DEAR DR. ROACH: Last year, at 57, I was diagnosed with Type 1 LADA diabetes. Initially I was put on insulin to get my blood sugar within the normal range. Then I was just on metformin until the “honeymoon period” was over. My endocrinologist is great. I now am back on insulin (six units at night). I walk anywhere between 3 and 8 miles about three times a day. My blood pressure is excellent. I initially lost about 18 pounds after diagnosis, so my weight is good. When looking at Google, it says my life expectancy has been cut by 20 years! Yikes, I JUST retired and if I go by their gauge, I’ll be passing around age 68! Is this based on someone who has had diabetes for many years, since Type 1 is usually diagnosed much earlier? The doctor said even though my initial sugars were over 500 when diagnosed, I was very healthy and that’s why nothing was “destroyed.” My vision was off for about a month but no permanent damage was done. Any reassurance would be appreciated! — M.W.
ANSWER: Most people are familiar with Type 1 diabetes, with a typical onset in childhood and at a normal weight. It is caused by an autoimmune destruction of the insulin-making cells in the pancreas. People also know about Type 2 diabetes, usually adult-onset and usually diagnosed in someone who’s overweight; it’s caused by resistance to insulin. But there are other subtypes of diabetes, including latent autoimmune diabetes in adults (LADA).
In the U.S. and Canada, it accounts for a small fraction of diabetes cases, but is more common in Scandinavian countries. It has some characteristics of both Type 1 and Type 2 diabetes, but the autoimmune nature and the usual progression to insulin need makes most experts feel it is closer to Type 1 than to Type 2. A recent paper has outlined a potential new classification of diabetes types.
The change in life expectancy from diabetes relates to how long you have had diabetes and how well-controlled it has been. With outstanding diabetes control (normal or near-normal blood sugar levels), the effect on overall mortality is modest, at best. In one model, the reduction in life expectancy is less than a year. However, it certainly is possible to have life expectancy drop by 20 years with very poorly controlled, longstanding diabetes.
For people with diabetes, to a very large extent, their potential to live longer (and healthier) can be improved by better blood sugar control. For new-onset autoimmune diabetes (both Type 1 and LADA), early and aggressive blood sugar control with insulin may reduce the amount of autoimmune damage and improve long-term prognosis. Studies are in progress to evaluate this.
DEAR DR. ROACH: I am a female, 16 years old. My white blood cell count is 16.6. I am suffering from so much weakness and pain in my legs, arms and shoulder area. I also have a cough and cold. Is it dangerous? What should I do for it? — K.C.
ANSWER: I don’t have enough information to help much. A white blood cell count that high suggests an infection. At your age, those symptoms are most likely a viral infection, but acute mononucleosis and even pneumonia are possible, so you need to see your doctor.