Double Diabetes

There were no diabetes "types" when I was diagnosed in 1945. All people diagnosed with diabetes were treated with insulin taken from pigs and cows. That crude form of insulin gave me back my health. In the years 1936-1939 it was discovered that there were two types of diabetes, but it was not until 1959 that the labels Type 1 and Type 2 were attached. Oral drugs for Type 2 diabeti...cs were introduced in the years 1955-1956.

Now, in current times, we are seeing more and more people with characteristics of both type 1 and type 2 diabetes. These individuals have "double diabetes". This occurs when:

1. A person with type 1 diabetes becomes overweight and develops the basic feature of type 2 diabetes – insulin resistance (IR). Typically, the type 1 diabetic would then use a type 2 medication to help control the IR. Insulin would still be necessary as well.

2. A person with type 2 diabetes has one of the key features of type 1 – the presence of antibodies in the blood against the insulin producing beta cells of the pancreas causing a decrease in the body's ability to produce insulin. The decreased insulin production can then lead to the type 2 diabetic becoming insulin dependent. These individuals still use their type 2 medication for their IR.

So double diabetics may have initially been either type 1, or type 2. Once they have become double diabetics they have IR, they are using insulin, and they are using a medicine (usually metformin) for their IR. I have several type 1 friends, and type 2 friends, who are double diabetics. Some of my type 2 friends are using a pump and a CGM.

In the 1990s I stopped using animal insulins, and began using synthetic insulins. I began gaining weight, even though I was following a much healthier diet, and eating fewer carbs. The only thing that had changed was my insulin. I have read many reports that say the synthetic insulins cause our cells to store fat. Maybe that was the reason for my weight gain, but I did not know that information until much later. I had never been more than five pounds above my ideal weight (185) until the 1990s. By the year 1997 I weighed 242 pounds. That was a net gain of 57 pounds. A lower carb intake and plenty of exercise did not seem to help at that time.

Finally, in 1998, I was diagnosed with insulin resistance. I had several relatives with Type 2 diabetes, and it seems likely I had the Type 2 gene. The gene and the weight gain are likely the explanation for my insulin resistance. In the early 2000s I reduced my daily carb intake, increased my amount of exercise, and lost 34 pounds. I initially used avandia for my IR, but started using metformin starting in early 2011. Using metformin for one year has been very good for me. That medication has helped many diabetics lose weight. I have lost an additional nineteen pounds, and am presently only four pounds above my ideal weight. Despite the weight loss, I still have IR. Metformin, eating an average of 140-150 carbs per day, and getting lots of exercise is keeping me in good health. My A1c's are typically below 6.0, and except for some mild nerve damage, I do not have any diabetes complications. Double diabetes can be controlled, and my health is just as good now as it was before I became a double diabetic.

I feel strongly that I did better on animal based insulins that what I am on now > Lantus and Novolog. Wasn't it nice taking only two shots a day ! And do you remember how cheap it was?
It is my understanding that there are four hormones that are naturally found in animal based insulins that are not in synthetic insulins. Two of them are Amylin and Peptin.
It would be nice if they could delvelop some sort of hybred insulin that would be a combination of both synthetic insulins and animal based insulins, so that we can have those hormones back.
I wonder if you would could have continued with animal based insulins, would you have developed this "insulin resistence" ?
I have asked three seperate doctors why that stopped making animal based insulin and I got three differnt answers, so I am not totally sure what the correct answer is to why that question.
So Richard, do you think you did better with animal based insulins? It sounds like it.

I have never been on animal-based insulin. I'm wondering also why they stopped producing it--maybe because it was so cheap there wasn't as much money in it for the drug companies?? Sticking it to the diabetics again (pun intended).

I hadn't heard of this concept of being both types of diabetic at the same time. I will have to research this more.

Technically this is not the case, though some people use the term. If you are correctly diagnosed as a Type 2, you have a disease characterized by insulin resistance and are always a type 2 and don't have antibodies because type 2 is not an autoimmune condition. In time, your overworked pancreas stops producing and you will need insulin. If you are correctly diagnosed as Type 1, you are suffering from an autoimmune disorder, and will always be a type 1. In time for various reasons you may develop insulin resistance. You are then a type 1 with insulin resistance.

