Forums » Smalltalk » AMA: Diabetes (Nov. is Diabetes Awareness Month!)

Hi!

I was diagnosed with diabetes in 2011 and discovered I have autoimmune diabetes (more specifically, type LADA/1.5).

November is Diabetes Awareness Month, and November 14th just so happens to be World Diabetes Day!

There are a LOT of misconceptions, myths and general lack of knowledge on diabetes. I'm very active in multiple diabetes communities and moderate some as well, so I like to consider myself rather knowledgeable on the various types. Did you know there are not two, but actually 8 currently known types?

Ask away, and I'll do my best to answer!

I had no idea there were so many types of diabetes, and it runs in my family! What differentiates them?

Most recently, what do you feel has been one of the most common and most important misconceptions to correct? What's the current big mistake people keep making?

Essentially the cause of the diabetes is the most differentiating thing about them. Most types share the name diabetes because they have the same symptoms, but they're technically different diseases. Type 1 and type 2 are both called diabetes for example, but they're not the same disease.

It breaks down like this:

Type 1: autoimmune disease. The body attacks the insulin producing cells and you need exogenous insulin to live. Can happen at any age, but is the most common form of diabetes in kids. it's commonly associated with being thin, but you can be of any weight and age and develop autoimmune diseases, so it's important not to assume you're ever immune to getting it.

Type 1.5/LADA: autoimmune disease, but has a very slow onset and progression. Often mistaken for type 2, we suspect that a significant portion of type 2s are actually LADA. Due to how it can take years for the pancreas to stop producing insulin due to the slow autoimmune attack, most won't ever know and just assume they failed to manage their type 2.

Type 2: insulin resistance that leads to diabetes. Can be caused by genetics, other conditions such as PCOS, steroid medication, and is usually strongly correlated to lifestyle but doesn't have to be - you can be skinny and exercise and eat well and still develop it. Type 2 has stronger genetic components than type 1! It can be managed by diet and exercise a lot of the time, but not always.

Type gestational: diabetes caused by pregnancy. It seems to be related to fetal development and an interaction with the fetus and the parent's body that leads to a disruption of the hormonal system and triggers diabetes. While it usually goes away after the pregnancy ends, there's approximately a 50% chance of developing some form of permanent diabetes in the following years.

Type MODY: a collective name for several hereditary forms of diabetes caused by mutations in an autosomal dominant gene disrupting insulin production. There are 13 subtypes depending on the gene/protein affected, but MODY 2 and 3 are the most common.

Type 3c: diabetes caused by damage to the pancreas from an external source or illness, such as pancreatitis, cancer, physical trauma and conditions like Cystic Fibrosis. Usually the pancreas is so damaged that both beta and alpha cell production (insulin and glucagon, glucagon makes your body release glucose) is inhibited or non-functional. CFRD, cystic fibrosis related diabetes, is often considered its own type but is typically included with 3c.

Type MIDD: maternally inherited deafness and diabetes, a 'mitochondrial disorder characterized by maternally transmitted diabetes and sensorineural deafness' to quote professionals. People usually experience hearing loss before the onset of diabetes, and it's not preventable due to the hereditary factor.

Type neonatal: a rare form of monogenic (genetic mutation) diabetes that happens between 0-6 months of age. It's extremely rare and has two main types: transient and permanent, with transient being slightly more common. It's called transient because it usually goes away within a year but can come back again later in life. Permanent is of course permanent. It may or may not be treated with insulin or medication that stimulates insulin production in the body.

There's some talk about how Alzheimer's is possibly a form of diabetes of the brain, but as of yet there's no official call on it!

It's really hard to narrow it down. I think the most damaging one is the implication that any type of diabetes is curable or reversible, including type 2.



The bottom line is that some forms of diabetes can be long-term managed without medication through diet and exercise, but the underlying disease is not gone. Straying from their management plan means the symptoms come back in full force. An analogy that I really like is that it's like a peanut allergy: avoiding peanuts and not having symptoms doesn't mean your allergy is just gone, it means you're avoiding the onset trigger. Managing type 2 diabetes for example is much like that if you find a specific diet and lifestyle that helps avoid your diabetes symptoms from showing up without the aid of medication. I'm always perplexed and irritated when doctors say you can 'cure' your type 2 this way, because it's not a cure and reversal of symptoms is not the same as reversal of the disease. There is no type 2 diabetic who ever got to go back to ditching their management plan and remain symptom free. Reliance on the management plan means it's a continuous management of the disease!

I frequently deal with spam in other communities from people who try to take advantage of the desperation we feel in not wanting to be sick with this disease. Cinnamon, herbal supplements and 'diets that cure autoimmune diseases' are common themes and they make my blood boil. I also try to encourage people not to offer these ideas to their loved ones with diabetes because they don't really help us and make us feel targeted by these spammers through our loved ones.
Not asking for the right tests. Which isn't really people's own fault, it's mostly a mistake doctors keep making.

Earlier this year, a very heavy person joined one of my communities who had gone into DKA (diabetic ketoacidosis) and got a type 2 diagnosis as a result. DKA in type 2 is very rare, but not impossible. He got a fingerprick glucose test and an A1C test (average 3 month glucose levels) and they decided, based on his weight, that he was type 2 anyway. He went home with some insulin and type 2 medication and told to lose weight. He dropped over 100lbs in just a few months but his glucose levels, while initially stable, started to go all over the place again. I recognized this as what I dealt with with my LADA journey as well, and the community encouraged him to get tested for insulin production and antibodies. His doctor initially refused and said he was definitely type 2, sent him home with new type 2 meds, and this medication made his glucose levels even worse. He resorted to taking long-acting insulin again to keep his numbers under control and demanded to get the tests done.

Lo and behold, he came back with the type 1 diagnosis. He was lucky he had access to insulin and staved off another DKA episode, but it's all too common for big people to get labeled with type 2 and have no additional tests done. Type 2 is the kind of diabetes you should diagnose by ruling out the other types, but most primacy care physicians/family doctors are too biased to see past people's weight and simply assume it's type 2. (On a side-note, this is also why I don't really find diabetes memes that rely on weight or junkfood to be funny anymore -- doctors are just as affected by these biases as your average joe is, and this can lead to people ending up in dangerous situations if they're unaware of how diabetes works.)