Blurring of T1and T2 diabetes

A

Amw66

Senior Member (Voting Rights)
My mother in law was prediabetic a couple of years ago , apparently was diagnosed with diabetes in march 23 and only told one of her sons ( the one who takes her to the doctor) . She was completely mismanaged by GP and had a Diabetic Ketoacidosis episode ( don't know if this is the right term ) last week . She nearly died. She's currently in hospital and making good progress .

My OH chatted with the endocrinologist after the A+ E admission who advised that the distinction between T1andT2 diabetes has been blurring for a while and that T2 can in effect become T1. This was news to me as I thought T1 was quite distinct .

I don't know whether this is more likely to be in elderly ( found paper below)

I thought this subject may be of interest as diabetes can be a comorbid condition for pwME

Autoimmune aspects of type 2 diabetes mellitus - a mini-review

https://pubmed.ncbi.nlm.nih.gov/24457898/
 
Sorry to hear about your MIL. It’s a topic I am personally familiar with. I’m here as a mother of an 18yo son with MECFS, but also have a 20yo T1D daughter who was diagnosed at 12. I’m middle aged (def not elderly), overweight & had been prediabetic for 4 years but had been able to reverse this through a very low carb diet & weight loss, exercise etc. I had a fairly solid understanding of the mechanisms of T1D & T2D and periodically used a CGM to ensure I was keeping it in check. Then 2 years ago my I very suddenly became symptomatic with no change in diet etc & my HBA1C had skyrocketed. My GP sensibly ordered the autoantibody tests and it came back that I was indeed T1D (or the LADA version of it). I am aware of people in their 30s who are extremely fit being diagnosed so it is not just elderly. I suspect it is under diagnosed and sadly not widely understood in primary care. This is a risk as it requires significantly more meticulous management than T2D. I highly recommend investing in a CGM for your MIL - either Dexcom or Libre.
 
Deanne NZ said:
Sorry to hear about your MIL. It’s a topic I am personally familiar with. I’m here as a mother of an 18yo son with MECFS, but also have a 20yo T1D daughter who was diagnosed at 12. I’m middle aged (def not elderly), overweight & had been prediabetic for 4 years but had been able to reverse this through a very low carb diet & weight loss, exercise etc. I had a fairly solid understanding of the mechanisms of T1D & T2D and periodically used a CGM to ensure I was keeping it in check. Then 2 years ago my I very suddenly became symptomatic with no change in diet etc & my HBA1C had skyrocketed. My GP sensibly ordered the autoantibody tests and it came back that I was indeed T1D (or the LADA version of it). I am aware of people in their 30s who are extremely fit being diagnosed so it is not just elderly. I suspect it is under diagnosed and sadly not widely understood in primary care. This is a risk as it requires significantly more meticulous management than T2D. I highly recommend investing in a CGM for your MIL - either Dexcom or Libre.
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Thanks @Deanne NZ - something I'll be sure to look into
 
Amw66 said:
My OH chatted with the endocrinologist after the A+ E admission who advised that the distinction between T1andT2 diabetes has been blurring for a while and that T2 can in effect become T1. This was news to me as I thought T1 was quite distinct .
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If the situation is anything like rheumatoid and osteoarthritis I suspect it is not so much that T2 becomes T1 as that gradual onset T1 in an adult who is not thin is likely to look like and be assumed to be T2. It may even behave like T2 to the extent that carbohydrate restriction and weight loss might temporarily restore glucose control.

I think the mechanism concepts that justified the labels remain distinct but medical professionals may be realising (or re-realising) that the clinical presentations were never completely distinct.
 
Jonathan Edwards said:
If the situation is anything like rheumatoid and osteoarthritis I suspect it is not so much that T2 becomes T1 as that gradual onset T1 in an adult who is not thin is likely to look like and be assumed to be T2. It may even behave like T2 to the extent that carbohydrate restriction and weight loss might temporarily restore glucose control.

I think the mechanism concepts that justified the labels remain distinct but medical professionals may be realising (or re-realising) that the clinical presentations were never completely distinct.
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Yes, having read around this in the past few hours it seems that this is a slow onset version. It does however share aspects of both T1 and T2. ( Mentioned as T1.5 to explain it to public). It is often misdiagnosed as T2, which can be an issue. Prevalence difficult as it's not being picked up until people start having issues , but it seems that antibodies specific to LADA could be up to 10% of diabetes cases .
So one to be aware of perhaps if you have comorbidities.

Wikipedia has a layman's summary
https://en.m.wikipedia.org/wiki/Latent_autoimmune_diabetes_in_adults

Diabetes UK
https://www.diabetes.co.uk/diabetes_lada.html
 
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