What do you think of this new 'Double Diabetic' classification for type 1s with insulin resistance?

Type 1 and LADA
1

Its even more confusing for the general public, now, with a 'double diabetic' classification that takes all the fun of insulin for Type one and combines it with the excitement of increased exercise and dieting for type 2s.

Do you think you have insulin resistance? How can you tell? 'They' say a lot of Type 1's have it, along with 1/3 non-diabetic Americans.

I am a twenty-year diabetic, with a high sugar diet, 170 lbs (20 lbs overweight), and the Doc keeps reprimanding me that my 35u basal dose is too high. I am frequently reaching bg = 300 by 2pm without supplemental correction bolus (typically 6-8u) mid-morning. She says I take too much insulin and I say that I don't take enough. Maybe, as usual, we are both kinda right and both kinda wrong. Maybe there's some insulin resistance creeping in....IDK.

2

How does she define "too much insulin". That could only be true if you are going low all the time. Running in the 300s requires more insulin, not less. When will some doctors learn that there is no "right" amount of insulin, on the amount right for you.

That said, if you do require a lot, this can affect absorption, so there may very well be some IR, and I know of quite a few T1s online taking metformin.

3

I've read somewhere that if a Type 1 takes more than 1 unit of insulin per kilogram of body weight, that is considered insulin resistance. If you are overweight/obese you will require more insulin than if you were at an ideal weight, but you won't necessarily have insulin resistance. I'm overweight, but even on days I eat lots of carbohydrates and do lots of corrections I only take about 0.8 units per kilogram of body weight (and more like 0.65 on a "normal" day).

So, if you trust that type of calculation, if you weigh 170 pounds then taking more than 77 units a day would be considered insulin resistance. But if you need that much insulin (or more) to keep good control, then that's what you need.

4

I do not use the various subcategory names unless it can clearly be diagnosed and differentiated from 1 or 2. I have insulin resistance but I am a type 1 diabetic. My TDD ranges from 50 to 70. Currrently it is out of the park due to a steroid injection. I had to stop Metformin due to kidney damage, but it had controlled my TDD to around 45 to 50.
Regardless of all that, I don't think it is useful to get bent about whether I am a type 1, 1.1, 1.4 or what. The treatment is various amounts of insulin, exercise, diet, etc, all the usual self management things. Type 2 and gestational diabetes have variations on the same theme with distinguishable profiles.

And, if the public has trouble differentiating type 1 from 2, think about what it would be like if suddenly everyone started calling themselves by subtype. It is not worth it. IMHO. Oh, and I think you need another endo if she considers 35 TDD too much insulin. she has not understanding of the pathophysiology and treatment. Perhaps just young in practice?

6

Its totally possible. After your body is "force fed" any drug for a while you can build up a resistance to it. Insulin is no different. You bodies cells which use the insulin are what become resistant. There is 2 halves the one being not making enough insulin (type 1) and the other being the cells not using the insulin they have(type 2). If the cells are not using the insulin they have, just giving them more insulin will do nothing to lower the blood sugars if the cells will not use it. You need to get the cells to use it and then your insulin use will actually be reduced. I won't go into the details about how to do that because they are widely known. I for one am glad to see that science is catching on to the fact that there are numerous reasons that the cause the body to develop high blood sugars.

7

wow, thanks for doing the kg conversion for me. Thats helpful. I prob average around 70. Maybe thats OK.

8

Interesting. I only know one on metformin, and I never knew quite what to make of him, but he an older type 1, in his 60s. Yeah, I'm not quite sure how she is defining 'too much.'

9

Interesting. I never even would have thought of something like fasting.

10

Thats a good explanation. Thanks for clarifying.

11

Oh, she's not young, but she can be a pretty nervous lady. She sees danger around every corner. Often, when there's nothing wrong. I tend to think her super-cautious nature is a good balance for me and my carefree attitude.

12

Between a few forums and a variety of facebook groups I know a bit less than a dozen T1s on met. But they are scattered all over the place, so it's a rare endo who will prescribe it.

