Adult Onset Type 1 Diabetes: What You Need to Know

Below, we’ve highlighted the importance of understanding the distinct origins of the two conditions, as well as their symptoms, treatments, and diabetes care management. 

It’s a fact adults are being diagnosed more frequently with type 1 diabetes (T1D) than ever before. A National Diabetes Statistics Report from the Center for Disease Control and Prevention cites a 30% rise in adult onset T1D diagnoses in the United States.

The unusual phenomenon is stumping doctors and scientists, and the confusion has often led to misdiagnosis of type 2 diabetes for adults with type 1. The Lancet Reginal Health published a report in June 2023, indicating an estimated 40% of T1D adults 30 years and older could have been misdiagnosed with type 2 diabetes.

The most significant problem is that though the two types are distinct in origin—the treatment is substantially different.

If you suspect you may have diabetes, it’s best to know the differences, disparities, and treatments of the two types.

Differences Between Type 1 and Type 2 Diabetes

The two conditions, so similar in name, are actually very different diseases. So distinct, in fact, that some people have debated whether or not to change the name of the latent autoimmune diabetes, or adult onset T1D, to insulin dependent diabetes. It’s also known as type 1.5 and LADA (latent adult onset diabetes in adults).

The main difference is that type 1 diabetes, whether it is juvenile diabetes or adult onset T1D, can’t be prevented or treated with oral medication. Also, people with a family history of type 2 diabetes can sometimes lower their risk of developing the disease by maintaining an exercise routine and a healthy diet and weight loss plan—this is not the case for type 1 patients.

The three main types of diabetes are:

Type 1 Diabetes

Type 1 diabetes is an autoimmune disorder where the body’s immune system attacks and destroys the insulin-producing beta cells in the pancreas. As insulin is the key that unlocks the cell’s door for energy, the body starves without it as the sugar gets trapped in the bloodstream. Glucose fuels the body’s cells. 

Originally called juvenile diabetes, most doctors treat patients with insulin therapy through a pump or injectable shots. Though there isn’t a cure for type 1 diabetes, the technology is constantly advancing with substantial research and developments like implantable insulin pumps and islet cell transplantation.

Type 2 Diabetes

With type 2 diabetes, the body still produces insulin, but the cells become resistant. As people with type 1 diabetes stop producing insulin, people with type 2 diabetes don’t make enough insulin or don’t respond to insulin as well as they should. The most common treatment for type 2 patients is tablets taken with or after meals that help keep blood sugar levels in check.

Patients can manage and even prevent type 2 diabetes with close monitoring along with a diet and exercise routine. Some doctors may prescribe medication to help the body use insulin more efficiently, and some patients are treated with insulin.    

Gestational Diabetes

Gestational diabetes is a type of diabetes that develops during pregnancy in women, who don’t have diabetes. In most cases a woman’s blood sugar level returns to normal after the baby is delivered. However some cases of women with gestational diabetes go on to develop type 2 diabetes.

Patients are encouraged to maintain a healthy weight and should have their physicians check their blood sugar levels six to 12 weeks postpartum, and then every one to three years after to monitor blood glucose levels.

Gestational diabetes is diagnosed through blood tests that measure high blood glucose and show how well the body uses glucose. This blood sugar test is typically performed by your healthcare team around the 24th week of pregnancy.‍

Other Types of Diabetes

According to the International Diabetes Federation diabetes has many variations. These different types include:

• Maturity onset diabetes (MODY): A rare genetic form of diabetes that may develop before 25 years old due to the mutation of certain genes.

• Latent autoimmune diabetes in adults (LADA): This form of type 1 diabetes develops in adulthood and progresses at a slower pace than type 1 diabetes.

• Monogenic diabetes: Instead of certain genes mutating, this type is caused by a change in a single gene.

• Diabetes from surgery: Caused by having surgery to remove the pancreas.

• Diabetes from damage to the pancreas: Caused by conditions such as cystic fibrosis or pancreatitis.

Similarities Between Type 1 and Type 2 Diabetes

Both chronic illnesses affect the body’s regulation of blood sugar or glucose. If left untreated, both types lead to high blood sugar levels, increasing the risk of serious complications. Both have similar symptoms, which add to the misdiagnosis.

Before, it was wrongly assessed that only older adults got type 2 diabetes and only children got type 1 diabetes. Now, children can get type 2, and older individuals can get adult onset T1D diabetes between six months to 70 years old in some cases.

Both types also have the risk of developing diabetic ketoacidosis (DKA), a severe complication where the body can’t produce enough insulin. When this happens, the body breaks down fat as fuel, which causes a buildup of acids or ketones in the bloodstream.

