The Third Type of Diabetes?

Many people know there are 2 types of diabetes.  Type 1, formerly called juvenile-onset diabetes and type 2 or adult-onset diabetes.  Gestational diabetes or pregnancy-induced diabetes resembles type 2.  

But did you know there is a third type of diabetes known as LADA (latent autoimmune diabetes in adults) or type 1.5 diabetes?

What are the differences?  Type 1 diabetes usually occurs in babies to young adulthood.  Those that have some type of genetic pre-disposition to diabetes get a virus such as mononucleosis or the flu bug which triggers the pancreas to stop producing insulin. This type of diabetes requires life-long insulin therapy.

Although Type 2 diabetes used to occur later in life we are now seeing young children and adolescents develop type 2.  It is brought on by a combination of genetics, weight, poor diet choices, and inactivity.  Insulin resistance precedes adult onset diabetes and occurs when your insulin becomes almost “sleepy” or sluggish, which increases carbohydrate cravings, weight issues and fatigue.  This type of diabetes can usually be controlled with lifestyle and oral medications.

The third type of diabetes is not as well known or understood.  Rather than the insulin being resistant, with LADA or type 1.5, an individual’s insulin becomes deficient.  The cells of their pancreas stop producing as much insulin as they once did - like a slowly developing type I diabetes.

This individual is usually thin, has slowly increasing blood sugars and develops diabetes over many months or years.  This type of diabetes is caused by the person’s immune system which develops antibodies that attack the pancreas hence lowering the amount of insulin produced over time.

Many times this type of diabetes is misdiagnosed or treated as type 2.  What do you do if you suspect you have LADA?  Ask your doctor to check a blood test called the c-peptide and measure over time.  C-peptide is a simple blood test which measures how much insulin your pancreas is producing.  Knowing the value can determine whether your antibody levels need to be checked.

What can you do in terms of your lifestyle?  Diet balance is essential and eating plenty of protein, healthy fats and moderating your carbohydrate intake with non-starchy sources such as fruits and vegetables can help give the pancreas a rest and keep your blood sugars normalized. 

Exercise helps the insulin you do make much more effective and efficient - up to 50%.  Besides diet and exercise, sleep and stress management are invaluable in keeping your system healthy.

If you suspect you may have LADA lifestyle and self-monitoring are of utmost importance.  Knowing what to do and what parameters to check can keep your system in good health.

Can you Have Diabetes without Knowing It?

Diabetes can be a slow silent killer and closer than you realize.  With one in three Americans insulin resistant and in the pre-diabetes range soon these people could be diabetic.

Double the amount of people in the US getting cancer and swine flu combined have diabetes, yet many are not even aware of the risk or take it seriously.  Diabetes is a serious disease with multiple complications, yet can so easily be prevented and or controlled with simple lifestyle management.

So where do we begin?  I am going to take a few blogs to answer questions and invite those reading to ask questions they may have regarding nutritional diabetes management.

If you have a parent with diabetes you have the gene and are at a much higher risk that those without a family history and/or have a poor lifestyle.  In general it is a good idea to have your doctor monitor your fasting blood glucose level (sugar taken prior to your am meal).  This number should be less than 95.  If you find your fasting blood sugars rising over several years you are slowly becoming diabetic.  Fasting numbers in the 100-115 range are considered pre-diabetic.  What are other measures to check if you suspect you are diabetic?

Glycosylated hemoglobin A1C – a fancy name for what your blood sugar averaged over the last 3 months - can be easily measured with a regular blood test. That number should be less than 6.0.  Many times patients will come to me stating they have pre-diabetes or a few higher blood sugars when indeed they are diabetic.  Once this number is over 6.0 you are technically diabetic.  Another way to diagnosis diabetes is to test your blood sugars 2 hours after a meal.  If that number is over 126 on more than 2 occasions then you are diabetic, according to the American Diabetes Association guidelines.

If you want to get more technical then have 2 other tests done- a fasting insulin level and c-peptide.  Both these measures can become elevated before the A1C rises and measure how hard your pancreas is working to achieve a normal blood sugar level.  The fasting insulin should be less than 10 and the c-peptide should be less than 4.0.  Normal ranges for some laboratories may slightly differ from these numbers.

Have these laboratory tests measured annually with a physical exam to keep track to prevent a possible surprise diagnosis.  Taking control of your health may mean you need to monitor these levels yourself since they may be in range, and passed over by your physician who may be looking for flagged numbers.  Because a lab does not differentiate whether a “normal” glucose is fasting or non-fasting it is very possible to be diabetic and not be aware of it.  So yes, you can have diabetes and not know it sometimes for many years.

Tomorrow – Preventing Diabetes