Talk about Types

Many primary care providers and just the population in general has no idea about the different types of diabetes. It's important because certain meds work better for certain types and that's where control issues are important. We need not only to educate the providers but people with diabetes as well. I see other chronic diseases where there is a better dispersion of information. Knowing your type is important so you can make the right medication and food choices. As it is epidemic in many other countries besides the US, I wish we were doing more to educate people particularly on diet and meds, one size does not fit all!

At least with Types 1 and 2 there are some information that is available on the web to educate the general public; however, the odd types such as Secondary Diabetes due to medications which is what the endo has labelled me there is very little information on it.

The Prednisone I take for my Rheumatoid Arthritis and Toprol for hypertension and heart flutters (byproduct of Graves Disease) resulted in Secondary Diabetes.

The only information I have found on the internet and from my doctor is that the underlying condition(s) need to be corrected in order for the diabetes to be controlled. The RA has never been under control. Otherwise, the secondary diabetes will be treated as Type 2 diabetes.

My question to him this past Friday was whether the inflammation from the RA will adversely impact my pancreas and destroy my beta cells since my blood glucose levels are now climbing; unfortunately, he had no answer for me.


Diagnosed with Anemia at birth, Allergies in early childhood, Graves Disease at 14, additional allergies at 26, Rheumatoid Arthritis at 26, Fibromyalgia at 40, Peripheral Neuropathy at 41, Secondary Diabetes at 43.

I think many doctors assume because someone is a certain age, that they are a certain type of diabetes. This is not a good assumption. There are more and more adults getting diagnosed with autoimmune types of diabetes as well as many children being diagnosed with type two.

I was diagnosed with diabetes at age 32 - and the doctor I went to just assumed I was a type two. Well - antibodies told a different story. My mom was diagnosed type one at age 62. Her blood sugar was also over 1200! She should have been in a coma. No type two drug was going to bring that blood sugar down!

Many type two drugs are being used off-label in type ones - and many type twos end up on insulin after many years of being on oral agents.

So I agree - one size does not fit all - no matter what type you are! One thing for sure is that type ones need insulin! Many type ones become insulin resistant and have type two characteristics - and some type twos need insulin - and some type twos can use diet and exercise alone to prevent any further progression of the disease.

I don't expect the general population to understand the differences, because there are lots of medical conditions I've heard of and might know a little about, but not in great detail. I do, however, expect medical professionals to know the difference between Type 1 and Type 2, especially if they treat people with diabetes conditions. Podiatrists, internists, ophthalmologists, etc. should all have a fairly good understanding. But orthopedists, general practitioners, dentists, etc. don't have much of a clue, and that's OK. It's very important for every Type 1, and every Type 2 that uses insulin, to see an endocrinologist at least twice a year. Internists are OK for Type 2's that don't require insulin. If there is not one near you, please consider moving to a larger area because it's critical to see someone who has that in-depth understand.

I actually disagree, angivan. I saw an Endo once right after I correctly re-diagnosed myself as Type 1. Other than that I don't bother. I see a PCP who writes my prescriptions and is available for non-diabetes related issues and for referrals. I don't expect a doctor to manage my D. That's my job. I'm not saying my choice is for everyone. Some people want/and/or need an endo to mange their Type 1 or insulin use in either type. I don't and find it a generalization to say "it is critical to see someone who has that in-depth understanding." It is a choice, like so much we do.

I agree, Zoe. Once I finally found a good PCP, I've had no problems with her providing my main care. While I am not on meds yet, the ignorance I have found in internists, nurses, etc is always a shock. Especially in the hospital a couple years ago, where they were clueless about what to do with a T2 not on meds yet......

I think that these problems are at the top of the pyramid. While there are many helpful and well-educated doctors, it can be a fight with insurers to get approval for tests to confirm T2 vs T1. I also see varying standards of care for DX, at one clinic, a 5.5 might "pass" while another place might run up to 5.8 or even 6.0 before the doc will "approve" a dx of T2 and maybe not even bother looking into T1. Insurers may be behind some of this, as it appears very cost-effective to "try metformin and come see me in 3 [or 6?] months" type of plans implemented. I am T1 and have like 5 people I work with bouncing things off of me, and all of them seem to be using slightly different "scales" with which to measure their approach to D.

This whole type thing is much worse than misunderstanding by the lay public. There is confusion and misunderstanding throughout the ranks of professionals and "experts." The latest guidelines on classification and diagnosis of diabetes was from just two months ago. It lists literally dozens of "types" of diabetes. There are certain types that have specific attributes that can be used for differential diagnosis. For example autoimmune T1 can be diagnosed with a set of antibody tests and a c-peptide test. MODY types can be diagnosed with genetic tests. But what we call type 2 is actually a diagnosis of exclusion and the guidelines even admit the heterogeneous nature of it by stating it is a combination of insulin secretion defects and insulin resistance.

The basic differential diagnosis is to:

Diagnose "diabetes" with HbA1c, fasting glucose, OGTT or symptoms and repeated high random glucose.

If you also have antibodies and low c-peptide you have T1 diabetes
If you also have genetic markers for MODY you have MODY
If you also are pregnant then you have GDM

Otherwise you have Type 2. There isn't any test for type 2. All known types of diabetes meet the diagnostic criteria for T2. It is a diagnosis of exclusion. It should just be called "diabetes of unknown cause." Suggesting it is a specific type is misleading.

It is any wonder there is confusion? T2 is in fact a huge bucket where lots of different people with lots of different things going wrong are just dumped. Of course different medications work by different actions and help different defects. Most T2 medications were useless in my case and I only achieved tight control once I moved to insulin. And lots of T1s find key T2 medications help them.

This whole thing of diabetes types is messed up, leads to diagnostic and stereotyping errors throughout the medical profession and makes the situation even more confusing for the general public.

So true Susan and once you're 'typed' by your doctor, it's hard to get 're-typed'. I've asked numerous times if my diabetes could be auto-immune related or just Type 2 due to genes, but the response always goes back to the medication.

Type 2 = Big ole ?

At least from my doctor's viewpoint -
Don't ask questions, just diet & exercise and keep BGs in range, we'll check A1C in 3 months. (kicking the can down the road)

Some great info thanks everyone for sharing. When I was first diagnosed at a walk-in clinic (they are very good there) they referred me to a clinic that specializes in Diabetes. At first I found them helpful but when I started asking a lot of questions regarding meds and alternatives, my doctor told me I had no business asking questions and looking at research. Need less to say, I no longer go to that clinic and have found an excellent endo who will spend an hour with me and answer my questions. I was also re-typed as a Mody which changed my perspective on things. I know now why I am on certain meds because they work for Mody and if I am at dinner with someone who is a type 2, they can eat more than I am able, particularly carbs as I maintain a low-carb diet and also have added herbs and supplements to my diet. I have been able to maintain a good A1C over the years but for me, I like to do the research to find out what is new on the market that might help me preserver the beta cells I have left. I will continue to be pro-active and thankful I have an endo who will discuss research and offer suggestions for other meds.

AR---I hadn't thought about that, but I have noticed the same thing--including within Kaiser over the 7 years I've dealt with them....