Am I now type 1?
While type 1 and type 2 diabetes have different causes, for some type 2 clients they identify requiring insulin as a change of diagnosis, rather than a progression of their existing type 2 diabetes.
Type 1 diabetes is an autoimmune condition. In people with type 1 diabetes the beta cells in the pancreas, which are responsible for producing insulin, are damaged or destroyed and therefor they can no longer produce insulin. As there is no, or not enough, insulin produced in type 1 diabetes, there is an insulin deficiency. Anyone at any age can develop type 1 diabetes, though it is more common in children, adolescents and young adults.
Type 2 diabetes develops slowly, mostly over years, due to the endogenous insulin no longer working properly. This is referred to as insulin resistance. Following a healthy lifestyle and keeping weight in a range that is good for the person, along with taking certain diabetes medication can help reduce the insulin resistance and improve endogenous insulin production. However, over time, the medications may be less and less effective and supplementing insulin by injections can become essential, to replace the insulin your body no longer produces.
So, while requiring insulin does not change the diagnosis of a person with type 2, in some circumstance a diagnosis change can occur.
LADA
There are some people who develop type 1 diabetes later in life. Latent Auto-immune Diabetes in Adults, or LADA is it is often known for short, is a type of type 1 diabetes that is slower to progress. A person with LADA generally has positive antibodies.
LADA sometimes responds to some diabetes medications for a little while in the earlier stages. Hence some people with LADA can initially be told that they have type 2 diabetes before the correct diagnosis is made, particularly if the person is also overweight or has other risk factors for type 2 diabetes.
It is also possible that a person with type 2 diabetes receives a separate diagnosis of type 1 at a later date, if they develop diabetes antibodies (more on this shortly).
LADA seems to straddle both type 1 and type 2 diabetes; some aspects are more like type 1 and others more like type 2. Hence LADA is sometimes also referred to as type 1.5.
Diagnosing diabetes
It is possible for someone’s type of diabetes to be misdiagnosed, as diabetes symptoms can be the same in both type 1 and type 2 diabetes. When hyperglycaemia occurs, a person may develop symptoms such as: frequent urination, thirst, fatigue, headaches, and other symptoms.
Generally, the symptoms develop more rapidly and suddenly in people with type 1 diabetes, while people with type 2 diabetes may have milder symptoms.
To diagnose diabetes blood glucose tests will need to be arranged. These include: a plasma glucose test (generally fasting), HbA1c or glycated haemoglobin or an oral glucose tolerance test. It is important to note that the results do not distinguish the two types of diabetes.
One test that helps to determine if a person has type 1 or type 2 diabetes is the C-peptide test. This blood test measures how much insulin the pancreas produces. A low result may indicate type 1 diabetes, whereas a high level may indicate insulin resistance.
Antibody testing
Other tests to determine the type of diabetes a person has is to check for antibodies.
Antibodies are made by the body as it tries to fight off foreign substances such as viruses, bacteria or other germs. In some people the antibodies attack things in their body that they should not attack, such as the beta cells in the pancreas. If antibodies develop and attack the pancreas type 1 diabetes will develop. Hence, the presence of antibodies usually means that the person has type 1 diabetes, as over 80% of people with type 1 diabetes have these antibodies.
Some of the antibodies that can be checked include:
- Insulin Auto-Antibodies (IAA)
- Islet Cell Auto-antibodies (ICA)
- Insulinoma-Associated-2 (IA2) auto-antibodies
- Glutamic Acid Decarboxylase (GAD) auto-antibodies.
These antibodies often appear years before symptoms begin, so if your client has a family history of type 1 diabetes it can be useful to get antibodies tested, to see if they may be at risk of developing type 1 diabetes themselves.
Diagnosing type 1 diabetes in earlier stages can significantly reduce the risk of developing diabetic keto-acidosis, or DKA, a life-threatening condition.
A negative antibody test can provide reassurance that the risk of developing type 1 diabetes is low.
Type1Screen
Children and young adults can get auto-antibody testing through the Type1Screen program, Australia-wide.
Type1Screen is a not-for-profit organisation which offers antibody testing as well as close monitoring of people who are found to test positive, but who do not have diabetes yet.
Early detection of diabetes can prevent serious health problems and result in a better prognosis and long-term management of the condition. Type1Screen also offers opportunities to participate in clinical trials and other research that aims to prevent type 1 diabetes. Find out more at https://type1screen.org.
When answering their question “Does my type 2 diabetes become type 1 diabetes if I start taking insulin?” is important to reinforce their diagnosis remains the same, it is their treatment that has changed. That progression is normal and not their fault and commencing as soon as required can result in fewer long-term complications.