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Re: [IP] Types of Diabetes (Was: Diabetic Magazines) -- LONG
I think a name change is totally appropriate, and I don't believe the issue is
trivial because the confusion between the main types often leads to
inappropriate or even harmful medical care for many people with Type 2, not to
mention misconceptions about what kind of diet is appropriate for someone who
is a non-obese Type 1. Also, there are functional differences between the two
main types. I blame much of this on The American Diabetes Association, who
was instrumental in getting the current definitions in place. The new names
are worse than the old ones they replaced. Even the current definitions the
ADA provides on their website does not clearly delineate important differences
between the major types of diabetes.
There are distinct names for other diseases which are similar to one another
... a good example is Chrohn's Disease and Ulcerative Colitis. (Crohn's
disease affects the end of the small intestine and the beginning of the large
intestine, but may involve any part of the gastrointestinal tract, while
ulcerative colitis is limited to the large intestine only.)
I also think the terms IDDM/NIDDM are NOT appropriate because it focuses on
the treatment of the condition, which may be the same regardless of the type,
rather than the underlying epidemiology of the disease. Personally, I prefer
something along the lines of Autoimmune Mediated Diabetes Milletus instead of
"Type 1" and Insulin Resistant instead of "Type 2" which are just numbers that
few people, including many medical professionals, even understand. I actually
sat next to an EMT on an airplane who spent 20 minutes telling me why I should
ask my doctor about trying glucophage instead of insulin because it worked
much better for her mother. I couldn't believe I was hearing this from
someone who worked in the medical profession. I then had to re-educate her on
the difference between Type 1 and Type 2 and why it was totally inappropriate
for her to be suggesting that.
Telling someone they have diabetes and giving them a vague, numbered "type"
suggests that the conditions are exactly the same, which they aren't. Its
akin to telling someone they have cancer and then numbering it. (OK, sir, you
have Cancer, Type 7. What the heck is that supposed to mean?)
There are probably more Type 2s who use insulin than there all Type 1s
combined (an estimated 40% of the 16 million people with Type 2). Some Type
2s may eventually become insulin dependent, as there is evidence to suggest
that many Type 2s have fewer beta cells than average to begin with, and its
possible that their insulin resistance requires the few beta cells to
overproduce insulin indefinitely, which can destroy the beta cells over time.
But even if they use insulin, people with Type 2 are still insulin resistant.
The writer who said they were a Type 2 who used something like 400 units per
day has no endogenous insulin production remaining and is therefore insulin
dependent, but their treatment would certainly kill me, as I am highly
sensitive to insulin. I am a 33 year old Type 1 male who weighs approximately
160 lbs. and I probably use less than 40 units per day in total, even when I
eat all day long (on Thanksgiving, for example). Even a small change in my
basal rates of as little as 0.05 units/hour can result in very dramatic
differences in my BG levels.
Aside from endogenous insulin production, there are also some things that are
functionally different between the two main types. For example, because the
Islets which contain both beta as well as alpha cells responsible for
production of glucagon are destroyed by autoimmunity, Type 1 individuals lack
a functioning counterregulatory system for blood glucose levels. When BG
starts to drop, they do not have as much protection from hypoglycemia as
someone who has insulin resistant Type 2 who still has functioning Islets.
People with Type 1 rely exclusively on a series of hormonal and neural
responses, most notably the secretion of epinephrine, which generates symptoms
(e.g., palpitations, sweating, anxiety, etc.) that warn the patient of the
dropping blood glucose. Over time, epinephrine secretion is reduced and, so
there are no symptoms occur to warn the patient of a problem, resulting in
"hypoglycemia unawareness". Although hypoglycemia unawareness can also happen
to individuals with Type 2, the fact that functionining Islets remain helps to
protect most of them.
For all of these reasons, I think renaming the different types of diabetes is
entirely appropriate, and not trivial in the least.
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