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Permalink Reply by karen on August 29, 2008 at 7:26am

Wow! good Question! I would like an answer on that. Wouldn't that come under the heading like me, I am older so not considered juvenile Diabetes, but i presented with dka which is what alot of jd people do. So they consider me type 1 but not 1.5. this is all so confusing to me, how they come up with the distinctions.

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Permalink Reply by Kimberly on August 29, 2008 at 7:27am

Type 1 is an autoimmune attack on the pancreatic cells that produce insulin and other goodies. The only way to become a Type 1 after being diagnosed a Type 2 is for your doctor to have gotten it wrong in the first place (like my experience and that of so many other adults). Type 2 is still a bit of a catch-all, but the most common form is insulin-resistance diabetes. Some folks can actually "wear out" their beta cells w/ Type 2, but that doesn't mean they are Type 1. They are 2 completely different diseases, really.

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Permalink Reply by Lee Ann on August 29, 2008 at 7:35am

No, you're one or the other. That's why there's endless confusion about which is which and what you're called if this or that happens. The names have been misnomers, juvenile and adult, insulin-dependent and non-insulin dependednt, and now type 1 and type 2, which, frankly I think are stupid names because they're completely non-descript, but the ADA didn't consult me ;P

Type 1 and type 2 have different causes and that's the overriding differentiation factor. Even if you're type 2 and require insulin, that doesn't mean you're diabetes is now caused by an auto-immune response. It's still type 2, but with markedly decreased insulin production.

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Permalink Reply by Steve Manwaring on August 29, 2008 at 9:18am

type 1 cause isn't known. Type 2 can be brought on by eating the american fast food diet, or any of the junk food which is the majority of food here in the US. This may even be incomplete information, I don't think anybody has ALL the information to answer the question, not even endocrinologists.

Its a constant cat and mouse game chasing the diabetes monster.

A poor lifestyle and junk food diet will not cause type1 but it will contribute to the onset of type2, not cause it. The only reason you would be a type2 and then develop type1 is if it is in your genetic makeup and your own immune system attacks the beta cells in the pancreas.

Some people are just lucky, they can eat truckloads of junk while they sit around all the time and cultivate excess body fat and artery plaque and be just fine.

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Permalink Reply by LoriRode on August 29, 2008 at 9:44am

And some of us develop Type 2, even when we are only mildly fat, and not terribly sedentary, because of apparently, genetic tendency.

I agree that the names are meaningless, and wish that there were a different name for Type 1 than for Type 2, but we're fighting 20 centuries of traditional naming here, it's beyond the ADA.

Many Type 2s eventually use insulin to control their diabetes disease process, but use of insulin does not make them Type 1s.

IMHO, Type 2s should not be afraid to use insulin, but there is such a stigma attached to it for Type2s. (Insulin use = Failure in some minds. It is such a lie!!!)

I often here the equally vague phrase "insulin dependent diabetes", when I think it may actually be Type 2 DM using insulin rather than oral meds. I talk with a lot of seniors. They say, "I have insulin dependent diabetes." I always ask, "And how long have you had that?" I'm hoping for an answer of under 20 years, and if so, I can usually infer that it is indeed Type 2.

Not that it matters for what I do, but still. The words around diabetes are confusing.

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Permalink Reply by Lee Ann on August 29, 2008 at 10:15am

It is beyond the ADA, but they've been contributing to the confusion for years. When they last changed their nomenclature, around 1990 if I recall correctly, from NIDDM and IDDM to type 1 and type 2, there was a faction who wanted to call juvenile-onset/IDDM/type 1 something along the lines of "auto-immune mediated diabetes" (I might have the exact name they were advocating wrong, but it was "auto-immune mediated" something or other). That right there would have been the perfect descriptive name for type 1, but they opted for something simpler yet a bazillion times more confusing to everyone (doctors included apparently). I don't know what the auto-immune mediated diabetes crowd was proposing to call adult-onset/NIDDM/type 2.

I disagree with a lot of what the ADA does though in spite of the fact that I know they do lots of good, and they're an important organization to the entire diabetes community. I just question some of their priorities and their methods for making decisions and implementing policy. I have lots of bones to pick with JDRF too, despite all the good they also do. That's another thread though ;P

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Permalink Reply by Lee Ann on August 29, 2008 at 10:01am

The etiology of type 1 is of auto-immune origin. "Cause" is a synonym for etiology, and I used that word since people are more familiar with its meaning than the meaning of etiology. I'm well-aware that no one understands what causes that auto-immune response, but the presentation of type 1 is caused by that response nonetheless.

Also, it's erroneous to only implicate poor eating habits and lifestyle choices as the cause of type 2. While there is absolutely a strong link, thus the increased incidence of type 2 over the last few decades, there are genetic factors that play a role just like with type 1. Additionally, there's a reason it was called adult-onset once upon a time - age is also a strong factor. There are a fair number of people who develop type 2 who aren't overweight or have the tell-tale lifestyle choices that are commonly associated with type 2. Those people just have crappy genetics.

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Permalink Reply by Misty on August 29, 2008 at 10:04am

I would assume that the type 2's that do not develop in the presence of obesity (note I did not say BECAUSE of obesity) are typically not insulin resistant. So then type 2 can be divided further into insulin-resistant and non-insulin-resistant. Do Type 1's also develop insulin resistance?

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Permalink Reply by Lee Ann on August 29, 2008 at 10:12am

They can. I don't know the incidence of that, and I don't know very many type 1 who've experienced it, but just because I don't personally know of them doesn't mean there might not be a fair number of them. I think it will become more common in the future since type 1's are living longer than they used to as a whole.

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Permalink Reply by ken wong on August 29, 2008 at 7:57am

oh wow. i didn't know about this? I thought if you didn't get your diabetes under control that you could develop from a type 2 to type 1.

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Permalink Reply by Steve Manwaring on August 29, 2008 at 9:10am

You aren't type1 until you have a doctor run the necessary blood test or tests that tell them you aren't producing any of your own insulin, or very very little. You will also experience the symptoms of diabetic ketoacidosis after a very short period of time and if you don't get your rear into a hospital bed you will either end up in a coma or die.

Type2 cannot turn into type1, and in the event thatt happens to somebody, they were just doomed to get type1 even without the presence of type2.

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Permalink Reply by Misty on August 29, 2008 at 10:00am

Dr. Bernstein and others talk about islet-cell burnout for type 2's. You are saying in your first paragraph that if you burn out your islet cells, you would go from type 2 to type 1. Then you are saying in your second paragraph that it can't happen. I'm confused.

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