Cathy Purpur used every excuse she could think of to explain away her symptoms.
Busy at work and training for a half marathon in 2004, the 38-year-old San Jose woman started feeling exceptionally tired, craving orange juice and going to the bathroom a lot.
“I just figured I’m up in the middle of the night because I’m drinking a lot more, and I’m exhausted because I’m up in the middle of the night,” said Purpur, now 46. “I rationalized everything.”
It wasn’t until she noticed her vision getting worse – soon after she had been to the eye doctor for a new refraction – that she started to panic. She returned to the eye doctor, who immediately suspected the cause and told her to get a blood test.
Her blood sugar was sky high. The cause: diabetes.
Physicians are seeing an increase in diabetes, a disease that makes it difficult for patients to control their blood sugar levels. But it’s not the type of diabetes – known as Type 2 – that has gotten the most attention in recent years and is linked to the growing obesity epidemic.
Rather, it’s the less common Type 1 form that historically has been found in children and young adults.
“Overall, Type 1 diabetes is increasing and we’re seeing it in all age groups,” said Dr. Tandy Aye, who specializes in pediatric endocrinology and diabetes at Lucile Packard Children’s Hospital at Stanford.
Studies show trends
Comprehensive numbers for this trend are hard to come by, especially for adults, but some studies are starting to show what doctors are seeing. For example, a large registry of diabetes data collected in Europe showed a 4 percent annual increase in the rate of Type 1 diabetes diagnoses among children from 1989 to 2008.
In Pupur’s case, it was clear she had diabetes, but determining the type proved to be difficult.
Initially, her doctor told her she had Type 2 diabetes, which is sometimes referred to as “adult onset” but is being increasingly diagnosed in children because of the growing problem of pediatric obesity.
Type 1, once commonly referred to as “juvenile” diabetes, is an autoimmune disease in which the body attacks its own ability to produce insulin. Patients need frequent insulin injections to survive.
The Type 2 form, which accounts for more than 90 percent of all diabetes cases worldwide, is not an autoimmune condition. In this type, the pancreas quits producing insulin or stops using the insulin efficiently to control blood sugar levels. While Type 2 diabetes may require insulin injections, it can often be controlled with oral medications or even weight loss, exercise and healthy eating.
Purpur didn’t fit the profile of either a Type 1 or Type 2 diabetic. She is physically fit and had no family history of diabetes of any type. After consulting with an endocrinologist, she learned she had traits of both Type 2 and Type 1 – in essence, Type 1.5.
Often misdiagnosed as Type 2, this murky Type 1 form is called “latent autoimmune diabetes in adults” and may account for some of the increase in insulin-dependent diabetes. Patients with this form, including Purpur, generally develop the disease more slowly but eventually become dependent on insulin.
Researchers don’t know exactly why the increasing prevalence of Type 1 disease is occurring, but some attribute it to better classification and understanding of the disease.
“We’re more aware of different types of diabetes and that’s why we’re seeing an increased incidence,” said Dr. Marina Basina, a Stanford endocrinologist and assistant clinical professor. “We have better assays for the antibodies and are coding the diagnosis more as Type 1.”
Latent autoimmune diabetes in adults, or Type 1.5, has only in recent years been reclassified as Type 1 diabetes, instead of Type 2, as doctors have been able to detect the presence of the antibodies that attack the pancreatic cells, she said.
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