It is not always easy – even for doctors – to determine if someone has Type 1 or Type 2 diabetes when diagnosed as an adult.
And a new study finds that errors are common.
"Oh no, I have to inject"
This happened with the British Prime Minister Theresa May, who was diagnosed with type 2 diabetes in 2012. She was in her 50s then. Despite all the symptoms that are common in type 1 diabetes, including rapid weight loss, her doctor first said that she has type 2 diabetes.
According to prescribed drugs, the doctor performed several tests in May and found that he had type 1 diabetes. Her daily regimen changed rapidly from oral medicines to an injection of hormonal insulin.
"My first reaction was that it's impossible because you do not understand this in my years," said Diabetes UK. "But then my reaction was:" Oh no, I have to inject "and think about what this means in practice."
So, how do doctors combine both conditions?
It's really hard to tell the differences in adults, said Dr. Nick Thomas.
"In childhood almost all diabetes is due to type 1 diabetes. After 30 years [there’s] a dramatic increase in type 2 diabetes and type 1 represents less than 5% of all cases of diabetes, so trying to identify cases such as finding a needle in the hay, "said Thomas, a clinical academic at the University of Exeter, England.
There is also often a misconception that type 1 diabetes can occur only in children. But that's not the case.
Insulin plays a key role in metabolism
"Type 1 diabetes can occur at any age. Doctors should pay attention to the possibility of type 1 diabetes in cases where patients fail quickly with oral therapy," added Thomas.
Type 1 diabetes is an autoimmune disease that leads the immune system to attack insulin-producing cells in the pancreas, according to the US National Diabetes and Gynecological and Renal Disease Institute (NIDDK). Insulin plays a key role in metabolism by introducing into the sugars cells of the body that are used as fuel.
But an autoimmune attack is blaming people that they can not produce enough insulin. Without insulin injections – using images or insulin pump – Type 1 diabetics could not survive.
The exact cause of type 2 diabetes is still unknown, but it is known that overweight and genetics play an important role, NIDDK believes.
People with type 2 diabetes do not use properly the insulin. As a result, the body produces more and more insulin. Over time, the pancreas can not keep up and people with type 2 may need insulin injections. But type 2 can often be managed by changes in lifestyle and oral medicine.
In the current study, after the age of 30, diagnosed diabetes was almost 600 people who needed insulin. The diagnosis was diagnosed between 2007 and 2017. The researchers also studied a group of 220 people diagnosed 30 years ago.
It was found that 21 out of 30 patients who were diagnosed after the age of 30 years had severe insulin deficiency, which the researchers confirmed a type 1 diagnosis. In this group, almost 40% of these patients did not receive insulin when they were diagnosed for the first time . Almost half of group 1 said they have type 2 diabetes.
The classification of diabetes is very generic
"Controlling type 1 diabetes as type 2 diabetes can cause a rapid deterioration in patient's health and the development of a potentially life-threatening condition called diabetic ketoacidosis," Thomas said.
Dr. Joel Zonszein, director of the Clinical Center for Diabetes at the Montefiore Medical Center in New York, was not surprised that some people misdiagnosed.
"We saw type 1 years ago only with young people, and now we are starting to see younger people with type 2. And type 1 is more difficult than it would be," he said.
Plus, "the classification of diabetes is very generic and not very good. A good endocrinologist can also release the diagnosis," Zonszein said.
However, he was surprised by the number of incorrect diagnoses in the British study.
"They found 20%, and I thought it would be around 10%," Zonszein said, adding that this could have some links to population differences between the United Kingdom and the United States.
The study was presented last week at a meeting of the European Association for the Study of Diabetes in Berlin, Germany. Studies presented at meetings are usually considered preliminary, until they are published in a revised magazine.
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