Screening for Diabetes
Living With 'Double Diabetes'
Successful type 1 diabetes treatment can yield an unwanted side effect: weight gain that puts you at risk for insulin resistance, casually referred to as "double diabetes." Here's what you need to know to protect yourself.
By Madeline R. Vann, MPH
Medically Reviewed by Farrokh Sohrabi, MD
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As the diabetes epidemic continues to escalate, a growing number of people with type 1 diabetes are developing characteristics of type 2, the form closely linked with obesity and lifestyle habits. Though it’s technically not possible to be diagnosed with both types, people whose diabetes falls in this gray area face unique treatment complications.
A recent study of people with type 1 diabetes found that those who gained excessive weight (often a side effect of treatment) developed the same kind of insulin resistance that is a hallmark of type 2 diabetes. Hearing that you have insulin resistance, or “double diabetes” as it’s sometimes called, when you’re already living with type 1 diabetes can be confusing. “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,” explains 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. “What they do develop is additional insulin resistance due to weight gain and a sedentary lifestyle.”
To understand how the two conditions may overlap, it’s important to understand the differences between type 1 and type 2 diabetes. With type 1 diabetes, the body is unable to make insulin, a hormone that allows cells to pull in glucose (sugar) from the blood and use it produce energy. To manage the condition, people living with type 1 diabetes must take insulin. People with type 2 diabetes can make some insulin, but their bodies don't use their own insulin properly, so the hormone is not as effective at controlling blood sugar. The same kind of inefficient insulin use, or insulin resistance, associated with type 2 can occur in people with type 1 diabetes: Your body is no longer able to use the insulin you’re giving it as effectively.
According to the recent research, which was published in the journalCirculation, excessive weight gain among people with type 1 diabetes not only leads to insulin resistance but also can progress to metabolic syndrome – a group of heart-health risk factors that include high blood lipids, high blood pressure, and a thick waist – and ultimately atherosclerosis, the dangerous narrowing of the arteries. Metabolic syndrome is considered a precursor to type 2 diabetes. In addition, insulin resistance and the development of metabolic syndrome often set the stage for unhealthy cholesterol levels and increased risks for stroke and cancer.
Recognizing and Treating “Double Diabetes”
One of the early signs that you might be experiencing insulin resistance is a need for more and more insulin to meet your blood sugar control goals. However, there are treatment alternatives to continually ramping up your doses.
“It’s likely that patients should also be put on another medication to improve their response to insulin, but this is not yet standard of care,” says Dr. Schauer. Metformin (glucophage), which is often used to reduce insulin resistance in people who have type 2 diabetes, can be taken by people with type 1 diabetes as well.
How to Prevent Insulin Resistance and Safeguard Health
You’ll want to step up the efforts you’re making to control your weight, blood pressure, and cholesterol levels. “Lifestyle change improves insulin sensitivity,” says Andrew Ahmann, MD, chief of endocrinology at Oregon Health & Science University in Portland. Better health habits make sense for everyone but are especially important for people with type 1 diabetes who also have type 2 diabetes in their family or risk factors for insulin resistance.
- Eat a healthy, balanced diet.
- Keep weight in the normal, healthy range.
- Be physically active for at least 30 minutes most days of the week.
- Keep tabs on blood pressure and cholesterol levels.
If you’re living with type 1 diabetes, be aware that leaping into a more active lifestyle, especially if you might already be already experiencing some insulin resistance, might put you at risk for hypoglycemia (low blood sugar). Before starting a new exercise program, talk with your doctor about how to proceed safely.
Dr. Ahmann recommends speaking candidly with your diabetes doctors and nurses about the possibility of developing insulin resistance. Together, you can set in place strategies to prevent it or treat it as early as possible to protect your health.
Video: Double Diabetes Diagnosis
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