5 ms·

Type 1 diabetes is not related with obesity.

deleted 5y ago
[deleted]
kennywinker 5y ago
It really is a shame that there isn’t better names for type 1 and type 2 diabetes. They have such different stories, and yet get lumped together constantly.
- DoreenMichele 5y ago
  There are other forms of diabetes. I know of CFRD and have heard it is neither type 1 nor type 2 and I think there is at least one other form beyond that, but can't recall anything about it. Edit: Diabetes is actually five separate diseases, research suggests https://news.ycombinator.com/item?id=16499376 https://news.ycombinator.com/item?id=16499376 You can add a sixth class. I have been told that Cystic Fibrosis Related Diabetes (CFRD) is neither Type 1 nor Type 2. https://news.ycombinator.com/item?id=16499548 https://news.ycombinator.com/item?id=16499548
  - mnw21cam 5y ago
    Disclosure: I work in diabetes research. That "five types" article is very poor. They simply applied k-means clustering to a large set of people with diabetes. The problem with k-means clustering is that it can generally find anything you want it to. For instance, you tell k-means clustering how many clusters you want it to find, not the other way around. In this example, there is significant overlap/fuzziness between the classes. It's better to say that there is a wide spectrum of the progression of diabetes. It is well-known that type 1 diabetes that arises late in life tends to progress very much more slowly than type 1 diabetes that arises in teenagerhood. A teenager with type 1 diabetes can have a very rapid progression, and have very severe symptoms. A person who develops type 1 in their seventies can have such a slow onset that the treating doctor can get very confused about what is going, and assume that it is type 2 instead, until the patient finally cannot live without insulin. K-means clustering has separated these two situations, but they are a spectrum from aggressive to gentle. But the distinction between type 1 and type 2 is still very relevant. With type 1, the problem is too little insulin (progressing to zero insulin produced because the immune system destroys the insulin-producing pancreatic beta cells), and the treatment is insulin. There is no other treatment. With type 2, the fundamental problem is too much insulin, which the body naturally produces to correct other fundamental problems, namely high blood sugar levels, which has a tight interaction with diet and obesity. The insulin encourages fat/muscle cells to suck sugar out of the blood to reduce it, but this causes other problems. A high level of insulin is then needed to keep the energy stored in the fat cells and stop it coming back into the blood as sugar, and the insulin-producing cells can eventually burn out from over-use. The treatment is to deal with the high blood sugar levels and obesity - the insulin problem is a second-order effect. Injecting more insulin into a patient with type 2 diabetes can make the problem worse - it might sort out the high blood sugar level, but it does that by cramming all that sugar into fat cells, so insulin injections are generally only used when the insulin-producing cells start failing. Diet, exercise, and blood sugar lowering drugs are better treatments. Different people respond differently to this disease, with some people storing fat around their legs (which is a more healthy option) and others storing it around their internal organs (which is really bad). K-means clustering will have separated this continuous spectrum of people into separate clusters too. There are multiple other rarer types of diabetes that tend to be overlooked, and probably don't have much participation in the k-means clustering because of their rarity. These include the CFRD you mention, but also gestational diabetes, diabetes associated with various other more syndromic conditions (like Down syndrome), and monogenic diabetes (a single-gene defect causes an inability to correctly produce insulin - we know of double-figures types of this, some of which can be very easily and cheaply treated, and others need to be treated like type 1). There's also diabetes that is caused by surgery, if a patient has their pancreas removed.
    - DoreenMichele 5y ago
      Thank you, thank you, thank you. Gestational diabetes is probably the other one I was trying to remember.
- watwut 5y ago
  You can be thin and have diabetes 2 too. There is strong correlation (as in weight is massive risk factor), but in fact thin people can get it too.
  - mnw21cam 5y ago
    As with everything, different people are different. Thin people can get type 2 diabetes, but this is often due to inappropriate fat deposits around internal organs. In a proportion of these "skinny-fat" people, a bit more exercise and a better diet may have prevented the type 2 diabetes. A lot of it is genetic, and each different person will have a different adiposity above which they will start to develop type 2 characteristics. People with an Indian heritage need to be extra-careful on this one.

deleted 5y ago

[deleted]

It really is a shame that there isn’t better names for type 1 and type 2 diabetes. They have such different stories, and yet get lumped together constantly.

