Do You Really Have Type 2 Diabetes?

Do You Really Have Type 2 Diabetes?

By Decadent Bitch, RN

Have you been diagnosed with Type 2 Diabetes or Pre-Diabetes AND you’re lean? Maybe you’re a serious runner and eat a healthy diet? You need to keep reading, because you may actually be “Type 1.5” or LADA.  

LADA stands for Latent Autoimmune Diabetes of Adults and is really Type 1 Diabetes Mellitus (DM), but it’s onset is different.  When you think of a Type 1 diabetic, you think of a kid who went from being normal to requiring insulin for survival over a very short period of time, such as days.  The reality, on the other hand, is that there are plenty of adults who become Type 1 diabetics later on in life.  According to a large European study, approximately 10% of those who are diagnosed with Type 2 DM are actually misdiagnosed, and should be diagnosed with LADA(1).  

First, let’s break down the difference between Type 1 and Type 2.  Type 1 is characterized by the autoimmune destruction of your pancreatic beta cells, which produce insulin.  This is why Type 1 diabetics have to inject insulin, because they don’t produce it.  Typically, some kind of infection throws the immune system into overdrive and it starts destroying the pancreatic beta cells.  Most frequently, according to common belief, this happens during childhood.  Type 2, on the other hand, is a result of the body over producing insulin to keep up with caloric intake and resulting in insulin resistance.  The cells need more and more insulin in order to allow glucose uptake.  The typical picture of a Type 2 diabetic is a sedentary adult who is obese with excess abdominal fat.  

If you check a 2014 CDC report on diabetes in the US, 18,000 youth (under 20 years of age) were diagnosed with Type 1 DM annually in 2008 and 2009.  On the other hand, 1.7 million people over age 20 were diagnosed with Type 2 DM in 2012(2).  This leads to an obvious bias among lay people that if you’re an adult with high blood sugars and have any history of diabetes in your family, you probably have Type 2 diabetes.  Unfortunately, this is true among physicians, especially primary care physicians (PCPs), as well.  When your PCP goes to medical school, she is taught this mentality, “When you hear hooves coming, think horses, not zebras.”  This is to help the budding doctors consider the more common diseases first, rather than jumping immediately to something exotic.  This works incredibly well, most of the time.  Unfortunately, PCPs are so overworked because of the way healthcare is structured in the US, that they barely have time to talk to their patients, examine them properly and make a diagnosis.  This leads many PCPs to not think outside the box, because they’re looking for “horses.”  In an adult with elevated blood sugars, Type 2 diabetes is the easy answer.  

Let’s finally turn to LADA.  Most people who are diagnosed are over age 30.  Frequently, rather than having a rapid progression of beta cell destruction, the disease can take years.  This means that people can walk around for a long time before they become symptomatic.  The only way to find out, prior to the onset of diabetes symptoms, which include increased thirst, increased urination, increased hunger and eventually unintended weight loss, is to do routine blood work.  This blood testing includes fasting blood glucose and/or HgbA1c, which is an average of one’s blood glucose over the last 3 months.  If you’ve been diagnosed as pre-diabetic, which means your HgbA1c is between 5.7-6.4%, or diabetic where your HgbA1c is above 6.4%, and you’re lean, exercise routinely or eat a diet with limited carbohydrates, you should pursue further testing.  Your PCP may tell you that you don’t need more testing because you’re Type 2 and may try to start you on an oral hypoglycemic agent, such as metformin.  If you’re still pre-diabetic, your physician may say that you should just monitor your HgbA1c on a yearly basis, keep exercising and watch your diet.  This physician is doing you a disservice by not considering your entire clinical picture.  If you fit this picture, or if you manage to lose weight, but your numbers don’t improve, you need to demand more blood testing.  C-peptide is a measure of your insulin production and should be drawn at the same time as a fasting blood glucose.  You can download and plug your numbers into the HOMA2 calculator, which can be found by doing a quick online search.  This calculator will tell you your insulin sensitivity as well as your beta cell function.  Typically, a person with Type 1 will have an elevated fasting glucose and a low or low-normal C-peptide level.  If your C-peptide level is on the high side, it means you have insulin resistance.  This doesn’t automatically exclude you from being Type 1, because often times there is insulin resistance within the disease process. To get a true diagnosis, you should request Type 1 diabetes antibodies, which must include GAD65 and may also include Islet Cell Autoantibodies, Insulin Autoantibodies and Zinc Transporter 8 Autoantibodies.  If you test positive for at least one, you should go see an endocrinologist immediately and start on insulin rather than wasting your precious beta cells time and insulin production.  The more insulin you need to produce on your own, the faster your beta cells will “burn out” and the sooner you will become insulin dependent.  
Going back to our previous statistic from the CDC and the Action LADA 7 study, out of 1.7 million Type 2 diabetics diagnosed in 2012, approximately 10% of them were misdiagnosed and are actually Type 1 LADA diabetics.  Are you one of those 170,000?

(1) Hawa, Mohammed I., Hubert Kolb, Nanette Schloot, Huriya Beyan, Stavroula A. Paschou, Raffaella Buzzetti, Didac Mauricio, Alberto De Leiva, Knud Yderstraede, Henning Beck-Neilsen, Jaakko Tuomilehto, Cinzia Sarti, Charles Thivolet, David Hadden, Steven Hunter, Guntram Schernthaner, Werner A. Scherbaum, Rhys Williams, Sinead Brophy, Paolo Pozzilli, and Richard David Leslie. "Adult-Onset Autoimmune Diabetes in Europe Is Prevalent With a Broad Clinical Phenotype: Action LADA 7. Diabetes Care 2013;36:908–913." Diabetes Care 37.5 (2014): 1494. Web. 11 July 2017.

(2) Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. Atlanta, GA: US Department of Health and Human Services; 2014.