Mehnert-kolumne: Das Ist Bei Double Diabetes Zu Tun
Etwa jeder zehnte Typ-1-Diabetiker bekommt in seinem Leben noch eine Typ-2-Erkrankung hinzu. Zu erwgen sind dann orale Antidiabetika zustzlich zur Insulintherapie. Arbeitsschwerpunkte: Diabetologie, Ernhrungs- und Stoffwechselleiden: Diesen Themen widmet sich Prof. Hellmut Mehnert seit ber 50 Jahren. Erfahrungen: 1967 hat er die weltweit grte Diabetes-Frherfassungsaktion gemacht sowie das erste und grte Schulungszentrum fr Diabetiker in Deutschland gegrndet. Ehrung: Er ist Trger der Paracelsus-Medaille, der hchsten Auszeichnung der Deutschen rzteschaft. Typ-1- und Typ-2-Diabetes sind zwei unterschiedliche Krankheitsbilder. Typ-1-Diabetes ist eine Autoimmunkrankheit, die sich durch Autoimmunmarker noch vor der Manifestation ankndigt. Je mehr dieser Marker bei einem Menschen frh auftreten, umso hher ist die Wahrscheinlichkeit, dass ein Typ-1-Diabetes entsteht. Da dann der diabetische Prozess relativ rasch verluft, ist die Phase zwischen Manifestation und endgltiger Diagnose sehr kurz. Ganz anders beim Typ-2-Diabetes: Hier rechnet man immer noch mit acht bis zehn Jahren Abstand zwischen Manifestation und Diagnose. Betroffene haben daher oft bereits bei der Diagnose Gef- und Nervenkomplikationen. Viele haben zudem ein metabolisch-vaskulres Syndrom in verschieden starker Ausprgung mit Hypertonie, Dyslipoproteinmie, androider Fettsucht, Gerinnungsstrung, Fettleber und womglich schon einer gestrten Glucosetoleranz. In den Vorstadien dominiert bei Typ-2-Diabetes eine Insulinresistenz, aber schon mit der Manifestation macht sich das zunehmende Defizit an endogenem Insulin bemerkbar. Insulin-Resistenz und -Mangel bestimmen die Pathogenese der Erkrankung. Es gibt zudem Situationen, in denen beide Diabetesformen zusammen auftreten. Bei etwa jedem zehnten Typ-1-Diabetiker kommt im Continue reading >>
Type 1.5 Diabetes
A form of diabetes sometimes called “double diabetes,” in which an adult has aspects of both Type 1 and Type 2 diabetes. Over the past three decades, diabetes researchers have gradually fine-tuned the classification of different underlying diseases that comprise diabetes. In the early 1970’s, they spoke of “juvenile-onset” and “adult-onset” diabetes to distinguish between two seemingly different forms of the disease based on when they tended to appear; however, sometimes the “juvenile” form showed up in adults. They later coined the terms “insulin-dependent” and “non-insulin-dependent” diabetes to distinguish between the two basic forms of the disease based on how they were treated rather than the age of onset. But this, too, was confusing because some people with non-insulin-dependent diabetes also used insulin. So scientists had to come up with yet another classification system. In the late 1990’s, they began classifying the two major types of diabetes by their underlying metabolic problems and called them Type 1 and Type 2. Type 1 diabetes is characterized by autoimmune destruction of pancreatic beta cells (and the resulting production of little or no insulin), and the presence of certain autoantibodies against insulin or other components of the insulin-producing system such as glutamic acid decarboxylase (GAD), tyrosine phosphatase, and/or islet cells. It often develops in children (although it can occur at any age) and requires insulin treatment for survival. Type 2 diabetes is characterized by insulin resistance and beta-cell dysfunction, usually develops in adults (although it is now occurring with alarming frequency in children), does not show signs of autoimmune disease, and usually does not require insulin to maintain survival (at l Continue reading >>
Defining Double Diabetes In Youth: Nutrition Intervention And Treatment Guidelines
The prevalence of type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in youth is on the rise. The increased incidence of obesity makes classifying diabetes difficult. At diagnosis, most young people present with characteristics of either T1DM or T2DM. Young people with double diabetes are obese, insulin resistant and have the immunological markers of T1DM. The appropriate markers must be used to identify double diabetes. Complications of double diabetes include abnormal lipids, polycystic ovary syndrome, hypertension, vitamin D inadequacy, and increased cardiovascular risk. Medical nutrition therapy is vital to the treatment and prevention of double diabetes and its complications. Department of Clinical Nutrition and the Diabetes Center for Children, The Children's Hospital of Philadelphia, Pennsylvania. Correspondence: Kelly Estell, RD, CDE, LDN, Department of Clinical Nutrition and the Diabetes Center for Children, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104 ( [email protected] ). The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article. 2012 Lippincott Williams & Wilkins, Inc. Thought you might appreciate this item(s) I saw at Topics in Clinical Nutrition. Your message has been successfully sent to your colleague. Some error has occurred while processing your request. Please try after some time. Continue reading >>