Symptoms of DKA include:

• excessive thirst
• nausea or vomiting
• frequent urination
• lethargy
• headaches
• stomach pains

If left untreated, it can result in loss of consciousness, coma and death. If you suspect DKA, seek emergency care right away. 

According to the World Health Organization, particular racial or ethnic groups may be more susceptible to developing prediabetes and type 2 diabetes, including African American, Hispanic or Latino, and Asian American people.

Overweight and obese individuals have accounted for about 65-80% of new cases of type 2 diabetes, where oral medication is used in the patient’s treatment plan. As healthcare professionals trace apparent health problems, some type 2 cases show no symptoms for several years. For this reason alone, your primary care doctor must perform a routine blood sugar test.

In the United States, American Indians/Alaska Natives are at a higher risk for diabetes, followed by Hispanics and non-Hispanic Blacks (NHB).

Symptoms of Type 1 and Type 2 Diabetes    

According to the American Diabetes Association (ADA), the most common symptoms of type 1 and type 2 include the following warning signs:

• Frequent urination

• Extreme thirst and hunger

• Lethargic or lack of energy

• Blurred vision

• Cuts or sores that won’t heal

• Fruity breath

• Mood swings

• Weight loss – even though you are eating more (type 1)

• Tingling, pain or numbness in the hands and or feet (type 2)

‍‍Complications of Type 1 and Type 2 Diabetes

‍The effects of consistently high blood glucose levels can result in diabetes complications. Some of the significant complications to avoid are :

• Diabetic retinopathy (eye problems)

• Diabetes foot problems

• Neuropathy (nerve damage)

• Heart attack and stroke

• Kidney problems (nephropathy)

• Gum disease and other mouth problems

• Related health problems like heart disease, cancer and high blood pressure may arise, which can damage blood vessels and nerves around the heart.

Causes for Misdiagnosis

‍Even though the symptoms of the two types are similar, they present themselves in very different ways. Since LADA develops much more slowly in adults than in adolescents, it’s often misdiagnosed as type 2 diabetes. It’s believed that type 2 diabetes develops over several years. Some individuals with type 2 don’t have symptoms for many months, and these symptoms develop slowly over a more extended period. Unfortunately, sometimes, there are no symptoms with type 2 patients. When this occurs, doctors can’t treat the condition until complications arise.

Typically, with young adults and children, autoimmune diabetes symptoms develop quickly over a few weeks; however, in more and more cases, type 1 patients develop the symptoms gradually, adding to the misdiagnosis confusion. In the past, some believed diet and lifestyle habits caused type 2 diabetes, but even this is untrue for all cases. Some researchers suggest genetic and environmental factors contribute to both. When doctors treat type 1 diabetes as type 2, they don’t account for the severity of the condition. Sometimes, patients leave the doctor’s office with a diet and exercise plan or pills for meals, which don’t treat the real problem, which is a lack of insulin. 

‍The only treatment for type 1 diabetes is insulin therapy.

‍Diabetes is on the Rise

Even though the two diabetes mellitus conditions are on the rise at an alarming rate, misperceptions surrounding adult-onset diabetes are shrouded in myths and misdiagnoses. Understandably, doctors have a tough time differentiating between the two types, especially as more adults receive a diabetes diagnosis of type 1.

The look of diabetes is changing too as now healthy, underweight individuals have both type 1 and type 2 diabetes. And LADA’s symptoms are similar to those of type 2 diabetes. The so-called ‘honeymoon phase,’ where the body still produces insulin, looks like type 2, when it’s just a slower progression of the autoimmune diabetes, T1D.

If you suspect you have diabetes, you should learn the facts, understand the different types, and come prepared with a list of questions for your next appointment.

Treatment and Diabetes Management Tips

Aside from the differences in treatment, some diabetes care tips are similar for adult onset T1D and T2D. With similar physiology, both types must monitor their blood sugar levels regularly and incorporate insulin when they eat carbohydrates. Both types need to create an insulin therapy plan with their endocrinologist.

The insulin therapy treatment for T1D and T2D may be regular insulin injections via multiple daily shots, insulin pen or insulin pump. While some type 2 diabetes patients can receive treatment through oral medication, others require additional insulin and the use of GLP-1 drugs.

Both types can benefit from wearable devices like a continuous glucose monitor (CGM) to prevent high and low blood sugar episodes. Speak with your diabetes care team to determine the right treatment plan for you.

Pathway to a Cure

While exponential insulin is still the only treatment for T1D, new studies and clinical trials are underway. Though pancreas transplant surgery is rare, other positive therapies include beta cell transplants, cell regeneration, and advanced insulin delivery solutions. A practical cure will likely be a combination of two or more of these components.

Patients must be their own advocates and learn how exercise, stress, and sleep affect their condition. Diabetes is a challenging but manageable disease, and armed with all the right tools, it can be treated quite effectively!