Ralflott - types of diabetes
judyvalentine512
Posts: 927 Member
It's funny you mentioned that in a previous discussion. Because of the damage to my pancreas from an error, my surgeon said I'm considered to have chronic pancreatitis(that should be over now), but also a type 3 diabetic, because it was caused by a trauma to my pancreas. Just like someone who may have damaged their pancreas in a car accident. When I asked if Iwas I insulin resistant or just not making enough insulin, his answer was YES, to both.
0
Replies
-
judyvalentine512 wrote: »It's funny you mentioned that in a previous discussion. Because of the damage to my pancreas from an error, my surgeon said I'm considered to have chronic pancreatitis(that should be over now), but also a type 3 diabetic, because it was caused by a trauma to my pancreas. Just like someone who may have damaged their pancreas in a car accident. When I asked if Iwas I insulin resistant or just not making enough insulin, his answer was YES, to both.
Aha!
There is a very knowledgeable guy on MFP who is both Type 1 and Type 2, @midwesterner85. I have never heard him mention Type 3 (which is sometimes attached to Alzheimer's) or any other number, but this condition obviously brings with it is own set of tough challenges.
In any event, I hope your Type 3 days are behind you!0 -
judyvalentine512 wrote: »It's funny you mentioned that in a previous discussion. Because of the damage to my pancreas from an error, my surgeon said I'm considered to have chronic pancreatitis(that should be over now), but also a type 3 diabetic, because it was caused by a trauma to my pancreas. Just like someone who may have damaged their pancreas in a car accident. When I asked if Iwas I insulin resistant or just not making enough insulin, his answer was YES, to both.
Aha!
There is a very knowledgeable guy on MFP who is both Type 1 and Type 2, @midwesterner85. I have never heard him mention Type 3 (which is sometimes attached to Alzheimer's) or any other number, but this condition obviously brings with it is own set of tough challenges.
In any event, I hope your Type 3 days are behind you!
Technically, there is no such thing as "Type 3" but yes, it has sometimes been used informally to describe Alzheimer's.
The surgeon is describing Type 2. Of all diagnosis, Type 2 is the most broad by describing both those who don't make enough insulin (yet still make some, unlike Type 1's... beyond the initial "honeymoon period" of onset) AND those who use it inefficiently. Most Type 2's use it inefficiently, but it is often described erroneously as "not making enough." Technically, when physicians tell patients they don't make enough, they are correct because that patient needs more than most and isn't making as much extra as needed. So if a patient needs 1.5 times as much as they would need at maximum efficiency of use, but is making only 1.35 times as much; then the patient is technically not making enough. I just don't think that is the right way to describe it.
Here are the types of which I'm aware:
A Type 1 doesn't make any insulin (the diagnosis is applied at onset before all insulin production is depleted).
A Type 2 doesn't make enough or doesn't use it efficiently (more than 90%... last I checked, it was estimated 98%... don't use it efficiently).
"Double diabetes" describes those with both Type 1 and Type 2. I don't believe it is an official diagnosis, but was first used in a research paper published in the early '90s (1991 IIRC). From my experience, it took 10-15 years before endocrinologists started using that as a common industry term.
Type 3 is also not an official diagnosis, but has been used to describe Alzheimer's.
LADA is Type 1 with adult onset. Onset period (i.e. "honeymoon period") takes much longer in adults, and some patients get misdiagnosed as Type 2 based on symptoms rather than pathway. I think the medical community created LADA as a new term for Type 1 in order to try to mask the rampant misdiagnosis.
MODY (i.e. monogenic diabetes) is a rare form of diabetes where the pancreas can make insulin (unlike type 1), but doesn't. These patients sometimes see their pancreas start making insulin again. They are also common misdiagnosed as type 1, based on symptoms and because they are not making insulin. A well known case is Halle Berry.
Deaf Diabetes - I will admit to being totally ignorant about this beyond just knowing it exists. It is probably the most rare form I've heard about, and it only affects those who are deaf. I think only those who are deaf at birth, but I might be wrong about that.... again, I know it is a thing, but don't know any details. Except that those patients don't make insulin, like type 1's.1 -
Thx!1
-
I don't think he was saying it's an official diagnosis, but because of my special circumstances, he said I am both insulin resistant and don't produce enough. I don't see Alzheimer's is connected to diabetes. My Mom has Alzheimer's , but now other ailments, include
I guess diabetes. I am working with 20% of a pancreas.
I just thought it was interesting what Ralf had said yesterday.1 -
Just checked something about LADA. It occurs in adults, usually because of an insult to the pancreas. Aye I'm not type 2 after all. I do see the diabetes doctor tomorrow, so I guess I'll ask about it.1
-
Would be interesting to know what the endocrinologist says. Type 1 / LADA (same thing) is an auto-immune disease. HLA genes (passed through on chromosome 6) cause this, but it also requires a trigger for the auto-immune response. Only about 1 in 20 persons who have the genes actually gets a trigger. So most who carry the genes never develop type 1.
