Type I / II Clarification

[aminal]

I had surgery which removed 2/3 of my pancreas in December. I now have hyperglycemia and diabetes as a result. I have been doing lots of study on the web.

My doctor says Type I diabetes is defined as requiring insulin and Type II is defined as not requiring insulin.

My own interpretation is that Type I is not producing enough insulin whereas Type II is insulin resistance.

Who's right? I'll be very disappointed if my doctor is wrong. I like him a lot, but if I'm right, I'm not sure he should be treating me now that I have this problem.

Thanks.

[JediSkipdogg]

What medication you take has NOTHING to do with type.

Type 1 is an autoimmune disease where your body attacks the islet cells (insulin producers) of the pancreas and essentially kills them off.

Type 2 is either insulin resistance or where your body isn't producing enough insulin for one reason or another (generally it's dying off from overworked.) Some type 2s eventually go on insulin as their resistance increases extremely high or they pancreas is overworked.

I would say you are a type 2 if you have part of the pancreas removed. Or maybe that's a type 7 (wait, you're new, so you won't get that yet.

Welcome to the site though.

[LancetChick]

Distinguishing the two types of diabetes by whether or not insulin is required is outdated, and your doctor should probably not be treating your diabetes if he isn't an endocrinologist specializing in diabetes, since anyone else is likely to misinform you. I would go further, and say that when it comes to insulin management, even an endo is really only good for scripts, which is the only thing I use mine for.

Have all your beta cells been destroyed? If you don't make any insulin, then I would say you're as good as type 1, even though you didn't get it from an autoimmune response. If you do make insulin, but not enough, then I give up on what type you are. I guess I'd still lump you in with type 1's.

[HelenM]

Your doctor seems to be using terms type 1 as insulin dependent ,type 2 non insulin dependent. Apparently between 1980 and 1985 they were interchangeable so I suppose your doctors older medical books could use them in this way.
According to the WHO classification 1999 (which I think is the latest.)

Type 1 : beta cell destruction leading to absolute deficiency
autoimmune
idiopathic

Type 2: may range from predominantly insulin resistance with relative insulin deficiency to a predominantly secretory defect with or without insulin resistance.


They then have another table (table 3) of 'other specific types' which includes 'trauma, pancreatectomy' ( I think that seems to apply to you but I could be wrong as I'm not a doctor!) if so so you appear to be neither type 1 nor type 2 but 'other'


the whole document explains things in detail and is at http://whqlibdoc.who.int/hq/1999/WHO_NCD_NCS_99.2.pdf


If your doctor is out of date in his understanding of diabetes, perhaps you would be better seeing a specialist.

[Funnygrl]

If your diabetes is from a partial pancreactomy, you're neither type.

[Injecto]

Or maybe that's a type 7 (wait, you're new, so you won't get that yet.

HA ha...LOL :rofl:

If your diabetes is from a partial pancreactomy, you're neither type.


Which brings up a very interesting insurance debate. If you are neither type (due to surgery), are you "really" a diabetic, or is the diabetes a result of an "accident" shall we say (for the argument). So, being neither type of diabetic you should still be as eligible for life insurance coverage just as any other "non" diabetic.


Either way, welcome to the site.

[Funnygrl]

Which brings up a very interesting insurance debate. If you are neither type (due to surgery), are you "really" a diabetic, or is the diabetes a result of an "accident" shall we say (for the argument). So, being neither type of diabetic you should still be as eligible for life insurance coverage just as any other "non" diabetic.




ICD-9 250.00

[Injecto]

ICD-9 250.00

Huh? .

[Funnygrl]

Huh? .
In medicine, everything exists. There's always something for the person that doesn't fit the norm. In the diabetes spectrum, 250.00 is basically diabetes- not otherwise specified.

Diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled

* 250.00 is a specific code that can be used to specify a diagnosis

Useful "catch all" thing.

[JasonJayhawk]

Aminal,

Welcome to the "club" that nobody wants to join.

If you had to tell someone what type of diabetes you have, I would say you have Type 1.

The currently thought process of getting Type 1 is an autoimmune attack upon the beta cells. The remaining beta cells will end up "burning out" (again, that's a layperson's way of putting it).

The decision to not call you Type 2 comes from the following ideas:
1) insulin-resistance modifying therapies would do little to benefit your current condition (e.g., you're not on oral drugs).
2) the levels of pro-insulin (a precursor to insulin) in your blood serum are low (like a type 1's).

If you had a high level of pro-insulin, then you've got the insulin, your body just isn't making use of it.

Keep in mind, some medications (especially steroids) may cause a temporary (or permanent) diabetic condition, caused by either creating insulin resistance (type 2) or beta cell destruction (type 1).

Regardless, hopefully you have been referred to an endocrinologist who can sort out the best treatment option for you.

Keep in mind, losing your pancreas is a different ballgame than just diabetes because of a shortage of alpha cells. This will make you more vulnerable for hypoglycemic events, making it difficult for you to regulate your glucose levels in both directions. (You've also got the deficiency of delta and gamma cells, but that isn't as significant as far as keeping you alive.)

--
Helen and Funnygrl are also right -- it's hard to really classify everyone as a "type." Clinicians generally learn of two types during the span of one day of lectures in medical school. As long as you find treatment that keeps you healthy, happy, and alive (or at least, 2 of the three), you're good.

[KCP]

PLus dont forget that with a partial pancreatectomy you may also, in the future,be prone to malnutrition from lack of digestive enzymes...
(ps. ONly reason I know that is I have NO pancreas due to a full panreatectomy at age 7 whcih subsequently left me diabetic. They call me Type one)

[JasonJayhawk]

Hey, KCP, I thought I remembered someone on this board mentioning that before.

How do you treat the potential malnutrition? (Just vitamins, or something a little more tricky)?

If you don't mind me asking... Do you have more problems with hypoglycemic unawareness?

[Funnygrl]

Hey, KCP, I thought I remembered someone on this board mentioning that before.

How do you treat the potential malnutrition? (Just vitamins, or something a little more tricky)?

If you don't mind me asking... Do you have more problems with hypoglycemic unawareness?
You can get prescription pancreatic enzymes.

[Cyborg]

I had surgery which removed 2/3 of my pancreas in December. I now have hyperglycemia and diabetes as a result. I have been doing lots of study on the web.

My doctor says Type I diabetes is defined as requiring insulin and Type II is defined as not requiring insulin.

My own interpretation is that Type I is not producing enough insulin whereas Type II is insulin resistance.

Who's right? I'll be very disappointed if my doctor is wrong. I like him a lot, but if I'm right, I'm not sure he should be treating me now that I have this problem.

Thanks.

Well, I'm a verified type 1 (LADA) and I do have insulin resistance... :hmmmm: