Double Diabetes: The Diagnosis You Didn’t Think Was Possible
Sadly, having type 1 diabetes doesn’t make you immune to type 2 diabetes. There are still risk factors, such as age, hypertension, cardiovascular disease, low HDL cholesterol, high triglycerides, non-alcoholic fatty liver disease, polycystic ovarian syndrome, and more that could contribute to the development of insulin resistance, a trait usually seen in type 2 diabetes.
Double diabetes occurs when a person with type 1 diabetes (characterized by the inability of the pancreas to produce the insulin the body needs to survive) develops insulin resistance, meaning the body becomes less and less able to effectively utilize insulin over time. But make no mistake—this is not a transition from type 1 to type 2, but rather an addition of type 2. Didn’t think that was possible? You’re not alone. In fact, this trouble-times-two wasn’t even discovered until 1991.
It technically is not possible to be diagnosed with both types of diabetes, but those with double diabetes must still treat their condition with a two-pronged approach, using insulin to control the type 1 and long-term lifestyle changes to manage the type 2. Endocrinologist Irene Schauer, MD, PhD, an assistant professor in the department of medicine’s division of endocrinology, metabolism, and diabetes at the University of Colorado in Denver, explains:
“Once people have type 1 diabetes, it’s not totally accurate to say that they ‘develop’ type 2 diabetes on top of it, since they already have diabetes. What they do develop is additional insulin resistance due to weight gain and a sedentary lifestyle.”
Double diabetes, as it’s still most often called, isn’t believed to be a very common condition, but it is not currently known exactly how common it is. We continue to learn more about the nuances of different types of diabetes, and sometimes this leads to more questions and hypotheses than it does answers. When the list of diabetes types and classifications is so long (type 1, type 2, type 1.5, prediabetes, diabetes insipidus, gestational, MODY, SAID, SIDD, SIRD, MOD, MARD, etc.) and many of the definitions and symptoms overlap, it can be difficult to determine what type of diabetes someone has.
Many experts believe double diabetes tends to happen to people with type 1 diabetes who are treating their condition with insulin but aren’t making any lifestyle changes. Type 1 diabetics with poor diets and low activity levels are more likely to develop double diabetes.
Having double diabetes can cause other health issues as well (on top of the diseases you’re predisposed to just by having one type of diabetes). For example, it increases the risk of microvascular and macrovascular complications. If double diabetes is misdiagnosed or mistreated as type 2, it can also result in diabetic ketoacidosis (DKA) and death.
You can minimize your risk of these complications and your risk of developing double diabetes. Lower your carbohydrate and sugar intake and avoid overindulging in food. Stay active and try to keep your BMI in the target range. If you smoke, quitting can also help decrease your level of insulin resistance. Ask your doctor about other changes you can be making. Some doctors are also coupling insulin treatments and type 2 diabetes treatments such as Metformin in an attempt to combat insulin resistance before it starts.
If you believe your diabetes has been misdiagnosed as the wrong type, please speak up. Do your research, get a second opinion from another doctor, and don’t give up until you know you’ve been properly diagnosed and are getting the treatment you need. You only have one body; it’s worth the work.