DoreenMichele 5y ago
There are other forms of diabetes. I know of CFRD and have heard it is neither type 1 nor type 2 and I think there is at least one other form beyond that, but can't recall anything about it. Edit: Diabetes is actually five separate diseases, research suggests https://news.ycombinator.com/item?id=16499376 https://news.ycombinator.com/item?id=16499376 You can add a sixth class. I have been told that Cystic Fibrosis Related Diabetes (CFRD) is neither Type 1 nor Type 2. https://news.ycombinator.com/item?id=16499548 https://news.ycombinator.com/item?id=16499548
- mnw21cam 5y ago
  Disclosure: I work in diabetes research. That "five types" article is very poor. They simply applied k-means clustering to a large set of people with diabetes. The problem with k-means clustering is that it can generally find anything you want it to. For instance, you tell k-means clustering how many clusters you want it to find, not the other way around. In this example, there is significant overlap/fuzziness between the classes. It's better to say that there is a wide spectrum of the progression of diabetes. It is well-known that type 1 diabetes that arises late in life tends to progress very much more slowly than type 1 diabetes that arises in teenagerhood. A teenager with type 1 diabetes can have a very rapid progression, and have very severe symptoms. A person who develops type 1 in their seventies can have such a slow onset that the treating doctor can get very confused about what is going, and assume that it is type 2 instead, until the patient finally cannot live without insulin. K-means clustering has separated these two situations, but they are a spectrum from aggressive to gentle. But the distinction between type 1 and type 2 is still very relevant. With type 1, the problem is too little insulin (progressing to zero insulin produced because the immune system destroys the insulin-producing pancreatic beta cells), and the treatment is insulin. There is no other treatment. With type 2, the fundamental problem is too much insulin, which the body naturally produces to correct other fundamental problems, namely high blood sugar levels, which has a tight interaction with diet and obesity. The insulin encourages fat/muscle cells to suck sugar out of the blood to reduce it, but this causes other problems. A high level of insulin is then needed to keep the energy stored in the fat cells and stop it coming back into the blood as sugar, and the insulin-producing cells can eventually burn out from over-use. The treatment is to deal with the high blood sugar levels and obesity - the insulin problem is a second-order effect. Injecting more insulin into a patient with type 2 diabetes can make the problem worse - it might sort out the high blood sugar level, but it does that by cramming all that sugar into fat cells, so insulin injections are generally only used when the insulin-producing cells start failing. Diet, exercise, and blood sugar lowering drugs are better treatments. Different people respond differently to this disease, with some people storing fat around their legs (which is a more healthy option) and others storing it around their internal organs (which is really bad). K-means clustering will have separated this continuous spectrum of people into separate clusters too. There are multiple other rarer types of diabetes that tend to be overlooked, and probably don't have much participation in the k-means clustering because of their rarity. These include the CFRD you mention, but also gestational diabetes, diabetes associated with various other more syndromic conditions (like Down syndrome), and monogenic diabetes (a single-gene defect causes an inability to correctly produce insulin - we know of double-figures types of this, some of which can be very easily and cheaply treated, and others need to be treated like type 1). There's also diabetes that is caused by surgery, if a patient has their pancreas removed.
  - DoreenMichele 5y ago
    Thank you, thank you, thank you. Gestational diabetes is probably the other one I was trying to remember.
watwut 5y ago
You can be thin and have diabetes 2 too. There is strong correlation (as in weight is massive risk factor), but in fact thin people can get it too.
- mnw21cam 5y ago
  As with everything, different people are different. Thin people can get type 2 diabetes, but this is often due to inappropriate fat deposits around internal organs. In a proportion of these "skinny-fat" people, a bit more exercise and a better diet may have prevented the type 2 diabetes. A lot of it is genetic, and each different person will have a different adiposity above which they will start to develop type 2 characteristics. People with an Indian heritage need to be extra-careful on this one.