I agree, Jerry, it does seem like I did better on animal insulins, but I also had much higher BG and A1c's. It seems that highs for almost 50 years would have caused complications, but there were none. Maybe it was the C-peptide in the animal insulins that protected me. There are others who also think that. I had mild retinopathy and neuropathy after I started synthetic insulins, even though my A1c's were consistently below 6.0. But synthetic insulins do not contain C-peptide. Hmmm!! I prefer the modern day insulins, basal/bolus control, and carb counting. It makes me much more comfortable seeing those good numbers every day. After pumping awhile my retinopathy disappeared and although my neuropathy is still present, I rarely feel any symptoms.

Many people had allergies to the animal insulins, and some found it less effective as time passed. I do not know why it worked so well for me for almost 50 years, but I sure am glad it did.

You are correct, Zoe. A T1 double diabetic is still a T1, but with a T2 characteristic. A T2 double diabetic is still a T2, but with a T1 characteristic. We do not change types.

Good reply!

Yes, C-peptide, that's what I was trying to think of.
I think if we had the testing of today with the insulins of yesterday, we'd being doing pretty good. The pee in the test tube thing was worthless.
When I was on animal based insulin I was a heavy swimmer, so my levels were quite decent, but I do not remember what they were.

When you did go "hypo" on the animal based insulin, it was much nicer what it is now, "crash and burn". There was no need for me to smoke pot, or any illegal drugs, when I got that nice "buzz" from going low.

your blog gave me inspiration after being diagnosed as a double diabetic this past February. I have been a type 1 for 35 years now and never heard of this term. I am now on my 2nd week of metformin along w/ my insulin pump and still working on it. Thank you for some positive reading:)

Francie, it took me a few weeks to adjust to Metformin. It enabled me to take less insulin, lose weight, and it helped my insulin resistance. I adjusted easily. The only problem I am having is too many lows, 35-60. I think that may be because Metformin keeps the liver from producing so much glucose, which can give us lower blood sugar. There are times we need the glucose from our livers. When it is not there we have lows. I am having to test more frequently and eat tiny snacks, like a few jelly beans, several times per day.

Zoe: You say that you developed T1 at age 58. It seems to me that it is entirely possible for someone who has had T2 since age 40 could also have the misfortune of developing T1 at age 58? If they really are two different diseases, then what is there to prevent any type from also developing the other. After all, one can have MS and T1 or 2. Thyroid issues and T1 or 2. Cancer and T1 or 2. etc. etc. Why must it be T1 and then T2 and not T2 and then T1?

That's a good question, Peetie, and I'm not positive I know the answer, but I don't believe it happens. You would think if that happened to someone on here they would talk about it!

Again, I don't feel that it is "T1 and then T2". I believe a T1 can develop insulin resistance but that does not make them a Type 2. They still have an autoimmune condition, which Type 2's do not. They can have one of the characteristics of Type 2 which is insulin resistance (that's why I protest the idea that we on insulin can eat whatever we want and bolus for it, because I think that idea if given free expression can lead to both weight gain and insulin resistance!).

Ok, now thinking out loud about your other question. Could someone who is Type 2 then develop antibodies and have an autoimmune attack and become Type 1. This is not a great answer, but I don't believe it happens, but am not scientific enough to explain why it doesn't. I do know someone who is Type 2 will in time burn out their beta cells (though not by an autoimmune attack) and need insulin. But they still have insulin resistance, still don't have antibodies, and are still a Type 2. I think 99.9% of the time someone who says "double diabetes" or "I changed from Type 1 to Type 2" or visa versa is talking about taking on one of the characteristics of the other type and mistakenly thinking it means they change (or add) a type. Is there a 1% (or was that .1 %) that are Type 2's who have an autoimmune attack? Not that I've ever heard of, but it's a good question!

I have had the same issues with weight gain. My BG continues to be good, but weight has been increasing over the past year or so. I've been trying very low carb diets (around 30-40g/day) with a weight loss of just about 10 pounds over the past two months, along with an increase in my already active lifestyle. My doctor refuses to prescribe Metformin based solely on the fact that I am not Type 2, even though I've read numerous studies on the benefits of Metformin for Type 1's with insulin resistance and/or lowering the TDD of insulin. I swear I've had to give up my weight for my health, which is a choice that I shouldn't have to make!