What the Type?

Although pretty much everyone has heard of diabetes, many people don’t understand the different types. There are two main types of diabetes Type 1 (previously called juvenile diabetes) and Type 2 (previously called adult onset diabetes). But more subtypes are being discovered, especially subtypes of Type 1. Although all types of diabetes result in high blood sugar (called hyperglycemia), the causes are very different.

Type 2, which is more common, used to be found only in older adults. It is caused by insulin resistance. The pancreas makes plenty of insulin, but the cells are resistant to accept the insulin and use it to lower blood sugar. Type 2 diabetes is caused by genetics and lifestyle choices such as eating poorly and not exercising. Many cases of Type 2 can be reversed by weight loss, a healthy diet and exercise. Type 2 is no longer found in just adults, there are kids and teens now being diagnosed with Type 2.

The exact cause of Type 1 diabetes is unknown but it is an autoimmune disease, the immune system attacks the pancreas destroying insulin production. With the pancreas unable to produce insulin, blood sugar goes high. The only treatment for Type 1 diabetes is injecting insulin either multiple times a day or using an insulin pump. It is not caused by eating too much sugar and it can’t be reversed. Although there is a gene known to influence developing Type 1 diabetes and it can run in families, what exactly causes Type 1 isn’t understood. Some people with the gene will never get Type 1 and many people who have Type 1 have no known family history like me. Type 1 diabetes used to be most commonly diagnosed in kids but it is now found in babies as young as 6 months old (and how could a baby have done anything to cause it?) and adults in their 40s and 50s. I was 27 at diagnosis, an age once considered too young for Type 2 and too old for Type 1.

Because Type 2 diabetes is still far more common in adults that Type 1, adults with high blood sugar who have Type 1 are commonly misdiagnosed as Type 2 initially. There are new subtypes of Type 1 being found in adults, one type called Latent Autoimmune Diabetes in Adults (LADA) which is what I have. The typical course of Type 1 diabetes is a sudden attack on the pancreas which causes a complete loss of insulin production within months. In LADA, the autoimmune attack is slower and causes a slow loss of insulin production often taking years. So it looks more like Type 2 initially and without the proper blood tests run (and which aren’t typically done in adults) it can take years to get a correct diagnosis. There are many stories in the diabetic community of adults who for years tried to reverse their Type 2 diabetes only to finally be diagnosed correctly with Type 1.

In some ways, the treatment for diabetes is the same no matter what type you are. But people diagnosed incorrectly with Type 2 who do everything “right” to reverse it with no success usually feel like a failure. Going on insulin also feels like a failure. And spending years on unneeded Type 2 medications (which often have side effects) can also be harmful. So I do advocate that all new diabetics get all the testing done to confirm type when diagnosed.

It is popular and acceptable in our western culture to make jokes about diabetes. Someone with a huge dessert will joke “I’m going to get diabetes from this!” I don’t think most diabetics would say they are offended by such jokes but there is frustration, especially among Type 1 diabetics, about the misinformation behind such statements. Those of us with Type 1 didn’t do anything that caused the disease and joking seems to make light of the work it takes to stay alive and healthy. Would you make similar jokes about cancer? Many people think that Type 1 diabetics just have to inject some insulin and everything is fine. But as the posts in this blog help you see, it is so much more complicated than that and it’s seriousness is no joke for those who live with it.

I think anyone with any disease will get comments and advice from people who think they understand but don’t. I will never be offended hearing such comments about my diabetes but I will tend to get on my “soapbox” in an attempt to explain to the person the error in their comment. I think it is important to better inform the general public about diabetes, especially Type 1, because the number of diabetics is likely to continue to grow. So next time you meet a diabetic, ask questions instead of offering advice, most people would love to help you understand their disease.

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