You are correct, though, that someone who loses their pancreas for various reasons (including a car wreck) would generally be diagnosed with type 1. The pathway to the disease is atypical in such a case, but I still believe the diagnosis is correct. I'm not sure whether it is correct when there is still some pancreatic function remaining unless something has already begun that is expected to destroy substantially all of the pancreas. That is a more complex question, and most physicians would not know the answer without either doing special research or consulting an endocrinologist.1 -
judyvalentine512 wrote: »Just checked something about LADA. It occurs in adults, usually because of an insult to the pancreas. Aye I'm not type 2 after all. I do see the diabetes doctor tomorrow, so I guess I'll ask about it.
Good luck! Keep us posted.0 -
It is very hard to categorize some people. I gradually lost my pancreatic function. It started as a young teenager for me. By the time I was 15 I was already taking oral meds and by the time I was 20 I was on insulin. When you check my c-peptide level, it shows that my pancreas still produces very small amounts of insulin. It slowly decreased over the years until my mid twenties I was only producing trace amounts of insulin. I still produce trace amounts, but it is not even enough for basic basilar needs so I am considered to be insulin dependent. I wear a pump and have for years. As I got older..and gained weight (grrr) I also developed insulin resistance, which of course is the basis for type 2. As a result, I also take Metformin as well to help me with the added resistance. The question is...would I have developed the insulin resistance if I had not gained weight....or did I gain weight partially due to the insulin resistance which caused more insulin requirements? I think it is a mixture of both to be honest and leads some credence to the idea that people develop type 2 partially due to a genetic predisposition to metabolic dysfunction.
Which came first...the chicken or the egg? Things that make you go hmmm.....1 -
It is very hard to categorize some people. I gradually lost my pancreatic function. It started as a young teenager for me. By the time I was 15 I was already taking oral meds and by the time I was 20 I was on insulin. When you check my c-peptide level, it shows that my pancreas still produces very small amounts of insulin. It slowly decreased over the years until my mid twenties I was only producing trace amounts of insulin. I still produce trace amounts, but it is not even enough for basic basilar needs so I am considered to be insulin dependent. I wear a pump and have for years. As I got older..and gained weight (grrr) I also developed insulin resistance, which of course is the basis for type 2. As a result, I also take Metformin as well to help me with the added resistance. The question is...would I have developed the insulin resistance if I had not gained weight....or did I gain weight partially due to the insulin resistance which caused more insulin requirements? I think it is a mixture of both to be honest and leads some credence to the idea that people develop type 2 partially due to a genetic predisposition to metabolic dysfunction.
Which came first...the chicken or the egg? Things that make you go hmmm.....
Sounds similar to my situation. I developed type 1 (which is what it sounds like you developed as a teenager - see above for an explanation of the auto-immune cause) at age 9. At the time of diagnosis, I was underweight for my height.
In the first month after diagnosis of type 1, I gained 20 lbs. Within the first year, I had doubled my weight. Within 3 year, I had almost tripled my weight at the time of diagnosis and showed significant signs of type 2. My endocrinologist wanted to be cautious before making the additional diagnosis of type 2, so she had me do a 2-day inpatient study to determine just how insulin resistant I was. At that point, I was given the additional diagnosis of type 2.
Part of the reason I gained weight was because of treatment method at that time, and the other part was application of that method. Back then, pumps were incredibly rare and didn't have the same functionality. Nearly all type 1's were on multiple daily injections (MDI). The insulins available were R and N (bolus and basal insulins, respectively) in different forms (beef, pork, and humulin); mixed at time of injection if needed. The schedule was extremely rigid. The same amount of each type of insulin was taken at the same time each day. Same with food... based on an early version of the exchange diet, I ate the same number of food "exchanges" at each meal at the same times each day, and snacks that were the same each day. Obviously the amount of food was at a calorie surplus because I gained so much weight so quickly. Eventually I was obese and developed a metabolic disease (type 2). This disease was independent of my pre-existing auto-immune disease (type 1).
Though it isn't an official disease in DSM-V (nor should it be), the existence of both diseases in a single patient is sometimes referred to as "double diabetes." As obesity and type 2 cases have increased, so have the prevalence of double diabetes cases. Logically, it makes sense that type 1 diabetics would experience a similar increase in type 2 diagnosis as any other randomly selected sample size of the population as a whole.1 -
What kind of nutritional direction do you get when you start using a CGM?
I hope it's not "Eat whatever you want and the pump will take care of it.'
0 -
I do eat some carbs, but I try to stick to more complex carbs as they dont spike my blood sugar as high and quick. I do also wear a CGM because I was prone to wild swings up and down. Once I started on the pump, my blood sugar evened out and I dont usually have those huge swings anymore. I do still wear a CGM as well though because I like the constant blood sugar readings. Nutritional direction should be the same for all diabetics really.2
-
@midwesterner85 Yes our stories sound very similar. I was also on MDI for years...I took a fast acting for meals and a long acting in the morning for all day basal coverage. Had to be so careful because that long acting would peak later in the day and if I didnt eat at a certain time I would crash and burn. With my job it was becoming a real problem because it was almost impossible to guarantee certain mealtimes. The pump was a real lifesaver! I have lost a significant amount of weight in the last couple of years and find my basal and I:C requirements have steadily decreased so I am hopeful
With using less insulin I also think it helps me lose weight.
