Double Diabetes

Type 1 and LADA
1

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 diabetics 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 was
predisposed to become type 2. The predisposition and the weight
gain are likely the explanationfor 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 in early 2011. Using metformin for one year
was 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 has kept 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.

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2

Disagree with the entire concept. In my view, diabetes is a spectrum with two distinct ends, insulin deficiency and insulin resistance. There are population clusters at both ends of that spectrum but many lie between at various places on that spectrum, and ones place on the spectrum can shift over time.

3

Richard157,

Congratulations on living so long with diabetes and doing so very well!

My reading of the research suggests that most diabetes comes down to genes. Though two thirds of Americans are overweight, and a large number of the overweight actually obese, only 9% of Americans are diagnosed with diabetes. It seems pretty clear from the genetic research that you have to have diabetes genes to become diabetic, and that the more genes you have the more likely you are to become diabetic.

Most of the identified diabetes genes cause insulin insufficiency, not IR, though there is one biggie very common in Type 2 in Western European populations that does cause IR.

But it is important to note that people who do not ever get diabetes DO become come insulin resistant as they age. A lot of them, including a huge proportion of women past menopause. However, because they don’t have diabetes genes, they apparently are able to grow more beta cells to produce more insulin.

So it is possible that your advancing insulin resistance was a natural part of aging, as it is for so many normal people. But you are much more aware of it as you know how much insulin you are using.

But the idea that people get Type 2 because they let themselves get fat is really a myth. If it were true 66% of Americans would have diabetes. They don’t, and they never will. Much of the scare stuff you read about the huge surge in diabetes diagnoses is just meant to fuel contributions and funding for the diabetes industry. The actual incidence of diabetes has been pretty constant for the whole time I’ve been following the topic (18 years.) The growth in the number is largely due to estimates of the “undiagnosed” which the ADA loves to inflate but which are hard to substantiate.

So as I see it, people like you who with Type 1 who develop IR in middle age don’t really have Double Diabetes. You have Type 1 diabetes with normal IR due to aging. If you hadn’t had an attack on your pancreas that wiped out your beta cells, you might have stayed IR and gained weight but still gone through life with normal (or high normal) blood sugars.

People with Type 2 who are on full insulin regimens don’t have double diabetes either. Some have other autoimmune conditions, Thyroid mostly and sometimes RA and MS, which seem to cause a certain amount of autoimmune attack on the pancreas too, which leaves a few insulin dependent, though many others I have met have ldetectable GAD antibodies but get by without insulin and don’t progress. I just heard from someone with Thyroid disease who was diagnosed as LADA 12 years ago because of the antibodies but is still doing fine on diet alone. Some people with Type 2 on full insulin regimens are simply heavy people whose LADA diagnosis was missed by ignorant doctors. That happens a lot. Doctors see a fat person and assume Type 2. And yet others are people who have a lot of those genes that make for poor insulin secretion where the natural IR of aging pushes them to where they can’t secrete enough to get control even with good diet.

And then there are people like me who still have completely normal IR when old enough to collect Social Security but have poor insulin secretion due to a gene defect leading to diabetic blood sugars, though their insulin secretion is not poor enough to make them insulin dependent through life.

There is so much confusion about IR and diabetes, and even most doctors are really uninformed about the broad spectrum of beta cell dysfunction and/or insulin resistance that exists in human populations. And when you add in people who are not of Western European extraction it gets even more complex. Most Asian populations have a completely different distribution of diabetes genes with very different expressions, body types, etc.

P.S. If I don’t reply to any replies it is because I’m going to be away from my computer for the week and I just can’t type long messages in my phone.

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4

Thank you for explaining this so clearly.

5

If you believe it is so largely genetic, doesn’t it follow then that the medical interventions that are saving lives are also proliferating the disease?

In other words, because medical treatments for diabetes have extended the lives of people with diabetes to near normal lengths, and given people with diabetes the same likelihood of reproducing the same amount as everyone else, is that why we are seeing a resulting exponential growth of diabetes genes in the gene pool?

Whereas 100 years ago a significant percentage of the people with diabetes genes might not have lived long enough or in good enough health to have reproduced… And those genes would have been kept from multiplying at near the same rate… A natural self limiting mechanism… Those percentages would add up over time wouldn’t they? And where does it stop? With another 2-3 generations of people with diabetes reproducing-- will the majority come to have some combination of diabetes genes?

Food for thought.

