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[Unca_Tim]

Obesity: Double diabetes threat?

The Sacamento Bee
Jul. 11, 2005 04:45 PM

The obesity epidemic appears to be fueling a hybrid type of diabetes that afflicts adults and children and, some believe, may increase the devastating complications of the disease.

Dubbed "double diabetes" by some and "diabetes one-and-a-half" by others, the combination of types 1 and 2 diabetes symptoms confounds doctors attempting to accurately diagnose patients and find the best medicines to treat them.

"We don't really know how prevalent this is," said Dr. Francine Kaufman, head of the Center for Diabetes and Endocrinology at Childrens Hospital Los Angeles. "We are just at the vista of realizing it's out there and trying to determine how do we get an understanding of it." Even Kaufman, former president of the American Diabetes Association and author of the book "Diabesity" -- about the obesity epidemic and related rise in type 2 diabetes -- does not always recognize the double diabetes cases.

Her patient, Cameron Stark, had classic symptoms of type 2 diabetes. Then 14, the girl's thirst was unquenchable. She was losing weight rapidly because her body wasn't absorbing necessary nutrients. She was vomiting. She felt tired all the time, one day falling sound asleep on the marble floor of her home. At just a little under 5 feet tall, about 200 pounds and with a family history of the disease, Stark appeared a prime candidate for the diagnosis.

A blood sugar test confirmed it. She was given insulin to control the high sugar levels in her blood, and the Sherman Oaks teen joined the growing cadre of children diagnosed with what used to be called "adult onset" and is now known as type 2 diabetes.

One month later, another test on Stark revealed telltale signs of the far more rare variation of the disease known as "juvenile diabetes" and more commonly called type 1 diabetes.

"It was a whole different ballgame from that day forward," said Cameron's mother, Shelley Stark.

Now 15, Stark's daughter appears to be part of an emerging population with a complex set of symptoms that may require multiple medications as well as strict adherence to a healthy diet and regular exercise.

Obesity long has been associated with type 2 diabetes, a condition in which the body doesn't use insulin efficiently. Increasingly, people with type 1 diabetes -- in which the body does not produce sufficient insulin -- are becoming obese and showing signs of type 2.

To understand how the two types of diabetes may overlap, it helps to look at the diseases separately.

Type 1 diabetes is defined as an autoimmune disorder in which the body starts attacking the "beta" cells in the pancreas that produce insulin, the hormone that escorts sugar into the body's cells for energy production. When the cells stop working, they no longer produce insulin and glucose builds up in the blood, starving the body's organs of fuel.

The causes of type 1 are not entirely understood, although genetics, viral infections and trauma to the pancreas can affect development of the disease. Type 1 diabetics must be treated with insulin shots.

In type 2 diabetes, the body produces insufficient insulin to meet increased needs for the hormones that occur because of insulin resistance, a condition in which the cells don't make efficient use of insulin.

Research has proven that, in many cases, type 2 diabetes can be controlled with a healthy diet and regular exercise. Many type 2 diabetics, however, require drugs, including insulin, to maintain healthy blood sugar levels.

For each type of diabetes, complications can vary in severity but are generally the same, ranging from heart disease, stroke and kidney disease to blindness, nerve damage, foot problems and skin disorders.

Although they don't agree on how the process works or which name to use to describe it, clinicians and researchers are finding evidence of both diseases simultaneously in the same patients. The rise in obesity is seen as a leading culprit.

In one study, for example, researchers at the University of Washington found that a majority of children with type 2 diabetes also had signs of type 1 diabetes in the form of antibodies and T-cells, immune system markers that respond to cell damage.

"There is some indication that obesity, by putting more stress on the beta cells, may in fact make the cells more susceptible to immune attack," said Dr. Jerry P. Palmer, who is head of endocrinology and metabolism at the VA Puget Sound Health Care System.

For her part, Stark gets four to six injections of insulin every day, in amounts that have dropped gradually in recent weeks.

Her mother said she now shops for low-carb, sugar-free foods. "I am learning to read labels," she said. "I check everything now." Regular exercise also has become part of the teen's daily routine.

"I work out with a trainer two days a week," she said. "We do kickboxing, tae kwon do, yoga and core work. I learned very quickly what I had to do with my life and to take care of myself to stay healthy."

[Jules]

Thank you for such an informative post. I am definitely going to mention this to my doctor when I go in November. I often thought I might be a Type I and they were just overlooking it because the Type II diagnosis was easy to make. Is a special bloodtest done to check if one has both Type I and Type II diabetes? I assume autoimmune disorders that run in the family would be a red flag to someone concerned with this? This is quite interesting. Maybe you will see this post before too long. Jules

[Unca_Tim]

Hi Jules,
I'm not really qualified to comment much on this. I thought the article may be of some use to our forum members.

You'll have to take this up with your Doctor. Maybe print out the article when you go for your next visit.

[pudgesmom]

I am starting Medifast tomorrow and am Type II db. Any suggestions?

[Unca_Tim]

Hi Cathy and welcome to the forum,

Check this post out for starters:
http://www.makemethinner.com/forum/diet-3478.html

If you have any specific questions, post them here, and I'm sure someone will chime in on it...

Visit regularly and keep us posted.

[pudgesmom]

Thanks so much! I will keep in touch!

[Jules, Guest]

Yes, there is a definite link between type I and type II diabetes according to my doctor. When he draws blood the next time todo the usual hemoglobin A1C, lipids, etc. he plans to order a "C-Peptide" panel to actually see if I could have both.