Historical summary of the types
Diabetes is known and treated since the time of the Egyptians and has symptoms that have long been well known.Before insulin was discovered, people or less died in a few months since the disease began, while those who appeared after 40 years of age could survive the disease years.
From the mid -1920s, all those who had diabetes during childhood or youth were put to insulin treatment, while this did not do with the elderly, but the why of the difference oftreatment.The only marker that at that time had to differentiate the 2 types was the presence in the urine of ketone bodies when the glycemia levels were high.If there were high levels of ketone bodies, it was a sign that the person could not manufacture enough insulin and began to call them insulin -dependent.
In the 80s there was a very important discovery to understand children's diabetes.It was discovered that in this type of diabetes it was really an autoimmune disease and that the organism itself destroyed beta cells.The antibodies that the autoimmune system launched was a clearly differentiating mechanism that did not appear in adult diabetes.The types began to be clearly defined ...
Type 1 diabetes (insulin -dependent diabetes) was a self -limm disease that generally appeared in childhood or youth, the symptoms at the beginning are very striking, the person has a lotThey used to be thin children or young people and remained thin many times for life.Only 10 % of all people with diabetes have type 1 diabetes, the base of treatment in these patients is to adjust the insulin doses to the foods that are ingested, and to the physical exercise that is performed.
Type 2 diabetes or not insulin -dependent was defined as the existence of high blood glucose values in patients over 40 years who are usually obese and have a sedentary life and many times had family history of type 2 diabetes. At first it can even have symptomsor if they are very slight.These people continue to produce insulin, but not in sufficient quantities to maintain glycemia levels normal.
The treatment of these patients generally consists of a combination of a food plan, physical exercise, and drugs including insulin.Around 35% of patients with type 2 diabetes use insulin but if this treatment is suspended, the patient does not die.Approximately 90% of diabetes patients have type 2 diabetes.
In the 90s, the definition of type 2 diabetes was extended to distinguish those patients with metabolic syndrome (Syndrome X).Patients with this syndrome associated with insulin resistance are presented with high levels of cholesterol, triglycerides and uric acid together with low levels of protective cholesterol-HDL collesterol-high blood pressure figures.
People with central obesity, who accumulate fat, especially in the abdomen are the greatest risk of developing metabolic syndrome, which due to the combination of classic cardiovascular risk factors that accumulates is associated with a very high risk of suffering from all kinds of cardiovascular diseases
Metabolic Syndrome: All people who have insulin resistance are included, diabetes will appear in these patients when the pancreas is not able to compensate with their insulin blockbuster.Of course, not all patients with type 2 diabetes have syndromeMetabolic but most (around 90 %).
Type 1.5 diabetes: When type 2 diabetes appears without insulin resistance, it is known as type 1.5 diabetes that generally occurs in thin patients, with an insulin sensitivity that is normal but has a scarce insulin production, althoughWithout a tendency to form ketone bodies and do not have the high frequency of high cholesterol or high voltage figures that are so frequently seen in patients with type 2 diabetes. Almost all have positive selfimmunity that is to say that they have a positive antibody (Ica, GAD,IA2, Antinsulina.
Some authors call Lada diabetes (latent autoimmune diabetes of adults) to those of this group that resemble a classic type 1, that is, they are generally thin and very sensitive to insulin.While they leave the term 1.5 diabetes for patients who look like a type 2 and have insulin resistance but share with the previous one to have some positive antibody.But to be objective among the different authors there is no consensus yet.15 % of all patients with diabetes have this type of diabetes.
Other types of diabetes: gestational diabetes, diabetes that appears in patients with polycystic ovaries, in acanthosis nigricans and in mody type diabetes (several hereditary types of diabetes).
The vast majority of people with diabetes have type 1, type 1.5 or type 2 but as we know more about diabetes it is certain that new types of diabetes will be defined.
Why it is important to know the type
If you understand what type of diabetes that has that will allow you to know if you are correctly diagnosed and what is more important if you receive the most appropriate treatment.For example, a diagnosed person of type 1 quickly requires insulin treatment.If the patient is not a typical type 1 patient, a diagnosis of type 2 diabetes is usually performed and could begin with oral antidiabetics and possibly these agents can for a short period of time stimulating the few remaining beta cells (less than 10%)Control glycemia levels, however, the blood glucose levels will be raised soon and insulin treatment will be needed and if this does not begin the person's health status can soon be suddenly aggravated.
While if, through the determination of antibodies, a diagnosis of type 1 diabetes has beenby facilitating that the secretion of residual insulin lasts longer.
