T1 or T2 - whats the difference?

[lucylocket61]

The question title says it all really.

Up until recently, I thought T2's were not on insulin, and T1's were.

Then I thought it was to do with T2's producing a bit of insulin, and T1's none

Then I thought it was to do with weight at diagnosis, or age at diagnosis.

Now I am totally confused. Do T2's turn into T1's when they start insulin, or what?

:crazy:

 

[smidge]

Hi Lucy!

No, Type 2s never turn ito Type 1s even if they start using insulin. The thing with different Types of diabetes is that the symptoms are the same - high blood glucose - but the conditions are actually quite different. It's nothing to do with age, weight, use of insulin or any of the other things that popularly get bandied around.

Type 1 (and it's variants such as LADA, Type 1.5 etc) is an autoimmune condition primarily. The body's immune system goes wrong and attacks itself, killing the pancreatic beta cells - either quickly (Type 1) or more slowly (LADA). The result is an inability to produce sufficient insulin and therefore high blood glucose. This is sometimes hereditary, but not always. It is always progressive and eventually requires insulin. It is sometimes accompanied by other autoimmune conditions such as thyroid problems.

Type 2 (and its variants such as some of the MODY types) is a metabollic condition primarily. The endocrine system develops a defect whereby insulin is produced but cannot be used effectively. The reasons for this differ between different forms of the condition and between individuals, but in most Type 2s, the common reason is insulin-resistance. (In some of the MODY forms, there is no insulin resistance, but a genetic defect). Insulin-resistance can sometimes be reversed by weight loss, exercise and reduced-carb diet. If bllod sugars remain high for too long, the pancreatic beta cells will die and insulin production will diminish or cease. At this stage, insulin is required, but that doesn't make a Type 2 become a Type 1. There are still differences. For example, the type 2 will still probably have insulin resistance and require larger doses of insulin - and possible different types of insulin to a Type 1. Also, Type 2 is often accompanied by other metabolic conditions such as high blood pressure and high levels of cholestorol - this is less common in Type 1.

For both Types, the treatment aims to manage BGs to 'safe' levels, thereby reducing the risk of diabetic complications such as retinopathy, heart diseaese, strokes, neuropathy etc etc etc. However, the appropriate treatment might differ for the two conditions.

Hope this helps to explain.

Smidge

 

[ladybird64]

While you wait for the experts to explain all the facts, you've got me..and my simple answers.

My 22 year old daughter is a type 2 diagnosed when she was 18, she has other health issues too. She was put on insulin at the age of 20..she is still type 2. She started insulin after trials with other injectable diabetes meds as well as oral medsdid not help her.

She is obese. So, unusual but not unheard of.

Now lets await the others.

Ah, sorry Smidge..we posted at the same time!

 

[borofergie]

T1s can eat 12 Jaffa Cakes, not just 10.

I don't think that there is much actual difference between a T2 with a failed pancreas and a T1, which is why there are a few people that get a weird T1.5 diagnosis.

 

[smidge]

T1s can eat 12 Jaffa Cakes, not just 10.

I don't think that there is much actual difference between a T2 with a failed pancreas and a T1, which is why there are a few people that get a weird T1.5 diagnosis.

Mmm...the two conditions certainly get more alike if the Type 1 eats the 12 Jaffa cakes, jabs a load of insulin to cover and ends up insulin resistant!

The really important thing, though, is that Type 2s generally have it within their power to prevent their condition progressing. I'd certainly swap the extra 2 Jaffa cakes for that!

Smidge

 

[Grazer]

Hi Lucy!


Type 2 (and its variants such as some of the MODY types) is a metabollic condition primarily. The endocrine system develops a defect whereby insulin is produced but cannot be used effectively. The reasons for this differ between different forms of the condition and between individuals, but in most Type 2s, the common reason is insulin-resistance. (In some of the MODY forms, there is no insulin resistance, but a genetic defect). Insulin-resistance can sometimes be reversed by weight loss, exercise and reduced-carb diet. If bllod sugars remain high for too long, the pancreatic beta cells will die and insulin production will diminish or cease. At this stage, insulin is required, but that doesn't make a Type 2 become a Type 1. There are still differences. For example, the type 2 will still probably have insulin resistance and require larger doses of insulin - and possible different types of insulin to a Type 1. Also, Type 2 is often accompanied by other metabolic conditions such as high blood pressure and high levels of cholestorol - this is less common in Type 1.
Smidge

