A while back, an author sought contributions from "young, thin women with Type 2 diabetes" here on TuD. The author was told that those "young, thin women with Type 2" were probably misdiagnosed and have Type 1 diabetes/LADA. In an email exchange with me, the author actually acknowledged that she had gotten so many responses regarding LADA. But sensationalism wins out, and Su Subramanian has published a horrible article in Women's Health magazine. The only sane person quoted in the article is Dr. Richard Bernstein, who says that the young, thin "Type 2" women are probably misdiagnosed and actually have Type 1 diabetes. Amy Tenderich over at DiabetesMine calls the article "c**p." I am really angry and appalled, because misdiagnosis can be so terribly harmful, and can lead to rapid onset of complications and even death due to DKA. What a terrible disservice to women (and all people).
Assuming some or all of those "T2's were not misdiagnosed T1's. Which is a big assumption as so many are.
I'm definitely not a scientifically oriented mind, but what do multiple genes have to do with antibodies?
From a strictly lay perspective, I have no doubt that the etiology of Type 2 is far more complex than the horrible media picture of "you ate too much junk, gained weight and gave yourself diabetes." Nevertheless, in the act of rejecting this awful stereotype that is also a great oversimplification, I think it might be premature to say "oh, it's an autoimmune disease like type 1."
My own experience illustrates I think some people's Diabetes which exists in a "bordertown" and then something motivates the D to cross over to one or the other side of the border. They then live in a completely new country. I fought 10-40 pounds of overweight all my life as did my father and his mother who I resemble. That grandmother did, I believe have type 2 and at least when I knew her in old age was quite overweight. I also struggled with high bp and cholesterol, both markers of type 2. But I also have, as I've described on here, a strangely powerful immune system that has fought off disease all my life. In 1994 I was diagnosed with Graves Disease and then in 2007 with Type 2 Diabetes which I recognized Was Type 1 in 2009 when the oral drugs stopped working. At the time of diagnosis I lost 40 pounds. So am I a Type 1 that could have "gone to the other side of the border and become a Type 2?"
I think there will always be the outliers that don't fit any preconceived mold, and to some extent that indicates knowledge we don't yet have. When I went through my head bending effort to discover my true diagnosis as LADA/Type 1, I told my conclusion to a friend who is an RN. She said, ahhh..that explains some things. We've always seen a number of people with Diabetes that didn't seem to fit into recognizable categories.
Hi Emmy: You said, “studies have shown that T2's can have the same antibodies that type 1's do” but the studies you provided links to don’t show that at all, quite the opposite. The studies you provided links to are interesting, but they do not discuss diabetes caused by immune-mediated destruction of the beta cells of the pancreas nor the autoantibodies (GAD, ICA, IA-2, Zn8) indicative of Type 1 diabetes.
The ‘10% of “Type 2s” who are antibody positive’ refers to results of studies that have been done all over the world over the past 30+ years that show that about 10% of people given the diagnosis of Type 2 diabetes are antibody positive (GAD, ICA, IA-2, and/or Zn8), have been misdiagnosed, and in fact have Type 1 diabetes. The UKPDS is an example of a study where 10% of “Type 2s” were antibody positive and had initially been misdiagnosed.
For the young, thin, athletic women who are portrayed in this Women’s Health article, it is highly unlikely that they have Type 2 diabetes. Far more probable is that they have Type 1 diabetes or monogenic diabetes.
I've gone back and checked.
Type-2 diabetes linked to autoimmune reaction in study
BY KRISTA CONGER
Renee Reijo Pera, Edgar Engleman
Type-2 diabetes is likely to have its roots in an autoimmune reaction deep within the body, according to researchers at the Stanford University School of Medicine and the University of Toronto.The finding, coupled with a similar study by the same group in 2009, vaults the disorder into an entirely new, unexpected category that opens the door to novel potential therapies.
“We are in the process of redefining one of the most common diseases in America as an autoimmune disease, rather than a purely metabolic disease,” said Daniel Winer, MD, a former postdoctoral scholar in the laboratory of Stanford pathology professor Edgar Engleman, MD. “This work will change the way people think about obesity, and will likely impact medicine for years to come as physicians begin to switch their focus to immune-modulating treatments for type-2 diabetes.”
I don't see how you can misinterpret that. It says quite clearly type 2 is probably initially caused by autoimmune problems.
Its quite clear to me. I'm not saying that its caused by the same things as type 1, but the two diseases are more closely linked than previously thought, and there is definitely inflammation involved. It may actually be the prime trigger in type 2, which is a totally new concept for most people and most doctors.
This doens't surprise me at all, since I have several auto-immune related conditions, and a lot of problems with inflammation.
