 By DORSEY GRIFFITH Sacramento Bee July 12, 2005
Dubbed "double diabetes" by some and "diabetes one-and-a-half" by others, the combination of types 1 and 2 diabetes symptoms confounds doctors attempting to accurately diagnose patients and find the best medicines to treat them. "We don't really know how prevalent this is," said Dr. Francine Kaufman, head of the Center for Diabetes and Endocrinology at Children's Hospital Los Angeles. "We are just at the vista of realizing it's out there and trying to determine how do we get an understanding of it." Even Kaufman, former president of the American Diabetes Association and author of the book "Diabesity" - about the obesity epidemic and related rise in type 2 diabetes - does not always recognize the double diabetes cases. Her patient, Cameron Stark, had classic symptoms of type 2 diabetes. Then 14, she experienced unquenchable thirst. She was losing weight rapidly, because her body wasn't absorbing nutrients. She was vomiting. She felt tired all the time, one day falling asleep on the marble floor of her home. At just a little under 5 feet tall and about 200 pounds and with a family history of the disease, Stark appeared to be a prime candidate for the diagnosis. A blood sugar test confirmed it. She was given insulin to control the high sugar levels in her blood, and the Sherman Oaks teen joined the growing cadre of children diagnosed with what used to be called adult onset and now known as type 2 diabetes. One month later, another test on Stark revealed signs of the rarer variation of the disease known as juvenile diabetes and commonly called type 1 diabetes. "It was a whole different ballgame from that day forward," said Cameron's mother, Shelley Stark. Now 15, Stark's daughter appears to be part of an emerging population with a complex set of symptoms that may require multiple medications as well as strict adherence to a healthy diet and regular exercise. Obesity long has been associated with type 2 diabetes, a condition in which the body doesn't use insulin efficiently. Increasingly, people with type 1 diabetes - in which the body does not produce sufficient insulin - are becoming obese and showing signs of type 2. "I think sadly we are going to see more of this," predicted Dr. Trevor Orchard, a professor of epidemiology at the University of Pittsburgh and a leading researcher of the double diabetes phenomenon. To understand how the types of diabetes overlap, it helps to look at the diseases separately. Type 1 diabetes is usually diagnosed before age 30 but can occur at any age. In this type of diabetes, the pancreas produces little or no insulin. The causes of type 1 are not entirely understood, although genetics, viral infections and trauma to the pancreas can affect development of the disease. Type 1 diabetics must be treated with insulin. Type 2 diabetes is characterized by insulin resistance and a defect in insulin production. Insulin resistance causes blood sugar to rise, which leads the pancreas to produce even more insulin. Research has proven that, in many cases, type 2 diabetes can be controlled with a healthy diet and exercise. Many type 2 diabetics, however, require drugs, including insulin, to maintain blood sugar levels. For each type of diabetes, complications can vary in severity but are generally the same, ranging from heart disease, stroke and kidney disease to blindness, nerve damage, foot problems and skin disorders. Although they don't agree on how the process works or which name to use to describe it, clinicians and researchers now are finding evidence of both diseases simultaneously in the same patients. The rise in obesity is seen as a leading culprit. In one study, for example, researchers at the University of Washington found that a majority of children with type 2 diabetes also had signs of type 1 diabetes in the form of antibodies and T cells, immune system markers that respond to cell damage. "There is some indication that obesity, by putting more stress on the beta cells, may in fact make the cells more susceptible to immune attack," said Dr. Jerry P. Palmer, who is head of endocrinology and metabolism at the VA Puget Sound Health Care System in Washington. Palmer uses the term "diabetes one-and-a-half" to describe these patients. In another study, researchers examined children diagnosed with type 1 diabetes and found evidence of type 2, particularly in African American children. Dr. Dorothy Becker, a pediatric endocrinologist at Children's Hospital of Pittsburgh, hypothesized that the excess weight associated with type 2 diabetes accelerated the onset of type 1. "They would have gotten type 1 later if they had not been overweight," she said. She calls this condition "double diabetes."
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