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[IP] Type 1 or Type 2?

email @ redacted wrote:
>   And  how do doctors know when your a type 1 or type 2.  I was 33.     Is 
> there a special number????   

Nope, no special number, no special age. Type 1 can occur at ANY age --
the incidence of new diagnosis apparently goes UP with age, but the
percentage of Type 1 goes down as it is washed out by the astronomical
numbers of Type 2. 

Type 1 often presents differently in adults, though. In children, the
onset is typically explosive -- one day they seem fine (although they're
drinking and peeing a lot!), and the next day they could be seriously

In adults, however, the onset is often much more gradual -- and some
Type 1's appear to be Type 2's for a period of time because they can get
by on diet and exercise, or oral meds for a while. This is sometimes
called LADA, or Latent Autoimmune Diabetes in Adults. 

Many or most docs automatically assume you're a Type 2 if you're over 40
and overweight. On the other hand, if you're younger than 40, and
present in DKA, they will ordinarily recognize that you're Type 1. 

So what about people between, say 25 and 50 (50 is the age when the
incidence of Type 2 begins to skyrocket), who are normal weight, or a
bit overweight, but not obese, and who are NOT in DKA?

In this case, most docs will treat you as if you are Type 2 -- that is,
they will try diet and exercise first, and if that doesn't work, they
will try orals, and if that doesn't work, they will try insulin.

Because the failure of the beta cells is so gradual, this type of
approach is not life threatening. The only question is whether using
sulfonylureas hastens the demise of the beta cells in someone who is
actually a Type 1. For that reason, it might be a good idea to do a test
to see if there are antibodies to insulin or to the beta cells, but most
docs don't.

There ARE some clues as to whether a person in this category is Type 1,
Type 2, or a combination of both, though. For example, do they have a
history of diabetes in their family, and which Type is it? Do they have
other auto-immune diseases, such as hypothyroidism? How long did they
last on diet and exercise or orals?  Are they losing or gaining weight,
or are they staying stable? Do their lipids come down with insulin
control? How much insulin do they need?

Between the ages of 25 and 50, Type 1's often have the pattern of no
family history, other autoimmune diseases, poor or no response to  diet
and exercise and orals, weight loss, and much improved lipid profiles
after starting insulin. They are also usually responsive to small doses
of insulin, unless they have insulin resistance in addition to their DM.

 Type 2's on the other hand usually DO have a family history of
diabetes, usually don't have other  autoimmune diseases, do well on
either diet and exercise or orals, often for many years, and tend to
gain weight on insulin. They often require large amounts of insulin to
stay in control. 

Mind you, these are all CLUES, not definitive answers -- there are
always people who don't fit the mold, and whose diabetes is affected by
other things. 

There are also several different varieties of Type 2, and not all of
them fit the classic obese, insulin-resistant framework. 

At some point, you realize that what type you are doesn't matter NEARLY
so much as finding the right treatment which will control you DM and
allow you as flexible a lifestyle as possible with as little risk of
complications as possible! 

I chose to treat my diabetes with insulin because I could never get
reasonable control on orals, no matter how high the dosage, my lifestyle
was severely impacted, and the diabetes in my family is NOT classic Type
2. (My grandmother had it, and in those days, they didn't distinguish
Type 1 and Type 2). In addition, neither of my parents had it.  

I've lost 30 lb. over the last 5 years, and my weight is in normal range
-- I take a small amount of insulin (20 - 25 units a day), and the
decline in my pancreatic function seems to be happening very gradually.
I do have auto-immune hypothyroid, which started around the age of 30.   

So I finally figured out that I either have an atypical Type 2 (rare) or
a very slowly developing Type 1, and anyway, I don't care -- I just care
about feeling good and preventing complications!!!!

 ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- ._c- 
 Natalie A. Sera, with all her ducks in a row!
 Type Weird, pumping!
 mailto:email @ redacted
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