If you have type 1 diabetes, your pancreas doesn’t make insulin or makes very little insulin. Insulin is a hormone that helps blood sugar enter the cells in your body where it can be used for energy. Without insulin, blood sugar can’t get into cells and builds up in the bloodstream. High blood sugar is damaging to the body and causes many of the symptoms and complications of diabetes.

Type 1 diabetes (previously called insulin-dependent or juvenile diabetes) is usually diagnosed in children, teens, and young adults, but it can develop at any age.

Type 1 diabetes is less common than type 2 — approximately 5-10% of people with diabetes have type 1. Currently, no one knows how to prevent type 1 diabetes, but it can be managed by following your doctor’s recommendations for living a healthy lifestyle, managing your blood sugar, getting regular health checkups, and getting diabetes self-management education and support.

What Causes Type 1 Diabetes?

Type 1 diabetes is thought to be caused by an autoimmune reaction (the body attacks itself by mistake) that destroys the cells in the pancreas that make insulin, called beta cells. This process can go on for months or years before any symptoms appear.

Some people have certain genes (traits passed on from parent to child) that make them more likely to develop type 1 diabetes, though many won’t go on to have type 1 diabetes even if they have the genes. Being exposed to a trigger in the environment, such as a virus, is also thought to play a part in developing type 1 diabetes. Diet and lifestyle habits don’t cause type 1 diabetes.

Symptoms and Risk Factors

It can take months or years for enough beta cells to be destroyed before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe.

Some type 1 diabetes symptoms are similar to symptoms of other health conditions. Don’t guess—if you think you could have type 1 diabetes, see your doctor right away to get your blood sugar tested. Untreated diabetes can lead to very serious—even fatal—health problems.

Risk factors for type 1 diabetes are not as clear as for prediabetes and type 2 diabetes, though family history is known to play a part.

Managing Diabetes

Unlike many health conditions, diabetes is managed mostly by you, with support from your health care team (including your primary care doctor, foot doctor, dentist, eye doctor, registered dietitian nutritionist, diabetes educator, and pharmacist), family, teachers, and other important people in your life. Managing diabetes can be challenging, but everything you do to improve your health is worth it!

If you have type 1 diabetes, you’ll need to take insulin shots (or wear an insulin pump) every day to manage your blood sugar levels and get the energy your body needs. Insulin can’t be taken as a pill because the acid in your stomach would destroy it before it could get into your bloodstream. Your doctor will work with you to figure out the most effective type and dosage of insulin for you.

You’ll also need to check your blood sugar regularly. Ask your doctor how often you should check it and what your target blood sugar levels should be. Keeping your blood sugar levels as close to target as possible will help you prevent or delay diabetes-related complications.

Stress is a part of life, but it can make managing diabetes harder, including managing your blood sugar levels and dealing with daily diabetes care. Regular physical activity, getting enough sleep, and relaxation exercises can help. Talk to your doctor and diabetes educator about these and other ways you can manage stress.

Healthy lifestyle habits are really important, too:

1. Making healthy food choices
2. Being physically active
3. Controlling your blood pressure
4. Controlling your cholesterol

Make regular appointments with your health care team to be sure you’re on track with your treatment plan and to get help with new ideas and strategies if needed.

Whether you just got diagnosed with type 1 diabetes or have had it for some time, meeting with a diabetes educator is a great way to get support and guidance, including how to:

1. Develop and stick to a healthy eating and activity plan
2. Test your blood sugar and keep a record of the results
3. Recognize the signs of high or low blood sugar and what to do about it
4. Give yourself insulin by syringe, pen, or pump
5. Monitor your feet, skin, and eyes to catch problems early
6. Buy diabetes supplies and store them properly
7. Manage stress and deal with daily diabetes care

Hypoglycemia

Hypoglycemia (low blood sugar) can happen quickly and needs to be treated immediately. It’s most often caused by too much insulin, waiting too long for a meal or snack, not eating enough, or getting extra physical activity. Hypoglycemia symptoms are different from person to person; make sure you know your specific symptoms, which could include:

1. Shakiness.
2. Nervousness or anxiety.
3. Sweating, chills, or clamminess.
4. Irritability or impatience.
5. Dizziness and difficulty concentrating.
6. Hunger or nausea.
7. Blurred vision.
8. Weakness or fatigue.
9. Anger, stubbornness, or sadness.

