What Is Double Diabetes?
When a person has elements of both type 1 diabetes and type 2 diabetes, they have "double diabetes" (or hybrid diabetes). How is this possible? :
- A child with type 1 diabetes becomes overweight and develops the basic feature of type 2 diabetes and obesity – the body becomes resistant to insulin.
- A child with type 2 diabetes has one of the cardinal features of type 1 – the presence of antibodies in the blood against the insulin producing beta cells of the pancreas.
More and more, people with type 1 diabetes are developing features of type 2 diabetes. Most often, this occurs in people with a family history of obesity and type 2 diabetes who become overweight and inactive.
To understand double diabetes it helps to know about what distinguishes the two main kinds of diabetes, type 1 and type 2:
- Type 1 diabetes is an autoimmune disease. This means that the body's immune system cells destroy the insulin producing beta cells of the pancreas. The key feature of the autoimmune destruction is the presence of beta cell antibodies in the blood. Destruction of these beta cells leads to a serious lack of insulin.
Inability to make insulin can be determined by measuring something called c-peptide in the blood (c-peptide is released molecule for molecule from insulin as it is processed in the pancreas). Therefore, the c-peptide blood concentration reflects how much insulin someone can make on their own. Typically someone with type 1 diabetes can make close to none.
- The main feature of type 2 diabetes is resistance to the action of insulin in the body's cells. This is almost always associated with obesity. As a result of insulin resistance, the body has to make more and more insulin to keep the blood sugar normal. When the body can no longer make the amount of insulin required, the person needs to take pills that increase insulin secretion and make the body more sensitive to insulin and/or the person needs to take insulin by injection.
Unlike type 1 diabetes, people with type 2 continue to make insulin -- it just doesn't work well because of insulin resistance. They have a lot of c-peptide in their circulation that can be measured with a blood test.
It's the apparent overlap of the features of type 1 and type 2 diabetes that leads to double diabetes. Double diabetes can be present at the time of diabetes diagnosis– making it difficult to diagnose what type of diabetes someone has. Some children with type 1 diabetes develop some of the features of type 2 several years after they are diagnosed.
In someone with type 1, the signs and symptoms typical of type 2 diabetes can develop gradually. How quickly they develop depends mostly on a person's genes and their degree of weight gain.
The combination of genetic tendency -– the risk that a person will inherit something from their parents -– and the degree of overweight, obesity and poor fitness will determine if someone becomes insulin resistant – and whether the resistance is moderate or severe. The appearance of double diabetes can be quite different, depending on the degree of a person's insulin resistance.
Since double diabetes is a new discovery, we don't know exactly how many children have it, the exact criteria for diagnosing it, or how best to treat it. What you are about to read is what we do know about this disease and what you can do to manage and control its impact.
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