I have a 35 year old, overweight female patient who was diagnosed with type 1 diabetes and he is now requiring 76 units of insulin per day. So, I believe that she must have insulin resistance and am wondering if I should start thiazolidinediones. Could you please explain the mechanism of insulin resistance in type 1 diabetes? Does she have the same risk factors for complications as some with type 2 and metabolic syndrome?

The difference between type 1 and type 2 diabetes is becoming more difficult as we see more and more patients with signs and symptoms that are found in both types of diabetes. The onset at age 33 is relatively old for a patient with type 1, however possible. Type 1 diabetes would have been characterized by DKA [diabetic ketoacidosis], insulinopenia, or the presence of anti-GAD, anti-islet cell or anti-insulin antibodies.

There are patients with type 1 diabetes who have marked insulin resistance. They usually have a family history of diabetes. That means they have the genetic predisposition to type 2 diabetes but need to give the insulin they would otherwise not make. The risks and complications are probably similar, especially when the sugars are not controlled. However, there may be even more large blood vessel disease in patients with type 2 diabetes.

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