'Double Diabetes' Poses Double Threat

MONDAY, Nov. 21, 2005 (HealthDay News) -- It's a scene occurring with increasing frequency in doctors' offices across America: A patient, usually overweight, comes in with all the symptoms of obesity-linked type 2 diabetes.

But blood tests reveal antibodies to the pancreatic beta cells that produce insulin -- a sign that the patient also has the rarer type 1 form of the disease.

"We call it 'double diabetes,' or hybrid diabetes," said Dr. Francine Kaufman, past president of the American Diabetes Association and head of the Center for Diabetes and Endocrinology at Children's Hospital, Los Angeles.

She and other experts warn that a growing number of patients are being spotted with both forms of the disease.

In type 1 diabetes, which affects 5 percent of all diabetics, the body's immune system turns against beta cells in the pancreas that produce the insulin needed to regulate blood sugar. Type 1 diabetics typically must take daily insulin via injection to remain healthy.

In the much more common, obesity-linked type 2 variety, increasing demand from the body fat's cells causes a gradual shortfall of, and resistance to, insulin. Medication and regular monitoring of blood sugar are essential to keep type 2 patients safe and healthy.

Kaufman, a pediatric endocrinologist, said "double diabetes" is a phenomenon that's being increasingly recognized by doctors. In fact, recent reports suggest that up to 30 percent of newly diagnosed diabetes among children involves youngsters with both type 1 and type 2 disease.

"They may clinically look like they have type 2 -- be overweight and maybe have a family history of type 2 -- but then they come back positive for [type 1] antibodies," Kaufman said.

On the flip side, other young patients may have had type 1 since childhood, become obese in adolescence "and begin to look like they have elements of type 2 diabetes," Kaufmann said. "They are becoming more and more insulin-resistant. So, it can go either way."

America's obesity epidemic is clearly driving the trend toward more and more diabetes, experts say. And while links between obesity and type 2 diabetes have long been clear, research is only just beginning to suggest it can also trigger late-onset type 1 disease.

"With the diet being hypercaloric and high in simple carbohydrates, the [pancreatic] beta cells that remain are taxed earlier. That would explain type 1 disease complicated by diet," said Dr. Stuart Weiss, an assistant clinical professor of medicine at the New York University School of Medicine in New York City.

Weiss deals mainly with adult patients, and said he is seeing more and more 20- and 30-somethings with newly diagnosed double diabetes. "Many are type 1s who have already been diabetic for years, and who are also eating a hypercaloric diet and require a lot more insulin," he said. "They become obese, and then become insulin-resistant."

Kaufman said treatment for double diabetes may be more complex than that provided to patients with type 1 or 2 alone. "It may mean that someone needs insulin and pills," she said.

Individuals who believe they might be diabetic need to get the condition recognized and treated as soon as possible, Weiss added.

"Whether it's type 1 or type 2, we have to look at the cardiovascular risk factors, waist-to-hip ratios, blood triglycerides and cholesterol issues that are common to all diabetics," he said. "That's where I think the focus should be -- not just in managing glucose, but in managing the consequences."

And he said good treatments are available. "Diabetes is a real problem -- it's always been there, but it's been under-treated and under-managed," Weiss said. "Now we have good tools to manage it, so there's less of an excuse for physicians not to treat it well."

Of course, prevention remains the best answer to fighting the disease. For parents, that means "trying to have your child keep to as close a healthy weight as possible, eating appropriate foods in appropriate quantities, and being active," Kaufman said.

"We're looking at a world now in which the rate of diabetes just continues to increase," she added. "We should all be aware of this disease and try and minimize it in every way we can."

More information:

For more on diabetes, head to the American Diabetes Association.