Most people are aware of two types of diabetes, conveniently named Type 1 and Type 2. Type 1's are typically thought of as people who are insulin dependent and Type 2's as non-insulin dependent. Type 1's develop the illness in childhood while Type 2's develop it in later life and are often overweight. This is all true up to a point, but the difference between the two is better defined as Type 1 being insulin deficient and Type 2 being insulin resistant. That is to say that in Type 1 the pancreas doesn't produce enough insulin to control blood sugar levels and in Type 2 the insulin is produced but something stops it getting to where it needs to go in order to control the blood sugar. That's why people with Type 1 need to take insulin but people with Type 2 often control their diabetes with medication which helps their own insulin perform better.
Still with me? Good. So, which type am I? Well, because Type 1 normally appears in childhood, people who develop symptoms in their adult years tend to get automatically classified as Type 2 and put on to medication such as metformin. In my case, the doctors were, like me, a little puzzled as to why I had developed diabetes - I didn't exactly fit the Type 2 profile. I cycle every day, swim a couple of times a week and don't eat any meat. I'm not overweight (one doctor even described me as 'lean', which I was rather sadly quite proud of!) and although several members of my family are Type 2, they didn't develop it until they were in their sixties. Anyway, the doctors decided to give me a chance to see if I could control my blood sugar by changing my diet, cutting out all the sweet stuff basically, and that seemed to do the trick. In the meantime a lipid clinic doctor decided to screen me for something called GAD antibodies and bingo, it turned out I was positive.
My somewhat rudimentary understanding of what this means is that GAD antibodies are nasty little bastards which fool the immune sytem into attacking the beta cells that produce insulin in a part of the pancreas called the Islets of Langahans (beautiful name - sounds like there should be a whisky distillery there). This is what happens to us LADA's - typically after the age of 40 (I was a month shy of my 41st birthday when I got diagnosed). Nobody knows why this happens or whether it's genetic or not. In fact it's only fairly recently been recognised as a discrete type of diabetes. Anyway, although developing diabetes in adulthood ticks the Type 2 box, I'm more of a Type 1 because I'm not producing as much insulin as I should - my last test measured it at about 15% of that of a healthy pancreas. However, I don't quite fit the Type 1 profile because on this 15% I'm still just about able to control my blood sugar without injecting insulin - so I'm insulin deficient but not insulin dependent...yet.
So that's how LADA's are different - we're about 10% of the total diabetic population apparently. Like most people in the same boat, the main questions I would like answered are 'why did I develop diabetes?' and 'how long can I carry on without injecting insulin?' So far, no-one's been able to give me a decent answer to either of these. It seems likely that LADA is genetic but there may well be other factors at work. On my last visit to the diabetes unit at Guy's Hospital, the doctor wanted to put me onto insulin because my average blood sugar level had crept up to about 7.5 (the ideal is around 6). I persuaded him to give me a stay of execution to see if I could get it back down again and he gave me two months - one month later and I'm averaging 6.1. If I'm lucky I'll be able to maintain this for a while, perhaps even years, but it seems likely that at some point I'll need to inject insulin. For the moment though, cycling rather than injecting is my most effective form of control. 30 minutes on my bike can make an impressive difference, so as long as my knees don't give up on me I shall continue to brave the elements, London's lethal bendy buses and the risk of saddle sores in pursuit of a perfect blood sugar level.
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