Jump to content

Photo

Reclassifying Diabetes: is it Time for an Expanded Definition?

- - - - -

  • Please log in to reply
7 replies to this topic

#1
georgepds

georgepds

    Senior Member

  • Seniors
  • 1,257 posts

http://www.diabetesi...ded-definition/

 

For those of who who seem to fall through the cracks...

 

 

"If we start by asking a few questions, the need for a reclassification or enhanced definition of diabetes becomes more apparent.

Such as…

  •       Is a patient with type 1 diabetes immune to developing type 2 diabetes in their lifetime, or can they possess features of both, such as dysmetabolic syndrome?
  •       Is it possible for the patient with type 2 diabetes to progress to insulinopenia, become ketosis prone, or even possess immune markers during the course of their disease?
  •       Are there type 1 diabetic patients who never test positive for antibodies, and are thus non-autoimmune yet insulin dependent?
  •    ..."

 

...When a patient presents or progresses in their disease with characteristics beyond the current definition, A V+ for variance would be added to the T1 (Type 1) or T2 (Type 2) nomenclature.

 

...Then the modifier that the patient exhibits would be added to the variant. Such as Ab +/- for antibody status, K +/- for Ketosis prone, IR +/- for insulin resistance, P 1/2/3 for phenotypic featuresand in the future G typing for Genetic Allele expression.


  • adiantum and JuliaDay2013 like this

#2
OldTech

OldTech

    Senior Member

  • Seniors
  • 566 posts
  • LocationNear Seattle WA USA
  • I am a:Type 2

I'm not sure I see the point. Every doctor worth his/her salt will look at all the biomarkers and family history before treating.


--Chet

 

Type 2. Diagnosed 12/2013. Last A1c 4.5. Average postprandial 86. Very little variability. Very low carb and metformin (2x500mg). Two meals a day with no snacks. Last updated 2/18/2015.


#3
Kit

Kit

    Weird is Awesome

  • Seniors
  • 5,125 posts
  • LocationInterval and Intersection
  • I am a:Type 2
Not necessarily. We've seen a couple of cases here where someone became diabetic due to pancreas damage but, because it was not autoimmune, was treated as an average T2 with the usual advice.

I can see how it could be helpful in differenting cases like that.
  • meyery2k likes this

10/6/2016 - A1C 5.2

Metformin ER 500mg x2, Daily Multi Vitamin, EstroSoy Plus x2

Dx T2 1/27/2014 - A1C 10.4

A1C History:  3/2016 - 5.1, 3/2015 - 5.1,  8/2014 - 5.2,  4/2014 - 6.7

 


#4
control

control

    Senior Member

  • Seniors
  • 558 posts
  • I am a:Type 2

Not necessarily. We've seen a couple of cases here where someone became diabetic due to pancreas damage but, because it was not autoimmune, was treated as an average T2 with the usual advice.

I can see how it could be helpful in differenting cases like that.

 

However...we cannot even get the medical community to recognize that their recommended diet is outdated and dangerous.  I have little confidence that if they cannot even take a look at the hard data and change their stance on something so basic, they will ever make any drastic changes.


  • miketurco and OldTech like this

#5
OldTech

OldTech

    Senior Member

  • Seniors
  • 566 posts
  • LocationNear Seattle WA USA
  • I am a:Type 2

Yep! Last week I went to the emergency room for mild chest pains and was kept overnight for observations and an NMR stress test (passed).

 

As I got my first meal it was obvious that they were following the ADA recommendations for diabetics.The meal consisted of a large (40%) helping of white rice, a thick beef stew, and a vegetable. They knew that I was diabetic so they included a 'Carbohydrate Count Alert' sticker along with a note to have a nurse observe what I ate so they could appropriately determine my insulin dosage (I'm not on insulin). I only ate the 3 chunks of beef in the stew and the vegetables hoping that I would not get too many carbs from the thick stew. 

 

All this is protocol and I suspect it will only change when heck freezes over. Studies simply do not matter. Protocol decisions are well above the decisions that staff and doctors are allowed to make so there is little point in discussing studies.

 

BTW: I did find the staff helpful (within limits) and that I was allowed to order the rest of my meals carte blanche.


Edited by OldTech, 17 October 2016 - 10:29 PM.

--Chet

 

Type 2. Diagnosed 12/2013. Last A1c 4.5. Average postprandial 86. Very little variability. Very low carb and metformin (2x500mg). Two meals a day with no snacks. Last updated 2/18/2015.


#6
NoraWI

NoraWI

    Senior Member

  • Seniors
  • 3,301 posts
  • LocationSW Wisconsin
  • I am a:Type 1
Anything that presents with high blood sugars gets stuck under the heading of *diabetes.* And we know well that there are almost as many distinctions to the causes as there are people with them. Can't pigeonhole something like this. Needs to be looked at in a case by case way. Unfortunately, it's not going to happen anytime soon.
NoraWI
Pumping NovoLog with an Animas Ping since May 2010. Levothyroxine for thyroid. Nothing else.

#7
notme

notme

    Super Moderator

  • Moderators
  • 14,079 posts
  • LocationCalifornia
  • I am a:Type 1
I guess it bugs me a bit but mostly it is because the general public really has no clue about diabetes. I can't be too mad because I was clueless until I was diagnosed.

I got type 1 (autoimmune) at age thirty. I had no clue what hit me. My Grandmother had diabetes and it didn't seem like a big deal until I realized that it was different. I wish I had understood from the get go, how my life had changed. I might have been a little more prepared. I had five young kids with. I time for myself and I really didn't take diabetes seriously for years.

They really are two (or more) very different issues and not only do people around you not understand, you don't yourself understand until it happens to you.

So for that reason, it would be nice to differentiate between the different types of diabetes.
  • meyery2k likes this
5a8d0d02d50b2731ee63eab231cbcc6a_zpslwwg
Nancy
“I don't expect everything to be handed to me. Just set it down anywhere.”.






diagnosed type 1 October 1986
currently using Medtronic MiniMed
Revel 723 with CGMS

#8
xMenace

xMenace

    Senior Member

  • Seniors
  • 11,186 posts

I don't see any discussion on MODY. Wiki is up to 13 types.

https://en.wikipedia...es_of_the_young



 

 

 

 

 

On MDI and doing well. A1Cs range from 5.6 to 6.4. December 2016 was 6.1. 12 911's in my career; a few highs; lots of shots. Diagnosed Oct 19th, 1975.
Proliferative retinopathy March 1994, 4,000 laser, vitrectomy Oct. 2006. Vision 20/25 in right, 20/40 in left (slight cataract).





0 user(s) are reading this topic

0 members, 0 guests, 0 anonymous users