Dr. Katz
  Photo: Mackenzie Stroh
Q: I may have double diabetes. What is it, and what does it mean for my treatment?
— Anonymous

A: There are two kinds of diabetes. Type 1, formerly called juvenile onset, is an autoimmune disease: The body's own defenses wipe out insulin-producing cells, disabling one's ability to process blood sugar. Type 1 usually starts in early childhood, isn't related to obesity, and requires insulin injections to treat. Unlike type 1, type 2 diabetes runs in families, is generally related to obesity and insulin resistance, and can usually be treated with oral medication that stimulates the action or production of insulin.

More and more, doctors are seeing double diabetes. The typical scenario is that someone with type 1 becomes overweight, leading to insulin resistance—a prelude to type 2. The challenge is that the insulin required to treat type 1 stops working due to the insulin resistance of type 2. So either a combination of insulin and oral medication or especially high doses of insulin becomes necessary to keep blood sugar levels normal.

While combination therapy may control blood sugar, you are exposed to the side effects of several medications, and high doses of insulin can contribute to more weight gain. Double diabetes may also increase heart disease risk more than either variety alone. Insulin resistance can be lessened and even reversed through exercise and weight loss. Work with your doctor to develop a physical activity regimen and diet that includes plenty of soluble fiber from oats, beans, lentils, apples, and berries. Your goal should be to reduce your body's need for medication and possibly undouble your diabetes.

As a reminder, always consult your doctor for medical advice and treatment before starting any program.

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