5 ms·

I was surprised to learn on reading this that the Type 1 classification always means "autoimmune disease". I was under the impression that the two type classifi

I was surprised to learn on reading this that the Type 1 classification always means "autoimmune disease". I was under the impression that the two type classifications were "1: unable to produce enough insulin", and "2: producing what ought to be normal amounts of insulin, but for some reason resistant to it"; naively, those seemed like much more natural classes for classifying a syndrome. Having a finer-grained analysis can't be a bad thing; for example, the paper identifies some increased risks for the individual clusters.

carlmr 9y ago
I had in my head that Type 1 was "unable to produce enough insulin, because of autoimmune problems with beta cells". I was surprised to read about Cluster 2 where they don't produce enough insulin and nobody knows why. I would have also intuitively put Cluster 2 under Type 1 diabetes though, because it's the same effect.
manmal 9y ago
AFAIK in type 1, most of the beta cells get destroyed, and it happens because of autoimmune processes. To me this means that immune-modulating medication or perhaps stem cell injections could help a great deal.
- outworlder 9y ago
  Immune-modulating medication maybe, but unless this is identified very early, they won't help. Once the beta cell destruction is complete, you are left without any. Even if the immune system stops attacking, at some point it no longer helps.
  - mnw21cam 9y ago
    In fact, a long time ago some experimental treatment was tried, where active beta cells were transplanted into type 1 diabetes patients. They were very quickly destroyed by the patient's immune system.
- ohtwenty 9y ago
  The problem with those are that they're more complicated (even when perfected) than current treatment. Immune modulation would require either suppressing the entire system (or very large chunks of it) which is done with some other diseases but generally has super high costs, as it leaves you quite vulnerable. Or you're targetting only the handful of cells responsible (my DM I knowledge is rusty but I'm guessing b-cells?) in which case you're on your way to solving a bunch of different diseases. Stem cells has a similar issue, in that once you made new beta cells your immune system will just react to those. Current treatment is quite alright. There's ground to be gained in earlier prediction and treatment, and a ton (this should excite people here on HN) in bettering the treatment method—create a proper feedback loop with insulin/glucose readers that automatically push out insulin when needed instead of a huge shot of it when you're guessing you'll need it.
  - pimeys 9y ago
    My doctor wants me to start thinking about a closed loop system on this year so I don't need to wake up every night for CGM alarms. One interesting project would be the open source pancreas, I've heard lots of good about it, of you have the right insulin pump and CGM. https://openaps.org/ https://openaps.org/
    - GiorgioG 9y ago
      Until there’s a dual (glucagon, insulin) pump released, you’ll still be waking up to deal with those low BG alarms. You may be dealing with fewer alarms because of the predictive suspend feature, sure. Our 6 year old has had a Medtronic 530g which (you probably already know) suspends basal delivery when it reaches a low threshold. I’m pretty sure it’s saved his life a few times (at night) over the past 4 years. He’s due for a new pump and we were hoping the Beta Bionics dusk chambered pump would be ready by this time, but sadly it still looks to be a couple of years away. The Medtronic 670g is likely his next pump, which will add predictive suspend and IIRC will also auto increase his basal rates to account for highs. OpenAPS looks interesting but for now I’m not willing to experiment with it on our son.
      - 9y ago
- maxerickson 9y ago
  There's an enormous amount of research into both understanding the autoimmune reaction and into safe insulin producing cells that could be introduced. Turns out they are both really hard problems. It's a reason to be pretty excited about medicine over the coming years. Doctors are starting to tease apart some of the specifics of the immune system.

carlmr 9y ago

I had in my head that Type 1 was "unable to produce enough insulin, because of autoimmune problems with beta cells". I was surprised to read about Cluster 2 where they don't produce enough insulin and nobody knows why. I would have also intuitively put Cluster 2 under Type 1 diabetes though, because it's the same effect.

manmal 9y ago

AFAIK in type 1, most of the beta cells get destroyed, and it happens because of autoimmune processes. To me this means that immune-modulating medication or perhaps stem cell injections could help a great deal.

outworlder 9y ago
Immune-modulating medication maybe, but unless this is identified very early, they won't help. Once the beta cell destruction is complete, you are left without any. Even if the immune system stops attacking, at some point it no longer helps.
- mnw21cam 9y ago
  In fact, a long time ago some experimental treatment was tried, where active beta cells were transplanted into type 1 diabetes patients. They were very quickly destroyed by the patient's immune system.
ohtwenty 9y ago
The problem with those are that they're more complicated (even when perfected) than current treatment. Immune modulation would require either suppressing the entire system (or very large chunks of it) which is done with some other diseases but generally has super high costs, as it leaves you quite vulnerable. Or you're targetting only the handful of cells responsible (my DM I knowledge is rusty but I'm guessing b-cells?) in which case you're on your way to solving a bunch of different diseases. Stem cells has a similar issue, in that once you made new beta cells your immune system will just react to those. Current treatment is quite alright. There's ground to be gained in earlier prediction and treatment, and a ton (this should excite people here on HN) in bettering the treatment method—create a proper feedback loop with insulin/glucose readers that automatically push out insulin when needed instead of a huge shot of it when you're guessing you'll need it.
- pimeys 9y ago
  My doctor wants me to start thinking about a closed loop system on this year so I don't need to wake up every night for CGM alarms. One interesting project would be the open source pancreas, I've heard lots of good about it, of you have the right insulin pump and CGM. https://openaps.org/ https://openaps.org/
  - GiorgioG 9y ago
    Until there’s a dual (glucagon, insulin) pump released, you’ll still be waking up to deal with those low BG alarms. You may be dealing with fewer alarms because of the predictive suspend feature, sure. Our 6 year old has had a Medtronic 530g which (you probably already know) suspends basal delivery when it reaches a low threshold. I’m pretty sure it’s saved his life a few times (at night) over the past 4 years. He’s due for a new pump and we were hoping the Beta Bionics dusk chambered pump would be ready by this time, but sadly it still looks to be a couple of years away. The Medtronic 670g is likely his next pump, which will add predictive suspend and IIRC will also auto increase his basal rates to account for highs. OpenAPS looks interesting but for now I’m not willing to experiment with it on our son.
    - 9y ago
maxerickson 9y ago
There's an enormous amount of research into both understanding the autoimmune reaction and into safe insulin producing cells that could be introduced. Turns out they are both really hard problems. It's a reason to be pretty excited about medicine over the coming years. Doctors are starting to tease apart some of the specifics of the immune system.