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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