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Tweet Double diabetes is when someone with type 1 diabetes develops insulin resistance, the key feature of type 2 diabetes. Someone with double diabetes will always have type 1 diabetes present but the effects of insulin resistance can be reduced somewhat. The most common reason for developing insulin resistance is obesity and whilst type 1 diabetes is not itself brought on by obesity. People with type 1 diabetes are able to become obese and suffer from insulin resistance as much as anyone else. What is the difference between type 1 and type 2 diabetes? Type 1 diabetes is an autoimmune disease whereby the body’s immune system attacks and kills off its own insulin producing cells. The autoimmune effect is not prompted by being overweight. Over a period of time, the vast majority, if not all, of insulin producing cells are destroyed. Without being able to produce insulin, blood sugar levels rise and the symptoms of diabetes appear. Type 2 diabetes is closely related to obesity, 85% of cases of type 2 diabetes occur in people who are obese. Although the process is not yet fully understood, it is largely believed that obesity causes the body’s cells to become resistant to insulin. As a result, people with either type 2 diabetes or pre-diabetes start to produce more insulin than those without the condition and one of the consequences of this is further weight gain which helps to reinforce the condition. Type 2 diabetes develops gradually, usually over a period of years before symptoms, such as frequent urination, become noticeable. Progression of double diabetes Similar to type 2 diabetes, double diabetes, if not treated appropriately can become more severe over time. If double diabetes is allowed to progress more insulin will need to be injected which promotes further w Continue reading >>
Your browser does not support the NLM PubReader view. Go to this page to see a list of supporting browsers. Korean Diabetes J. 2009 Feb;33(1):1-8. Korean. Published online February 28, 2009. Copyright 2009 Korean Diabetes Association 1Department of Internal Medicine, Service Support Group, Ministry of National Defense of Korea, Seoul, Korea. 2Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, Korea. 3Research Institute of Endocrinology, Kyung Hee University School of Medicine, Seoul, Korea. Generally, most cases of diabetes mellitus (DM) are classified as either type 1 DM or type 2 DM based on their pathophysiolgic features. However, it is not always possible to classify this disease clearly according to current diagnostic criteria. Recently, the existence of non-typical diabetes has been found in patients with simultaneous features of both type 1 and type 2 DM. In these patients, obvious evidence of insulin resistance, positivity of islet autoantibody, and progressive beta cell loss are observed concurrently. Moreover, this non-typical diabetes that usually occurs among children and adolescents has been defined as 'double diabetes', and its worldwide incidence has been on the increase as of late. Thus, there has been heightened interest among researchers about this ambiguous condition. Keywords: Autoimmunity; Biological Markers; Diabetes Mellitus; Genetic Predisposition to Disease American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2009;32 suppl 1:S62S67. Atkinson MA, Maclaren NK. The pathogenesis of insulin-dependent diabetes mellitus. N Engl J Med 1994;331:14281436. DeFronzo RA. Pathogenesis of type 2 diabetes mellitus. Med Clin North Am 2004;88:787835. Kolb H, Mandrup-Poulsen T. An Continue reading >>
The Causes Of Insulin Resistance In Type 1 Diabetes, Type 2 Diabetes And Prediabetes (video)
