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type 2 can convert to type 1. LOL

Discussion in 'Parents of Children with Type 1' started by C6H12O6, May 25, 2013.

  1. C6H12O6

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    His other videos were recommended to me for help with interpreting arterial blood gasses

    http://www.youtube.com/watch?v=98uMco2YiCM


    now I am wondering how much to trust the other videos because he says type 2 can convert to type 1

    i don?t even have a youtube account to comment
     
  2. Joretta

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    I think he miss spoke because I know a person can be diagnosed type 2 and actually be a type 1 with resistance. Seems not all doctors think to test hroughly and don't think it is a big deal. But misdiagnoses does happen when child is caught early and does not present skinny.
     
  3. C6H12O6

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    Honestly, I think it is a really common misconception that when a type 2 goes on insulin they convert to type 1. The thing that bothers me about that is that it basically says that type 1 can be caused by lifestyle.
     
  4. Joretta

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    This is where I get confused because your saying a type 2 stays type 2 even if the pancreas stops working. But that a type 1 is a non functioning pancreas. My line is that plus anti bodies I think. I really am not sure but it my daughters doctors. But this then means lots of kids without diabetes are not type 1 and that can't be either. I am not trying to start a debate nor hurt anyone ( so please dont rip me to shreds) but an educated inquiry. This also brings into the slow change of type 1 no longer being Juvenal diabetes if your under 18 you can now have type 2. I think honestly type 2 is a slow onset where diet helps slow the process even allows for remission, whereas, type 1 quick onset is triggered by antibodies and/or some other health issue and is only manageable with medication. I am no doctor nor am I in denial, but I do believe there is so much we do not know.
     
  5. C6H12O6

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    It is a sticky issue. I just do not think going on insulin as treatment for type 2 diabetes means you now have a diagnosis of type 1 diabetes. Even physicians make this error.

    One old term for type 1 was ketosis prone diabetes. I am type 1 and I get large ketones if I get a bad pump site

    Type 2?s who omit or forget their insulin do not tend to go into DKA although they can get into a hyperosmolar hyperglycaemic state. There is literature that says type 2?s can go into DKA, but I have looked at quite a few of those journal articles and the major problem with them is they never describe the methodology of how they clarified someone was type 2. Like C peptide testing etc

    Even a type 2 on insulin still has non insulin dependent diabetes. To me type 1 means if you omit insulin or get a bad pump site you get ketones as a result, and ultimately will become acutely ill without insulin.

    I think it is problematic to say type 2 can convert to type 1, because it is widely accepted that type 2 is linked to lifestyle. Therefore, if it is accepted that type 2 can convert to type 1 that is like saying type 1 can be caused by lifestyle.

    Misdiagnosis is a different story.

    like I said being type 1 means that without insulin you will become acutely ill and die.
     
  6. C6H12O6

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    Also, gastric bypass is known to reverse diabetes in people with type 2 on insulin.

    There are very few people with type 1 who have received gastric bypass. However, in cases of people with type 1 who received gastric bypass their diabetes was not reversed and they did not come off insulin.

    http://care.diabetesjournals.org/content/27/10/2561.full

    To me that just reinforces that being on insulin with type 2 does not mean you have type 1 diabetes. it means you have type 2 diabetes treated with insulin
     
  7. miss_behave

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    Yup, that's correct. T1 and T2 are 2 different diseases with 2 different pathophysiological processes. T1's require insulin due to autoimmune destruction of the insulin-producing beta cells. T2's who require insulin do so as years of insulin resistance (with subsequent over- production of insulin by the pancreas in an effort to combat this) leads to the beta cells basically wearing out. Lack of insulin quickly causes ketosis in T1's as they have little to no insulin production. T2's very rarely experience ketosis.
     
  8. Joretta

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    I appreciate the input and I now see an aspect that I can see is lacking in type 2. Which is a Lack of insulin quickly causes ketosis, which my child has so it helps me understand. Thanks!
     
  9. nanhsot

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    The presence of auto-antibodies is the main difference. The way that I explain it to others is that Type 1 always needs insulin, Type 2 usually can be managed by diet but over time some need to add insulin to their regimen.

    What really compounds the confusion, IMO, is that I believe many Type1s (likely LADA or MODY) are misdiagnosed as Type 2 due to age, medical misinformation, and poor medical care. I've known several people who swear up and down they are T2 because they were diagnosed as an adult, but have needed insulin since the beginning. These are fit people, active, not overweight in any way. Even within the medical community there is misinformation, IMO.
     
  10. ChristineJ

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    Studies have shown that many T2's go on insulin within 10 years of diagnosis, though that does not mean the type of D changes. T2 involves insulin resistance, which can eventually cause such overproduction of insulin that the beta cells die off. T1, of course, results primarily from the autoimmune destruction of beta cells.

