At the end of my blog post a couple of weeks ago ("Type 2 Diabetes—An Environmental Illness), Mary A wrote: “I am female, white, 47 years old, 5′9", 142 pounds, a runner, and in January 2007, I was diagnosed with Type 2. No one else in my family has diabetes. I have always been active. I have never been obese. Go figure.”
Here’s what I figure, Mary: You may not have Type 2 at all.
You may have late-onset of Type 1. This is sometimes called LADA (latent autoimmune diabetes of adults). It’s also called Type 1.5 diabetes or “slow-onset Type 1.”
In researching my book Diabetes: Sugar-coated Crisis—who gets it, who profits, and how to stop it, I came across no fewer than three cases of people misdiagnosed with Type 2 diabetes. These were people who, like Mary, were thin, athletic, middle-class, and not especially stressed or depressed. It didn’t make sense to me that they would have a lot of insulin resistance, which is what Type 2 is all about.
It seemed more likely that they were just not producing enough insulin. They were taking pills for insulin resistance, knocking themselves out with lots of exercise and a very strict meal plan, and their HbA1c levels still wouldn’t come down below 9% or 10%. When they went back to their doctors and asked to have their insulin production tested, it turned out that those levels were quite low. They needed insulin. When they got it, their blood sugar levels returned to near normal, and they resumed their healthy lives.
In LADA, your own immune system, or possibly a virus or chemical exposure, damages your beta cells. It doesn’t destroy them completely, so you still produce some insulin—just not enough. LADA or Type 1.5 diabetes usually comes on in adulthood, often slowly, so many doctors assume that you have Type 2 diabetes (which used to be known as “adult onset” diabetes) when you really don’t. People have died or developed unnecessary complications because they were treated for insulin resistance when they really needed insulin injections or inhalers.
Whether you have Type 1.5 or Type 2 diabetes, I encourage you to ask your health-care provider about insulin. The West Suffolk Diabetes Service in England encourages all of its Type 2 diabetes patients to consider insulin. “Up to 70% [of people with diabetes] report an increase in well-being following the change to insulin,” they say. They see an average HbA1c reduction of 1% to 2% with insulin. “Insulin used to be considered a last resort in Type 2,” these doctors say. “But the new trend is to start insulin at a much earlier stage.”
Even though Type 2 diabetes is a condition strongly related to insulin resistance, as long as your pancreas can pump enough insulin to overcome the resistance, blood glucose levels tend to stay normal. It’s only when the pancreas can’t keep up that a person starts to experience symptoms. So starting insulin therapy sooner may be the best treatment for many people.
That’s in Type 2 diabetes. If you have LADA or Type 1.5 diabetes, you can expect even better results. Getting the correct diagnosis and treatment might save your life.
If you have lots of abdominal fat, high cholesterol, and high blood pressure (elements of the metabolic syndrome), you probably have Type 2 diabetes. But if you’re like Mary, fit and active, there’s a chance you may have Type 1.5, so please aks your health-care professional to test you.
And let me know how it goes—post comments and questions here.
Here’s a good study on the value of early use of insulin in Type 2. As I said in the post, it’s even better if you have late-onset Type 1, or LADA.
Insulin Therapy in Type 2 Diabetes
from Journal of the American Pharmaceutical Association
Posted 03/20/2003
R. Keith Campbell, John R. White Jr.
David
Posted by DavidSperoRN | Jul 20, 2007 at 12:41 amI would be inclined to ask Mary,the 47 year old, other wise healthy and fit if she recently had a virus or infection that could have possibly sparked off this issue.Type 1 or juvenile diabetes is usually dormant within the body until a virus or infection will cause the body to wage an auto-immune war within the body damaging beta cells within the pancreas.
Posted by Bryan | Jul 25, 2007 at 2:06 pmPlease visit & contribute your story to my blog at http://www.juvenile-diabetes-stories.blogspot.com
The Trials of Raising a Diabetic Child
I have LADA , when asked if I have Type I or Type II diabetes should I put Type I?Most forms only give these two options.
Posted by Wendy | Aug 02, 2007 at 10:27 amLike Mary, I was diagnosed as an adult in my 50’s. I have always been thin and active. I had gestational diabetes, but was still thin. I have no family members with diabetes that I know of. However, my grandmother and two of her sisters had it. I have been tested for LADA antibodies and came up negative. I am on very small amounts of Novolog insulin(2-3 units), and was on Lantus until recently. Metformin did not help at all as I am not insulin resistant. There is speculation that I have MODY but the testing is too expensive and my insurer won’t cover it. Is MODY also a type 1.5? Do those with LADA have to test positive?
