January 8, 2014

Diabetes, Type 1 and Type 2 an Over Simplification

Ever wonder why there is so much confusion about whether some people are first a type 2 and then later are reclassed as a type 1 person with diabetes. Even people diagnosed with type 2 later in life do not fit into the mold as true type 2 diabetes. Some persons with type 2 diabetes actually don't fit the symptoms of type 2 because of how they became people with diabetes. Back in March 2013, I became aware of the over simplification when I wrote this blog.

Then in August, September, and October of 2013, further information came to light in three more articles that I blogged about. Now, in December 2103, even more researchers and physicians are declaring that there is more involved in the diagnosis of diabetes. “The current subdivision of cases into type 1 or type 2 'is a gross simplification, and poorly describes the true range of diabetes,' wrote Leif Groop, MD, PhD, of Lund University in Sweden, and his co-authors online Dec. 4 in The Lancet.”

Yet, in the United States, doctors are becoming even more close-minded and want everything simplified so they don't have to think. They refuse to accept that diabetes can develop from several overlapping mechanisms that can be modified by both genetic and environmental factors. I will not go so far as to say this could be the reason they are abandoning support for diabetes, but their over simplification could be a large part of their treatment and greater desire to not support patient needs for education and methods of treatment to help manage the different subgroups of people with diabetes.

No one is yet positive that the growing obesity epidemic is some areas of the world is the total cause, yet doctors in the United States declare that type 2 diabetes is a lifestyle disease and that it is progressive. Most doctors still want to blame poor nutrition and sedentary lifestyles totally for obesity.

When we read books by Dr. William Davis about the effects of wheat on the body, many bloggers about low carb, high fat nutrition and the results that are positive in reducing obesity, we know that what we are being told by the U.S. Department of Agriculture (USDA), registered dietitians, and doctors is not correct.

Many patients with diabetes present with features of two or more types. While this used to be young adults between the ages of 20 and 40, recently more confusion was added by youth presenting with forms of type 2 diabetes. Previously, most youth were correctly diagnosed with type 1 diabetes. Now we have many youth presenting with type 2 diabetes and even some with a monogenic subset, maturity-onset of diabetes in the young (MODY).

Most doctors are confused by this and not even aware of the changes happening. They do not know how to test for the variances in our youth and up into the later ages of adults. Many doctors have thrown up their hands in defeat because they cannot keep up with the changing and complex research required by diabetes. This may be another reason for the medical community turning against people with diabetes as I covered in my blog here.

Obesity used to be a clue for the presence of type 2 diabetes. Now with the rise in obesity and the number of people who are not obese being classified with type 2 diabetes, this characteristic is less helpful as a diagnostic tool.

Other subtypes of diabetes in adults include ketosis-prone diabetes in adults, a hybrid form of the disease in which patients have features of both type 1 and type 2 diabetes. Then we come to latent autoimmune diabetes of adults (LADA), in with patients tend to be younger, secrete less insulin than those with type 2, have less evidence of metabolic syndrome, and have faster progression to insulin dependency than antibody-negative patients.

Don't expect the American Diabetes Association to do anything about this as their classifications have not changed in the 2014 guidelines. They will use a foreign study when it suits them, but the study has to fit their needs.

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