What do new doctors need to know about Type 1?

[Unique pixie]

I have a teaching session with medical students in a couple of weeks. I have 25 minutes to talk to them about type 1 and living with it. What would you like your Dr's to know? What should I cover?
Many confuse Type 1 and 2 so I thought I'd cover the difference and awareness of hypos but any ideas otherwise?

 

[Type1Bri]

The need to get on a dose adjustment course for type 1,s. dafne is so important and without it people are at risk

 

[Unique pixie]

So an awareness about the balance between food and insulin?

 

[urbanracer]

NHS dietary advice is wrong.

 

[Unique pixie]

I think it's about stressing the difference between Type 1 and 2 and making them realise that they're different conditions. That would explain the NHS dietary advice. Thoughts?

 

[Type1Bri]

Totally agree about different in type 1 and type 2. Amazing how people think type 2 can develop into type 1.

 

[donnellysdogs]

Give them a handout of this:
It explains what type 1's have to think about each day before we even get out of bed!!

 

[RHNtype1]

This made me laugh, she forgot to add in small details like....the kids, am I angry in a normal way with my teenager or is my sugar high? how long until I need to adjust my basal so I can go to my exercise class? Have I got sweets in my bag in case I go shopping after I drop the wee man to football.....should I take less insulin for this in case we have sex later.......my head hurts have I had a hypo and not noticed, I'm knackered, what's wrong with me? LOL. Rx

Sent from the Diabetes Forum App

 

[urbanracer]

I think it's about stressing the difference between Type 1 and 2 and making them realise that they're different conditions. That would explain the NHS dietary advice. Thoughts?

No, it's not just about the difference. There are people on this forum who've reported being told to INCREASE carb intake. NHS personnel rarely recommend reducing carb intake although most find this highly beneficial.

 

[Type1Bri]

Type 2 should definatly go for the lower carb diet. Type 1 could eat medium carb and bolus for it easily, nobody should aim for a solely high carb diet unless they want big weight gains

 

[Spiker]

Unique pixie , as you are a new user, it would help us to answer your question more effectively if we could know a little bit more about you, what you do, and what your connection with diabetes is & your knowledge of diabetes?

 

[Unique pixie]

OK
Type 1 diabetes since the age of 5. Pump user for 5 years. Healthcare professional but teach undergraduate med students. I have my own ideas about what I'd like to tell them but realise I'm biased, hence the post.

 

[Spiker]

If I had a group of medical students in front of me I would impress this on them as strongly as possible:

- the orthodox medical approach to diabetics of all types is not working, and is making the problem worse.
- even the classification of diabetics into type 1 and 2 is crude and out of date
- that as physicians they should educate themselves on the facts and the research, stay up to date, and not rest on orthodox recommendations. Almost by definition these will always be decades out of date
- in the case of T1 to read the work of Dr Richard Bernstein
- in the case of T2 to read the work or Prof Roy Taylor
- to understand how orthodox medicine can deviate very badly from the scientific data and scientific method, on diabetes and on metabolic syndrome / CVD, read The Diet Delusion by Gary Taubes.

 

[Spiker]

Totally agree about different in type 1 and type 2. Amazing how people think type 2 can develop into type 1.

It's not that surprising if they think about T1 and T2 as two different types of treatment (insulin or non insulin) rather than two kinds of problem (insulin lack or insulin resistance). T2s do sometimes progress to insulin dependency. Also some T2s are misdiagnosed LADAs, who are technically a sub type of T1s.

 

[Jemzor]

There's only so much you'll get into 25 minutes but I would definitely cover hypos & how they should be treated. By the same token, I would also touch on effects of high BG's and long term complications.

 

[NoCrbs4Me]

Everything?

 

[Type1Bri]

It's not that surprising if they think about T1 and T2 as two different types of treatment (insulin or non insulin) rather than two kinds of problem (insulin lack or insulin resistance). T2s do sometimes progress to insulin dependency. Also some T2s are misdiagnosed LADAs, who are technically a sub type of T1s.

Even when insulin dependant type 2 is still not type 1 though, it is not auto immune

 

[zand]

What about 'double diabetes'? Where a T1 also has insulin resistance? (I'm a T2)

 

[smidge]

There are auto-immune and non-auto-immune types of diabetes.

Auto-immune is where the body attacks its own beta cells. In children and some adults this tends to happen very quickly and the person becomes very ill and requires immediate insulin - Type 1. In many adults, it happens over a long or very long period of time and progression to requiring insulin can be quick or slow depending on a number of factors - LADA. Do NOT make the mistake of believing anyone presenting with diabetes over the age of 35 is Type 2 - use diagnostic tests GAD antibody and c-peptide to differentiate - it's important to prognosis, follow-up and ultimately to selecting the appropriate treatment.

Non-autoimmune is where the body produces but cannot effectively use its own insulin - Type 2. Reducing insulin resistance is usually initially the most effective treatment - low-carb diet, exercise, weight loss - these can often stop Type 2 progressing - it does not cure it.

There are other, less common, genetic types of diabetes - MODY - these should be considered where there is family history of genetic types of diabetes, where the person is not auto-immune (rule that out first), where risk factors for Type 2 are missing or where the person does not respond as expected to Type 2 treatments.

That's what I would teach them in a nutshell.

Smidge

 

[Type1Bri]

There are auto-immune and non-auto-immune types of diabetes.

Auto-immune is where the body attacks its own beta cells. In children and some adults this tends to happen very quickly and the person becomes very ill and requires immediate insulin - Type 1. In many adults, it happens over a long or very long period of time and progression to requiring insulin can be quick or slow depending on a number of factors - LADA. Do NOT make the mistake of believing anyone presenting with diabetes over the age of 35 is Type 2 - use diagnostic tests GAD antibody and c-peptide to differentiate - it's important to prognosis, follow-up and ultimately to selecting the appropriate treatment.

Non-autoimmune is where the body produces but cannot effectively use its own insulin - Type 2. Reducing insulin resistance is usually initially the most effective treatment - low-carb diet, exercise, weight loss - these can often stop Type 2 progressing - it does not cure it.

There are other, less common, genetic types of diabetes - MODY - these should be considered where there is family history of genetic types of diabetes, where the person is not auto-immune (rule that out first), where risk factors for Type 2 are missing or where the person does not respond as expected to Type 2 treatments.

That's what I would teach them in a nutshell.

Smidge

100% bang on analysis smidge
Exactly what all gp's should know