Posted by Becky | Jan 30, 2009 at 4:40 pmHi Becky,
Thanks for writing. Keep in mind that I am not a doctor, but I believe the difference between LADA and MODY (and between the different types of MODY) is mainly of interest to researchers.
For people living with these forms of “Diabetes 1.5″, I believe it’s best to think of it as a mild form of Type 1. That’s a mild form of a very serious illness. I can’t tell if you’re on enough insulin. Maybe you need more and maybe you don’t, but there is, IMO, no sense in taking the oral type 2 meds. There IS a lot of sense in doing all the other self-management things you read about here. How are your sugars running?
David
Posted by David Spero RN | Jan 30, 2009 at 8:08 pmI have just been diagnosed with LADA after being mis diagnosed 5 yrs ago as type 2
Posted by shortie | Jan 31, 2009 at 1:35 pmI have had to push to get this sorted out and ended up paying privatley to get to the bottom of it
I have suffered with hyperglycimia since i was 14yrs old was alway under weight and was told by a gp to eat choclate to stop myself fainting
at 21 was diagnosed graves disease, at 28 i gained 2 stone in one month and thought my thyroid had gone under active but was told it had not. I struggled with my weight ever since was diagnosed with Type 2 at age 34 and at 36yr old had to go on insulin ,when i put on another Stone in a week !
I have had real trouble balancing my blood even tho i exercise and am very active and eat a low Carb High soya protien diet
I am hopeful that the resent diagnosise will be the start of feeling better.
I was diagnosis with type 2 diabetes about 5 years,and have been taken meds.(pills and byetta) my a1c is very good, it’s like i don’t have diabetes at all. but i do suffer with the chronic pain associated with diabetes. no one in my family have diabetes that i know off. when diagnosised, i was told that i had “on set” diabetes, but when i went to the classes for diabetes,there i was told by the instructor there was no,”on set” it was either diabetes or not, no in-between. so henced, the type two.
Posted by Hattie Brumfield | Jul 30, 2009 at 12:20 pmHiya
I was diagnosed with LADA after suffering a stroke at the age of 41. Have never been overweight and no other family member has diabetes to my knowledge. My memory of that time is pretty bad but I remember being taught to inject myself with insulin - then moved to tablets and lately being threatened with having to self-inject again. Do ‘experts’ even understand all diabetes?
From an early age I couldn’t face sugary foods so perhaps might I be type 1 which was never picked up on because I was a healthy eater? My mother used to be concerned about the times I was brought home from junior school due to fainting.
Any thoughts welcome please
Lynda
Posted by Lynda | Oct 28, 2009 at 1:11 pmDavid,
Posted by Becky | Mar 20, 2010 at 10:17 pmMy A1c is 5.4 as long as I take my 4 shots a day:) I also carefully count carbs and try to exercise 3-4 hours a week. I was told by 2 doctors that 15% of people with Type 1 don’t test positive for antibodies. I had not read that bit of information anywhere in all the research I have done. I wonder if that 15% are the MODY people.
Becky
I was sure my Type 2 was under control since it was not high and i had lost a lot of weight. I ran out of strips for testing. We moved and until now I had no doctor. It takes months to get an appointment with one since there is a crisis in care.
I went to a Internalist for a physical and was told to go on Insulin pens. The PA nurse met with me for educational training. She did not tell me how to use the meter or inject myself. She gave me a schedule for injections prior to bedtime. I chickened out and couldn’t do it without help.
I asked for a referral to a Diabetic Specialist. He didn’t seem to have education for injection,etc. either. I told him of my sister having it in the hospital. He said, oh they don’t do that any more.
Have others experienced this lack of Diabetic education?
I started Metformin but it doesn’t agree with me very well. Forget talking with the doctors or nurse (call back 24-48 hrs).
What tests are necessary to check for Type 1.5? LADA has auto-antibodies like Type I but are adults.
The lack of good care and training is starting to catch up with us. Being old in a this country with Diabetes is dangerous.
Posted by Judith | May 18, 2010 at 8:53 pm