Ask the Doctors

Dear Doctor: I always thought Type 1 diabetes developed when you were a child, or not at all. But now they're saying it can happen as an adult, which is very alarming. How do I know if I develop it?

Dear Reader: While there are several different types of diabetes and different pathways through which the disease develops, they all have one basic thing in common -- the body has lost the ability to adequately regulate the levels of glucose in the blood.

When things are working properly, this glucose control is achieved by insulin, a hormone produced by the pancreas. Insulin makes it possible for the body to either use the glucose that enters the blood after digestion, or to store it for future use. Over time, people with chronic high blood glucose levels will face serious health problems like heart disease, kidney disease, nerve damage, eye problems, poor wound healing, foot problems and even stroke.

In Type 2 diabetes, which can develop at any age, the body has either stopped responding to insulin, or no longer produces enough to properly regulate blood sugar and keep it within optimal levels. In Type 1 diabetes, often referred to as "juvenile diabetes," the body's immune system goes haywire and attacks the insulin-producing cells of the pancreas. Genetics is believed to play a role in Type 1 diabetes, and recent research has shown that viruses may also be involved.

Because Type 1 diabetes is an autoimmune disease, the attack on the insulin-producing cells, known as the islets of Langerhans, is a sustained one. Unlike in Type 2 diabetes, which can sometimes be managed through diet and lifestyle changes, there is no middle ground in Type 1 diabetes. The insulin-producing cells of the pancreas are destroyed and in order to keep blood glucose within a safe range, insulin must be introduced to the body at regular intervals.

Type 1 diabetes is most commonly identified in childhood, but according to the National Institutes of Health, up to 25 percent of cases get diagnosed in adults, some as old as 80 or 90. When certain characteristics are present, this type of diabetes is referred to as latent autoimmune diabetes of adults, or LADA.

Symptoms of Type 1 diabetes, which can occur quite suddenly, may include:

-- Extreme thirst that cannot be quenched

-- Frequent urination

-- Lethargy or exhaustion

-- High sugar content in urine

-- Sudden changes to vision

-- An increased appetite

-- Unexpected weight loss

-- A sweet or fruity scent on the breath

-- Loss of consciousness

If you experience any of these symptoms, get in touch with your health care provider right away.

At this time, there is no cure for Type 1 diabetes. However, in the vast majority of cases the disease can be successfully managed with insulin, diet and exercise. And in the meantime, research continues. Of particular interest is the field of immunotherapy, in which gene splicing and gene editing are used to reprogram the immune system's T cells, which attack the pancreas. What would have sounded like science fiction just a decade ago could someday lead to a long-term cure.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

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