chances of finding a shidduch.

And the author is wrong about the risks. Passing on diabetes to your children is not “likely” at all.

The rest of the article explains how difficult it is for a children to live with diabetes, and for the entire family. The implication is that marrying someone with diabetes will cause suffering for your future children.

But what are the facts? According to Genetics of Diabetes from the American Diabetes Association website:

Risk of Passing on Type 1 Diabetes (formerly known as juvenile diabetes):

. . . . In general, if you are a man with type 1 diabetes, the odds of your child getting diabetes are 1 in 17. If you are a woman with type 1 diabetes and your child was born before you were 25, your child’s risk is 1 in 25; if your child was born after you turned 25, your child’s risk is 1 in 100.

Your child’s risk is doubled if you developed diabetes before age 11. If both you and your partner have type 1 diabetes, the risk is between 1 in 10 and 1 in 4.

There is an exception to these numbers. About 1 in every 7 people with type 1 diabetes has a condition called type 2 polyglandular autoimmune syndrome.

In addition to having diabetes, these people also have thyroid disease and a poorly working adrenal gland. Some also have other immune system disorders. If you have this syndrome, your child’s risk of getting the syndrome including type 1 diabetes is 1 in 2.

The article also notes, “In most cases of type 1 diabetes, people need to inherit risk factors from both parents.” The gene is recessive, so one can carry the gene without being sick.

Risk of Passing on Type 2 Diabetes:

Type 2 diabetes runs in families. In part, this tendency is due to children learning bad habits eating a poor diet, not exercising–from their parents. But there is also a genetic basis.

In general, if you have type 2 diabetes, the risk of your child getting diabetes is 1 in 7 if you were diagnosed before age 50 and 1 in 13 if you were diagnosed after age 50.

Some scientists believe that a child’s risk is greater when the parent with type 2 diabetes is the mother. If both you and your partner have type 2 diabetes, your child’s risk is about 1 in 2.

The Torah Tidbits article doesn’t distinguish between Type 1 and Type 2, although most cases of Type 2 are diagnosed after a woman is past child-bearing age. It might be an issue for younger women dating older men. The significant risk factor for passing on Type I, polyglandular autoimmune syndrome, is also not mentioned.

It’s legitimate to consider medical history when choosing a marriage partner. But exaggerating risks is unethical and counter-productive. Just as with Tay-Sachs, the worst thing is when diabetics can only marry each other, seriously increasing the risk of passing on the illness to their children.

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