Lori Flynn, C.D.E.
The Centers for Disease Control reports over 29 million people, fewer than 10 percent of the U.S. population, have diabetes. It’s also estimated that of those, 8.1 million people are undiagnosed.
In the past, there generally were only two known types of diabetes — juvenile (now known as Type 1), which is most often diagnosed in children, and Type 2, more commonly diagnosed in adults. Today, there are more categories of diabetes, including prediabetes, Type 1, Type 2, MODY, LADA and gestational.
Prediabetes, formerly called borderline diabetes, is a condition in which blood sugars are higher than normal, but not high enough for an official diagnosis of Type 2 diabetes. Type 2 can develop if no lifestyle changes are made, such as maintaining a healthy weight, eating healthy and doing daily physical activity. With modifications, it is possible for some people to prevent prediabetes from developing into Type 2 diabetes.
Type 1 occurs in only 5 percent of all people with diabetes. It has a rapid onset and is considered an autoimmune condition, meaning the immune system mistakenly destroys the cells in the pancreas responsible for making insulin. When most of these cells are destroyed, the body no longer can make insulin. Insulin is a hormone the body needs to move glucose from the bloodstream into the cells of the body. Those who have been diagnosed with Type 1 diabetes must take insulin to stay alive. People living with Type 1 diabetes also need to have an understanding of the body and how physical activity, mood, stress and different foods can affect blood sugars. No one is exactly sure what causes Type 1 diabetes, but it is not caused by eating sugar.
Type 2 is the most common form of diabetes and is a disorder of insulin resistance. The cells do not use insulin efficiently, and the body becomes less sensitive to the insulin it produces. The longer a person has Type 2 diabetes, the more likely that insulin production will decrease over time. Type 2 diabetes is treated with lifestyle changes, pills, injectable medication and insulin. Today, more and younger people are being diagnosed with Type 2 diabetes.
MODY, or maturity-onset diabetes of the young, is caused by a gene mutation. Most people are diagnosed before age 25. This defect is in the gene that regulates insulin, meaning the pancreas is unable to produce enough insulin to maintain normal blood sugar control, which leads to diabetes. MODY is most typically diagnosed in adolescence or early adulthood. MODY can mimic Type 1 or 2 diabetes, so it commonly is misdiagnosed. MODY also is hereditary, so if one person in a family has been diagnosed, chances are higher another family member will be diagnosed. Genetic testing can confirm the diagnosis, but not all insurance covers the lab test. By confirming the diagnosis, a health care provider can customize a treatment plan.
LADA, or latent autoimmune diabetes in adults, is a slow-developing autoimmune Type 1 diabetes that occurs as an adult. Some call LADA Type 1.5, because it has symptoms similar to Type 1 and 2 diabetes. LADA gradually destroys the cells that make insulin. Most people with LADA may need insulin injections six months or more from diagnosis. Lab testing to measure autoantibodies and insulin production may help with tailoring the treatment. There is some evidence indicating early insulin treatment can keep the insulin-making cells healthier for a longer period of time. With LADA, there is uncertainty on how it develops, how to define it and the importance of the correct diagnosis for patients.
Gestational diabetes occurs when blood sugars are higher than normal during pregnancy. Because of the rise in hormones during pregnancy, cells can become more insulin resistant, causing blood sugar levels to increase. Most cases of gestational diabetes resolve once the baby is born. However, a diagnosis of gestational diabetes can increase the likelihood of developing Type 2 diabetes later in life.
So, what does all of this mean? If you have a family history of diabetes, sedentary lifestyle, unhealthy eating or being overweight, your risk of developing prediabetes or Type 2 diabetes is increased. Having an action plan to exercise daily, eat healthy, quit smoking and lose weight may help lower the risk of developing the disease. Meeting with a diabetes educator and registered dietitian also can help tailor a plan that will work best for you.
Lori Flynn is a certified diabetes educator who sees patients at Mayo Clinic Health System in Eau Claire, Wisconsin. November is National Diabetes Awareness Month.