There is no misinterpretation. I am saying that Type 2 diabetes does not involve immune-mediated destruction of the beta cells of the pancreas. Some Type 2 may have an autoimmune component, as these studies suggest, but T2 does not involve immune-mediated destruction of the beta cells.
I knew that after I posted my thoughts using metaphors and subjective experience, Melitta would appear and give it the scientific base I knew was there all along! (Just like you do when I say "full panel of antibody testing" and then you list the unpronouncable names that entails.) ::::waves:::: Hi, my scientific friend!
Hi Zoe: Yes, still just trying to prevent misdiagnosis or get people more quickly to the correct diagnosis! You and I know about that. I hope someone suggests to those poor women in the Women's Health article that they go to a competent endo....
I think the miscommunication here is around the historic use of the term "autoimmune diabetes" as short-hand for "autoimmune destruction of the beta cells in the pancreas resulting in T1 diabetes".
What the NEW research is showing it that there are OTHER kinds of autoimmune processes creating insulin resistance, which can be found in both T1's and in T2's.
To clarify: you don't have to be T2 to have autoimmune-related insulin resistance, but only T1's have autoimmune-related destruction of the beta cells.
I will not tread into the murky and shark-infested waters of "double diabetes" here, but the bottom line is that you can no more give yourself T2 by eating too many M&M's than you can give yourself T1 by eating too many M%M's. All types of diabetes have a genetic component that MUST be present for diabetes to develop.
I think the flighty writing speaks for itself.
I'm a young, thin type 2 and do kind of feel frustrated that there is very little information about or people who believe that you can be a young, thin type 2.I'm honestly disappointed that all of those thin type 2's were actually LADA/T1s. Before anyone asks, no I did not have the c-peptide and GAD tests and I may in the future, but the way my body acts is much more like a type 2.
I have a history of gestational diabetes 9 years ago and developed type 2 last year. I'm 29 and have been underweight most of my life, even during my pregnancy. Right before my diagnosis (which was difficult to even get because my doctor didn't want to run the tests since I was thin and there's no way I could be a diabetic), I was hungry all of the time and rapidly put on weight. I went from 105lbs to about 118lbs in the span of about 6 months. Once finally diagnosed and put on Metformin and reducing my carbs, I dropped to 100lbs in a few months. Now I'm up to 104lbs because I haven't been as strict with carbs. Last a1c was 5.5 early this month.
I don't fit the stereotype of a type 2, but my body acts like one. I don't believe I have been misdiagnosed because I am able to control my bg with cutting carbs and Metformin, I also had an OGTT done and my insulin levels were also tested and were high. The endo said that he would've thought I was type 1 if it weren't for the fact that my insulin was high. Other evidence is that I have a half-brother who was also diagnosed young and at normal weight. He has had type 2 for over 10 years now and still doing just fine on oral meds. Also, I have reactive hypoglycemia and suspect I had it long before my diagnosis of type 2. If my pancreas is still able to produce excessive insulin, I don't see how I could possibly be LADA unless I'm in a very long honeymoon.
Another possibility is monogenic diabetes (aka MODY). There is a Monogenic Diabetes group here on TuD, with some excellent resources.
Yes, I've read a lot on MODY and it's a possibility, but I'll probably never have the chance to be tested. I act like a type 2 and the type 2 treatment has been working for now. Type 2 treatment has also worked for my brother who has had it for over 10 years.
My boyfriend is another atypical type 2. He was diagnosed in his teens (about 13 or 14) and normal weight. Since he was young and ended up in the hospital, he was diagnosed with type 1 and took insulin from then on. When I started having diabetes symptoms and did my research, I became curious about his bg and insulin regimen as I never saw him testing or taking insulin. He said he took his long acting insulin most days, but didn't bother with the fast acting because it used to make him low too often. I convinced him to start testing his bg and at the same time he was getting into running and found that his insulin needs dropped until he stopped taking it. I told him to see his doctor because if he's really type 1 that couldn't be right. I recommended he ask for anitbody and c-peptide testing which they ran. He came back with no insulin or GAD antibodies and c-peptide showed that he makes plenty of insulin so he has been reclassed to type 2.
We are an interesting bunch, aren't we?
It never ceases to amaze me how doctors (and endos!) can get away with presenting such inaccurate, incomplete and outdated information to their patients when so much information is available on the internet and in the DOC. Oh, that's right doctors look down on internet info as being unprofessional and not credible!
In trying to start a Type 1 group here in the northstate I'm considering sending a flyer to the medical group in Redding that misdiagnosed me. Since I left the country shortly thereafter they would have no way of knowing what happened. I'd love to see their faces when they read, "Zoe Heyman, Type 1 Diabetic???