Most people believe that people with type 1 diabetes are not insulin resistant simply because they are not overweight. This could not be farther from the truth. While insulin resistance affects many overweight individuals, many people with type 1 diabetes remain skinny their entire lives despite a large degree of insulin resistance (1–3). Over the past decade, I have helped many people with type 1 diabetes measure, track and reverse insulin resistance. In practice, 100% of all my clients with type 1 diabetes suffer from insulin resistance despite the assumption that they were insulin sensitive. By measuring their baseline insulin resistance, we were able to identify an impaired ability to utilize glucose as a fuel, and through dedicated diet modification and frequent exercise, some of my clients have reduced their insulin usage by as much as 60%. If you have type 1 diabetes, do not be fooled into thinking that you are insulin sensitive simply because you are skinny. Insulin resistance is a hidden condition, and affects both normal weight and overweight individuals (1–3). What Causes Insulin Resistance? Insulin resistance underlies all forms of diabetes, and is a condition which primarily affects your muscles, liver and adipose tissue. Many people think that diabetes is caused by an excess intake of sugar and candy starting from a young age. While eating artificial sweeteners and drinking soda can certainly increase your risk for the development of insulin resistance and diabetes, in most cases diabetes is caused by excessive FAT intake. The most important thing you can do as a person with diabetes is understand the following: Diabetes is caused by a fat metabolism disorder, which results in a glucose metabolism disorder. At the heart of all forms of diabetes is insu Continue reading >>
Insulin Resistance In Type 1 Diabetes: What Is ‘double Diabetes’ And What Are The Risks?
Go to: Double diabetes The term ‘double diabetes’ was first coined in 1991 based on the observation that patients with type 1 diabetes who had a family history of type 2 diabetes were more likely to be overweight and rarely achieved adequate glycaemic control even with higher insulin doses . The more extensive, or stronger, the family history, the higher the dose the patient received. The authors suggested that this might indicate the presence of increased resistance to insulin-mediated glucose disposal in this subgroup of people with type 1 diabetes and asserted that, over a lifetime, some of these individuals would likely have been diagnosed with type 2 diabetes at some point, had they not first developed beta cell destruction by an independent pathological process (i.e. type 1 diabetes). At this stage, it is important to differentiate this description of double diabetes, which considers autoimmune diabetes to be an independent process from obesity and insulin resistance, from the accelerator hypothesis , which describes triggering of autoimmune diabetes by factors including BMI and insulin resistance. Other studies of people with type 1 diabetes and a family history of type 2 diabetes have supported the notion that this combination might promote both microvascular and macrovascular complications of type 1 diabetes. For example, in a prospective study of 3250 patients with type 1 diabetes recruited from 16 European countries (EURODIAB), it was demonstrated that women with a parental history of type 2 diabetes had a higher risk of developing albuminuria than those without a positive family history (HR 1.36, p = 0.04) . Furthermore, in a cross-sectional study of 658 patients from the Pittsburgh Epidemiology of Diabetes Complications (EDC) cohort, 112 of who Continue reading >>
"Diabetes" redirects here. For other uses, see Diabetes (disambiguation). Diabetes mellitus (DM), commonly referred to as diabetes, is a group of metabolic disorders in which there are high blood sugar levels over a prolonged period. Symptoms of high blood sugar include frequent urination, increased thirst, and increased hunger. If left untreated, diabetes can cause many complications. Acute complications can include diabetic ketoacidosis, hyperosmolar hyperglycemic state, or death. Serious long-term complications include cardiovascular disease, stroke, chronic kidney disease, foot ulcers, and damage to the eyes. Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced. There are three main types of diabetes mellitus: Type 1 DM results from the pancreas's failure to produce enough insulin. This form was previously referred to as "insulin-dependent diabetes mellitus" (IDDM) or "juvenile diabetes". The cause is unknown. Type 2 DM begins with insulin resistance, a condition in which cells fail to respond to insulin properly. As the disease progresses a lack of insulin may also develop. This form was previously referred to as "non insulin-dependent diabetes mellitus" (NIDDM) or "adult-onset diabetes". The most common cause is excessive body weight and insufficient exercise. Gestational diabetes is the third main form, and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels. Prevention and treatment involve maintaining a healthy diet, regular physical exercise, a normal body weight, and avoiding use of tobacco. Control of blood pressure and maintaining proper foot care are important for people with t Continue reading >>
Type 1 And Type 2 Diabetes At The Same Time?
