[mellitus]

Diabetes type terminology needs updating.

I propose:

The term "Keto Pancreatic Diabetes" for a condition of little or no insulin production causing ketoacidosis (in an untreated state).

The term "Onset Pancreatic Diabetes" for a condition of reduced insulin production (usually due to auto immunity, or overstress failure of the pancreas).

The term "Metabolic Diabetes" for a condition of cellular insulin resistance

Terms type 1, and type 2 would no longer be used, all other terms remain in use.

Thanks for reading. Comments anyone.

 

[onaughmae]

No matter what labels we use, there are too many different circumstances to rename them all. At least T1 and T2 cover a basic idea....one is positive for GAD antibodies and one is not. But...lets not forget about LADA, or T1 that also have insulin resistance, or T2 that requires some additional insulin because of failing beta cells...or T2 with no beta cell function left at all..etc, etc....There are enough people just freaked out with being told they are diabetic at all..much less giving them complicated labels to deal with also. My opinion of course

 

[foxl]

I actually like the name, KPD / Ketosis-prone diabetes -- to describe how I was diagnosed. The coiners of the term categorized people diagnosed in ketosis into four groups, by antibodies and beta-cell functionality. A+B- to A-B- I wish my docs had read that and looked further without my prodding!

The problem with GAD antibodies is that SOME clinicians (and readers on forums ... mostly NOT LADAs ) still believe there are anomalous GAD-positive people, therefore using GAD antibodies to determine autoimmune activity is useless. Amazingly. There ARE some people without D who are GAD-positive. But that is not to say they might not develop D later ???

Other than that, there is the recent study on T-cell reactivity in T2, to contend with ...

But I like your thinking -- there is so much more to this disease, than 2 "types!"

 

[jwags]

I think it would be hard to differentiate between the 3 types. Already we have so many people that are misdiagnosed as Type 2's or Type 1's or LADA's. I think a lot of times the extent of diabetic damage is how long it has been undiagnosed and how much pancreatic damage has taken place. I do think with some D's, type 1's and type 2's the pancreatic damage is more severe and they are the ones who seem to be at risk for DKA.

 

[mellitus]

Here is the proposal again, but with more detail.



Proposal to Redefine Diabetes Type Terminology
By M. Ingraham, April 2011


Currently the term “Type 2 diabetes” includes two very different species of diabetes, each best treated differently, yet they have one name. Where does LADA fit in, if it is essentially a slow onset type 1, should it have a separate name. What about type 1.5, type 3, MODY, or the rare or genetic types?

I propose:

The term “Diabetes”, refer to a persistent disease causing abnormal blood sugar levels. Diabetes Insipidus would not be included, nor would a passing chemical or allergic reaction.

The term "Keto Pancreatic Diabetes" for a condition of little or no insulin production, generally causing ketoacidosis in an untreated state. This new term replaces the old “type 1 diabetes”, and will include any other diabetes type if it progresses to a stage where keto acidosis generally occurs in an untreated state. This generally occurs only in complete pancreatic failure.

The term "Onset Pancreatic Diabetes" for a condition of reduced insulin production, or a condition of relative inadequate insulin production, in a person not having resistance to insulin. Included under this term is gestational diabetes, in which the extra requirements of the unborn child and tissues of pregnancy increase insulin demand beyond the output of the pancreas. In this case the illness would be termed “Gestational Onset Pancreatic Diabetes”. This term includes the old “type 2” when referring to decreased insulin output of the pancreas.

The term "Metabolic Diabetes" for a condition of cellular insulin resistance.

Terms type 1, and type 2 would no longer be used. Other types would prefix the three proposed basic types. If a “Keto” type patient develops insulin resistance in old age, the term is “Keto-Metabolic Diabetes”. “MODY Onset Pancreatic Diabetes”, or “MODY Onset Diabetes”, are other examples.

Some blood sugar diseases would best retain their current labels – “hypoglycemia”, by it’s various causes of the liver, kidneys or pancreas would remain “hypoglycemia”. Genetic or nervous conditions causing one of the three major diabetic conditions – “Keto”, “Onset”, or “Metabolic”, would use it’s prefix with the appropriate suffix, “Rabson-Mendenhall Onset Diabetes” is an example. If the “LADA” term is useful, it may remain in use as a prefix to it’s appropriate major type suffix, “LADA Onset Diabetes”, which may progress to “LADA Keto Diabetes”.

 

[onaughmae]

Again, this seems so complicated to me...for instance...where do I fit?

I am T2 and insulin resistant. So I would be called a metabolic diabetic. But..I no longer produce insulin...so that would classify me as a Keto Pancreatic diabetic. So in essence...I would now be considered a Metabolic Keto Pancreatic Diabetic? Wow, I gotta say, insulin-dependent T2 seems so much easier to me

I really dont think there is ever going to be a decisive clear cut way to describe diabetics. There are so many different situations that make us diabetic.

 

[Vytautas]

Type 1 and type 2 are perfectly good names. A regular person would understand me a lot easyer if I said "For T1 diabetes..." instead of "If you have "Keto Pancreatic Diabetes"..."

There is nothing wrong with using type 1 and type 2. Here's another example:

With a fellow physisit I might be talking about a fiber single mode laser. What does that mean to you, the regular person? A pretty laser that has good uses.

The terminology exists, the fact that the regular people don't use it does not require to throw out perfectly good terms.

Type 1 - beta cell failure caused insulin dependant diabetes
Type 2 - a secondary form of diabetes that may or may not be insulin dependant but is not caused by beta cell failure making the organism unable to produce insulin.

Problem solved. YOU, the regular person, don't need to know any more than that. YOU are NOT the one deciding on the type of treatment.

As a patient your job is to:

• find out the details about your particular case (whatever the desease may be)
• Find out the possible treatment methods
• Consult and find the best treatment method for you
• Follow the doctors instructions
• Be able to make your own decisions (T1 diabetics always taking the exact dosage the doctor ordered outright scare me)

In short: it's fine that you want some new terms, but no need to change the old ones that are perfectly fine and don't confuse anyone

What you propose is that people would go "What's that?" And the answer would be: "It's the same as diabetes but the causes are different and treament is different as well" (In short, T2)