Type 2 diabetes can be misdiagnosed in one in five people who have been told they have adult-onset diabetes. Doctors consider high blood sugar, age and obesity to be the most important determining factors. And diabetes mellitus is undoubtedly a growing problem.
Men and women who are normal or underweight and still develop high blood sugar should be suspected of having latent adult autoimmune diabetes, but they are misdiagnosed because they are not children.
Medical science has taught us all to expect type 2 diabetes, old age and obesity to be found together. And two out of three are enough for some people to make the diagnosis.
Type 2 diabetes misdiagnosis and LADA
Some doctors still don’t know that type 1 diabetes can also develop in adults. But Mary Tyler Moore was diagnosed with it when she was 33. That was many years ago, so some doctors have known LADA for quite a while.
How can up to 20% of diabetics be misdiagnosed with diabetes mellitus when they actually have type 1? And why do some have to end up in the hospital before someone catches them?
The most troubling thing about this misdiagnosis is the mindset of doctors and nurses. When a patient over the age of 20 presents with high blood sugar, the first diagnosis is diabetes mellitus because everyone equates type 1 diabetes with infants and children.
The first line of treatment for a type 2 diabetic is oral medications. And these seem to work well for latent autoimmune type 1 diabetics, at least for a while. The reason seems to be that it takes time for the antibodies to completely destroy every beta cell in the pancreas.
Some call this the honeymoon period in LADA because your T cells take a long time to do their job of attacking the beta cells of the pancreas. If you want to see this attack in action, go to your web browser and type in a phrase – “T cells attack pancreatic islets”.
You will be taken to a video captured with a proton camera at the La Jolla Institute for Allergy and Immunology. It captures in real time the T cells attacking a beta cell in a mouse and it is the first live evidence of what happens in a diabetic who loses beta cells during or after infancy.
Why Type 2 Diabetic Misdiagnosis is Dangerous
What’s the big problem with diabetic misdiagnosis? If you are an ignorant type 1 diabetic, you will lose more and more beta cells. You can change your diet and exercise habits, but you won’t stop the process.
Your body is literally allergic to the beta cells and there is no scientifically known way to stop it. If you are not already on insulin, you will develop problems with your eyes and kidneys early on.
Some cases of ketoacidosis and death or near-death have been reported because doctors treated LADA patients as type 2 and refused to give them insulin because they didn’t think it was necessary.
Some patients later found out that their doctors had never heard of this LADA, which meant they also didn’t know there were tests to differentiate between it and type 2 diabetes.
The tests are necessary because assessing the condition based on symptoms can lead to an incorrect diagnosis. The similarities of LADA’s early stages to Type 2 can deceive a doctor who doesn’t know what to look for.
Type 1 autoimmune diabetes, caused by the destruction of beta cells, is a disease that begins quickly in children but is fairly slow in adults. It’s genetic and hereditary, but the high incidence of type 2 diabetes in adults muddies the waters for too many medical professionals who aren’t well acquainted with the process of eradicating type 1 and type 2 diabetes in adults .
Once an adult type 1 diabetic is on insulin and the hemoglobin A1C falls below 7, treatment for type 1 and type 2 looks pretty much the same. Exercise and a healthy diet help with both, although most Type 1 types don’t necessarily need to lose weight.
However, if you have LADA but are diagnosed with Type 2, it may be harder to get an insulin pump, although that’s changing fast. As long as you don’t take any oral medications, admission may not be an issue.
Diabetics who find out they have LADA appear to be more likely to suffer from depression and eating disorders. Whatever the cause, they need good support and diabetes education to get them through adjustment to their new diagnosis.
Clarification of type 2 diabetes misdiagnoses
There are things doctors can look for that don’t fit the type 2 diabetes diagnosis. One is a normal or low BMI. Some type 2 diabetics have a normal BMI, but most are overweight. It is also true that some type 1 diabetics are also overweight in adulthood.
So doctors have to look for other things, and cholesterol is one of them. Type 2 diabetes is associated with elevated levels of bad cholesterol and triglycerides, and if your levels are not high, you may have type 1 diabetes as an adult.
If you take oral medications and have a low BMI, yet your hemoglobin A1C remains high, you could be a type 1 diabetic adult and it’s time to get some tests to find out what is going.
Your doctor may do the C-peptide test, which measures insulin secretion. Numbers are higher in type 2 due to overproduction of insulin. They are usually lower in LADA as you lose islet beta cells.
Antibody testing changes type 2 diabetes misdiagnosis
The GAD antibody test shows antibodies found in type 1 diabetics whose beta cells are destroyed by an autoimmune reaction. The ICA or islet cell antibody tests are often positive in LADA diabetics, but type 2 diabetics rarely test positive for the antibodies.
Another test is the IAA or insulin antibody test. It will help distinguish between LADA and type 2 diabetes. All of these tests help clarify your diagnosis and distinguish type 1 from type 2, but the tests are not routinely done. There has to be a good reason for giving them.
What’s the message here? If you are not satisfied that the doctors have diagnosed you correctly, talk to them about what you have learned. If your concerns are not met, go to an endocrinologist who will run the tests that will clarify the problem for you.
Of course, if you’re already taking insulin, it doesn’t matter to you what type of diabetes you have, as long as your HbA1c is within a good range and you’re not plagued by complications. This is your journey. Please pay attention.
Thanks to Martha J Zimmer