Diabetes Self-Management Articles

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Reviewing the Types of Diabetes

Type 2 diabetes usually develops in adults, but it is now occurring with alarming frequency in children. The growing epidemic of obesity in children is believed to be a major contributor to the increase of Type 2 diabetes in children. Symptoms of Type 2 diabetes are generally the same as those for Type 1 diabetes, but they may be much milder. In fact, many people with Type 2 diabetes are unaware that they have it. Other symptoms may include wounds that heal slowly, frequent infections, and, in adults, sexual dysfunction, including impotence.

Treatment for Type 2 diabetes may include taking oral medicines to decrease insulin resistance and/or increase insulin secretion and taking other drugs to treat any diabetes-related conditions; it may also include taking insulin. Attention to diet and regular physical activity are important treatment components. Weight loss can also help to reverse insulin resistance and lower blood glucose if a person is overweight.

Type 1.5 diabetes
When a person has characteristics of both Type 1 and Type 2 diabetes, he is sometimes said to have “double diabetes,” or Type 1.5.

Among the people who do not require insulin at diagnosis (most of whom are assumed to have Type 2 diabetes), some show autoantibodies, especially antibodies against islet cells and GAD. Initially, the term “latent autoimmune diabetes in adults” (LADA) was applied to this subset of people with diabetes. It has also been dubbed “slow-progressing Type 1 diabetes.” In the late 1990’s, some researchers coined the term “Type 1.5 diabetes,” because it had features of both the major types.

Further study of people who at least initially do not require insulin yet have autoantibodies has revealed some distinct variations, leading some researchers to subdivide those placed under the umbrella term LADA into three groups: Type 1–LADA, Type 1.5 or “double” diabetes, and Type 2 diabetes with autoantibodies. Under this scheme, people with Type 1–LADA are thought to have a more slowly progressing form of Type 1 diabetes. Like people with Type 1 diabetes, people with Type 1–LADA have autoantibodies and are usually not obese. Although they may initially be able to get by with diet therapy and oral diabetes medicines, they usually need to use insulin within about five years of diagnosis because of the destruction of their beta cells.

People with Type 1.5 diabetes are said to have “double” diabetes because they show both the autoimmune destruction of beta cells of Type 1 diabetes and the insulin resistance characteristic of Type 2 diabetes. People with Type 1.5 have autoantibodies and gradually lose their insulin-producing capability, requiring insulin within 5–10 years of diagnosis. As their insulin resistance suggests, many people with Type 1.5 diabetes are obese or overweight.

People in the third group are obese or overweight with insulin resistance like most people with Type 2 diabetes, and they also have autoantibodies. However, they still manage to produce insulin for more than five years after diagnosis and can continue to manage their diabetes with diet, exercise, and oral medicines. It is suspected that the autoimmunity in these people is very mild.

Some researchers suggest screening anyone newly diagnosed with Type 2 diabetes for GAD antibodies. In the landmark United Kingdom Prospective Diabetes Study (UKPDS), most study subjects with Type 2 diabetes between 35 and 45 years old who tested positive for antibodies against both GAD and islet cells progressed rapidly to insulin dependency. Some researchers have also suggested that anyone who tests positive for GAD antibodies be screened for autoantibodies to thyroid and adrenal cells, because like people with Type 1 diabetes, people with Type 1.5 diabetes seem to be at higher risk of having other autoimmune diseases.

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