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Diabetes: Hybrid Types 1.5 and 2.5

December 21, 2005 09:48 AM

The old classifications of diabetes are breaking down.

Type 1 used to be called juvenile onset diabetes, but is suffered by many later in life. It is more properly classified as an autoimmune disease in which the islet cells of the pancreas are attacked by the immune system.

Type 2 diabetes is the end result of the metabolic syndrome in which insulin resistance plays the central role. High abdominal obesity promotes resistance to the action of insulin and poor glucose management. This is part of a more complex cascade, but the end stage is extreme resistance to the action of insulin and eventual pancreatic insulin insufficiency. The pancreas may eventually collapse and cease to produce insulin in the "burn out" stage.

Type 1.5 diabetes is a way to describe the progression from type 1 diabetes to the conditions of type 2 diabetes. Poor insulin and glucose management lead to high insulin resistance in the type 1 diabetic. Thus, the apparent paradox that someone whose pancreas fails to produce insulin may become resistant to the action of insulin. Likely, this individual has become obese in the abdominal region from injecting too much insulin to control blood glucose. The fat produces hormones that make one insulin resistant. The progression is thus from insulin insufficiency to excess insulin (exogenously produced and injected) to insulin receptor burn out.

Type 2.5 diabetes is a simple way to label the progression experienced by type 2 diabetics into type 1 diabetes. This means that high insulin resistance in the face of high insulin production of type 2 diabetes eventually leads to collapse of the pancreas and a frank type 1 diabetes.

Type 2 diabetes is not a failure to produce enough insulin, it is a receptor failure. There are too few and poorly acting receptors to insulin, particularly in the muscle cells. High levels of insulin are toxic to receptors. One of the "fixes" for type 2 diabetics, pharmaceuticals that promote higher insulin production from the pancreatic islet cells, may accelerate the progression to eventual burn-out and the transition from type 2 to type 2.5 diabetes. The other "fix" is to promote higher receptor sensitivity. This may be less of a threat, but there is the potential to make the receptors more vulnerable to insulin toxicity if endogenous levels of insulin are high enough to fall into the toxicity range.

There is a third way: get lean and add some muscle. Muscle is the glucose disposal site and muscle contraction dramatically increases its insulin sensitivity. Getting lean takes the fat-produced hormones out of the loop and increases insulin sensitivity. Triglycerides fall too since they are produced by abdominal fat.

I manage my wife's diabetes with her meals and what little exercise she can now do so that her insulin injections are so small that doctors often question if she is diabetic. She clearly has high insulin sensitivity.

Climb the stairs before lunch, take a short walk to lunch and after, sleep on an empty stomach, eat simple meals of moderate size. Get strong. Work out your hormones, don't just try to burn energy.

Muscle is your best friend.

· Evolutionary Fitness

Comments

Posted by: Flower Online [TypeKey Profile Page] at September 12, 2006 3:33 AM

Audley:

Prediabetic is a term usually applied to incipient Type 2 or insulin resistant diabetes. In Type 1, your pancreatic islet cells shut down and no longer produce insulin.

Most doctors use glucose tolerance tests to determine status. This is not precise. Do have your insulin level checked. A simple blood test will do. You must get your insulin below 10. Not hard to do at all. A good guide is Dr. Rosedale's book, The Rosedale Diet.

Posted by: Art [TypeKey Profile Page] at December 28, 2005 5:34 PM

Having been recently diagnosed as a pre-diabetic, I find the type breakdown to be very interesting. At 48 I thought I was eating well and working out as I should be, with bodyfat around 10-12%. What went wrong? Speculation is genetics, both of my mother's parents are diabetics, at 93 my grandmother is not obese(never has been) and is on oral meds, my late grandfather was on insulin at 62. Am I type 1 or 2? The doctor says this has most likely been brewing for years, but because I do take care of myself, I most likely am a really late bloomer type 1. But because of my age, the diagnosis would be type 2, I am guessing it is a combination of the above. I have increased the workouts and made the diet a bit stricter, hopefully the plan will work.

Posted by: Audley [TypeKey Profile Page] at December 28, 2005 7:02 AM

A very good comment. Some people call that type 3 Diabetes. My 10 year old son's got Diabetes 1 since two years and these kind of things you never get to hear from your doctor.
I've got to admit that it is darn hard, not to say impossible, for us to feed our child no carbs. Starting with breakfast. That goes on in school. An apple, an orange, nuts doesn't quite fill him and a salad with stuff for school isn't appropriate for a child.
Having said that we still manage to keep his carb intake below 100 grams a day (at times) being aware of the downside of too much insulin. Going below that and he isn't growing, as far as we are able to say with our two years experience.

Posted by: roland r. [TypeKey Profile Page] at December 21, 2005 11:01 PM

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