Dear Dr. Edelman,
I have type 1 diabetes, but type 2 diabetes does run in my family. I’ve heard there’s a chance I could develop it too. Is that really possible?
Dr. Edelman: It sure doesn’t seem fair, but it is possible to have both type 1 and type 2 diabetes at the same time.
Type 1 diabetes is an autoimmune condition that leads to the destruction of cells that produce and secrete insulin from the pancreas. Its exact causes are still unknown, but every single person who has type 1 diabetes needs insulin therapy. Type 1 is also associated with other autoimmune conditions such as hypothyroidism and celiac disease.
Type 2 diabetes is a hereditary condition caused by a mutation in genetic makeup and it leads to a condition called insulin resistance, as well as other defects. When people are diagnosed with type 2, there’s actually still plenty of insulin around, but it just doesn’t work well in terms of getting glucose out of the bloodstream and into the cells of the body for energy.
People with type 2 also often have abdominal obesity, high blood pressure, abnormal cholesterol levels, and if untreated, elevated levels of heart disease. They can treat their diabetes with lifestyle changes, oral medications, and non-insulin injectable medications, but if the glucose control is still not at goal, insulin therapy will be needed.
Type 1 and type 2 diabetes are two completely different diseases, but they have one thing in common – high blood sugars, if not treated properly. Certain therapies and technologies are also used to treat both type 1 and type 2.
So how does someone get lucky enough to have both type 1 and type 2 diabetes? Let me give you an example from one of my patients.
Phil developed type 1 when he was six years old, and he managed it extremely well for a long time. However, both of his parents had type 2 diabetes, and when both of your parents have type 2, your chances of getting type 2 during your lifetime is virtually 100%. So, in his early to mid-40s, he started to develop weight problems in his abdominal area, along with high blood pressure and abnormal cholesterol levels. His insulin requirements also started to go up because the insulin resistance of type 2 makes the body resistant to the glucose-lowering effects of insulin. I treated his with type 2 medications (metformin and a GLP1-RA such as Trulicity) and continued his type 1 insulin regimen. I also had to start blood pressure and cholesterol medications to get him to goal.
Double diabetes is not that uncommon, and it is important to have a level of awareness if you are at risk. You can be treated successfully and live a long and healthy life. You can use the diagnosis to have your prescriptions covered by insurance. For example, you can get a CGM and some of the newer type 2 meds such as SGLT2 inhibitors and GLP1-RAs. There are several lectures in our video vault that go over these medications in great detail if you’d like more information.
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I have just been diagnosed with Type 2 Diabetes. I am a 66 year old male, who takes a lot of Medications for Mental Health. In addition , I am being treated for Cholesterol,Triglycerides, and High Blood Pressure. Since being diagnosed, I have to Exercise, change my Diet, and I feel TRAPPED entering into another lifestyle . My appetite for food is being constrained. This, I feel, prevents me from enjoying one of the few pleasures I get out of life. No Alcohol, No Sex (ED),no friends. My only Hobby is being an Amateur Meteorologist. I’m too old and Too Poor to go to Meteorology School. Instead, I am Trying to be practical- studying Web Design. It is a competitive field, and I don’t look forward to Job Hunting , perhaps next year. Things are Down for me.
We totally understand that a diabetes diagnosis is overwhelming, especially if you’re dealing with other medical concerns. But you can live a long and healthy life with type 2 diabetes…you just need to get educated, and learn how to adjust. There are so many things you can do, and it really can be a silver lining. Please check out the videos for type 2 diabetes in our video vault. Welcome to the club.
Here is a link to our video vault and a video I did on being newly diagnosed with type 2:
I have type 1 and type 2 I also have type 3 and 4 due to my heart conditions as well I have multiple sclerosis my daily life is just horrible . I feel so trapped it’s not funny . I need a lot of help please pray for me I’m on novalog 5 units 3 times a day one of the only insulin I can take I also take lantus 5 units a day I’m a bit sensitive to it though I also take jardiance as well as tradjenta . My life totally sucks ..
Diabetes is incredibly hard to deal with, and you have additional stress for the other health challenges you’re facing. Here are a few resources that may be able to help you:
Behavioral Diabetes Institute:
Center for Diabetes and Mental Health:
Integrated Diabetes Services:
Psychology Today has a good tool for finding a therapist:
Also you may want to consider connecting with a Certified Diabetes Specialist:
Odd. I have had type 1 since I was 13. Years went by, and my dose remained the same at 30 L 1 x day and 15 R at meals.
While I was pregnant in my late 20’s, my bloodsugars went up, and I had to increase my dose.
My access to doctors during this time was somewhat limited due to the fact that I was living in the middle of nowhere, 2 hours away from the nearest medical specialists. Mostly, I was under the care of a small town general practitioner, who was pretty much terrified to recommend anything, ever. I did have a high-risk specialist, but I think I saw that guy twice in 9 months, mostly for ultrsounds and a few blood tests that amounted to nothing.
I suppose the general practitioner guy who did the bulk of my care considered a pregnant type 1 a serious liability risk, and hey, I don’t blame him for being nervous. I was nervous too, maybe for different reasons. Still, his reluctance to even TRY had disasterous results for me.
(Don’t worry. The baby was fine. I made sure of it, even without the doctor’s help.)
I was forced to gradually increase my own dosage without doctor supervision until my bloodsugars were back under control. Since I didn’t have a doctor willing to advise me or prescribe anything diabetes related (even though my bloodsugars were climbing as the pregnancy progressed), I was forced to buy my own insulin without a prescription to make up the difference. I did it myself, if only to make sure the baby would have a chance in h$#! to come out healthy.
