Question about Type 1 vs Type 2

I understand the difference between type 1 and type 2. But I have a question about it. If you are type 2 and your pancreas burns out, are you then considered type 1? Or still type 2, but insulin dependent?

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.

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.

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 :stuck_out_tongue_winking_eye:

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.

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.

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.

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.

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.

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.

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.

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?

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.

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 :stuck_out_tongue_winking_eye:

Lee Ann is right, ADA,did not consult us about the new classification for diabetes. It is confusing
( Type1a, autoimmune ( positive antibodies
Type1b, non autoimmune ( negative antibodies

Type2 insulin resistance, mainly
Gestational diabetes
Other rare genetic causes,MODY and others
Secondary diabete ,cystic fibrosis

Type 1 depends on insulin to live
Other types may need insulin for better control

And, another note, if a type one gains weight and stays sedentary, they will have insulin resistance and require the use of other injectables like Symlin. Losing weight and more exercise can help in the exogenous insulin working better for us.

It isn’t that we become ‘Type 2’, but we are similar to a type 2 in the struggles of BG control and weight loss. Needing more insulin, other meds which re given to type 2’s aren’t given to us, but we can use Symlin to delay the rush of glucose to our blood. I’ve lost 13 lbs, and was able to stay on Symlin, but reduce insulin requirements for the day.

My mom was able to toss all her type 2 meds when she lost 15lbs. When she gained it back and more, she went onto insulin.

My mother was diagnosed T2 in her 30’s. At first she tool sulfanylureas then metformin. she carried a little weight, but not much. She was at the high side of normal. She didn’t look obese, just healthy. In her 60’s the doc wanted to put her on insulin, but she was needle phobic and refused despite our urgings. In her 60’s, her feet and ankles were turning dark and she stopped telling me about her doctor’s visits. She had severe circulation problems and neuropathy. At 66, her kidneys failed and she was on dialysis. She died of complications 1 year and 3 days later.

Because I knew the symptoms from my mom’s experiences, I knew what was wrong when my thirst increased and my mouth was so dry I could stike a match on my tongue. I was in my 30’s. I hated going to the doctor, so I took matters into my own hands and changed my diet. If something exacerbated my symptoms, I eliminated it. Eventually, I eliminated sodas, candy bars, bread and potatoes and everything els in moderation. I had stumbled onto the adkins diet by trial and error. I took no pills. My weight was in the 160’s…I was slim.
In my early 50’s, I was rebuilding some apartments in Houston, tx and stepped on a nail. It became infected. I bought antibiotics in mexico, but could not eliminate the infection and two years later I noticed fiery red streaks radiating up my leg. Blood poisoning was setting in and I made the trip to the VA in Kerrville. They operated to remove the staf infection and diagnosed me officially diabetic., hypertensive and hyperlipidemia. I’m on drugs for it all including insulin. My pancreas makes bout 20% of normal output.
Anyway, what this all means is a type two will progress despite diet and excersize. Nobody knows why someones imune system will attack istself. noone knows what causes T2. We all know the symptoms. A t1 is inicially characterized by rapid weight loss leading to DKA if un checked. T2 is iniltially characterized as weight gain, but not always…
At diagnosis and untreated T1 is lucky to live 5 years uncontrolled. A T2 might live 25 years. I am glad I am on meds. When I exert myself, I no longer feel the pressure on my chest. I generally feel better and sleep better.
Sorry to talk so much.

Take care of yourselves. Life has a lot to show us

“Anyway, what this all means is a type two will progress despite diet and excersize.”

Perhaps I misunderstood but, if tight control is kept on BG then diabetes doesn’t necessarily progress. Of course, diet and exercise alone doesn’t always give tight control - medications may be required.



there are 4 types of Diabetes: Type 1, Type 2, Gestational, and Other. You can find an excellent description of the types from the UCSF Website Diabetes Education Online

and the Etiologic classification of diabetes mellitus –
based on American Diabetes Association criteria HERE

MY history is rather long, twisted and unusual to say the least.

I was Dx’d (of sorts) with diabetes when I was hospitalized for diabetes after drinking about 2ox of coke and my wife had to call 911. I had recently had a sore throat (my doc refused to see me for follow up, “just a sore Throat” he said. So my intro to teh world of diabetes was more typical of a type-1. I even had a honeymoon of sorts, then ended up on insulin after ust over a year.

PROBLEM, I was too young for T-2 and too old for T-1 and did not know my mother was a needle diabetic, or even diabetic.

When I was 14 I MAYBE(?) had pancreatitis in the hospital not sure, but I do remember the docs saying it was not an apendasitis. A comment was made to me that I would end up on shots. To me that was a SHOCKER and wanted to hear and know NOTHING about the subject, maybe I should have, but hey I was 14 and recovered…or did I?

After that whateveritwas episode when I got sick, I GOT SICK and tool longer to recover. I had hepatitis and was hospitalized for 5 weeks, home 2 weeks and then back to school, while everyone else was back to work/school in just 2 weeks (go figure).

In the Navy I was admitted and re-admitted a couple more times before recovering from a simple URI, well maybe not so simple/typical. A little over a year later I was written up for Captain’s Mast for failure to seek medical treatment upon admision to the hospital for pneumonia. The sick bad doc had GOMERed me (kicked me out for 10 days, then got mad one morning and marched me down to Xray saying he was going to PROVE there was nothing wrong with me, then called for an ambulance.

In the meantime several possable diabets related issues developed, a sudden vision problem (3 main possable causes, one being diabetes and the other 2 no history of) and others, well before I was Dx’d, even before joinning the Navy.

I have a request in for my Navy medical records and just this past week requested (if available) medical records of my hospitalizations when I was 14 and 15. If nothing else they may shed some light on WHY my diabetes is not quite T1 nor T2 and been a GOMER ever since boot camp.

BTW I keytone at BS levels typical of a T1, not like a T2 except maybe a little slower than many T1s.


To me, trying to typify diabetes creates a false dichotomy. In 2009 I was diagnosed with late onset type 2 because I was over 40 years old with a healthy lifestyle and nobody in my family is diabetic. Nobody prescribed anything except food and exercise, which were both well balanced, but a subsequent routine HbA1C test scared the doctors, who asked me to rush to Accident & Emergency (We call the emergency room A&E)twice in one week during May 2012 with suspected type 1 diabetes. Healthcare professionals wanted to pump in insulin and water but my veins froze up and I refused injections unless they were prepared to diagnose the condition they wanted to prescribe for.

To me it is unethical to prescribe prior to diagnosis.

It took months before anyone agreed to do any of the tests (for insulin, ICA and GAD antibodies) which I believed could inform their treatment. Finally the GAD test results were off the scale and type 1 diabetes was diagnosed.

I spent eleven months on insulin and finally found it depressed me more than I could tolerate so I stopped at the beginning of July this year, whereupon my blood sugars went down to below normal. I am delighted that I can influence my immune system and would like to continue to improve it.

I do not know if I can. All I know is that 'experts' misdiagnosed me because of numbers (over 40 years of age must be type 2)and this was inconsistent with my symptoms, which were simply excessive sweat and poor concentration.

Without insulin, my entire energy system seems to have improved and my eyesight and teeth are both returning to normal with some vigilance on my part. It seems that high protein low carbohydrate food intake is good for my health, but I have lost some weight and do not want to become anorexic.

Recently I ate some bread and my blood sugars went up extortionately. My cholesterol is already above normal, so I am requesting an appointment with a dietician. I hope she can give me some advice about how to maintain my weight without upsetting the other numbers.