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[IP] Diabetes Types, including Gestational

Interesting reading in the last digest, and I thought I'd add comment on
several posts that were included in that distribution.

First, this is largely a discussion on what to call someone's condition.  Call
it whatever you want, but a Type 2 will never become a Type 1, even if they
now require insulin for whatever reason, although a person with Type 1 may
also develop Type 2.  You can also add to the list surgically mediated,
Gestational, LADA, and some even use 1.5 diabetes.

Type 1 is an autoimmune-mediated condition (thus the cause is similar to MS,
Parkinsons, Crohns Disease and other autoimmune-mediated conditions), where
the body's immune system mistakenly attacks and destroys the Islets of
Langerhans (which contain both beta and alpha cells).  Frequently insulin
resistance plays a role in many people with Type 2 who require insulin,
because their bodies require excessive amounts of insulin to function, and
that need destroys or "burns the beta cells out" out in the process of
continually overworking these cells.

This the main reason the term IDDM was abandoned is partially because many
people with Type 2 later require insulin, but that does not make them a person
with Type 1.  The cause is different.

The current classification and diagnosis of diabetes used in the U.S. was
developed by the National Diabetes Data Group (NDDG) and published in 1979
(1). The impetus for the classification and diagnosis scheme proposed then
holds true today.

That is, the growth of knowledge regarding the etiology and pathogenesis of
diabetes has led many individuals and groups in the diabetes community to
express the need for a revision of the nomenclature, diagnostic criteria, and
classification of diabetes. As a consequence, it was deemed essential to
develop an appropriate, uniform terminology and a functional, working
classification of diabetes that reflects the current knowledge about the
disease. (1)

It is now considered to be particularly important to move away from a system
that appears to base the classification of the disease, in large part, on the
type of pharmacological treatment used in its management toward a system based
on disease etiology where possible.

For more details on the classification and later re-classification, you may
review the article:


Personally, I think the term "autoimmune mediated" or "metabolic condition
mediated" is far better than giving it a random "type", but its largely
irrelevant.  The important thing is that the cause of each form of the disease
are very distinct.

Pregnancy frequently causes insulin resistance because of the excess of
hormones caused by the pregnancy, thus is given the term Gestational Diabetes.
 The hormones causing insulin resistance, or as I prefer to call it, "insulin
interference" is different from a structural insulin resistance because it is
usually a temporary condition, much as a woman's whose menses temporarily
increase her need for insulin.  This is also why some adolescent Type 1
patients are now being prescribed certain Type 2 meds in addition to insulin,
because the hormones circulating during puberty frequently causes interference
with the injected insulin's ability to function properly.  The Type 2 meds can
reduce the need for as much insulin and improve the insulin's ability to
function, thus giving better "control".  It should also be noted that there
are a few well-known cases where an expectant mother is first diagnosed with
another form:  Latent Autoimmune Diabetes in Adults or (LADA), which is
essentially the same as Type 1 in terms of etiology -- both are caused by
autoimmunity, it just takes longer for the onset of the disease to occur with
LADA.  Mary Tyler Moore is perhaps the best example of someone who fits into
this category; she was diagnosed following the miscarriage of her first baby.

Surprisingly, many doctors are not up to speed on the classifications, and
they will tell someone they have a particular type without good evidence (or
any at all other than looking at them, their age and their weight) that the
patient actually has a particular type.  Frequently, its not endocrinologists
who make these mistakes, but general practitioners who haven't had updated CME
training on the endocrinology and diabetes.

Anyway, hope this answers questions for many people, and settles some of the
disagreement that people had on these topics.

Dx'd Type 1 9/1976 at age 7; pumping with Animas R1000 since 6/2002 at age 33
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