Afterwards, still without supervision, my plan was to decrease my dosage gradually until I was back to, or at least closer to, my normal dose. I found very quickly that it wasn’t possible. Any time I reduced my dose by more than a unit or two, my bloodsugars would climb to unhealthy levels.
Since then, over a decade’s time, I’ve been stuck in a cycle of trying to convince multiple terrified doctors to prescribe the correct dosage to keep my bloodsugar under control (too much! you’ll die of a low bloodsugar! i wont do it! they protest), buying the extra insulin I need with cash, and a gradually increasing need for even MORE insulin to keep things under control.
In the meanwhile, they discontinued L insulin, so I had to switch to N, which was even less effective at keeping my bloodsugars steady over time. I’m now taking 50 N 1 x day and 25 R at each meal.
Worse, I’ve developed another autoimmune disorder that’s landed me in the hospital 4 times in two years. They’re still trying to figure out how to treat me, so I keep ending up in the hospital in spite of following the latest treatment plan.
Do you know what they do in hospitals? They pull your medical records. They see a list of the medicines that are prescribed, and if you are diabetic, they want to take control of your diabetes care during your stay. Makes sense, of course, unless you are secretly dosing almost twice what the doctors are willing to prescribe.
I’ve found myself arguing with the nurses about my dose, getting refused by the doctors when I ask for an increased dose even when my bloodsugars are so high I’m slipping in and out of a hyperglycemic coma, and eventually I was forced to go ahead and sneak the extra insulin dose I need when no one was looking.
Or, as happened in one hospital, when they caught on to what I was doing, there was a physical altercation that resulted in hand-shaped bruises on my arms when the nurses tried to restrain me, me removing my IV on my own, followed by a lot of shouting and an AMA release. They almost killed me. I was fighting for my life.
So recently, I’ve been thinking maybe the problem has been, all along, that I developed insulin resistance during my pregnancy. I’ve spent a while now trying to decide if I’m just a hypochondriac, or if I really also have Type 2 as well as Type 1. Since pretty much all doctors are too terrified of a malpractice suit to do much to help in such a complex case, I’m stuck dealing with all of it on my own.
(And, before you ask, I’ve never sued any of them, even the ones who gave me the bruises. They’re just bruises. They healed. I don’t like predatory lawyers any more than the doctors do. Anyways, it seems that the lawyers, and the fear they create, are the REASON I can’t get any medical professional to help me.)
Ugh. My health has been a trainwreck ever since that pregnancy. I’ve even had to make a plan with my family to monitor my bloodsugar and dose me secretly if I’m ever in the hospital and unable to do it myself, you know, so I don’t die from hypoglycemia/hyperglycemia, because I’ve learned I CANNOT trust the doctors. They’re scared of me. After having to literally fight them for my life, I am admittedly a bit scared of THEM too.
You need CGM and Insulin pump. I would recommend Dexcom and Omnipod. You also need FIASP Insulin. It would make a world of difference to you.
You also need to see Endocrinologist. Primary Care doctors are clueless when it comes to managing Type 1.
I am not sure what happened to my comments, so I will try to reply again
1. You need to see Endocrinologist. Primary Care doctors are not equipped (with proper knowledge) to manage Type 1.
2. You need CGM and Insulin pump. I recommend Dexcom and Omnipod.
3. You need insulin FIASP in a pump. You will see a world of difference with this insulin.
I’m 71 and was diagnosed with Type 1 back in 2012. Now taking 18 units Lantis, (I started it about 10 years ago at ~14 units). In 2014 I also started taking Humalog at meal time, 6 to 8 units after A1C had climbed to 12.3 back then.
A1C (by lab) came down after 2014. It was 7.8 in February, up from 7.0 June 2022. I had pneumonia last October and my weight went from ~175 down to ~155; it was a struggle to get the weight back. I started wearing a Dexcom G6 about a year ago and Clarity says my avg sugar has been 136 last 90 days.
My endo doc (I assume it was him..) added a diagnosis of Type 2 last February but didn’t tell me about it, I just found out today reading some charts online by chance (currently waiting for an answer from him). Excepting the pneumonia, my weight has been unchanged for many years, ~170 pounds (I’m 6′ tall).
My lipids seem okay: CHOLESTEROL 156 mg/dL, HDL 65 mg/dL, CHOL/HDL RATIO 2.4, LDL 71.4 mg/dL. TRIGLYCERIDES 98 mg/dL
Could there be some other blood test or other indication to prompt adding a Type 2 diagnosis? (BTW – parental diabetes status is unknown.)
From what you have told me, I don’t see anything that would lead me to believe that you have type 2 diabetes. If you were my patient, I would have a lot more questions for you. I don’t understand why your doctor thinks you have type 2. Feel free to write me back when you get more information.
Apologize for posting on an old post. How can I convince my Dr that he can diagnose me as type 2 and explain how to do it? He says you cant and they are only allowed to diagnose one or the other.
My history. Diagnosed at age 10 as type 1 about 37 years ago. Good control, most of that credit goes to my folks and great care from John Hopkins. Both my parents and brother are all type 2.
About 3 years ago i started to have cholesterol issues, triglycerides, high blood pressure, and weight gain. My daily insulin requirements were going through the roof to the point i was taking 240 units a day. Changed my endocrinologist to another. New Dr put me on Ozempic and currently at 1mg. My A1c is down to 6.2 and average insulin is 175 units. He would like to move me to 2 mg but my insurance is refusing to cover it.
Is it even possible to be diagnosed a type 1 and a type 2?
It sounds like you do have both. I commonly put in my notes that a patient has type 1 and type 2 diabetes, however I am familiar with all the billing practices at a major university, and you do have to pick one for billing purposes. I would pick the one that has the most extensive drugs so you can get those covered. I usually say type 2 because type 2s are eligible for insulin, but type 1s are not eligible for type 2 drugs.