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Type 1 and 2 diabetes at the same time, nonsense?

  1. Mar 22, 2015 #1
    Even though a type 1 diabetic can have insulin resistance - a Type 1 cannot have the disease of Type 2 at the exact same time.

    I would agree that a type 1 can have insulin resistance to synthetic insulin that they inject, though that isn't the same as the definition of the disease Type 2, in which a their pancreas can still produce some insulin but they are resistant to their own insulin, due to fat lipid cells or some other unknown issue.

    It's true that a Type 1 can share a characteristics of Type 2 diabetes, in the form of insulin resistance, but I would not say that a Type 1 can have Type 2 diabetes - both are totally different conditions, even if they do share some characteristics.

    If a Type 1 diabetic is resistant to synthetic insulin, then by its very nature how would that translate into the condition of Type 2, in which a person still produces X mount of THEIR OWN insulin though is resistant to it, as their cells fail to respond to the production properly. Obviously in a Type 1 the insulin producing beta cells have been destroyed, insulin resistance from then on, should be considered just that, insulin resistance - not the disease of Type 2 Diabetes, which I see many people falsely claiming to be the case.

    The notion of of 'Double Diabetes' isn't that the Type 1 holds both diseases, it's that they share a characteristic that is common of type 2.
     
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  3. Mar 24, 2015 #2

    DaveC426913

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    I think there's an issue of semantics here. Diabetes is a complicated disease, and does involve both inadequate production of insulin as well as insulin resistance. But I'm not entirely sure that the labels Type I and Type 2 are correlated 1:1 with those mechanisms so much as they are with the circumstance of the disease. i.e. a Type I = early onset Type II = late-onset.
     
  4. Mar 24, 2015 #3
    A of people seem to wrongly assume that Type 1 and 2 diabetes are near enough the same condition, which is utterly false. My real issue is the fact that there are some within the Diabetic Community (And not) who feel the need to say that a Type 1 diabetic, can develop Type 2 diabetes (Insulin resistance), I refuse to accept that would be the case, as the very definition of type 2, as mentioned above would entail resistance to their own production of insulin, whereas Type 1 the beta cells are completely destroyed, therefore any resistance would be that to a synthetic hormone. As you say, it might just be semantics, though I feel it is wrong for people to state that a Type 1 can develop Type 2.
     
  5. Mar 24, 2015 #4

    Ryan_m_b

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    Type 1 diabetes is an inability to produce one's own insulin, Type 2 is defined as a systemic resistance to insulin and/or reduced insulin production. It's absolutely possible to have both and the medical profession agrees with this statement (e.g. here's a review on double diabetes). If I understand you correctly you think this shouldn't be deemed the same as you think Type 2 should exclusively refer to a situation in which you are resistant to your own bodies insulin? Well as that is at odds with what the medical profession uses to argue against it you'd need to show that your definition is more useful than the current one.
     
  6. Mar 24, 2015 #5
    I feel it it's more useful and causes less confusion...Many experts distance themselves from blankly stating a person can have type 1 and 2, instead they say a person can hold "Characteristics of Type 2" which seems to be a more accurate representation at hand. Wouldn't the definition of type 2 contradict that a type 1 can have type 2?
     
  7. Mar 24, 2015 #6

    Ryan_m_b

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    From what I've read no I don't see that it does. Part of the diagnosis for type 2 diabetes is being insulin resistant, doesn't matter if said insulin is produced by the pancreas or injected. I don't think there's a lot of confusion surrounding the issue, again from what I've read it seems like most healthcare professionals and researchers use the term regularly and with little problem.
     
  8. Mar 24, 2015 #7
    There's no doubt this new form of diabetes holds characteristics of insulin resistance - common with T2D along with showing auto-antibodies to B cells that occurs in T1D, therefore maybe the current classification of diabetes as we know it, needs to be revised to take account for this relatively new form of Diabetes, in which they call "Double Diabetes".

