Type 2 diabetic misdiagnosis may happen to one in five people who have been told they have adult-onset diabetes. Doctors look at high blood sugar, age and being overweight as the top defining factors. And diabetes mellitus is a growing problem, no doubt about it.
Men and women who are normal or underweight and yet develop high blood sugar should be suspected of having latent autoimmune diabetes of adults, but they get misdiagnosed because they are not children.
Medical science has taught us all to expect type 2 diabetes, age and overweight to be found together. And two out of three is enough for some to give the diagnosis.
Type 2 Diabetic Misdiagnosis and LADA
Some doctors still do not know that type 1 diabetes can develop in a grownup. But Mary Tyler Moore was diagnosed with it when she was 33. That was many years ago, so some doctors have known about LADA for quite a while.
How can up to 20% of diabetics be misdiagnosed with diabetes mellitus when they really have type 1? And why do some have to end up in the hospital before someone catches it?
The most disturbing thing about this misdiagnosis is the mindset of medical doctors and nurses. If a patient over 20 presents with high blood sugars 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 of the time it takes for your T cells to finish their job of attacking the pancreatic beta cells. 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'll be directed to a video made with a proton camera at the La Jolla Institute for Allergy and Immunology. It captures the T cells attacking a beta cell in a mouse in real time, and it is the first live proof of what is happening in a diabetic who loses the beta cells during or after childhood.
Why Type 2 Diabetic Misdiagnosis Is Dangerous
What's the big problem with diabetic misdiagnosis? If you are an unknowing type 1 diabetic you will lose more and more beta cells. You can change dietary habits and exercise but you will not stop this process.
Your body literally has an allergy to the beta cells, and there is no way science knows of to make it stop. If you are not already on insulin you will develop early problems with your eyes and kidneys.
Some cases of ketoacidosis and death or near death have been reported because doctors were treating LADA patients as type 2, refusing to give them insulin because they don't think it is necessary.
Later some patients found out that their doctors had never heard of this LADA, which meant they also didn't know there were tests to differentiate between this and type 2 diabetes.
The tests are necessary because judging by symptoms can give the wrong diagnosis. The similarities of the early stages of LADA to type 2 can fool a doctor who does not know what to look for.
Type 1 autoimmune diabetes caused by destruction of beta cells is a rapid onset disease in children, but in adults is quite slow. It is genetically linked and hereditary but the high incidence of type 2 diabetes in adults is muddying the water for too many medical people who are not well acquainted with the process of weeding out type 1 from type 2 in adults.
Once an adult onset type 1 diabetic is put on insulin and gets the hemoglobin A1C down below 7, the treatment for type 1 and type 2 looks pretty much the same. Exercise and a healthy diet help both, although most type 1's do not need to lose weight.
However, if you have LADA but are diagnosed a type 2 it may be harder to get approved for an insulin pump, although that is changing fast. As long as you are not on oral medications approval may not be an issue.
Diabetics who find out they have LADA seem to have a higher incidence of depression and eating disorders. Whatever the cause, they need good support and diabetes education to get them through the adjustment to their new diagnosis.
Clearing Up Type 2 Diabetic Misdiagnosis
There are things doctors can look for, things that don't fit the type 2 diabetic diagnosis. One is a normal or low BMI. Some type 2 diabetics do have a normal BMI but most are overweight. It is also true that some adult onset type 1 diabetics are also overweight.
So doctors need other things to look for, and cholesterol is one. Type 2 diabetes goes along with elevated bad cholesterol and triglycerides, and if yours is not high you may have adult onset type 1 diabetes.
If you are on oral medications and have a low BMI and yet your hemoglobin A1C stays high, you might be an adult onset type 1 diabetic, and it is time to get some testing done to find out what's going on.
Your doctor might perform the C-peptide test that measures insulin secretion. Numbers are higher in type 2 due to overproduction of insulin. They are usually lower in LADA since you are losing islet beta cells.
Antibody Tests Change Type 2 Diabetic Misdiagnosis
The GAD antibody test reveals antibodies that are found in type 1 diabetics whose beta cells are being distroyed by an autoimmune reaction. The ICA or islet cell antibodies tests will often come up positive in LADA diabetics, but type 2 diabetics seldom test positive for the antibodies.
Another test is the IAA or insulin antibodies test. It will help distinguish between LADA and type 2 diabetes. All of these tests will help clarify your diagnosis and separate type 1 from type 2, but the tests are not given routinely. There has to be a good reason to give them.
What is the message here? If you are not satisfied that the doctors have diagnosed you correctly, talk to them about what you have learned. If you do not get your concerns met, go to an endocrinologist who will do the tests that settle it for you.
Of course, if you are already on insulin it may not matter to you which kind of diabetes you have as long as your A1C is in a good range and you are not being plagued by complications. This is your journey. Please take care.
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