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In <[log in to unmask]>, on 06/22/98
   at 11:24 AM, Fran  Gillespie <[log in to unmask]> said:

>>As for insulin resistance- there are varying degrees such as MODY and
>>others who do not have the classic presentation, and fall somewhere in
>>between- have "sputtering pancreas" that is they have irregular insulin
>>production.

There are likely 20 different kinds of  diabetes. Over the years, they've
been incorrectly shoehorned into two categories with various pairs of
names. The latest definition, Type 1 and 2 (not I and II) is in terms of
disease mechanism, even though in the clinic, it's done differently. For
our purposes here two kinds are sufficient, the current definition:

Type 1: varying degrees of shortfall in insulin production caused by
pancreatic problems AND no insulin resistance. Measured by the glucagon
challenged c-peptide test, not the c-peptide test normally used. Test
measures the lack of change in c-peptide, hence likely insulin response,
in response to stimulated rise in blood sugar. Baseline c-peptide is
irrelevant.

Type 2: inability to fully use the insulin produced due to defect(s) in
the insulin chain from blood to the end user cells. Always involves
"insulin resistance," which can be measured in a research lab, but almost
never is in the clinic.

At least one MODY is a Type 1, according to this definition. If another's
really a sputtering pancreas, without insulin resistance, then Type 1, I'd
say, but I'll bet there's resistance..

>>I don't  understand what you mean by medical management for the two
>>types being "quite different", other than the mandatory insulin
>>requirement for Type 1's.

Blood sugar changes faster, both up and down, in a Type 1 or than in a
Type 2 who no longer makes any insulin and hence must inject. Hypoglycemia
is a constant, real threat. The Type 2 is protected both by the insulin
resistance and, if still making insulin, by the blood sugar buffering
ability of the liver. 50 % of insulin from the pancreas is captured by the
liver and used, among other things, to store glucose for release when
blood sugar falls.  Little of injected insulin gets to the liver. Further,
the other missing hormone from the damaged beta cells of the pancreas,
amylin, is unavailable to control glucagon release, another safety valve
against low blood sugar.

Injecting insulin, even "human" insulin is just as unnatural as taking
whichever pill for Type 2. The grass is not greener and, indeed, more
dangerous. --
                                          Kemp
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Kemp Randolph <[log in to unmask]>
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