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Re: [IP] Gestational Diabetes, then Type 1 (Long)

When I said "not all Type 1's are auto-immune, so I don't think that's
definition of it," I was referring to the small sub-classification of Type
1's known as Type 1B.  There are new labels and definitions of Diabetes
these days and Type 1 is now being broken down into different subtypes:

Type 1A (autoimmune)
Type 1B (idiopathic - not autoimmune)
LADA (Latent Autoimmune Diabetes of Adulthood)

When I was diagnosed as a Type 1 last year at the age of 37, I had a fasting
BG of 328 with very large ketones and was very thin.  I'm also
insulin-sensitive.  My TDD is approximately 14 units and 1 unit of insulin
will usually drop me 130 points.  I have low blood pressure, low cholesterol
and triglycerides.  When tested for GAD, Islet Cell and Thyroid antibodies,
however, I tested negative (I'm also Hypothyroid).  My C-peptide test showed
I still had some insulin production, though very little (don't know the
number).  My Endo still considers me a Type 1 because of my insulin
sensitivity, ketone production with high BG's, the presence of
Hypothyroidism, and the lack of family history of Type 2's.  I had a
maternal aunt with Type 1 who died before I was born.

The following is taken from this source regarding Type 1B:


Type 1B Diabetes/Idiopathic Diabetes:

Type 1B, or idiopathic diabetes, is diabetes of unknown origin. Unlike type
1A diabetes, it is not triggered by an autoimmune response.............

In both type 1A and type 1B diabetes, beta cell function is destroyed,
hampering insulin production and consequently raising blood glucose levels.
In type 1A, the cause is an autoimmune response. In type 1B, no autoimmune
response is present. The exact mechanisms behind type 1B remain unknown, but
it has been theorized that a chromosomal abnormality or a viral infection
may be possible triggers.

Type 1B diabetes presents with the same symptoms as type 1A, and is
initially diagnosed through a fasting plasma glucose, casual plasma glucose
test, or oral glucose tolerance test. An educated guess can be made to the
subtype of diabetes by looking at the age, ethnicity, and medical background
of the patient, but tests for islet cell antibodies and other autoimmune
markers are required to clinically differentiate the two. In cases of type
1B (idiopathic) diabetes, these tests will come up negative. Type 1B may
also be suspected in cases where insulin requirements dwindle and/or
disappear; however, since individuals with type 1A diabetes can also
experience this phenomenon (known as a "honeymoon period"), this by no means
a failsafe indication of idiopathic diabetes.

Because of the rapid onset of the disease, type 1B diabetes may reach the
point of medical crisis (i.e., ketoacidosis) before diagnosis occurs.

Idiopathic diabetes is rare in Caucasians. Individuals of African, Hispanic,
or Asian decent are more likely to develop type 1B diabetes. Idiopathic
diabetes also has a strong hereditary component.

Insulin therapy is the initial treatment approach to controlling
hyperglycemia (elevated blood glucose levels) in idiopathic diabetes.
However, after an initial period of insulin therapy some patients may not
require prolonged insulin injections to regulate blood sugars. In fact, they
may go for long periods of time without requiring insulin at all. For some,
initial treatment with insulin may be followed by blood glucose control
through oral medications such as metformin and/or diet and exercise.
Eventually, insulin dependence may re-occur, either intermittently or
permanently. Regular blood glucose monitoring, both at home and with three
month HbA1c lab tests, are important to keeping a handle on the progression
of the disease.

dx'd T1 3/02, pumping 8/02 clear Paradigm

----- Original Message ----- 
From: <email @ redacted>

> From: "Shawna"
> Not all Type 1's are auto-immune, so I don't think that's today's
> definition of it. From what I understand, the big differences are that
> tend to be insulin-sensitive rather than insulin-resistant, have little to
no insulin
> production and develop ketones and the propensity for DKA rapidly in the
> absence of insulin.

> Well, that is interesting. What is the citation for the first sentence?
> In Type 1 diabetes, a diagnosis can be made by the presenting symptoms,
> and if in doubt, through the laboratory blood tests to identify islet cell
> antibodies, autoimmune antibodies, glutamic acid decarboxylase antibodies
> (GADA) or tyrosine phosphatase antibodies (IA-2A). Also, note that Type1
> individuals make very little to no C-peptide, a precursor to insulin

> BarbaraB.
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