13

here are some discussions on type1s using metformin

https://forum.tudiabetes.org/topics/type-1-diabetes-and-metformin
https://forum.tudiabetes.org/topics/type-1-and-metformin-1
https://forum.tudiabetes.org/topics/type-1-diabetics-using

14

Been T1 for 23 years and started on Metformin about 5 months ago. Didn’t notice much change as I’m still pumping around 100 units total per day. Found out I have gastroparesis about 2 months ago and suspect this has been going on for at least a few years. I’m starting to figure out that eating less and only certain types of food really helps. I have lost 5 pounds and I think that has helped way more than the metformin.

15

Geeze, Tough Cookie. Thats a tough one. Tricky variable - the gastro variable, I mean.

16

no, that's not what type 1 diabetes is. many (most) type 1's never develop insulin resistance and it has nothing to do with injecting analog insulins. insulin resistance, as stated by terry, is due to the factors that type 2's have, weight gain, etc...

17

I think the 'double diabetic' classification is just another diabetic made up term. If a T1 wants or requires Metformin for insulin resistance it does not change her type of diabetes. Also, the folks who study / research / help diabetics don't recognize the classification even if they find IR and use of Metformin to be beneficial. I am a long time T1 who has managed my love of carbs - the poison kind (according to the DOC !!), remained able to match my insulin to diet, not gone overweight, or become insulin resistant. These are things that can be avoided in my opinion. If your bg / weight / health / insulin requirements become a problem we have all the tools we need to manage them. I never want to be called Double D anything - LOL!!!

18

Thats whats confusing about it. I always joke about it with people, because people kinda watch what I eat and lecture me a lot. I take a big bite out of a cupcake and say, "What do you think is gonna happen to me?, I'm gonna get DIABETES?" Then, they laugh. Now, that joke doesn't make any sense. I'm worried that if insulin resistance is common in the general public, it might be common in us, too. I eat myself a LOT of corn syrup. One of the diabetes paradigms seems to be, that we all have different sensitivities to insulin that varies throughout the day. So, people on the high end of that spectrum, might be suspected as having some insulin resistance, right? I think that is, sort or, what I need to be able to measure, if I want to calculate multiple basals on a pump. I don't really know how to do that, yet. And, I doubt, at age 33, that I have insulin resistance, but its something to watch. I stopped eating meat at age 7, so I tend to eat a high carb diet, which I don't really think is a great nutritional choice for a diabetic, but I was vegetarian before I was diabetic, and it just stuck. Will probobly lead to insulin resistance, at some point, if I don't just stick to beans.

19

I think we all have insulin resistance at certain times of day...mine is particularly stubborn in the early morning (dawn phenomenon due to growth hormone), and at other times especially when stress is involved. My basal is about 20u now, but when I'm premenstrual it's about 25u. And when I used to be about 30 lbs heavier, even more than that. I'm guessing that if you can get your weight to a healthy level, your basal needs will come down significantly. I agree that this is a "made up" situation, kind of like "brittle diabetes". Good god, we're all brittle!

20

IMO, if you aren't controlling your BG, you're not taking enough insulin, period. (within reason, of course, of what you're putting in your mouth)

If you're eating a "normal" diet, 200-400g carbs a day, and want to, that's within the range of "reasonable", although for a diabetic a lower daily carb load is recommended because it makes managing BG easier. Still, with insulin as a tool, you can manage your BG quite effectively within typical "average" sort of diet.

Insulin Denial is a serious problem in our society right now. Diabetes should not be a death sentence for living and enjoying one's life, but this is the basic prescription we offer diabetics, in particular type 2s.

It is completely reasonable to tell an obese T2 continuing to feed their obesity that society is not going to fund their 800g carb, 4000 calorie a day indulgence. All the extra insulin necessary for that, well, they're on their own to pay for it.

However, a T2 that is controlling their weight and their BG effectively should not be denied access to the quantity of insulin necessary to live as happy and rich a life as a non-diabetic vis a vis gastronomic pleasures, adventures, etc.

I'm a T2 on insulin, about 30 lbs overweight, losing it slowly right now (about 2-3 lbs a month). My IR with an IC of around 1:3 to 1:4 depending on the time of day requires about 100U a day to cover everything -- basal and boluses.

To a typical T1, that A LOT of insulin. To me, it's simply what I need to tightly control my BG.