    Also isn't it true that a person can hold a characteristic of many conditions - yet doesn't mean they would actually have said condition? - (If you get where I'm coming from)

    It would only make sense to reclassify the diabetes types, in order to reflect changes in the disease. I am still not convinced many healthcare professionals blatantly say: "You have Type 1 and 2 Diabetes" - the term "Double Diabetes" or "Hybrid Diabetes" reflects that.
     
    Last edited: Mar 24, 2015
  9. Mar 24, 2015 #8

    Ryan_m_b

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    Calling it a "new form of diabetes" implies to me that it's separate to Type 1 and Type 2 but I don't see any reason to think it is. It occurs specifically to people who have Type 1 already and from the link above and some general reading I haven't seen anything to indicate that it isn't these people acquiring a second disease. Given that this second disease fits the definition of Type 2 diabetes I don't see why it shouldn't be diagnosed as such.

    Due to this the term double diabetes makes sense and is quite useful because it indicates unique treatment requirements whilst conveying what those are.
     
  10. Mar 24, 2015 #9
    It's certainly a form of diabetes which is new - as stated http://www.sld.cu/galerias/pdf/sitios/diabetes/double_diabetes-_definition,_diagnosis,_treatment,_prediction_and_prevention.pdf [Broken] at the bottom of the page where it mentions it as just that, a "form of diabetes". Also, as mentioned in literature you posted, it said that the current understand of 'Double Diabetes' is insufficient to produce a rigid definition. Though many do acknowledge this as a different form of diabetes, as said here too. As it is a new form of Diabetes, with a distinctive difference in medication regime, I feel a reclassification is needed, this in no way is as simple as having both types; totally not.
     
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  11. Mar 24, 2015 #10

    Ryan_m_b

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    The first link is a lecture, not a credible source really, but I take the point. I just don't agree with the turn of phrase particularly. I'm not sure why you think the term double diabetes implies it's a simple matter, clearly it's a very big problem given that insulin resistance inhibits treatment of type 1 diabetes. I see your argument entirely and don't think it's without merit but I'm not convinced this is a hugely pressing issue.
     
  12. Mar 25, 2015 #11
    In my case, maybe, but I'm a very special case.

    A little back story - mid to late 2012 I was placed in a hospital for a month with a rather fierce gall stone induced necrotising pancreatitis. I lost most function in my pancreas and had to have my gall bladder removed.
    This lovely situation put doctors in a spin and they couldn't decide if it would be classified as type 1 or type 2.
    Here's the thing, I can actually get insulin resistance from my own insulin, because I'm still producing some, my pancreas didn't completely die, otherwise I'd probably be on hormone replacement drugs.
    On the other hand I can lose enough weight and possibly get function of my pancreas and be in remission of type 1 diabetes. However that situation is such a rarity, I'm not holding out for it to happen.

    So I'd say yes, but they are special cases like mine
     
  13. Mar 28, 2015 #12

    bobze

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    Labels, Labels, Labels! We always want labels. Like someone points out, DM is a complicated process and as such is probably better to think of as a process then fixed disease state if you need more than a laymans understanding of it.

    Typically in medicine we don’t even call it type 1 and type 2 diabetes anymore. Maybe some times in the outpatient world or maybe by paraprofessionals. It’s less useful terms than using insulin dependent vs insulin independent diabetes and IDDM w/ resistance etc.

    Both can exhibit overlaps, which makes strict “type 1” or “type 2” less useful in a clinical sense. Early in the course of “classical type 2”s, we’ll say that classical metabolic syndrome (searchable term) type picture the problem is largely one of insulin resistance (there are of course caveats to this, that I have not the time to delve into at the moment). As the disease progresses, there seems to be a finite workload the pancreas can endure and you get a transformation from a problem of purely resistance to one of diminishing quantity.

    Conversely, we can also see patients of the classic “type 1” who, in our ever increasing quest for an unhealthy-overweight-population, develop the classical hallmarks of metabolic syndrome; including insulin resistance.

    Pathology here can be a great teacher, particularly in how people present with acute failures of their diabetic control. Here I’m talking about diabetic ketoacidosis vs hyperosmolar hyperglycemic state. Unfortunately, I’ll have to elaborate on that later though, I’ve run out of time for now and need to do some patient care!
     
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