If you have hypoglycemia several times a week, talk to your doctor to see if your treatment needs to be changed.

Maturity-onset diabetes of the young (MODY) is a rare kind of diabetes that runs in families. Like type 1 and type 2 diabetes, MODY affects the way your body uses and stores sugar from food. But treatment can be different, so it’s important to get the right diagnosis.

What Causes MODY?

MODY is brought on by a change, called a mutation, in one of your genes. This is different from type 1 and type 2 diabetes, which are caused by a combination of different genes and other things, such as obesity.

The genetic change that happens because of MODY keeps your pancreas from making enough insulin, a hormone that helps control the level of sugar in your blood.

Who Gets It?

MODY is usually inherited, so your odds of getting it are higher if you have family members with the disease. If you have a parent with MODY, there’s a 50% chance that you’ll get it. In many cases, the disease reaches across more than one generation. It can affect a grandparent, parent, and child.

The disease usually happens in teens and young adults under 35. But you can get it at any age. Unlike type 2 diabetes, MODY isn’t linked with obesity or having high blood pressure. People with MODY are often at a healthy weight.

What Are the Symptoms?

The signs of MODY can depend on which of your genes is affected. In some cases, there may be no symptoms at all. But in general, the disease comes on gradually. You may have high blood sugar for years before you notice one of these warning signs:

1. Thirsty or hungry more often
2. Peeing more often
3. Blurry vision
4. Skin or yeast infections
5. Weight loss
6. Fatigue

What Are the Complications?

Like other types of diabetes, MODY causes high blood sugar levels. If you don’t get treatment, over time it can lead to complications like:

1. Nerve damage
2. Heart disease
3. Eye damage, including blindness
4. Foot problems
5. Skin problems such as infections

How Is It Diagnosed?

Because there can be no symptoms or mild ones, you and your doctor may not realize at first that you have MODY. Your doctor may diagnose you with diabetes when a blood test shows that your blood sugar levels are high. The next step is figure out what kind of diabetes you have.

Your doctor will ask about your family history of diabetes. They may order blood tests that can rule out other types of the disease besides MODY.

Based on these results, your doctor might suggest that you get genetic testing to confirm you have MODY. They’ll take a sample of DNA from your saliva or blood and send it to a lab. A technician will look for changes in a gene that cause MODY.

How Is MODY Treated?

MODY 1 and MODY 4. They’re usually treated with sulfonylureas, a type of diabetes medication. These drugs cause your pancreas to make more insulin. Some people with MODY 1 and MODY 4 may also need to take insulin.

MODY 2. This disease is usually managed through diet and exercise. You usually don’t have to take medicine.

MODY 3. At first, this form of the disease can be treated through diet. Over time, you may need sulfonylureas and then insulin.

MODY 5. You’ll need to take insulin to treat it. This rare form of MODY can harm other organs, such as your kidneys. You’ll need treatment for complications, such as kidney cysts or kidney failure.

MODY 6. This type tends to appear later in life, around age 40. You’ll get treated with insulin.

What is LADA?

We usually hear that there are two types of diabetes. Type 2 is caused primarily by insulin resistance. The insulin isn’t effectively used by the body’s cells, so too much glucose stays in the blood and causes complications. Type 2 comes on slowly and used to be called “adult-onset diabetes.”

Type 1 is caused by the body’s immune system destroying the beta cells in the pancreas, which produce insulin. Without insulin, our bodies can’t use glucose, and eventually people with Type 1 will die without injected insulin. Type 1 usually comes on rapidly in childhood or adolescence.

LADA is a mixed type. It comes on slowly during adulthood like Type 2, but is caused mostly by an immune system reaction like Type 1.

