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Diabetes classifications, T2 subtypes?

Eternal422

Eternal422

Well-Known Member
Relationship to Diabetes
Type 1
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As some of you know, I have been going through a fairly unsettling time over type classification and threats from my consultant to take me off insulin. Luckily my DSN is more realistic and supportive of keeping me on my current MDI insulin regime.

However, this has got me wondering about diabetes classifications and whether they are artificially simplistic. I can go with T1 representing people with loss of beta cell function due to an autoimmune condition and little insulin resistance and T3 with its various subtypes representing loss or damage to the pancreas due to reasons other than autoimmune.

But T2 being an unsubdivided type? Looking on this forum there seems to be a fair variety of people classed as T2 who exhibit different responses and have different treatment plans ranging from oral meds to insulin. I myself likely fall into this category having reduced endogenous insulin production, little insulin resistance, initial presentation in my 40s but negative antibody results. My endogenous insulin production looks to have been at the same level from 5 years after initial presentation for the past 18 years as evidenced by roughly the same insulin TDD for all this time and the amounts indicating little insulin resistance.

Instead of letting sleeping dogs lie and just accepting I need insulin and will stay on my MDI regime, a bit like scratching an itch :rofl: I have been searching online about possible T2 subtypes and come across (amongst others) this paper :

which suggests :
These novel subgroups were labeled as severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD), and mild age-related diabetes (MARD)

Anyway, I thought it may be of interest to some on here and worth sharing.
 
Don't forget that viruses can cause beta cell loss which many in the medical profession don't understand. There are many like us who may be slim at diagnosis which may have come on rapidly. Antibody tests may be negative and C-Peptide show a lower than 'T2' level and perhaps into the 'T1' region. Many of us will be dumped into the T2 classification which is ridiculous. It's a mess and mainly because the role of viruses and perhaps other unknowns cause beta cell death but not thru auto-immunity. I had a long discussion with my diabetes consultant who agreed I was a 'one-off' and needed to be treated as T1 and has done so but left me listed as a T2 because I didn't meet the strict T1 classification. There is no strict T2 classification - it's just a dumping ground.
 
DaveB said:
I had a long discussion with my diabetes consultant who agreed I was a 'one-off' and needed to be treated as T1
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I strongly suspect I'm in the same category as is Tony and a couple of others on here.

I fit the profile of T1 but likewise my c-peptide and antibody tests seemingly put me in the T2 box.

But without injected insulin my BG goes bonkers within hours and I just don't use Etsy insulin I produce myself.

I have my first appt with my consultant on Thursday so will discuss this with her.
 
There is a paper from Denmark, I think, that looked at a lot of data and found 3 or 4 main phenotypes. The biggest group exhibited insulin resistance and beta-cell dysfunction, with other groups having just one of those conditions.

I believe they called the biggest group ‘Classic diabetes’
 
dannybgoode said:
It is something I'm going to raise with the DS consultant when I meet her on Thursday.

If she has any interesting thoughts on the subject I'll update you 🙂
Click to expand...
good luck on Thursday @dannybgoode
 
DaveB said:
Don't forget that viruses can cause beta cell loss which many in the medical profession don't understand. There are many like us who may be slim at diagnosis which may have come on rapidly. Antibody tests may be negative and C-Peptide show a lower than 'T2' level and perhaps into the 'T1' region. Many of us will be dumped into the T2 classification which is ridiculous. It's a mess and mainly because the role of viruses and perhaps other unknowns cause beta cell death but not thru auto-immunity. I had a long discussion with my diabetes consultant who agreed I was a 'one-off' and needed to be treated as T1 and has done so but left me listed as a T2 because I didn't meet the strict T1 classification. There is no strict T2 classification - it's just a dumping ground.
Click to expand...
I was diagnosed as a child. (“Juvenile diabetes,” back then.) Now in my middle age guess what the assumption from DSNs is? Lol, but they are pleased I lost any weight I didn’t loose in the first place. They must wanna know what my secret was. I didn’t have one.
 
harbottle said:
There is a paper from Denmark, I think, that looked at a lot of data and found 3 or 4 main phenotypes. The biggest group exhibited insulin resistance and beta-cell dysfunction, with other groups having just one of those conditions.

