Type 1 diabetes used to be called juvenile-onset diabetes, meaning it starts in childhood. But new studies show Type 1 is frequently being diagnosed in adults as well.
A study at Exeter University in the United Kingdom found that adults are as likely as children to develop Type 1 diabetes. More than 40% of Type 1 diabetes cases occur after the age of 30, but many are misdiagnosed as Type 2.
What’s the difference?
Both Type 1 and Type 2 diabetes limit our bodies’ ability to use carbohydrate foods. In the body, carbohydrates break down into a sugar called glucose, which is our cells’ main source of energy.
Normally, we need the hormone called insulin to transport glucose into the cells of the body. In Type 1 diabetes, the body no longer produces much insulin. The insulin-producing beta cells in the pancreas have been destroyed. Immune cells, usually GAD (glutamic acid decarboxylase) antibodies, or sometimes other antibodies, have attacked them.
The reason for the attack is unknown. People with Type 1 diabetes are dependent on injected or infused insulin to get glucose into their cells to stay alive. This “autoimmune” destruction of cells usually happens to children, but we now know it can happen at any age.
In Type 2 diabetes, the body still produces insulin, but the body’s cells don’t cooperate with it. They have become “insulin resistant,” meaning the body needs extra insulin to maintain normal blood sugar levels.
Type 2 used to be called “adult-onset diabetes” or “non-insulin dependent diabetes.” Those names are now outdated. People age 10 and younger are getting Type 2, and many people with Type 2 take insulin.
The difference between types is important because the treatments are different. Type 1 is treated with various types of insulin. Type 2 can be treated many different ways, starting with diet and exercise, and including medications that work in the liver, the digestive tract, the kidneys, the pancreas, and the muscle cells. People with Type 1 are rarely given these pills.
Because of the mistaken idea of adult-onset and juvenile-onset diabetes, older people who develop Type 1 are often misdiagnosed as Type 2. They may be denied insulin and given a variety of oral medications that don’t work for them.
According to the Exeter study, it takes over a year, on average, for a misdiagnosed adult with Type 1 to be started on insulin. A lot of damage can be done in that time.
There is also the mixed type of diabetes called LADA (latent autoimmune diabetes of adults), also called Type 1.5. LADA is basically a slow-onset Type 1.
Like Type 2 diabetes, Type 1 diabetes is becoming more common. In a study of children ages 0–14 living in Philadelphia, the rates of Type 1 increased by 7.8% over a five-year period.
Type 1 may well be increasing in adults, too. The reason is unknown, but I strongly suspect a link with toxic chemicals in the environment, which you can read about here.
Can Type 1 diabetes be prevented?
If you have any doubt about your Type 2 diagnosis, you might want to ask for a lab test to confirm that you do not have Type 1 or LADA. It’s hard to prevent something when you don’t know the cause, but some approaches have shown potential. A mouse study published in Nature Immunology showed that a high-fiber diet prevents Type 1, possibly by promoting production of short-chain fatty acids (SCFAs) that help the immune system function better.
Viral infections, vaccinations, cow’s milk, low levels of vitamin D, and unhealthy, sugary diets have all been suggested as contributors to Type 1. Studies have shown a slight increase in Type 1 in vaccinated children, but not enough of a difference to justify avoiding vaccines.
Research has shown earlier introduction of cow’s milk to be associated with a higher risk of Type 1 diabetes. But the type of milk might make a difference. Breastfeeding sharply lowered Type 1 risk in a number of studies.
Low vitamin D levels have been associated with higher risk of Type 1 diabetes in several studies, and supplementing vitamin D improved blood glucose control in youth with Type 1.
High-glycemic diets, high in refined starches and sugars, stimulate insulin production and put pressure on the beta cells. A study from the University of Colorado in 2008 showed that a diet like that could speed up the progression to Type 1 diabetes in children with signs of autoimmunity in their pancreas. Lower-glycemic-index foods are usually healthier anyway and may help prevent Type 2 as well as Type 1 diabetes.
So, there are things you can do to lower your risk, or your child’s risk, of Type 1. Vitamin D, breastfeeding, eating more fiber and less refined food, and reducing exposure to toxic chemicals are all good ideas. See if you can fit them into your life.
Want to learn more about recent Type 1 diabetes research? Read “Reversing Type 1 Diabetes: New Research From Boston Children’s Hospital,” “New Staging Classification for Type 1 Diabetes” and “IBM and JDRF: Organizations Partner to Combat Type 1 Diabetes.”