When you think about it, insulin is a type of growth hormone. When you overeat and are not diabetic your pancreas is still dumping excess amounts of insulin into your system to cover the blood sugar so the result is the same...added weight. Even look at infants of mothers who are diabetic...when they are uncontrolled especially. These babies are often very large, fat, chubby arms, legs and cheeks. (not to mention other problems they have, but that is another discussion altogether) These babies put out a lot of insulin in utero because mom's blood sugar is high...and they grow large. Most type 2 diabetics produce insulin just fine, they simply cant use it properly...so they end up with high amounts of circulating insulin in the bloodstream. Does that add to the difficulty in losing weight? Personally, I think so.2 -
@midwesterner85 Yes our stories sound very similar. I was also on MDI for years...I took a fast acting for meals and a long acting in the morning for all day basal coverage. Had to be so careful because that long acting would peak later in the day and if I didnt eat at a certain time I would crash and burn. With my job it was becoming a real problem because it was almost impossible to guarantee certain mealtimes. The pump was a real lifesaver! I have lost a significant amount of weight in the last couple of years and find my basal and I:C requirements have steadily decreased so I am hopeful With using less insulin I also think it helps me lose weight.
When you think about it, insulin is a type of growth hormone. When you overeat and are not diabetic your pancreas is still dumping excess amounts of insulin into your system to cover the blood sugar so the result is the same...added weight. Even look at infants of mothers who are diabetic...when they are uncontrolled especially. These babies are often very large, fat, chubby arms, legs and cheeks. (not to mention other problems they have, but that is another discussion altogether) These babies put out a lot of insulin in utero because mom's blood sugar is high...and they grow large. Most type 2 diabetics produce insulin just fine, they simply cant use it properly...so they end up with high amounts of circulating insulin in the bloodstream. Does that add to the difficulty in losing weight? Personally, I think so.
Yes, one of the major benefits of a pump is to eliminate unwanted basal peaks. It also provides a lot more control over basals. If an MDI patient on a standard diet exercises at an intensity below their lactate threshold, they are prone to hypoglycemia unless they ate prior to exercise. At that point, eating can start to really offset calorie burn from exercise. The same patient, when using a pump, can temporarily reduce basal rates before exercising. That can reduce the likelihood and severity of hypoglycemic occurrences, which should result in lower calorie intake.1 -
I have so much to learn. In 2014 i was hospitalized with impacted gallbladder and had it removed but i had pancreatitis too and hospitalized for 9 days... Have had pancreatitis 4 (once my lipase level was 11,802.) more times since and am now T2 since mid 2015. The Dr believes I have pancreas divism and tomorrow I am having an endoscopic ultrasound done to see for sure. I don't know what I'm doing. I feel like I am in a vicious circle... can't get diabetes controlled because my pancreas is out of wack which is causing the diabetes... I'm on metformin, actos and just started an insulin pen because my BG is usually up to and over 200. Since diagnosis of T2 my A1c has risen from 6.9 to 9.2. Guess I need different meds or something. I am so frustrated.. I'm sorry, i just zerod in on the message talking about the pancreas and started rambling. Thanks for listening/reading2
-
I have so much to learn. In 2014 i was hospitalized with impacted gallbladder and had it removed but i had pancreatitis too and hospitalized for 9 days... Have had pancreatitis 4 (once my lipase level was 11,802.) more times since and am now T2 since mid 2015. The Dr believes I have pancreas divism and tomorrow I am having an endoscopic ultrasound done to see for sure. I don't know what I'm doing. I feel like I am in a vicious circle... can't get diabetes controlled because my pancreas is out of wack which is causing the diabetes... I'm on metformin, actos and just started an insulin pen because my BG is usually up to and over 200. Since diagnosis of T2 my A1c has risen from 6.9 to 9.2. Guess I need different meds or something. I am so frustrated.. I'm sorry, i just zerod in on the message talking about the pancreas and started rambling. Thanks for listening/reading
@ConleighS Good luck tomorrow! I hope you get some answers.0 -
If you haven't stumbled across Dr. Bernstein's videos on controlling diabetes, they are packed with good info. He's a T1D who had to figure out on his own how to control his blood glucose. He's now 82 and still practicing full time (and exercising).
https://www.youtube.com/channel/UCuJ11OJynsvHMsN48LG18Ag/videos?view=0&sort=p&flow=grid1 -
The EUS wasn't as conclusive as we hoped. There's too much scaring from all the pancreatitis attacks so they couldn't tell if I have divism or not. Hopefully the gastroenterologist can read more.1
This discussion has been closed.