How do I know for sure I have type 1 and not type 2?
The differentiation is primarily based on clinical factors and secondarily through certain laboratory tests. In type 1, you are usually lean (normal weight), have a sudden onset with significant symptoms, have positive ketone bodies and need insulin immediately. Age under 30 and the absence of metabolic syndrome (obesity, hypertension, dyslipidemia) suggest type 1 diabetes.
Blood tests include autoantibodies specific to type 1 diabetes (GAD, IA-2, IAA, ZnT8), which are present in 90% of type 1 diabetes cases. Low or absent C-peptide shows the lack of significant insulin production, arguing for type 2 diabetes. In type 2, autoantibodies are negative and C-peptide is normal or even sometimes elevated (insulin resistance). If the picture is unclear, time usually clarifies the situation, with continued progression of the insulin secretion deficit.
What is LADA diabetes and how does it differ from type 1?
LADA (Latent Autoimmune Diabetes in Adults) is a form of type 1 diabetes with slow onset in adults. The immune system destroys beta cells gradually, so you can manage for months or even a few years with pills before needing insulin. It is also popularly called "type 1.5" or "late-onset type 1".
Differences from classic type 1 include onset after age 30, slow progression without ketoacidosis, longer period until insulin dependence (0.5-5 years), and often only one positive autoantibody (usually GAD). Treatment is identical to the classic form and involves insulin, initially administered only as basal insulin. If you have LADA, it is crucial to start insulin when C-peptide is still only slightly decreased. Don't wait until it's depleted!
Can I go from type 2 to type 1?
You cannot "go" from type 2 to type 1. They are completely different diseases with distinct mechanisms. What can happen is that you were initially misdiagnosed. Approximately 10% of adults labeled as type 2 actually have LADA (type 1 with slow progression), who will eventually require insulin obligatorily.
The confusion arises when a person with LADA responds temporarily to pills, being considered type 2. When pills no longer work and insulin becomes necessary, it seems like a "transformation". In reality, it was autoimmune type 1 from the beginning, with slower destruction of beta cells. Testing autoantibodies at diagnosis can prevent this confusion.
What is MODY diabetes and how is it different?
MODY (Maturity Onset Diabetes of the Young) is a monogenic genetic diabetes (a single mutant gene causes the disease). It represents 1% of diabetes cases and is transmitted in an autosomal dominant pattern (50% chance for children). There are over 10 types of MODY, each with its own mutation and specific treatment. Some forms require only diet, others sulfonylureas, others insulin.
Differences from type 1 include gradual onset without ketoacidosis, negative autoantibodies, persistently present C-peptide, strong family history (over 3 generations). Unlike type 1 where destruction is autoimmune and almost complete, in MODY diabetes beta cells are present but function defectively. Diagnosis requires genetic testing (expensive), but sometimes worth it to have personalized treatment.
Is type 1 diabetes more severe than type 2?
It is not correct to say that one is "more severe" than the other. Type 1 has a higher risk of severe hypoglycemia and ketoacidosis, requires constant vigilance and does not allow treatment breaks. Type 2 has more comorbidities (cardiovascular diseases, hypertension) and early macrovascular complications.
What makes type 1 more difficult for many is the onset at a young age, absolute dependence on insulin, high variability in blood glucose and constant psychological burden. Type 2 may seem "easier" initially, but it also becomes complex over time. Ultimately, both require careful lifelong management, and severity depends more on control than type. Generally, however, life expectancy after onset (at any age) is higher in type 1 compared to type 2 diabetes.
Why can't I take pills like those with type 2 diabetes?
You cannot take only pills because your pancreas no longer produces almost any insulin, and diabetes pills work either by stimulating insulin production or improving sensitivity to existing insulin. Without enough internally produced insulin, these mechanisms are almost useless. It's like trying to repair an engine that's run out of fuel.
Some new pills that eliminate glucose through urine can sometimes be added to insulin for additional control, with some risks and not instead of insulin. Any attempt to treat type 1 diabetes without insulin ultimately leads to ketoacidosis, which can be fatal. Insulin is not a choice for you, it is the only survival option.
Is there type 1.5 diabetes?
"Type 1.5 diabetes" is an informal term for the LADA form of type 1 diabetes. It is an autoimmune diabetes with adult onset and slow progression. It is not an official type in medical classification, but the term is useful for describing the gray zone between the sudden onset of classic type 1 and the slower onset in type 2. Approximately 10% of adults diagnosed with diabetes have this form.
"1.5" characteristics include age 30-50 years at onset, normal or only slightly increased weight, positive autoantibodies (usually GAD is measured), initial response to pills, followed by the need to introduce insulin in 0.5-5 years. Treatment evolves relatively quickly from pills to insulin as beta cells are destroyed. Early recognition allows insulin introduction before total depletion of pancreatic beta reserve.