Re: T1/T2/LADA

[Guest guest]

--- In diabetes_int , Samante <kulas1@j...>

> None of us remember being in a coma.

Not that you would, of course VBG

[Guest guest]

On Mon, 27 Jun 2005 17:06:57 -0400 cappie@... writes:

> Perhaps , but you were diagnosed as a child.

>

As most type Is are. Of course you didn't keep the original answer in

your reply so it makes it more difficult to refer back. :-(

> Someone who develops T1 as an adult has a different path to

> suspicion of T1 & many do lose lots of weight before finding out why.

I know of another two type Is who were dx'd as adults from pancreatitis

(sp?) and one would make Abe Lincoln look like he was overweight and the

other is of normal weight. They might have lost some weight before dx,

partly from the pancreatitis maybe but I still think " massive " weight

loss is in the domain of type II rather than type I, even as an adult.

Now if you were talking percentages of over all weight loss, that might

mean 5-8%?

> In any event one would not " know " in 's scenario to be able to

tell the

> doctor one has no insulin--one would need the doctor to do tests to

> discover this.

>

Well I didn't read 's scenerio but I have changed doctors and not

always with my file in hand and I just tell them when I was dx'd, how

long I have had DM and once the doctor asked how much insulin I used in a

day and that was that. I think the clue that I was a type I would be that

a type II uses a heck of a lot more insulin than a type I. The only time

I ever remember having a c-peptide test was when I was hospitalized the

first time while in college. I guess I was tested when dx'd but that was

so long ago all I remember was being poked for blood a lot but that is a

child's memory.

[Guest guest]

Well that is a whole different ball of wax & you shd have said

that to begin with.--your previous doctor would have to send your

medical records to the new doctor & it shd say that in those records.

cappie

Greater Boston Area

T-2 10/02 5/05 A1c: 5.3 = 111 mean glu

50-100 carb diet, walking, Metformin

ALA/EPO, ALC, Vit C, Calc/mag,

low dose Biotin, full spectrum E,

Policosanol, fish oil cap,

fresh flax seed, multi vitamin,

Lovastatin 40 mg/coQ10 100mg, Enalapril 10 mg

5/05:140 lbs (highest weight 309)

5' tall /age 67,

cappie@...

[Guest guest]

> SO when my dad can't go without his insulin because it raises his bg

over 300 doesn't mean he is insulin dependant? My parents are using

pills and insulin at meals. I use pills and insulin morning and night

right now.

>

Hi Kathleen

Over 300?

I think it may be time to suggest to your parents that they may

benefit from asking a few questions here too. Or from at least reading

this list, Gretchen's book, and 's advice:

http://www.alt-support-diabetes.org/NewlyDiagnosed.htm

Cheers, Alan, T2 d & e, Australia

[Guest guest]

Not very efficent when you are going through the yellow pages trying

to find a doctor. Once you find one, THEN you have your records

forwarded. While you are looking for one, you just need to be able to

discuss your current condition and what your goals are.

OR, you are in a wreck and need to tell the emergency room folks your

condition.

OR you join an e-mail list and want to discuss your current treatment

and what things might help.

If I want to let someone know that I don't produce insulin, I would

tell them I am a type 1. If I want to tell someone I don't use insulin

effiently, I would tell them I am type 2 or that I am insulin

resistant. I don't see any other value to the terms type 1 and type 2,

other than my current condition.

If the " official " definition of type 1 and type 2 is only based on

history, I don't find them very usefull at all.

P.S. - Cappie, any chance you can include at least part of the message

that you are responding to? Reading just your response, how would

anyone now what the first ball of wax looked like? LOL

> Well that is a whole different ball of wax & you shd have

said

> that to begin with.--your previous doctor would have to send your

> medical records to the new doctor & it shd say that in those

records.

>

>

> cappie

[Guest guest]

My daughter was in a diabetic kids group sponcered by Eli Lilly so

considering how few diabetic kids there were we saw quiet a few as

they came from far and near and there were lots of pictures. She

said there were some " fat " kids but I don't actually remember seeing

any. As for symptoms prior to being diagnosed her's were such that

they thought the problem was neurotic or abusive parents. She

would " fall " and hurt herself, we learned she was dizzy, she ate very

little and " failed to thrive " . None of the doctors were on the right

track until God had our path cross with the right one. He said

looking at her records there were long symptoms that should have been

picked up on. I knew nothing about diabetes and apparantly the

doctors didn't either. But I think children either finally are

diagnosed or die.

