Amy Campbell, CDE, is a registered dietitian and the author of several books about diabetes, including 16 Myths of a Diabetic Diet and Staying Healthy with Diabetes: Nutrition and Meal Planning.
When we think about having diabetes, we often think of a person as having type 1 or type 2 diabetes. We might even know someone who has had gestational diabetes, which is diabetes that appears during pregnancy. And prediabetes, while technically not diabetes, is a term we hear more and more about these days as well, given that 86 million people in the United States have it. But “double diabetes”? What the heck is that?
What is it?
Admittedly, the term “double diabetes” was new to me, but it has been around since 1991. Back then, researchers observed that some people with type 1 diabetes who had a family history of type 2 diabetes were more likely to be overweight and struggle to achieve glycemic control, despite taking higher doses of insulin.
Double diabetes is when someone who has type 1 diabetes develops insulin resistance, a key feature of type 2 diabetes. A person who has double diabetes does not morph into having type 2; he or she will always have type 1 diabetes. The person just happens to have some degree of insulin resistance too.
Insulin resistance is closely linked with metabolic syndrome, and it’s believed that people who have double diabetes also tend to have this condition. Metabolic syndrome is the name for a group of risk factors that raise the chances of developing heart disease, diabetes, and stroke. How do you know if you have metabolic syndrome? The following criteria can clue you in:
- A large waistline. This also is called abdominal obesity (think “apple shape,” or having a “spare tire” around your waist). Excess fat in the stomach area is a greater risk factor for heart disease than excess fat in other parts of the body, such as on the hips.
- A high triglyceride (blood fat) level (or you're on medicine to treat high triglycerides).
- A low HDL cholesterol level (or you're on medicine to treat low HDL cholesterol). HDL is sometimes called "good" cholesterol. This is because it helps remove “bad” cholesterol from your arteries. A low HDL cholesterol level raises your risk for heart disease.
- High blood pressure (or you’re on medicine to treat high blood pressure). Left untreated, high blood pressure can damage the heart and raise the risk for having a stroke.
- High fasting blood sugar (or you're on medicine to treat high blood sugar). Mildly high blood sugar may be an early sign of diabetes.
The weight factor
Many of us have been taught that people who have type 2 diabetes tend to be overweight, while those with type 1 are usually thin. And while there is a measure of truth in that, the reality is that there are folks with type 2 who are lean, just as there are folks with type 1 who are overweight and even obese. As the saying goes, “You can’t judge a book by its cover.”
The Pittsburgh Epidemiology of Diabetes Complications study followed a group of people with type 1 diabetes. Between 1987 and 2007, the prevalence of obesity rose sevenfold (to 22.7 percent) and overweight increased by 47 percent (to 42 percent). We’re also seeing more weight issues in youth with type 1 diabetes: researchers from the T1D Exchange ran the heights and weights of 33,000 type 1 pediatric patients through two massive databases. Nearly 40 percent of children in both registries were considered to be overweight or obese. And, perhaps not surprisingly, a higher body mass index was associated with a higher A1C level.
How common is double diabetes?
It’s hard to determine just how many people have double diabetes. One explanation is that it’s not always apparent which type of diabetes a person has. For example, we know that adults do get diagnosed with type 1 diabetes, while more and more children and adolescents are getting type 2 diabetes. And as we’ve just seen, a person’s weight is not always a good predictor of what type of diabetes they have. But given the rise in prevalence of overweight and obesity in the U.S., we’re no doubt going to see even more cases of double diabetes.
What is the big deal about double diabetes?
Having any type of diabetes is a big deal. Double diabetes raises the ante a bit because someone who has this condition has a higher risk of developing both macrovascular complications (e.g., heart disease, stroke, peripheral arterial disease) and microvascular complications (e.g., diabetic eye disease, kidney disease) compared to someone who has type 1 alone.
How can you manage double diabetes?
It seems like a low blow to have type 1 diabetes and then be told that you have insulin resistance (or metabolic syndrome) on top of that. But don’t let that stop you from taking action. First, talk with your healthcare provider if you have type 1 and any of the risk factors of metabolic syndrome. Second, focus on the following lifestyle steps to help you lessen (and possibly reverse) your insulin resistance:
Be mindful of ever-increasing insulin doses. This can be a catch-22, as the higher your blood sugars climb, the more insulin you’ll need to bring them into your target range. Yet, if your motto is, “I’ll eat what I want and just bolus more insulin,” perhaps it’s time to reexamine the reasons you’re taking more insulin. Large doses of insulin can make it difficult to lose weight and can sometimes lead to weight gain as well. If you’re using your insulin as a license to eat more, maybe it’s time to rethink that strategy.
Lose weight. It’s advice that we may all tire of hearing, but it’s truly one of your best bets when it comes to insulin resistance. Even a small amount of weight loss, such as five to seven percent of your body weight, can make your insulin work better and, at the same time, lower your triglycerides, your blood pressure, and your blood sugar.
Be more active. You do have time to fit it in. Really. Aim to do about 30 minutes most days of the week. Break it up into three 10-minute segments if you need to. And don’t overlook the power of resistance training, such as lifting weights or doing calisthenics.
Stop smoking. Smoking increases insulin resistance. Talk with your provider about ways to quit.
Cut down on refined carbs. Even if you’ve already sworn off regular soda and sugar, eating processed carbs like white bread, white pasta, and white rice can increase insulin resistance. Choose healthier carbs like whole grains, legumes, fruits, and vegetables.
Eat more fish. Fatty fish, such as salmon, tuna, and mackerel, are high in omega-3 fatty acids, a type of fat thought to possibly help lower insulin resistance.
Get some sleep! Forget about burning the midnight oil. Most people need between seven and nine hours of sleep each night. Skimping on sleep raises insulin resistance. If the quality of your sleep isn’t good, ask your doctor about having a sleep study conducted to rule out sleep disorders such as sleep apnea or restless legs syndrome.
Slash the stress. Easier said than done, but if stress is what’s eating you, it’s time to deal with it. Exercise, yoga, meditation, deep breathing, and even counseling can help.
Have you been diagnosed with “double diabetes”? How have you coped with it? Add a comment and tell us about your experiences.