One thing I hear occasionally among type 1 diabetics is, “Well, at least I can’t get type 2 diabetes!” This reasoning makes sense if you think only about the two diabetes as two points along a single spectrum, with type 2 diabetes being a metabolic disease that is “the less severe” type 1 diabetes. I felt compelled to answer: Yes, yes you can. You absolutely can. Yes you can have type 1 and type 2 diabetes at the same time. You’re unlikely to get diagnosed with type 2 diabetes if you already have type 1, because it’s hard to measure the difference in blood sugar values, but you can still suffer from both types of diabetes simultaneously. Consider: type 1 diabetes is an autoimmune disorder characterized by the T cell mediated destruction of the insulin-producing beta cells. In other words, no beta cells. Type 2 diabetes is a metabolic disorder characterized by insulin resistance in many of the cells in the body, and can progress to stress-induced (we think) death of the beta cells. So, if your beta cells are already gone as a result of type 1 diabetes, they can’t die again because of type 2. But you can definitely become insulin resistant, due to obesity, genetic predisposition, and/or hyperinsulinemia. As if type 1 diabetes weren’t hard enough– consider doing it while your body is insulin resistant as well. Ugh. Don’t do it, people– watch your weight, stay active, eat well. Avoid type 2 diabetes, especially if you’re a type 1 diabetic. I am thinking about all of this in the wake of having watched the HBO miniseries/documentary, The Weight of the Nation. I highly recommend it– it was made in conjunction with the NIH, and hits a nice balance of being understandable and compelling, and being scientifically based. Plus, Francis Collins makes seve Continue reading >>
There were no diabetes "types" when I was diagnosed in 1945. All people diagnosed with diabetes were treated with insulin taken from pigs and cows. That crude form of insulin gave me back my health. In the years 1936-1939 it was discovered that there were two types of diabetes, but it was not until 1959 that the labels Type 1 and Type 2 were attached. Oral drugs for Type 2 diabeti...cs were introduced in the years 1955-1956. Now, in current times, we are seeing more and more people with characteristics of both type 1 and type 2 diabetes. These individuals have "double diabetes". This occurs when: 1. A person with type 1 diabetes becomes overweight and develops the basic feature of type 2 diabetes insulin resistance (IR). Typically, the type 1 diabetic would then use a type 2 medication to help control the IR. Insulin would still be necessary as well. 2. A person with type 2 diabetes has one of the key features of type 1 the presence of antibodies in the blood against the insulin producing beta cells of the pancreas causing a decrease in the body's ability to produce insulin. The decreased insulin production can then lead to the type 2 diabetic becoming insulin dependent. These individuals still use their type 2 medication for their IR. So double diabetics may have initially been either type 1, or type 2. Once they have become double diabetics they have IR, they are using insulin, and they are using a medicine (usually metformin) for their IR. I have several type 1 friends, and type 2 friends, who are double diabetics. Some of my type 2 friends are using a pump and a CGM. In the 1990s I stopped using animal insulins, and began using synthetic insulins. I began gaining weight, even though I was following a much healthier diet, and eating fewer carbs. The only thing that Continue reading >>