Whereas I don't disagree with any of this as such, the insulin resistance story always leaves me in doubt. Take me. I was never really overweight, and my diabetes was caught luckily at an early stage by chance. Now, my BMI is 22, my waist is 34ins and my blood pressure is normal for a young man. If insulin resistance could be reversed, I must have done it. By theory, my beta cells shouldn't have died as I've not been exposed to high sugar levels for long and now theyre normal. So I shouldn't be diabetic right? But I am. I believe that all full type 2s have beta cell destruction, but that it can either be caused by continuous pancreatic stress through undetected insulin resistance causing sustained very high insulin production because if high BGs, OR, that you can just have a genetically deficient pancreas that runs out of beta cells prematurely. ALL people with age lose pancreatic function. I saw an estimate that the average 60 yr old is down to 70% of beta cells. So if you had less to start, you could just run out sooner. If I then abused a smaller supply of beta cells with too many sweet carbs, they die sooner again. Remember, beta cells don't rebuild, they are a finite supply. Just my theory, but I wonder if studies have been done on quantities of beta cells and variation across younger non diabetics? Anyone know?

 

[borofergie]

T1s can eat 12 Jaffa Cakes, not just 10.

I don't think that there is much actual difference between a T2 with a failed pancreas and a T1, which is why there are a few people that get a weird T1.5 diagnosis.

Mmm...the two conditions certainly get more alike if the Type 1 eats the 12 Jaffa cakes, jabs a load of insulin to cover and ends up insulin resistant!

The really important thing, though, is that Type 2s generally have it within their power to prevent their condition progressing. I'd certainly swap the extra 2 Jaffa cakes for that!

Smidge

I don't really think that T1s "eat all the Jaffa cakes" I was just teasing Lucy over her Jaffa Cake shaped meltdown yesterday.

 

[smidge]

Hey Grazer!

No idea if people have different supplies of beta cells, but I'd put money on Type 2 actually covering a whole range of different diabetic conditions that just haven't been identified yet. Maybe some people produce 'defective' insulin whereas others produce good insulin but have cell resistance. And maybe beta cells can be replenished. I live in hope! Who knows?

Stephen - I have Jaffa cake envy at anyone who can eat them LOL

Smidge

 

[Unbeliever]

I was told by a diabetes specilist GP that , as a slim T" I had probably been diabetic all my adult life but that my pancreas had been producing extra insulin to compensate for the insulin resistance and when I wwas diagnosed just before age 60 i was because my beta cells were finally depleted.

Sounds reasonable and I can accept the pronciple, but I was diagnosed entirely by accident and had shown no symptoms although I had experienced symptoms ten years earlier which were dismissed.

Alhough I had never been overweight at all my weight had flucuated from ime o time. As I am only 5'2 this was always immediately noticeable . But I thought it was all part of being female.

I have learnt , since diagnosis , that the pancreas and beta cells don't deteriorae gradually and regularly but In bursts ad then things setle for a while - or even appear to improve.

There is still a lot to be learned abut it all. I think that all tyopes of diabetes are more closely related than we hink. oth yoes can have a genetic connection and I am sure that both types may also be auto -immune. I don't know why say both types. I know there are far more types - but then again, maybe there are no types -just individuals with a fauly pancreas or problems with insulin production and resistance. It would be good o be treated as an individual. The one-size fits all -approach doesn' work and probably causes more problems han it solves.

 

[lucylocket61]

Smidge said:

The really important thing, though, is that Type 2s generally have it within their power to prevent their condition progressing.

can you tell me what that power is? From what I read, even low-carbing may not work long term to stop progression.

 

[borofergie]

Smidge said:

The really important thing, though, is that Type 2s generally have it within their power to prevent their condition progressing.

can you tell me what that power is? From what I read, even low-carbing may not work long term to stop progression.

Well if you read the "standard NHS party message" then T2 diabetes is always progressive. If you follow their preferred "carbs with every meal" and "keep adding more medications" treatment approach, then they are probably right, your diabetes will almost certainly progress. It's kind of a self fulfilling prophecy.

If on the over hand, you maintain excellent control and get a normal(ish) HbA1c and lose some weight (if you have some to lose), it's a bit difficult to see the mechanism by which it can progress. I'm certainly not going to damage my pancreas by overworking its insulin production capacity, because I eat hardly and carbs, and presumably produce very little insulin to deal with them.

There are lots of anecdotal claims of people that have managed to control their T2 for many years without any deterioration. Obviously you can't guarantee anything, but the good news is, that if your T2 does get worse you still get to work through all medication and good stuff.

I'd bet any amount of money that I will never experience any diabetic complications.