Knowing your type of diabetes will help you better understand the changes that can happen as the years go by and your disease progresses;for example.If he had a diabetes with insulin resistance for years and now he is increasingly uncontrolled with the sulfanilureas that he had been taking, they can do a test of the C peptide and leave very low.Which means that its insulin production is not only ineffective but has also become scarce, it is possible that some association of oral drugs help you some time but will soon need insulin and that is how the natural history of type 2 diabetes andWe have not yet been able to modify with our treatments.
Who is more likely to be wrong the diagnosis
Many people with diabetes are not even diagnosed.In Spain it is estimated that almost a million people have diabetes without knowing it.
The people who are diagnosed with diabetes in whom age or morphotypus do not marry type 1 classic diabetes;for example.a 36 -year -old person, thin andIt has moderately high sugar levels, what type of diabetes does it have?Type 1.5 without insulin resistance but with decreased insulin secretion.While in this same case if the same person is thin and has very high sugar levels when diagnostic, then the most likely diagnosis is that of type 1 diabetes.
Can you change the type of diabetes?
The border disappearance, not only in the European Union but also between types 1 and 2 of diabetes is increasingly frequent.This is not uncommon to see patients attending patients with diabetes of one guy in whom characteristics of the other type of diabetes begin to appear.
If a patient with type 1 diabetes begins to overheat and lead a sedentary life, then he begins to store abdominal fat as the passes to so many people as they are aging and then can develop resistance to insulin and not only that but also they can presentthe high cardiovascular risk that patients with metabolic syndrome have.Everything said would lead to associate medications such as thiazolindiones or metformin to achieve good control.
How can you know what type of diabetes has
Today there is a battery of analysis and tests that can be performed to know the type of diabetes when the diagnosis of one of the three most common types is not obvious.
Ketone bodies: ketone bodies are an intermediate product that our body produces when our body uses fat as a source of energy and this occurs when you cannot take advantage of what comes from carbohydrates because there is no insulin.Generally, except for a rare exceptions when a person has high blood or urine bodies, the patient will have type 1 diabetes. If the patient has already been treated with insulin then we will lose the opportunity to see the elevation of ketone bodies.There are reactive strips to check both in blood and urine the existence of ketone bodies.
Antibodies: Type 1 diabetes is an autoimmune disease, so the diagnosis about 90% will have positive antibodies such as ICA, Anti Gad 64, IA2 or anti -censulin.These antibodies determine with a blood analysis and if they are positive then the person has or will develop soon type 1 diabetes.
High levels of HDL triglycerides: This high triglycerides profile and low levels of HDL cholesterol is a typical characteristic of insulin resistance, so it is frequently found in type 2 patients with insulin resistance.This marker is very easy, cheap and fast to make.
Uric acid: The high levels of uric acid observed in people with gout are another component of metabolic syndrome, so when a patient is high the uric acid and high the figure of glycemia, most likely it is that it is aType 2 diabetes.
Péptide C: It can help us when the other tests have not yet clarified the type of diabetes, what it represents is how much insulin the patient is capable of producing since for each insulin molecule another C peptide C, when it is normal orThe most likely diagnosis is raised is type 2 diabetes, when the levels are very low we are faced with type 1 diabetes, but when the result is almost normal - then we cannot draw conclusions from this test.It is very important when it is at insulin treatment, one must ensure that blood glucose is 200 mg % 6 superior because in caseotherwise C Peptide can give a low result falsified by the braking of the beta cell.
When these tests must be performed
It is not always necessary to perform them, because in addition to the discomfort to the patient, some of them have a high cost.
They should be used only when in a person we are not clear what type of diabetes has or when the treatment is not being answered as expected.
Although these tests do not always clarify everything, they generally provide sufficient information to establish the diagnosis and correct treatment of diabetes
Are diagnostic errors frequent?
Diabetes type errors are frequent.If some time ago they diagnosed the diabetes, they probably told him that he had type 1 diabetes or type 2 diabetes that clear and single and UD accepted it because they had told him that there were 2 types of diabetes and although they are a majority of those that enter insideOf those 2 great types, some people do not fit clearly or even some patients who fit in one of the types with time the borders between them begin to fall and things are no longer so clear, think that after the years their first diagnosisIt is still correct.
The wrong diagnoses can bring problems and consequences for your health by not having the most appropriate treatment and if it is not understood that over the years there are changes that can also bring bad consequences by not adjusting your treatment.
Nowadays with the tests we have, we can make better diagnoses that translate into more successful treatments, although unfortunately they are not done when they are due and others however are done when it is not indicating but life is.
