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July 31, 2000

Diagnosis and Symptoms, Genetics and Heredity

Question from Waterford, Michigan, USA:

Is it possible to have both type 1 and type 2 diabetes at the same time? I don't see why not if they are two different diseases. If you had type 1 and developed type 2 diabetes later in life, then you would notice that you would need more insulin, right (due to insulin resistance)? I'm just curious. I have type 1, duration 16 years. My grandfather and great grandmother had type 2 diabetes. There is no history of type 1 that we know of. Is it possible I could develop type 2 also someday?

Answer:

What you suggest is certainly theoretically possible, but I have never read a convincing report of its occurrence. There are some difficulties though about the concept. The first is that diabetes can no longer be categorised as just type 1 and type 2. Type 1, for example, is now divided into type 1A which is antibody positive and type 1B which is antibody negative and very common in Hispanic and African American families, but not in Caucasians. Type 2 Diabetes is now increasingly recognised in children and, there are all the rare forms of diabetes in young people like the MODY’s and the Mitochondrial Diabetes. A Japanese group recently described yet another form of acute antibody negative diabetes in young people.

Type 2 diabetes, on the other hand, is rather less well categorised, but already a variety of different chromosomal disorders have come to be linked to the disorder. On top of all this, the overriding principal of treatment of all forms is to keep blood glucoses as near to normal as possible by whatever is the simplest means. Because of this, perhaps, there has been rather little impetus to press for an exact molecular definition in all cases. Ultimately, this will get much more attention as treatment increasingly focuses on genetic engineering, on relevant environmental factors and on specific immunomodulations.

DOB