The changing world of diabetes

            In barely a century the disease known as diabetes has undergone seismic changes relative to its incidence, its treatment and quite recently, its very nature. The ancient Greeks knew only type 1 diabetes, a condition marked by a large outpouring of urine, so they gave it the Greek word for siphon. It occurs when the insulin-producing cells of the pancreas are wiped out by an aberrant immune response, and it usually occurs in persons below the age of thirty. Without insulin, victims rarely survived more than a few weeks until the Nobel Prize-winning discovery of insulin in the 1920s. Type 2 diabetes has a very different mechanism but that wasn’t recognized until the post-World War Two era, at which time it began its spectacular rise. Known at that time as adult-onset diabetes, it is caused by an excess intake of refined carbohydrates and a simultaneous marked reduction in physical activity. Diabetologists refer to it as an exercise-deficiency disease. The incidence has skyrocketed to the current figure of thirteen percent of Americans; it affects more than thirty percent among those over the age of sixty years. The CDC predicts that more than half of all Americans will have type 2 diabetes by 2050.

            Now we have another major shift in our understanding of type 2 diabetes. Some type 2 patients have an immune response similar to those with the juvenile (type 1) form, namely that they also have an altered immune response and produce antibodies to insulin, though at lower levels than type 1 patients.  

            Some persons with apparent type 2 diabetes have difficulty maintaining normal blood sugar levels. The patient usually gets the blame for this but in at least some cases, it’s because they have Latent Immune Diabetes of Adults (LADA), a relatively new entity that some refer to as type 1.5 diabetes, a label that is itself in some dispute. Adding to the confusion is that LADA is a variable condition, sometimes occurring in persons who do not have the usual risk factors for type 2 diabetes, such as being overweight or obese.

Although most physicians are probably aware of this previously unrecognized form of diabetes, which may affect roughly ten percent of patients that have been diagnosed with the type 2 form, there are numerous examples of individuals who did not receive appropriate, timely treatment for several years. Thus, my reason for posting this blog is to alert patients who have difficulty in managing their disease to discuss this issue with their physician. Considering that there are now more than forty million Americans who have been diagnosed with type 2 diabetes, it is certain that some are suffering from and struggling with LADA. I encourage readers to forward this message to anyone who has or is at risk of developing type 2 diabetes.