Tuesday, November 24, 2020

Diabetes not limited to only two main types

(c) 2020 North America Synd., Inc.

(c) 2020 North America Synd., Inc.

DEAR DR. ROACH: Last year, at 57, I was ­diagnosed with Type 1 LADA diabetes. Initially I was put on insulin to get my blood sugar within the ­normal range.

Then I was just on ­metformin until the ­“ honeymoon period” was over. My endocrinologist is great. I now am back on ­insulin (six units at night).

I walk anywhere ­between three and eight miles about three times a day. My blood ­pressure is excellent. I ­initially lost about 18 pounds after ­diagnosis, so my weight is good.

When looking at Google, it says my life expectancy has been cut by 20 years! Yikes, I just retired and if I go by their gauge, I’ll be passing around age 68.

Is this based on ­someone who has had diabetes for many years, since Type 1 is usually diagnosed much ­earlier? The doctor said even though my initial ­sugars were over 500 when ­diagnosed, I was very healthy and that’s why nothing was ­“ destroyed.” My vision was off for about a month but no permanent damage was done. Any reassurance would be appreciated. — M.W.

ANSWER: Most ­people are familiar with Type 1 ­diabetes, with a typical ­onset in childhood and at a ­normal weight. It is caused by an ­autoimmune ­destruction of the insulin-making cells in the pancreas.

People also know about Type 2 ­diabetes, ­usually adult-onset and ­usually ­diagnosed in ­someone who’s overweight; it’s caused by resistance to insulin. But there are other subtypes of diabetes, ­including latent ­autoimmune diabetes in adults (LADA).

In the U.S. and Canada, it accounts for a small ­fraction of diabetes cases, but it is more common in ­Scandinavian countries. It has some ­characteristics of both Type 1 and Type 2 ­diabetes, but the autoimmune nature and the usual progression to ­insulin need makes most ­experts feel it is closer to Type 1 than to Type 2. A ­recent ­paper has outlined a potential new ­classification of diabetes types.

The change in life ­expectancy from ­diabetes relates to how long you have had diabetes and how well-controlled it has been. With outstanding diabetes ­control (normal or ­near ­normal blood sugar levels), the ­effect on overall ­mortality is ­modest, at best. In one ­model, the ­reduction in life expectancy is less than a year. ­However, it certainly is possible to have life ­expectancy drop by 20 years with very ­poorly controlled, longstanding ­diabetes. For people with ­diabetes, to a very large ­extent, their potential to live longer (and healthier) can be improved by better blood sugar control.

For new onset­ autoimmune diabetes (both Type 1 and LADA), ­early and ­aggressive blood sugar ­control with ­insulin may ­reduce the amount of ­autoimmune ­damage and improve long-term prognosis. Studies are in progress to evaluate this.


DEAR DR. ROACH: I am a female, 16 years old. My white blood cell count is 16.6. I am suffering from so much weakness and pain in my legs, arms and shoulder area. I also have a cough and cold. Is it dangerous? What should I do for it? — K.C.

ANSWER: I don’t have enough information to help much. A white blood cell count that high suggests an infection. At your age, those symptoms are most likely a viral infection, but acute mononucleosis and even pneumonia are possible, so you need to see your doctor.


Dr. Roach regrets that he is unable to answer ­individual questions, but will ­incorporate them in the column whenever possible.

Readers may email questions to ­ToYourGoodHealth@med.cornell.edu.

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