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There is an interesting debate going on over at Diabetes Daily. (I know, I know, I said I was done over there, but some habits are hard to break. And, I have to admit, this debate is not as one sided and infuriating as most have been in the past.)

The question being debated is whether or not it is possible to be thin had have Type 2 diabetes:

Stacy describes herself as 5’5″ tall, 105 lbs, and exercises 6 days a week. Although there is some slight possibility that someone is a “thin Type 2,” it is a truly slight possibility. Far more likely is that the person has been misdiagnosed and has either Type 1 diabetes (in adults, sometimes called LADA or Type 1.5) or monogenic diabetes (aka MODY). If an adult has a fasting blood glucose of greater than 125 mg/dl, most doctors will simply label the person as having Type 2 diabetes, without ever doing tests to determine if the person truly has Type 2 diabetes.

The thread I was reading was begun by a thin Type 2 who wanted other Type 2’s to comment on this assertion. Somehow the discussion turned to insulin resistance. If a person is strongly insulin resistant, then the assumption is that that person is a Type 2. However, they contend, if the person in question does not have insulin resistance, and, in fact, is insulin sensitive, then they can’t possibly have Type 2 diabetes.

My question is: if a person responds to Type 2 diabetes medications and can control their blood sugars with diet and exercise, but appears to be insulin sensitive, does that mean that in a year or two or five, they will develop insulin dependent diabetes, whether it is labeled Type 1 or Type 1.5?

Is that what happened to me?

I was fairly well controlled on diet and exercise when I was first diagnosed. I was on Metformin for a time after my diagnosis, but I went off of it and my sugars stayed fairly stable under 180 for 6-7 years. (I know 180 is high…but that was rare and it never really went above that) I was never insulin sensitive, of course, but my insulin resistance did not become an issue until my last pregnancy when everything went to hell in a handbag….

During my pregnancy, I took an increasing amount of insulin until I was taking nearly 200 units a day (my insulin resistance increased drastically during my pregnancy, and then fell back down). After my pregnancy, I was taken off of insulin and put on Metformin. My numbers immediately skyrocketed and I was put on Byetta, Januvia, and, finally, Levemir. During this time, I rapidly lost 80 lbs…the only time in my adult life I ever lost a large amount of weight and definitely the only time I lost weight without trying.

So, if this is what happened to me, then why am I insulin resistant?

Am I Type 1, MODY, Type 1.5, or just a Type 2 whose condition deteriorated so badly that I now require an insulin pump?

Personally, I think this discussion is just another way to put people into perfectly constructed compartments.

The thing is, no one really understands diabetes enough to make statements of complete certainty.

To use insulin or to not use insulin…that seems to be the only, true difference between diabetes patients. In the end, we all face the same struggles, the same strict adherence to exercise and food choices, the same complicated relationships with our doctors, and the same possibilities of complications.

So why do we continuously feel the need to point fingers and search for someone to blame?

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