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Re: [IP] Re: Type 1 vs. Type 2

This discussion just never seems to quit.  Just to clarify, the ADA website
provides only partial definitions on its consumer webite.  The ADA's website
definitions attempt (unsuccessfully, in my opinion) to provide a universal
definition that applies to all people with diabetes as if they all had the
same issues, but it fails to adequately address the root cause of the disease
-- which is what the definitions are actually based upon.  The National
Diabetes Data Group (NDDG), based partially on recommendations from the World
Health Organization (WHO) defined the definitions in great detail.  Please
read the documentation on the official definitions at the following website:


Borrowing from this document, the definition for the two primary types is as

The class, or form, named type 1 diabetes encompasses the vast majority of
cases that are primarily due to pancreatic islet _-cell destruction and that
are prone to ketoacidosis.  This form includes those cases currently
ascribable to an autoimmune process and those for which an etiology is

While most type 1 diabetes is characterized by the presence of islet cell,
GAD, IA-2, IA-2_, or insulin autoantibodies that identify the autoimmune
process that leads to _-cell destruction, in some subjects, no evidence of
autoimmunity is present; these cases are classified as type 1 idiopathic (but
still Type 1).

Type 1 DOES NOT include those forms of _-cell destruction or failure for
which non-autoimmune-specific causes can be assigned (e.g., cystic fibrosis).

The class, or form, named type 2 diabetes includes the most prevalent form of
diabetes, which results from insulin resistance with an insulin secretory

Unless the beta cells are destroyed by autoimmunity, you cannot be classified
as a Type 1, (though, depending on the circumstances, you might be considered
Type 1 idiopathic).  A majority of people, however, are considered Type 2. 
Type 2 diabetes ranges from predominantly insulin resistance with relative
insulin deficiency to predominantly an insulin secretory defect with insulin
resistance.  As a result, people with Type 2 may not have apparent insulin
resistance.  Unfortunately, the problem is that there isn't really a reliable
way to measure insulin resistance that I'm aware of other than clamp studies
done in research,  but they are rarely done outside of a research environment
because they are difficult, costly and uncomfortable for the patient.  As a
result, doctors and diabetes specialists tend to rely on insulin requirements
and other things to determine if a patient has insulin resistance.  Its worth
noting that a temporary excess of certain hormones antagonizes insulin action
(many women require more insulin to accommodate menses, for example), but this
is a temporary, rather than permanent condition.

Finally, there are several forms of diabetes which are officially identified,
though they are less common.  These forms are either associated with genetic
defects in _-cell function; genetic defects in insulin action; diseases of
the exocrine pancreas; endocrinopathies (which is excess amounts of hormones
which antagonize insulin action; drug- or chemical-induced diabetes;
infections associated with _-cell destruction; and of course, Gestational
diabetes mellitus (GDM).

I hope we can put this subject to rest!


Date: Wed, 30 Jul 2003 20:04:38 +0000
From: email @ redacted
Subject: Re: [IP] Re: Type 1 vs. Type 2

>> Many Type 2 diabetics can, in fact, develop Type 1 diabetes...in that
>> body loses the ability to produce insulin altogether.
>> Ryan

>I don't believe this is a true statement. Just because a T2 pancreas burns
>does not make them a T1. Would make them a T2 "Insulin Dependant" Diabetic.

Type 1 diabetes is NOT defined as those who have loss insulin-producing
ability by the autoimmune response.  Type 1 is simply those who have lost the
ability to produce insulin.  The MOST COMMON way people lose this in Type-1 is
the autoimmune response.

Even the ADA website defines Type 1 in this way.  There are other ways to 
become Type 1 diabetic, including the one example of the person who lost their
pancreas in an accident, as well as the Type 2 diabetic's pancrease "burning
out".  In this last case, it is a Type 2 diabetic who developed Type 1
diabetes.  But, there are plenty of insulin dependant Type 2 diabetics who
NEVER develop Type 1.  
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