Betty

> Cappie, since most type Is are not overweight to start with, losing

> " massive amounts of weight " might be a tiny exaggeration (is that an

> oxymoron?) for a type I. I was never overweight, even as a child

and

> > they all tell similar stories with each being skinny kids who

were " very

[Guest guest]

If I changed doctors it would depend on why I changed as to if I would

make my records available or not. If I thought the doctor was right on

target it would be one thing but if I doubted him or any such I would

not. I think one reason it took so long to diagnose my daughter's

diabetes is that one doctor makes a judgement, enters it into the

record and it becomes " fact " ...ie improper diagnosis or treatment

follows.

BVan (Betty)

> Well that is a whole different ball of wax & you shd have said

> that to begin with.--your previous doctor would have to send your

> medical records to the new doctor & it shd say that in those records.

>

[Guest guest]

Considering how little so many medical professionals know about

diabetes I would not discuss type at all, but what is needed to control

the situation. I've met medical professionals (including doctors) that

don't seem to even know the difference in insulins.

BVan (Betty)

> > OR, you are in a wreck and need to tell the emergency room folks

your

[Guest guest]

Rotramel wrote:

> If I was a type 2 and lost my pancreas in an accident, would you still

> call me a type 2, or would you now call me a type 1? Or would you say

> I had two different types of diabetes?

>

I would say you were a very unlucky man! I would also say

you had two difference kinds of diabetes. I think in principal, you

are still a Type 2, because you would still suffer from insulin

resistance. However, the accident would give you Secondary Diabetes

(traumatic subtype).

Is insulin dependence the issue underneath your questions?

Insulin dependence is a symptom. THe definition, these days, is based

on the cause of the diabetes, not the symptoms anymore.

Type 1 and Type 2 are two different diseases, in the since tha

they have different undrelyin causes. I imagine it's quite rare, but

theoretically, you could develop both diseases, autoimmune and insulin

resistance. You'd then be both Types 1 & 2. And then, if you were

stabbed in the pancreas by a madman and it were removed surgically, you

would have all three kinds.

Edd

[Guest guest]

cappie@... wrote:

> Someone who develops T1 as an adult has a different path to suspicion of

> T1 & many do lose lots of weight before finding out why. In any event

> one would not " know " in 's scenario to be able to tell the doctor

> one has no insulin--one would need the doctor to do tests to discover

> this.

I think 's example shouldn't be taken too literally. He

was citing an example, as a question, to help understand the

distinction between the types of diabetes. I'm sure he didn't mean a

patient should know whether he produces insulin or not when he goes to

the doctor.

Edd

[Guest guest]

Rotramel wrote:

> If I want to let someone know that I don't produce insulin, I would

> tell them I am a type 1.

It would be more accurace to say you're insulin dependent.

> If I want to tell someone I don't use insulin

> effiently, I would tell them I am type 2 or that I am insulin

> resistant.

That would work.

> I don't see any other value to the terms type 1 and type 2,

> other than my current condition.

>

> If the " official " definition of type 1 and type 2 is only based on

> history, I don't find them very usefull at all.

>

They're not based on history. They're based on the cause of

the disease. The different causes require somewhat different

treatments. That's the value. A type 1 doesn't have to deal with

insulin resistance. It's an autoimmune disease. Treating a Type 1

with drugs to improve insulin resistance would be ineffective.

Edd

[Guest guest]

Betty wrote:

> Considering how little so many medical professionals know about

> diabetes I would not discuss type at all, but what is needed to control

> the situation. I've met medical professionals (including doctors) that

> don't seem to even know the difference in insulins.

> BVan (Betty)

Yeah. Too many of those docs. Docs who write incorrect

instructions for prescription drugs. Docs who misdiagnose Types. Docs

who don't bother to tell a patient he's diabetic when his glucose comes

back at 300.

Edd

[Guest guest]

Thanks for that one, Edd -- you made my day!

Vicki, ROFLOL

Re: Re: T1/T2/LADA

>>

I imagine it's quite rare, but theoretically, you could develop both

diseases, autoimmune and insulin resistance. You'd then be both Types

1 & 2. And then, if you were stabbed in the pancreas by a madman and

it were removed surgically, you would have all three kinds.

>

>

> Edd

>

>

[Guest guest]

I have read several articles that say a type 1 can develope insulin

resistance and therefore also type 2. Being a type 1 does not insure

that you will not become insulin resistant.

BVan (Betty)

> I would say you were a very unlucky man! I would also

say

> you had two difference kinds of diabetes. I think in principal,

you

> are still a Type 2, because you would still suffer from insulin

> resistance. However, the accident would give you Secondary

Diabetes

> (traumatic subtype).

> >

> theoretically, you could develop both diseases, autoimmune and

insulin

> resistance. You'd then be both Types 1 & 2. And then, if you

were

> stabbed in the pancreas by a madman and it were removed surgically,

you

> would have all three kinds.