    While it may be "widely accepted" by the mis-informed media and others, T2 is not caused by lifestyle. Yes, lifestyle can affect the development and progression, but it does not cause T2. More and more research is showing a large genetic component to T2, as well as some indications of secondary autoimmune activity. There are many people with T2 who are fit, active, and eat healthfully.
     
  11. C6H12O6

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    I have never seen anything that indicates progression to needing insulin with type 2 is a result of declining beta cell function.

    If you know of any evidence I would be interested to see it.

    Ex. Do people with type 2 who are put on insulin have lower c peptide levels?

    People with type 2 who need to be put on insulin do not tend to have weight loss as a result of insulin deficiency. they do not tend to have ketosis. So they don?t show the symptoms that are hallmarks of type 1. Even though type 2?s spill glucose in their urine and there is a loss of calories they don?t tend to lose weight.

    I find it hard to accept the premise that there is insulin deficiency in type 2 bc they would have ketones - as their caloric needs would not be being met if there was not insulin allowing glucose to be converted to energy

    Also , if it was a matter of insulin deficiency when a type 2 goes on insulin why and how does gastric bypass reverse the need for insulin in type 2?s ?

    Type 2 has a totally different pathophysiology it has nothing to do with insulin deficiency. I feel that is a myth, and it blurs the line between type 1 and type 2.

    type 1 is ketosis prone diabetes. that is the most accurate way to describe it. and the fact that type 1 are ketosis prone reveals the nature of the pathophysiology of type 1. the fact that type 2 is not ketosis prone reveals the nature of the pathophysiology of type 2. people with type 2 can present with very high bgs in the 900's yet be morbidly obese
     
  12. Mary Jayne

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  13. C6H12O6

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    They say that beta cell function declines, but do they say how they determined that ? they seem to just state it as a matter of fact.
     
  14. Megnyc

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    This is interesting:

    "Conclusions: With increasing duration of diabetes, the decrease of postprandial insulin secretion is becoming more prominent, and postprandial β-cell responsiveness may be a more important determinant for glycemic control than fasting β-cell responsiveness."

    http://eje-online.org/content/155/4/615.long
     
  15. Megnyc

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    People with type 2 can and do go into DKA though. Obviously, HHS is more common but I am finding 20-30% of patients with previously diagnosed diabetes who present with DKA have type 2 not type 1.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2842543/

    http://clinical.diabetesjournals.org/content/22/4/198.full
     
  16. jilmarie

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    I recently had a middle-aged patient with antibody negative longstanding type 2 diabetes. She had an undetectible c-peptide. Sometimes determining the type of diabetes is not straightforward.

    I'm typing on my phone, so I can't do a literature search, but I think that decline of beta cell function in adults with longstanding type 2 diabetes is pretty well described.
     
  17. C6H12O6

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    My endo claims that being on exogenous insulin suppresses C peptide. Not sure if there is any truth to this at all.

    The only problem that I see with studies that claim that type 2 can get DKA is that they don?t state how they determined the person is type 2. Other than they self report as type 2.

    A lot of this is type 2 diabetes minutia. I don?t think anyone is trying to claim that type 2 transitions to type 1 though.

    I think if anything there is transient beta cell suppression, rather than death. Otherwise how could the need for insulin be reversed by gastric bypass ?
     
  18. Joretta

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    Sounds like there is a lot of information still not known. But it does sound a lot like other chronic illnesses where there are different levels that are caused by various causes and proceeds at various speeds that leads to the final devastating stage of complete dependence that cannot find remission.
     
  19. Megnyc

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    One of the studies I linked above excluded individuals on exogenous insulin from the c-peptide analysis.

    This discusses exogenous insulin and c-peptide in individuals with type 2:
    http://www.ncbi.nlm.nih.gov/pubmed/15936461

    This is fascinating about how gastric bypass actually does reverse type 2. It appears that it is hormones that have something to do with belly fat that result in suppression of beta cell function and that reducing the amount of belly fat increases beta cell function. So you would be correct that beta cells are suppressed rather then dead. But isn't there some research that suggests beta cells are suppressed and can be stimulated to produce insulin in type 1 as well? I thought that was what Dr. Faustman was looking at, though I admit I don't really follow type 1 research as closely as I should.

    http://www.news-medical.net/news/20130228/Study-indicates-how-gastric-bypass-reverses-diabetes.aspx

    Anyway, it obviously has nothing to do with type 1 but I find all this stuff really interesting :D
     
  20. C6H12O6

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    I think beta cells have the ability regenerate just like other tissues in the body, but the problem is that we have various anti islet cell antibodies. So even when they do regenerate they are attacked again.
     

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