Payperview: Double Diabetes: A Mixture Of Type 1 And Type 2 Diabetes In Youth - Karger Publishers
I have read the Karger Terms and Conditions and agree. The increase in the incidence of type 1 diabetes (T1D), especially in children <5 years of age reported over the past decade can be attributed to changes in environmental factors, either quantitative or qualitative, rather than to an effect of genetic factors operating in such a short period of time. The notable increase in the incidence of type 2 diabetes (T2D) in children and adolescents is very likely the consequence of the increase in obesity and sedentary life style occurring in developed countries. The increase in the number of children and adolescents with a mixture of the two types of diabetes has recently come to light (i.e. subjects who are obese and/or with signs of insulin resistance as well as positive for markers of autoimmunity to cells). Under the current classification, it is difficult to define the type of diabetes affecting these young subjects, being classified as T2D because they are obese and insulin resistant, but also as T1D because of the presence of auto-antibodies to cells. There is no doubt that these subjects show an overlapping diabetes phenotype typical of both T1D and T2D suggesting that the current classification of diabetes should be revised taking into account this new form of diabetes which has called double diabetes or hybrid diabetes. Continue reading >>
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Type 1.5 Diabetes: An Overview
Type 1.5 Diabetes (T1.5D) is also known as Latent Autoimmune Diabetes of Adults (LADA). LADA is considered by some experts to be a slowly progressive form of Type 1 Diabetes (T1D) while other experts in the field consider it a separate form of Diabetes. LADA or T1.5D is sometimes thought of as T1D that is diagnosed in adults over the age of 30—T1D is commonly diagnosed in children and younger adults. T1.5D is often found along with Type 2 Diabetes (T2D): up to 25% of individuals with T1.5D also have characteristics of T2D.1 This is sometimes called “double diabetes”. Individuals with T1.5D are all eventually dependent on insulin for treatment, and have a very high risk of requiring insulin within months or years (up to six years) after the initial diagnosis. This is in contrast to people with T1D—these people tend to need insulin within days or weeks of diagnosis.2 Individuals diagnosed with T2D relatively rarely require insulin treatment. Current recommendations are to treat individuals with T1.5D immediately with insulin, though this is not universally accepted (see below). The Causes of T1.5D Just as with other forms of diabetes, we don’t truly understand the underlying cause(s) of T1.5D. There are autoimmune components in Types 1, 1.5 and 2 diabetes with some overlap in the types of antibodies formed, so it is clear that as in T1D, the immune system has become “confused” and begins to act against the beta cells of the pancreas—the source of the insulin needed to control blood sugars. Both T1D and T1.5D have antibodies to glutamic acid decarboxylase or anti-GAD antibodies. As with T1D, individuals with T1.5D tend not to be obese, whereas in T2D, most individuals are overweight or obese. Genetics and Environmental Susceptibility Individuals with T1.5D Continue reading >>
The 'double' Whammy: What Is Type 3 Diabetes?