>

>

> Edd

[Guest guest]

I am a Type II diabetic who is now insulin dependent. I had a C-peptide

test done last year (9/04) and it came back at 0.2 (as I recall). My

doc mad the comment that, if I had been on Medicare, I would qualify

for an insulin pump based on that value. That means that I produce very

little insulin. I now take Lantus and Humalog. I also still take

Metformin XR to reduce the insulin resistance and decrease the amount

of insulin needed.

Oh, for those of you discussing the differences between Type I and Type

II diabetics, I have seen a document (which I can't find right now)

that listed about 28 sub-types of Type II diabetics. Maybe someone can

retrieve that list, it was interesting.

> Plenty of type 2s are insulin dependent. C-Peptide tests show who is

> producing insulin and who isn't. Many type 2s, after many years with

> the disease, are no longer producing insulin and will die without it.

> Even those who are producing some insulin can die without it. It might

> take a bit longer, but it will happen.

>

=+=+=+=+=+=+=

Maurer

Type II diabetic since 4/87

(diet, exercise, & meds)

Insulin dependent Type II since 9/04

(diet, exercise, Lantus, Humalog, & Metformin XR)

=+=+=+=+=+=+=

[Guest guest]

Maurer wrote:

> Oh, for those of you discussing the differences between Type I and Type

> II diabetics, I have seen a document (which I can't find right now)

> that listed about 28 sub-types of Type II diabetics. Maybe someone can

> retrieve that list, it was interesting.

That stirred a memory of one of Gretchen's posts on another list

in an alternate universe somewhere else in time. Strangely, enough

I was able to find it hidden deep within the bowels of my

computer. I dusted it off and here it is:

There have been several questions about subtypes of type 2 diabetes

recently. Some say there are 28 or more subtypes. There's some confusion

about this terminology, because in older classification systems, they

classified according to the *treatment* as either IDDM or NIDDM. If you

needed insulin you were IDDM, and if you didn't you were NIDDM. With this

scheme, a NIDDM who eventually burned out the pancreas and needed insulin

would then be considered IDDM.

As they learned more, they started classifying DM according to the *cause*

rather than the treatment. Most IDDMs are type 1, and most NIDDMs are type

2, so some people use the words as synonyms, but they really aren't. If

you're a type 2, even if you eventually depend on insulin, you're still a

type 2, even though you're IDDM.

Most of the known relatively rare subtypes of NIDDM are not considered type

2 in today's classification scheme. Here's a brief summary. If you're

interested in this, please save this because I don't want to type it up

again <G>:

I. Type 1. Almost total destruction of beta cells, resulting in insulin

requirement.

1A. Autoimmune

1B. Cause unknown.

II. Type 2. Insulin resistance plus relative beta cell deficiency.

III. Other types

A. Genetic defects in beta cell function

1. Mitocondrial DNA defect

2. Wolfram's syndrome

3. Maturity onset diabetes of the young (MODY) with several subsets

(MODY1, MODY2, etc.)

B. Genetic defects in insulin action

1. Type A insulin resistance

2. Leprechaunism

3. Rabson-Mendenhall syndrome

4. Lipodystrophy

C. Diseases of the exocrine pancreas

1. Pancreatitis

2. Removal of the pancreas

3. Severe trauma to the pancreas

4. Neoplasia

5. Cystic fibrosis

6. Hemochromatosis

D. Endocrinopathies

1. Cushing's syndrome

2. Acromegaly

3. Pheochromocytoma

4. Glucagonoma

5. Aldosteronoma

6. Hyperthyroidism

7. Somatostatinoma

E. Drug or chemically induced

1. Nicotinic acid

2. Glucocorticoids

3. Thyroid hormone

4. Beta-adrenergic agonists

5. Thiazides

6 Phenytoin (Dilantin)

7. IV pentamidine

8. oxide

9. Vacor

10. Interferon-alpha

F. Infections

1. Congenital rubella

2. Cytomegalovirus

3. sackie B

4. Mumps

5. Adenovirus

G. Uncommon forms of immune-mediated diabetes

1. Anti-insulin receptor antibodies

2. Stiff man syndrome

H. Other genetic syndromes sometimes associated with DM

1. Down syndrome

2. Klinefelter's syndrome

3. 's syndrome

4. Prader-Willi syndrome

5. Myotonic dystrophy

6. ce-Moon-Biedle syndrome

7. Friedreich's ataxia

8. Huntington's chorea

9. Porphyria

10. Other

IV. Gestational diabetes

As you can see, most of the *known* subtypes are relatively rare conditions.

I suspect that they'll eventually be able to separate class II, type 2 with

insulin resistance, into subtypes, but they don't have that knowledge yet.

Gretchen