‘Double Diabetes’ Alarms Experts

Having one type of diabetes is bad enough, but two? Doctors are seeing a new phenomenon dubbed double diabetes, which makes it harder to diagnose and treat patients -- especially children.

The mix can strike at any age, and comes in various forms: Children who depend on insulin injections because of Type 1 diabetes gain weight and then get the Type 2 form in which their bodies become insulin resistant.

Or someone with classic Type 2 symptoms isn’t responding to therapy, and tests reveal he also is developing the insulin-dependent form of the disease. Or he may not fall clearly into either category.

The exact diagnosis is important -- different forms of diabetes require different treatments.

Yet “there are many people in which it’s very blurred as to what kind of diabetes they have,” says Dr. Francine Kaufman, a USC pediatric endocrinologist and past president of the American Diabetes Assn.

There are no good statistics on this complex disease-mixing.

But the Children’s Hospital of Pittsburgh counts about 25% of child patients with Type 1 diabetes who also are overweight and have other Type 2 features, says Dr. Dorothy Becker, a pediatric endocrinologist and leading double-diabetes researcher.

And an ongoing study to determine the best treatment for child Type 2 diabetics is uncovering many participants who harbor antibodies that signal they have or are developing the Type 1 form too, Kaufman says.

Those findings echo a handful of recent research reports raising concern about the phenomenon, which some call atypical diabetes, “diabetes 1 1/2 “ or even Type 3 diabetes.

Diabetes occurs when the body can’t turn blood sugar, or glucose, into energy, either because it doesn’t produce enough insulin or doesn’t use it correctly.

With the Type 1 form, the patient’s own immune system attacks the insulin-producing islet cells in the pancreas. Once thought to strike only in childhood, it also can develop in adults. Symptoms usually appear suddenly and can quickly become life-threatening. Insulin, given by shots or a pump, is required to survive.

With the Type 2 form, the body loses its ability to use insulin properly, even though the pancreas pumps out extra and drugs often are given to rev up that production even more. Type 2 usually develops slowly, and once was thought to hit only the middle-aged but now is striking overweight children.

Both forms can lead to heart and kidney disease, blindness and limb amputations, and kill if not properly treated. But Type 2, which afflicts more than 90% of the more than 18 million U.S. diabetics, has received more attention recently because it’s an epidemic fueled by increasing obesity.

Yet specialists knew Type 1 was quietly increasing too -- and then they began spotting double diabetics.

The theory: Overweight people need more insulin to process glucose regardless of whether they’re insulin-resistant yet. So, perhaps obesity overworks the pancreas until it wears out, Pittsburgh’s Becker suggests. Or perhaps obesity accelerates the autoimmune destruction -- meaning someone genetically predisposed to Type 1 diabetes might not have gotten it if he had stayed thin.

“You’ve not just exceeded what you can make but perhaps accelerated the destruction,” and then insulin-resistance sets in, agrees Kaufman, whose new book, “Diabesity,” explores the overall obesity-diabetes threat.

Whatever you call that mix, it complicates treatment.

Consider Martha Larkin of Pittsburgh, diagnosed with Type 1 diabetes at age 3. For years, her mother would wake up in the middle of the night to test Martha’s blood sugar and administer insulin. Set mealtimes and off-limit foods became the family’s norm.

Then early puberty hit at 10, and Martha began gaining weight, says her mother, Cindy Stevans. Now almost 12, Martha needs as much insulin each day as a grown man, which signals developing insulin resistance. And, in a vicious cycle, the more insulin she gets, the hungrier she feels.

A recently implanted insulin pump is helping. The family joined a pool in hopes that physical activity will help Martha stave off double diabetes, and help her twin brother remain diabetes-free. But weight is a problem for this whole family of bookworms who hate exercise so much that Stevans calls it “torture.”

“It’s painfully hard,” she says of her daughter’s co-battles with diabetes and weight.

Scientists don’t yet know if double diabetics will need special treatments. For now, the emphasis is on prevention. For Type 2, that means weight loss. For Type 1, scientists are enrolling pregnant women from diabetes-prone families into a major study to investigate what might protect their babies from the illness later in life. To enroll, check https://www.trigr.org.