6

Since all the forms of diabetes except for Juvenile Type 1 become evident only when people are well into their reproductive years or past them, I doubt that better survival plays any part.

However, there is a huge amount of research linking man-made organic toxins to genetic damage. Pesticides, herbicides, pharmaceuticals, plastics and plasticizers, nonstick compounds, and flame retardants all have been shown to cause either IR, and/or obesity and/or diabetes. In some cases the researchers have been able to show that the obesity or IR is passed along to the next generation and even, in one study I saw, grandchildren.

So it is much more likely that we are suffering an epidemic of genetic damage as a result of the invasion of our environment by these toxic organic chemicals. In my youth, the DDT truck used to drive down the street while we children were playing and spray big clouds of pesticide to kill mosquitoes. When I was pregnant with my first child, I lived in a rented apartment where management sent exterminators around every few months to spray they apartment with a stinky pesticide. No one thought anything about what impact these would have on us. And now of course, we eat foods filled with pesticide and herbicide residues, breathe air full of chemical smog, and many are prescribed drugs known to increase IR and significantly raise the risk of diabetes (SSRIs, Statins, and more.)

So you might have had people who had marginal genes regulating glucose metabolism who would not have developed diabetes in the past who, thanks to these chemicals further damaging their genes do get it.

But you also have to remember that diabetes wasn’t diagnosed even 30 years ago in Type 2s until they were peeing pure glucose. Now it gets picked up a lot earlier, probably because there are more expensive drugs to sell them to drug companies have educated doctors to be more alert. I was sent away from my doctor and told that a blood sugar of 250 mg/dl was normal and not to worry as late as 1998. I get emails from places in Europe where people are still being told the same thing.

7

True, but if we consider it through that lens… Civilization abruptly went from having zero “juvenile diabetes genes” (if there is such a thing) entering the gene pool… To a whole lot of them entering into the gene pool… And we’re several generations past then, maybe it’s not a black and white issue, maybe some of the same genetic markers that might have caused a child to have “juvenile diabetes” back in the thirties are now causing their middle aged great grandchild to have insulin resistance now… In combination with many other factors like you mention…

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Richard 157 there is no such thing as “double diabetes” as you describe.

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This is so surprising. I have posted this on several other diabetes sites, and on Facebook. Many replies, but only here does anyone say it does not exist. That is okay, I posted this for discussion.
There are many articles on Google that say it does exist. Some of them are from reliable sources. Here is one of them. You can find many more.

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10

I never doubted. Was told long ago it did by my endo, I think. I’ve met insulin dependants who are insulin resistant. One disease doesn’t eliminate a second similar one. But the type three diabetes name has already been used to mean friends and family of diabetics. It’s understandable to be afraid of double D happening. And it does seem rare. And what a monkey wrench in the gears that would be. It feels like a death sentence. The one guy I met used u500 in a pump which meant no fast acting in the pump at that time.

11

I only read the summary-- but it appears they are basically just calling it “double diabetes” when a type 1 becomes highly overweight and suffers weight-related health consequences… Doesn’t seem like a real separate disease to me… and they even acknowledge that it’s not necessarily a real thing.

I really think the establishment did us no favors with the way they’ve categorized diabetes into type 1 and type 2. Many people, like me, don’t exactly fit either mold too well. That’s what our healthcare system likes to do though, categorize and sort us all into little boxes whether we fit or not.

12

You are so right about the fitting every one into the round hole. I have had T2 since 1974, have been on insulin now for about 15 years, used a pump for about 5, then had gastric bypass to try to manage the disease. That reduced my dependance on insulin from 100 units a day to about 20 at most. I do not test out as a type one, but am unable to make enough of my own insulin, or am resistant to it so that I still require daily maintenance with insulin. My weight is within great guidelines, and have 22% body fat rate. With that said, my insurance acts like I am irresponsible over eating and only will cover 3 test strips a day. I am small and need to check about 2 hours after eating as low sugars have been causing me to have difficulty driving.
Enough rant. Thanks for listening!

13

Thanks for your reply, Kathy. I have seen a few other type 2 people post about having very similar situations. Some of them were using several hundred units of insulin each day, and eating low carb. They were frustrated by not being funded for enough test strips. Two of these individuals are using an insulin pump and a CGM.
I am thinking that you may eventually be producing so little insulin, as determined by a C-peptide test, that you may be re-diagnosed as a type 1. Then additional test strips might be covered by insurance.
In the meantime, I hope you can do very well with your present routine.