I am 32 years old and was diagnosed with type 1, but I am not insulin-dependent right now. I take oral medications. Explain why I am type 1?

Your question is not an uncommon one. We have an imperfect nomenclature for designating different types of diabetes. Previously, thin people less than 30 on insulin had juvenile-onset or type 1 diabetes. Individuals who were overweight and over 40 typically had adult-onset or type 2 diabetes. With better tools, more information, and more experience in diagnosing diabetes individuals who do not fit the typical picture noted above, it is clear that there are many who have type 1 diabetes diagnosed after age 30 and many individuals who have are being diagnosed with type 2 diabetes before 40 (at an alarming rate). The tools used to make these distinctions include medical history, family history, body type (lean or obese), antibody levels (which are markers of islet cell destruction), and response to a variety of challenge tests which measure the ability of the beta cells to make insulin. It is therefore possible to be diagnosed with type 1 diabetes after the age of 30 and still be on oral agents. This diagnosis could be made by the presence of antibodies, lack of a family history of diabetes, and low C-peptide and insulin responses to a beta cell challenge.

If you truly have type 1 diabetes, and are still on oral agents, it is likely that your ability to make insulin will begin to wane over time and you will eventually will require insulin in the coming months. If this is not the case, please talk with your physician about how your diabetes was diagnosed and what may be needed to treat you in the future.

JTL

[Editor’s comment: It is also possible that you have a from of diabetes called type 1B. In that case, it is often treated with oral agents, since the need for insulin is intermittent. The distinction between type 1A and type 1B can be made by performing antibody tests. However, these tests are expensive and will really not alter treatment.

Continue to carefully monitor your blood sugar levels, see your physician and have your HbA1c level measured every three months so that your treatment plan can be changed as needed to prevent complications.

SS]