I just recently found out that my 13 year old daughter now has type 2 diabetes, in addition to the type 1 diabetes she has had since age seven. Is it common for a child to have both types of diabetes? Where can I get more information on this? I would like to know if there is anything more I can do to help her in this situation. Is there anything I need to be more aware of now or start watching out for?

This is a confusing issue. You may want your daughter’s pediatric diabetes specialist to comment and answer your questions.

No, it is not common for a child with type 1 diabetes to develop type 2. Type 1 is due to inadequate insulin production therefore insulin is required. Type 2 is due to an underlying insulin resistance. So, it is not common for someone who does not make insulin to later also become resistant to the effects of insulin. It can occur; it can be inherited. It is very, very rare.

What we do see a bit more often, especially in children of Latino and African-American heritage is a “combination” that people informally describe as Type “1-1/2″. These youngsters usually are quite stocky folks who indeed have type 1 diabetes. However, more commonly, I think is the type 1 patient who is lax with meal planning (but seemingly not) and their insulin requirements go up and up.”Why do they need so much insulin?” Because they aren’t following an optimal meal plan. In order to limit glucose output from the liver, curb appetite, and perhaps enhance the body’s response to insulin a bit, they are often placed on one the common type 2 medications called Glucophage [metformin], but I do not think that is really the same as having developed type 2 diabetes.

Talk with your daughter’s pediatric endocrinologist/diabetes team and see if you can clarify what they mean about your child.

DS

[Editor’s comment: See Deteriorating diabetes control during adolescence: physiological or psychosocial? J Pediatr Endocrinol Metab 2002 Feb;15(2):115-26.

SS]