David Lazarus had just moved to Los Angeles to begin a new job as a company and consumer columnist for the Los Angeles Times when he suddenly developed a few of the traditional signs of diabetes: extreme thirst, tiredness and weight loss. He fell close to 15 lbs in 2 weeks.
Lazarus was in his early 40s. “The weight loss was the first large red flag. It happened really quickly,” he states. He consulted a physician who identified him with Type 2 diabetes and advocated a “monastic” low-carb, macrobiotic diet.
When he continued to feel bad a couple of days afterwards, Lazarus spoke with the other physician. That physician suggested that Lazarus could have Type 1 diabetes, an autoimmune disease in which the insulin-making cells in the pancreas are destroyed and attacked. But that physician didn’t take insurance.
Eventually Lazarus made his way to the diabetes centre at the University of California, Los Angeles. There an endocrinologist diagnosed him with Type 1 diabetes and instantly place him on the appropriate treatment, insulin.
Without insulin injections or infusion via a pump, people with Type 1 diabetes normally fall into a coma and die within days to weeks, although sometimes adults may have a little quantity of book insulin that keeps them going longer. Still, finally all people with Type 1 diabetes must get insulin.
Lazarus’ narrative is not unusual. It has long been thought that Type 1 diabetes appears primarily in childhood or adolescence and only infrequently in adulthood. In fact, Type 1 diabetes was previously called “juvenile” diabetes, and that term is still widely utilized, although the terminology was officially changed in 1997.
Now, it seems like not only can Type 1 diabetes happen in adults, it’s just as likely to appear in maturity as in childhood or adolescence.
Utilizing data from a resource called the UK Biobank, Dr. Nicholas J. Thomas and colleagues from Exeter University implemented a hereditary risk score they developed from 29 genes normally associated with Type 1 diabetes to 13,250 people who developed diabetes within the first 60 decades of their lives.
Overall, 42 percent of cases of Type 1 diabetes began when people were 31 to 60 years old, while 58 percent were diagnosed at age 30 or younger. Type 1 was likely to appear across the first six years of life, whereas the occurrence of Type 2 diabetes rose dramatically with age, accounting for 96 percent of instances in the 31-60 age group.
Type 2 diabetes is usually associated with obesity and is originally treated with diet, exercise, and medications aside from insulin (although a few do end up taking insulin finally).
In comparison to this Form 2 group, those with Type 1 of ages were generally thinner, more were prone to have started insulin treatment in a year of diagnosis, and were more likely to have experienced ketoacidosis, a dangerous metabolic condition that appears when the body lacks insulin.
The results were printed November 30 in Lancet Diabetes & Endocrinology.
Easily overlooked, maybe not easily detected
The massive preponderance of Type 2 diabetes among adults at least partially explains why Type 1 has been believed to occur mostly in childhood: When a child develops diabetes, it gets detected. Among adults, there are numerous with Type 2 that those with Type 1 are easily missed. Even if they end up on insulin treatment rather quickly, they may still be assumed to have Type 2. (Further complicating matters, a few obese and obese kids are now developing Type 2 diabetes)
Problematically, there is no single definitive test that doctors can use to differentiate the kinds. A protein called C-peptide indicates whether the pancreatic islet cells are making insulin, but a few people with Type 1 may still have reduced levels of vitamin C-peptide in the first few years after diagnosis.
There are tests to assess the radicals attacking the islet cells, but people with Type 2 diabetes may even possess those antibodies. “It is typical for an adult who grows Type 1 diabetes to be originally diagnosed as Type 2, particularly if obese and there is no family history of Type 1 diabetes,” says Dr. Roy W. Beck, executive director of the Jaeb Center for Health Research in Tampa.
“In a lean adult who develops diabetes, Type 1 must be closely considered but in an overweight adult who develops diabetes, type 1 remains potential,’he states. But the U.K. researchers hope to develop their genetic evaluation for general use along with other measures to enable doctors to more easily pick out the adults with Type 1 diabetes.
“I thought I’d dodged the bullet”
In hindsight, Lazarus’ analysis should have been easy, because he is not overweight and he can have a family history of Type 1 diabetes. His dad, aunt and brother all had it, but they had been diagnosed at much younger ages — his aunt was a child (and subsequently died of this illness in young adulthood) along with his dad and brother had been in their early 20s.
“I thought I’d dodged the bullet,’ Lazarus states. “I have always been quite healthy, and quite careful about what I eat. By making it into my 40s, I thought cool, I’m the person who managed to skirt it. But it came with a vengeance.”
Today, he is doing fine. He wears an insulin pump and a continuous glucose monitor, and works hard to keep his glucose levels normal.
But his story could have been different had he not been so consistent — he is a consumer reporter, after all — in seeking proper care. He advises others diagnosed with diabetes to do the same. “Your treatment regimen should be producing great [blood sugar] numbers. If you are not receiving the data you would like to see, then something is wrong.”
Miriam E. Tucker is a freelance journalist specializing in medicine and wellness. You can trace her Twitter: @MiriamETucker
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