AskNadia: My Physician Says It Makes No Difference If I Am a Type 1 or Type 2 Diabetic

Dear Nadia:

I was diagnosed as type 1 in 1965 at age 13. My father and brother also were type 1. They were thin while I have always been obese. I have always only been treated with insulin. Now doctors say I have type 2 not type 1. I have had the blood test twice to see if I make insulin. I do not!

Doctors say the type of diabetes makes no difference to my treatment. If I am really type 2, what should my treatment plan be? I am really confused.

Rose

Dear Rose:

Your questions are some of the most complex in the study and treatment of diabetes. My answer will start at the beginning—your diagnosis as a person with diabetes—and try to explain how you got to where you are now.

First, type 1 diabetes: It’s an autoimmune disease caused by the body’s mistaken attack on insulin-producing pancreatic beta cells. Because there’s no way (yet) to make the body call off its mistaken T-cell attacks on the pancreatic cells, type 1 diabetics are soon brought to the point where they cannot produce any insulin at all.

This means that type 1s are always put on insulin just as soon as they are diagnosed. There is no other drug that can do for them what insulin does, which is to function literally as a life saver.

Type 2 diabetes was not detected until 1936, when a diabetes researcher noticed that while some diabetics were sensitive to insulin—type 1s—others still produced insulin but could not metabolize it properly: They were “insulin resistant.”

However, sooner or later both types depend on insulin to manage their condition. Type 1s do so right from the start, while type 2s often take years to reach the point where they need basal and bolus insulins to manage their disease. That’s because through the years their bodies produce ever smaller and smaller amounts of insulin that by themselves just aren’t enough to maintain good blood sugar levels. That puts them in the same boat as type 1s.

So you can understand my conclusion: Your doctors are right in the sense that at your age and stage, there is no real difference between type 1 and type 2. Both types are insulin-dependent and at this point there is no significant difference in the treatments for either. The only exception is that type 2s can take a limited number other diabetes medications alongside insulin, although insulin remains their core treatment.

Why did your doctor not diagnose you as type 2 in your initial 1965 diagnosis? It may be that because diabetes seemed to run in your family it influenced what your doctor diagnosed. While one of the indicators of type 2 is being overweight, the profile for that condition in 1965 was pretty sketchy. This was an era before advanced technology and drug treatments for type 2 became available.

The silver lining here is that you began treatment right away with insulin. That prescription probably saved you from considerable threats throughout the years to your health and well being. But: insulin can make users put on weight. That may have been the case with your course of treatment.

Whatever the reason for the diagnosis of type 1, it is now 52 years later and you have lost the ability to produce your own insulin. Still, I’m puzzled by the change in your diagnosis from type 1 to type 2. Even though treatments for both conditions at this point are mostly the same, I’m wondering what your doctor(s) saw to reach the conclusion that you were type 2 all this time. I’d certainly ask that question.

The real test of your type 2 diagnosis would be for you to develop diet and exercise habits that would help you shed weight and lower your blood sugars. Those are the actions type 2s take in the hopes of weaning themselves away from diabetes symptoms. But if you are no longer producing insulin, I don’t see how effective diet and exercise would be in your case.

Keep in mind that the study of diabetes, for all the attention and resources directed at it, isn’t an exact science. Researchers have fine-tuned their definitions of the disease several times over the past 95 years (insulin was discovered in 1921). In your case, I think your diagnosis, as described, will have its greatest effect on your perception of your disease rather than on where you go from here; here being decades-long use of insulin.

I wish you well.

Nadia

Disclaimer:

Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.

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About Nadia:

Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.

Nadia has received 19 nominations for her work as a diabetes advocate.
 She has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics, and many other media outlets.

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