I believe they called the biggest group ‘Classic diabetes’
Click to expand...
Is that the paper @Eternal422 linked in the OP?
@harbottle
 
JITR said:
Is that the paper @Eternal422 linked in the OP?
@harbottle
Click to expand...

No, it's not. I can't remember where it was from, it's been a while since I read it.

pubmed.ncbi.nlm.nih.gov

Type 2 diabetes classification: a data-driven cluster study of the Danish Centre for Strategic Research in Type 2 Diabetes (DD2) cohort - PubMed

Different HOMA2-based approaches did not classify patients with T2D in a consistent manner. The T2D classes characterized by high insulin resistance/hyperinsulinemia appeared most distinct.
pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov

This references that study, I think, but is from Sweden.
 
DaveB said:
because the role of viruses and perhaps other unknowns cause beta cell death but not thru auto-immunity.
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You have made this statement before and it has usually come with the response that the viruses do not kill off the beta cells - they trigger the auto-immune response. If the viruses just killed off the cells, they would "rebuild" (sorry, there is a better term at the end of my tongue but I cannot see it!) or an islet transplant would work. The auto-immune reaction is continuous so beta cells are not able to grow or be transplanted without being killed off.
I wish it was just the virus I had before my Type 1 diagnosis which killed off my beta cells but sadly, they have never regrown.
 
I believe that it's been seen that some viruses can cause beta cells to stop working without an auto immune response.
I know someone who is T2, but never been slightly overweight and it developed in his 30s. The Drs have just told him that he might have had a virus that has stopped beta cells from working - and he does remember just before he started getting symptoms he had a really bad cold. Had all the tests for T1 which came back negative. Just doesn't produce enough insulin.
 
dannybgoode said:
GP tomorrow as well and hoping for the CGM signoff. Fingers crossed...
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Good luck! Hope it gets signed off for you!

My hospital DSN is more than happy to keep me on CGM, I guess it comes under the NICE recommendations that T2 who have been asked to test at least 8 times per day are eligible. Given insulin on an MDI it is reasonable to assume tests before each injection, so a minimum of 4 times a day. If you add tests following meals and for the odd correction, etc. then 8 times can easily reached for someone on a typical basal-bolus insulin regime.
 
harbottle said:
I believe that it's been seen that some viruses can cause beta cells to stop working without an auto immune response.
I know someone who is T2, but never been slightly overweight and it developed in his 30s. The Drs have just told him that he might have had a virus that has stopped beta cells from working - and he does remember just before he started getting symptoms he had a really bad cold. Had all the tests for T1 which came back negative. Just doesn't produce enough insulin.
Click to expand...
I had chicken pox as an adult just before getting the diabetes diagnosis. I did see a paper from Japan that cited this virus as a possible trigger for the immune system to sort of go into overdrive and end up killing off beta cells.

I have also read a paper from Oxford University that talks about high blood glucose “reprogramming” beta cells causing them to stop producing insulin :

www.ox.ac.uk

Key cause of type 2 diabetes uncovered | University of Oxford

Oxford Research reveals high blood glucose reprograms the metabolism of pancreatic beta-cells in diabetes.
www.ox.ac.uk www.ox.ac.uk
 
harbottle said:
There is a paper from Denmark, I think, that looked at a lot of data and found 3 or 4 main phenotypes. The biggest group exhibited insulin resistance and beta-cell dysfunction, with other groups having just one of those conditions.

I believe they called the biggest group ‘Classic diabetes’
Click to expand...
Interesting! I would put myself in a group that just has beta cell dysfunction as I don’t have any appreciable insulin resistance. It would be nice to see these sub types recognised rather than a bucket T2 that we have now.
 
Eternal422 said:
If you add tests following meals and for the odd correction, etc. then 8 times can easily reached for someone on a typical basal-bolus insulin regime.
Click to expand...
Plus the before run/after run tests, before/whilst driving etc.

The good news is the GP said, so long as the hospital say I can have one he'll happily just sign it off from a GP perspective.

The consultant I am seeing is called Dr Marni Greig and a quick google search shows her to have done plenty of research into insulin response etc and has a paper on insulin use in T2 diabetics so she may be a very good person to speak to. My GP said she's one of the best diabetic consultants at the hospital so fingers crossed...
 
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