The 'Double' Whammy: What is Type 3 Diabetes? Being diagnosed with diabetes by your physician is enough of a shocker. Now, some patients are learning that not only do they suffer from one type of diabetes, but two types simultaneously. Indeed, type 3 diabetes – also known as hybrid or double diabetes – is a new and dangerous phenomenon that has many health officials deeply concerned. As we enter National Diabetes Month, learn the signs and symptoms of diabetes as well as how to help loved ones with this disease. What is type 3 diabetes, and how can you prevent it? Read on, and don't forget to take the quiz to test your sugar IQ... There's a new public health threat, and it means business. The phenomenon is known as “double diabetes” or “hybrid diabetes,” and it’s harder to diagnose and significantly more difficult to treat. This new breed of disease is also sometimes referred to as "diabetes 1-1/2 ," or type 3 diabetes. What has been called double diabetes can strike at any age. According to recent reports, physicians are seeing increasing numbers of patients with double diabetes, in which an individual has the symptoms of both type 1 and type 2 diabetes. Treatment is especially difficult in children. Type 1 or insulin-dependent diabetes, which affects 5% of all diabetics, happens when the body's immune system attacks the insulin-producing cells of the pancreas. When the body cannot turn blood sugar, or glucose, into energy – either because it does not produce enough insulin or does not use it correctly – diabetes will result. Although it was previously thought that type 1 diabetes only occurs in children, it is now known that it also can develop in adults. However, type 1 is still the rarest form. The majority of diabetics nationwide suffer from type Continue reading >>
Types Of Diabetes
What Is Type 1 Diabetes? Type 1 diabetes, formerly called juvenile diabetes, is an autoimmune disease where the body's own immune system destroys the insulin-producing beta cells in the pancreas. People with type 1 usually have certain autoantibodies that may appear years before the disease develops, even in the womb. These autoantibodies are used as markers of the disease, but do not necessarily cause the beta cell destruction. Some people, in fact, have these autoantibodies but never develop diabetes (Narendran et al. 2005). (The immune cells that cause the beta cell destruction are thought to be largely T-cells (CD4+ and CD8+), although other immune cells may also play a role.) A number of genes have been identified that are associated with the risk of developing type 1 diabetes. Some people, then, have a higher genetic risk than others, in other words, are more genetically susceptible. The genetic component of type 1 diabetes, however, is "neither sufficient nor necessary" (Vehik et al. 2008). That is, there is some environmental component to the disease: someone with high genetic risk might never develop it, while someone with low genetic risk might. More than 85% of the people who do develop type 1 diabetes do not have a parent or sibling with the disease (Larsson et al. 2004). (See the section at the bottom of this page for more on genetics). Type 1 has been divided into type 1A and type 1B, where type 1A has an autoimmune cause, and type 1B is "idiopathic" diabetes, that is, has no known cause. People diagnosed with type 1B show signs of type 1 but have no evidence of autoimmunity (American Diabetes Association, 2011). A surprisingly high percentage (16%) of children and young adults newly diagnosed with type 1 diabetes in a Colorado diabetes center test negativ Continue reading >>
Do You Know The 5 Types Of Diabetes?
(BlackDoctor.org) — What is diabetes? Essentially, it’s a disorder where your body has problems producing or effectively using insulin, which can, in turn, cause many other mild to severe health problems. There are several different causes of insulin problems – managing your diabetes will depend on which type you have. Type 1 Diabetes: Little To No Insulin With type 1 diabetes, which used to be called juvenile diabetes, your body does not produce insulin or produces very little. Type 1 diabetes is known as an autoimmune disease because it occurs when your immune system mistakenly attacks the insulin-producing cells in your pancreas. Type 1 diabetes usually develops in children and young adults and accounts for 5 to 10 percent of diabetes cases in the United States. Symptoms may include thirst, frequent urination, increased hunger, unexplained weight loss, blurry vision, and fatigue. People who have type 1 diabetes need to take insulin injections daily to make up for what their pancreas can’t produce. Type 2 Diabetes: Insulin Resistance Type 2 diabetes, which used to be called adult-onset diabetes, is the most common form of diabetes, accounting for 90 to 95 percent of diabetes cases. While most people who develop type 2 diabetes are older, the prevalence of type 2 diabetes in children is on the rise. The exact cause of type 2 diabetes is largely unknown, but the disease tends to develop in people who are obese and physically inactive. People who have a family history of diabetes or a personal history of gestational diabetes are also at increased risk of developing type 2 diabetes. In addition, certain groups, particularly African Americans, have a higher risk of developing type 2 diabetes. Symptoms of type 2 diabetes usually develop gradually, and are similar to Continue reading >>