This Sharepost might be a bit muddled because, according to the latest news buzz, people with diabetes are apt to have "cognitive decline," a polite word for senility. So bear with me if I end up talking about the 1938 World's Fair instead of diabetes. It's not my fault; I have diabetes.
Of course, ...
Genes and Diabetes
1/22/09 12:07pm
Nicely argued!
One of the MODY genes is also implicated in other forms of Type 2.
Our familial thing is IR in non-obese individuals. Probably the diabetics also have a second disfunction in insulin production or control.
All types of diabetes have a genetic basis. Some people have the misconception that type 1 diabetes is caused by bad luck in having diabetes genes whereas type 2 is caused by sloth and gluttony. In fact, the genetic connection to type 2 diabetes is even stronger than that to type 1. An identical twin whose twin has type 1 diabetes is less likely to become diabetic than an identical twin whose twin has type 2 diabetes.
And isn't it sad when this is trotted out by Type 1s? Divide and rule . . .
1/22/09 3:19pm
If you don't have dysfunctional beta cells in addition to IR, you wouldn't show signs of diabetes. Your beta cells would just multiply and grind out enough insulin to cover the IR. That happens in a normal pregnancy and in overweight people who don't have diabetes.
Hence type 2 diabetes is called a "two-hit disease."
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indeed our knowledge advances- when I was a student, I was taught that a difference between I + II was B-cell destruction: type I commenced with B-cell destruction, whereas type II progressed first from B-cell 'exhaustion" which over time led to cell death. We now know that type II as well proceeds from B-cell destruction- that is, even in the early stages of type II, there is B-cell loss, within the same context of hyperinsulinemia and IR- I think what this post infers is that the only curative would be genetic, somehow able to 'fix' dysfunctional genes; but it also serves as a good thought experiment to point out that the complexity of genetic mutation may make a cure-all impossible (oh well, back to diet and exercise...)
I don't think gene therapy is the only option. We need to find out what is causing the autoimmune attack on the beta cells and what is causing insulin resistance, in other words, what are the various genes doing that is causing harm. Then we can try to fix that.
As an analogy, genes make my hair brown, and then age makes the hair gray. But I don't need gene therapy to change my hair color, at least on a temporary basis.
If we know that a mutant gene produces a faulty enzyme, then we can provide the missing correctly functioning enzyme (as we provide insulin for those who aren't producing it) or we can figure out some smaller molecule that
will make the faulty enzyme work like a normal enzyme. Some day we might be able to alter the genes to produce the own correct enzyme, but that type of correction is a long way off.