More adults are being diagnosed with type I diabetes

More adults are being diagnosed with type I diabetes

Type I diabetes has historically been diagnosed in childhood, but some recent studies have shown that it is on the rise in the adult population. A study published in the National Library of Medicine showed that almost half of all new type I diabetes diagnoses are in adults.

The exact reasons for the rise are nuanced and varied. The study also found that diagnosing type I diabetes in adults is more difficult than in children because adults have different genetic risk, levels of immune cells and antibodies, metabolic conditions, and often misclassification of type II diabetes when it is type I.

"Type I diabetes is an autoimmune condition, which means your body makes antibodies against your normal cells," said Kavita Seetharaman, MD, an endocrinologist with Endocrine Center of Cape Cod. "In type I diabetes, the antibodies (islet antibodies) damage the insulin-making cells in the pancreas called beta cells, which help the body turn the food you eat into energy and controls your blood sugar levels. Eventually, the damage from these antibodies will result in complete loss of insulin production that can only be replaced with life-long injections of insulin."

The Difficulties of Diagnosing Type I Diabetes

"There can be challenges in diagnosing type I diabetes in adults," Dr. Seetharaman said.

HbA1C, fasting glucose and glucose tolerance test can diagnose prediabetes or diabetes mellitus. These tests cannot differentiate type 1 from type 2 diabetes. Patients can have symptoms of type I, type I.5 (LADA) or type 2 diabetes which include excessive thirst, frequent urination especially at night, unintentional weight loss and fatigue. Type 1.5 and type 2 diabetes can also evolve into type I.

The following blood tests can help determine the type of diabetes and are also used to monitor the progress of the diabetes, according to Dr. Seetharaman:

• A1C: Measures your average blood sugar levels over the past two to three months. This test is primarily used to screen for prediabetes and diabetes mellitus.
• Fasting plasma glucose (FPG): Measures blood sugar levels after fasting for eight hours. It is a screening tool for prediabetes and diabetes mellitus.
• Oral glucose tolerance test (OGTT): Measures how well your body uses sugar and is used to diagnose diabetes mellitus, prediabetes and gestational diabetes.
• Autoantibody panel looks for specific proteins created by the body when antibodies attack the pancreas. Two or more antibodies indicate a likelihood of type I diabetes.
• C-peptide is a byproduct produced and released by the pancreas as it secretes insulin. This shows how much insulin you are making at the time of diagnosis and will be low or undetectable if it is type I diabetes.

While the above test results are helpful to make a diagnosis of type I diabetes, there can still be some questions about the type of diabetes.

As people age, "the antibodies that attack the pancreas naturally reduce in numbers and we may not be able to detect antibodies at the time of diagnosis," said Dr. Seetharaman. "If we check C-peptide levels and they still have some insulin detected, it cannot be concluded if you have type I or II diabetes and some may be diagnosed with 1.5 diabetes. The diabetes can be treated as type I or type II depending on how the sugar levels behave and the need for insulin."

Daily Living with Type I Diabetes

Elizabeth Hiatt of Sandwich was diagnosed with diabetes when she turned 60.

"I knew something was going on because my primary care physician had mentioned that my blood sugar level was a little high at my annual physical just before my birthday," said Hiatt. "I was living out of state and by the time I saw my PCP on the Cape a few months later, I was having the classic symptoms of type I diabetes, including excessive thirst all the time, unintentional weight loss and fatigue."

She was initially diagnosed with diabetes type 1.5 and has since graduated to type 1.

"I was started on insulin right away," said Hiatt. I use an insulin pen (a pre-loaded injection device) that contains insulin to self-administer my insulin. I regulate what I eat, especially counting carbohydrates. I give myself insulin every time I eat and then add in a long-acting insulin at night to cover through the next day."

The Challenges of Diabetes Type I

"Type I diabetes is a constant companion that never leaves you," said Hiatt. "I constantly think about the amount of insulin I need, adjust it according to what I am going to be eating, wear a glucose monitor that tracks my blood sugar levels. The monitor always needs to be close to my body and I usually wear it in a pocket, but not all clothing has pockets. It is wi-fi connected and sometimes the connection is lost and when it happens at night, the alarm wakes me."

The uncertainty that goes along with having type I diabetes is a big challenge.

"Everything that happens in my life affects my glucose level," Hiatt said. "The medications I take, stress, exercise, anything I eat or drink, and activities all affect glucose levels, so I am always looking and checking to see what they are."

She senses when her blood sugars are running low because she begins to have fuzzy thinking. She will eat a piece of candy or glucose tablets which are in her car and at home to raise blood sugar level. Her husband knows how to administer nasal medication to raise her blood sugar if she becomes unconscious.

When Hiatt was first diagnosed, she attended a program at the Joslin Diabetes Center in Boston. No one in her family had diabetes and she wanted to learn more about it.

"I was the only new type I diabetic in the program, the rest had been type I from childhood or early adulthoods," Hiatt said. "They came back to the program because they were so weary of trying to manage everything and it was constant. I didn't understand it then, but I do now."