Diabetes Types 1 and 2 Combined for Some
It is a scene occurring with increasing frequency in physicians' offices across America: A patient comes in with all the symptoms of obesity-linked type 2 diabetes, but a physician finds both type 2 and type 1.
 In some cases the blood tests reveal antibodies to the pancreatic beta cells that produce insulin - a sign that the patient also has the rarer type 1 form of the disease.
"We call it 'double diabetes,' or hybrid diabetes," says Dr. Francine Kaufman, past president of the American Diabetes Association (ADA) and head of the Center for Diabetes and Endocrinology at Children's Hospital, Los Angeles.
She and other experts warn that a growing number of patients are being spotted with both forms of the disease.
In type 1 diabetes, which affects 5 percent of all diabetics, the body's immune system turns against beta cells in the pancreas that produce the insulin needed to regulate blood sugar.
Type 1 diabetics typically must take daily insulin via injection to remain healthy.
In the much more common obesity-linked type 2 variety, increasing demand from the body fat's cells causes a gradual shortfall of, and resistance to, insulin.
Medication and regular monitoring of blood sugar are essential to keep type 2 patients safe and healthy.
Dr. Kaufman, a pediatric endocrinologist, says "double diabetes" is a phenomenon that is being increasingly recognized by physicians. In fact, recent reports suggest that up to 30 percent of newly diagnosed diabetes among children involves youngsters with both type 1 and type 2 disease.
"They may clinically look like they have type 2 - be overweight and maybe have a family history of type 2 - but then they come back positive for [type 1] antibodies," says Dr. Kaufman.
On the flip side, other young patients may have had type 1 since childhood, become obese in adolescence "and begin to look like they have elements of type 2 diabetes," notes Dr. Kaufman. "They are becoming more and more insulin-resistant. So, it can go either way."
America's obesity epidemic is clearly driving the trend toward more and more diabetes, experts say. And while links between obesity and type 2 diabetes have long been clear, research is only just beginning to suggest it can also trigger late-onset type 1 disease.
"With the diet being hypercaloric and high in simple carbohydrates, the [pancreatic] beta cells that remain are taxed earlier," says Dr. Stuart Weiss, an assistant clinical professor of medicine at the New York University School of Medicine in New York City. "That would explain type 1 disease complicated by diet."
Dr. Weiss deals mainly with adult patients, and says he is seeing more and more 20- and 30-somethings with newly diagnosed double diabetes.
"Many are type 1s who have already been diabetic for years, and who are also eating a hypercaloric diet and require a lot more insulin," he says. "They become obese, and then become insulin-resistant."
Dr. Kaufman says treatment for double diabetes may be more complex than that provided to patients with type 1 or 2 alone.
"It may mean that someone needs insulin and pills," she says.
Individuals who believe they might be diabetic need to get the condition recognized and treated as soon as possible, cautions Dr. Weiss.
"Whether it's type 1 or type 2, we have to look at the cardiovascular risk factors, waist-to-hip ratios, blood triglycerides, and cholesterol issues that are common to all diabetics," he says. "That's where I think the focus should be - not just in managing glucose, but in managing the consequences."
And he notes that good treatments are available.
"Diabetes is a real problem - it's always been there, but it's been under-treated and under-managed," Dr. Weiss comments. "Now we have good tools to manage it, so there's less of an excuse for physicians not to treat it well."
Of course, prevention remains the best answer to fighting the disease. For parents, that means "trying to have your child keep to as close a healthy weight as possible, eating appropriate foods in appropriate quantities, and being active," says Dr. Kaufman.
"We're looking at a world now in which the rate of diabetes just continues to increase," she adds. "We should all be aware of this disease and try and minimize it in every way we can."
Always consult your physician for more information.
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Diabetes is a metabolic disorder characterized by a failure to secrete enough insulin, or, in some cases, the cells do not respond appropriately to the insulin that is produced.
Because insulin is needed by the body to convert glucose into energy, these failures result in abnormally high levels of glucose accumulating in the blood.
Diabetes may be a result of other conditions such as genetic syndromes, chemicals, drugs, malnutrition, infections, viruses, or other illnesses.
The three main types of diabetes - type 1, type 2, and gestational - are all defined as metabolic disorders that affect the way the body metabolizes, or uses, digested food to make glucose, the main source of fuel for the body.
In prediabetes, blood glucose levels are higher than normal but not high enough to be defined as diabetes. However, many people with prediabetes develop type 2 diabetes within 10 years, states the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
Prediabetes also increases the risk of heart disease and stroke. With modest weight loss and moderate physical activity, people with prediabetes can delay or prevent type 2 diabetes.
How does diabetes affect blood glucose?
For glucose to be able to move into the cells of the body, the hormone insulin must be present. Insulin is produced primarily in the pancreas, and, normally, is readily available to move glucose into the cells.
However, in persons with diabetes, either the pancreas produces too little or no insulin, or the cells do not respond to the insulin that is produced. This causes a build-up of glucose in the blood, which passes into the urine where it is eventually eliminated, leaving the body without its main source of fuel.
According to the American Diabetes Association (ADA), 20.8 million people - 7 percent of the US population - have diabetes. Of this number, 14.6 million persons have been diagnosed and 6.2 million persons are undiagnosed.
A more alarming figure is the statistic for prediabetes, a condition that precedes diabetes - 41 million persons.
In 2005, 1.5 million new cases of diabetes were diagnosed in people aged 20 years or older, states the ADA.
Diabetes is the sixth leading cause of death among Americans, and the fifth leading cause of death from disease.
Although it is believed that diabetes is under-reported as a condition leading to or causing death, each year, more than 200,000 deaths are reported as being caused by diabetes or its complications. Complications of diabetes include eye problems and blindness, heart disease, stroke, neurological problems, amputation, and impotence.
Because diabetes (with the exception of gestational diabetes) is a chronic, incurable disease that affects nearly every part of the body, contributes to other serious diseases, and can be life threatening, it must be managed under the care of a physician throughout a person's life.
Always consult your physician for more information.
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