- With Mayo Clinic diabetes educators
Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.read biographyclose window
Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.Nancy Klobassa Davidson and Peggy Moreland
Nancy Klobassa Davidson, R.N., B.S.N, C.D.E
Nancy Klobassa Davidson is a registered nurse who has worked in diabetes education for 17 years. She is a certified diabetes educator (C.D.E.) and is currently in graduate school working on a Master of Science in nursing (M.S.N.) and health care education.
Nancy works with adults who have type 1, type 2 and other forms of diabetes. Nancy is coordinator of the Diabetes Unit's intensive insulin therapy program within the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn. Nancy has worked extensively with insulin pump therapy and continuous interstitial glucose sensing.
Peggy Moreland, R.N., M.S.N.
Peggy Moreland is a certified diabetes educator (C.D.E.) in the Division of Endocrinology, Diabetes, Metabolism, & Nutrition at Mayo Clinic in Rochester, Minn.
Peggy graduated with a Master of Science in Nursing and Health Care Education from the University of Phoenix and is a member of the American Association of Diabetes Educators and the American Diabetes Association. A certified diabetes educator (C.D.E.), Peggy enjoys working with patients to set and achieve diabetes self-management goals.
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Diabetes diagnosis — Type is not always clear
By Nancy Klobassa Davidson, R.N., and Peggy Moreland, R.N.
I've noticed in writing this blog and reading the comments a surprising bit of animosity between individuals with type 1 diabetes and type 2 diabetes. In my practice, I've heard statements such as:
- "Type 1 diabetes, that's the bad one?"
- "People with type 2, it's their own fault they have diabetes. If they would've taken better care of themselves they wouldn't have diabetes."
Diabetes is bad, no matter what type you have. And the end result can be the same if blood glucose isn't well controlled.
Interestingly, the lines between the types of diabetes are getting a little blurry as we learn more about diabetes. When I first started as a diabetes educator, diagnosing type 1 versus type 2 was pretty clear cut. You were type 2 if you were over 40, were overweight and had a family history of type 2 diabetes. You were type 1 if you were thin, had small insulin requirements, were under 30 years of age and had ketoacidosis.
Today endocrinologists say there are multiple classifications of diabetes. According to the American Diabetes Association's 2009 Standards of Medical Care in Diabetes, there are four clinical classes of diabetes:
- Type 1: Results from beta cell destruction, leading to zero insulin production (autoimmune disorder)
- Type 2: Results from progressive insulin cell release defect in addition to insulin resistance
- Other types due to specific causes: May result from genetic defects in the cells that release insulin, diseases of the pancreas (such as cystic fibrosis), or drugs or chemicals (such as treatments for AIDS or after organ transplant)
- Gestational diabetes
Some patients can't be clearly classified as having type 1 or type 2 diabetes. Occasionally, patients who are diagnosed with type 2 will actually turn out to have type 1, and vice versa. True diagnosis becomes more obvious over time. One form of type 1 diabetes I'm beginning to see is latent autoimmune diabetes in adults (LADA), sometimes called type 1.5 diabetes. These are older adults with slow onset of progression to type 1 diabetes. Sometimes granny is started on an intensive insulin program at age 82.
OK people, enough with the animosity.