The diabetes website diabetes.co.uk defines LADA as “initially non-insulin requiring diabetes diagnosed in people aged 30–50 years.”

It’s a common and serious problem. According to a study in the journal Diabetes, “Among patients [who appear to have] Type 2 diabetes, LADA occurs in 10% of individuals older than 35 years and in 25% below that age.” LADA is often misdiagnosed as Type 2. People with LADA may be denied needed insulin and given advice that doesn’t work.

Symptoms of LADA

According to diabetes.co.uk, early LADA symptoms may be vague. They include:

1. Foggy headedness
2. Feeling tired all the time or feeling tired after meals
3. Feeling hungry again soon after meals

As LADA develops, a person’s ability to produce insulin will gradually decrease, and this may lead to more typical diabetes symptoms such as:

1. Constant or extreme thirst
2. Needing to frequently urinate
3. Blurred vision
4. Tingling nerves

Diagnosing LADA

Diabetes is diagnosed by higher-than-normal blood sugars, as shown on a fasting plasma glucose (FPG) test, oral glucose tolerance test (OGTT), random plasma glucose test or A1C test. But what type of diabetes do you have? There are some clues that should lead you and your doctor to suspect LADA rather than Type 2.

Absence of metabolic syndrome features. People with metabolic syndrome often have Type 2 and tend to be heavy and have high blood pressure and bad cholesterol levels. A person with above-normal sugars but without these other factors may well have LADA. However, fat people with metabolic syndrome can have LADA, too.

Glucose that stays high despite taking oral diabetes medicines. Most Type 2 diabetes drugs treat insulin resistance, which is not the cause of LADA, so the pills won’t work.

Evidence of other autoimmune diseases including Grave’s disease, rheumatoid arthritis, or hundreds of others you can see here.

No family history of Type 2 diabetes.

If any of these clues are present, or if you are a thin, physically active person with high blood sugars, you might want to be tested for autoantibodies. Autoantibodies are the proteins that attack the pancreas or destroy insulin. Antibodies to glutamic acid decarboxylase (GAD) are the most common. Others are called islet cell antibodies (ICAs). A person with LADA will usually test positive for one or both groups of antibodies, but there are several other types as well.

Treatment for LADA

Oral diabetes medicines like metformin (brand names Glucophage, Glucophage XR, Glumetza, Riomet) probably won’t help unless you also have Type 2, which often happens. Another class of diabetes pills, the sulfonylureas (tolbutamide [Orinase], tolazamide [Tolinase], chlorpropamide [Diabinese], glimepiride [Amaryl], glipizide [Glucotrol and Glucotrol XL] and glyburide [Diabeta, Micronase, and Glynase]) may actually worsen LADA by increasing autoimmunity.

You may, however, benefit from insulin. Many experts say start insulin sooner rather than later, because some studies show injected insulin protects beta cells from damage.

This is why it’s important to know if you have LADA. Your doctor may prescribe sulfonylureas and not prescribe insulin if he thinks you’re Type 2.

Other studies have found the TZD, or thiazolidinedione, drugs (pioglitazone [Actos] and rosiglitazone [Avandia]) help preserve beta cells in people with LADA. The incretin drugs, such as exenatide (Byetta and Bydureon), liraglutide (Victoza), albiglutide (Tanzeum) and dulaglutide (Trulicity), have been shown to increase beta-cell growth and improve glucose control, but have not yet been tested in people with LADA

You also want to do things to slow or stop the autoimmune process. According to functional medicine and naturopathic doctors and websites, these treatments could include reducing stress, getting more sleep, getting more touch and social support, avoiding foods you are allergic or sensitive to, and healing your gut bacteria with probiotics and fiber. Functional medicine practitioner Dr. Mark Hyman, author of The Blood Sugar Solution, advises supplements starting with vitamins C and D and fish oil, and possibly including several others as needed.

If LADA continues, you may eventually need insulin even with good self-management. If you want to stop the LADA process, your pancreas may benefit from the support of outside insulin, and other measures like the ones listed above.