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June 29, 2003

Diagnosis and Symptoms

Question from Wellington, New Zealand:

I know of a 59 year old woman who was diagnosed with type 1 diabetes at the age of 41, but she believes that she should have been diagnosed with diabetes some seven years earlier when she experienced constant falling over. At the time of diagnosis, she presented with typical symptoms including dizziness that had been building for a couple of months previously. At age 36, she experienced constant urinating although this was treated in one visit to her doctor. At age 40, she mentioned a terrible thirst, and sores on her behind (vulval thrush -- common in uncontrolled diabetes). That leads us up to age 41 and her eventual diagnosis after two months of more acute symptoms. Should this woman have been diagnosed with type 1 diabetes earlier? Would early detection have made any difference to her current condition? Do adults with type 1 diabetes suffer any greater injury later on the longer they are undiagnosed?

Answer:

Even though there are not enough data in your story for us to judge her diagnosis in a definitive proper way, it is rather suggestive for Late-onset Autoimmune Diabetes of Adulthood (LADA). To address your questions. I might say that only over the last years, a proper diagnosis of type 1A (autoimmune) diabetes in adults has been made possible through the widespread laboratory testing for antibodies (GAD 65 in particular). However, provided that good metabolic control has been assured from the very beginning of the disease anyway, especially with insulin therapy, early detection would have made no significant difference in terms of greater risk for long term complications.

MS