It is well known that diabetes is associated with cognition impairment (CI). Recent studies have recorded a link between diabetes and mild cognitive impairment in parsons of earlier onset and greater severity of diabetes. There is evidence that lack of glycemic control resulting in hypo- or hyperglycemia leads to CI in patients with diabetes. Cognition impairment can present as changes in memory, mood swings, perception, reaction times and concentration. While the association between CI (and dementia) and diabetes is clear, researchers do not fully understand the mechanism of how diabetes triggers dementia.
It was therefore with some trepidation I absorbed the news that Britain has elected as their new prime minister a woman who suffers from type 1diabetes. Theresa May has earlier been the Home Secretary of Britain and has carried herself with distinction but overseeing Brexit may prove vexing even for her undoubted capabilities. Added to Brexit is the chaos that Europe is facing for the first time after World War II. Recession is staring most of Europe and could clasp a ‘leaving’ Britain. Chinese stock market has nosedived by 40%, Japanese stock are down by 25%, German stocks are down by nearly 20%, and the Italians continue to have a torrid time. Italian banks are sitting on 350 billion Euros of bad loans, and capital levels are barely above that of Bangladesh. The USA is 19.4 trillion dollars in debt. There have been shootings in Orlando, Dallas, Baton Rouge, and Munich. A crazed man has mowed down more than 80 people to their death in Nice. Paris was attacked last November. The world seems to streaking to an irreversible storm capable of cracking most institutions and systems, as we know them.
Great Britain has been a key nation of the planet, which has gifted civil liberty, abolition of slavery, universal suffrage, cricket and even the modern form of hockey. They have more than made up for the follies and ruthlessness of the East India Company. It shall by all accounts continue to have a premier role to play in world economy and politics. For the British prime minister to have type 1 diabetes could therefore become a major chink in for the entire world.
But mercifully the British prime minister does not have type 1 diabetes. She actually suffers, strictly speaking, from a variant form of diabetes requiring a different treatment protocol and prognosis. Mrs. May suffers from ‘LADA’ or latent autoimmune diabetes of adults. We have known of 2 types of diabetes for decades. Children got one type while adults caught the other. We also know that children can get type 2 diabetes and that type 1 not uncommonly appears in adults. During pregnancy women can get ‘gestational’ diabetes that resembles type 2 diabetes and usually disappears after childbirth but may linger.
Researchers have identified LADA as another variant of diabetes and it accounts for about 10% of people with diabetes making it commoner than type 1 diabetes. LADA is often misdiagnosed as type 2 diabetes with subsequent inappropriate treatment. There is still no consensus on the pathogenesis and definition of LADA.
Latent autoimmune diabetes in adults was discovered accidently in the 1970s. Researchers were trying to find a method to detect the antibodies that trigger type 1 diabetes (by attacking the pancreas). The new test confirmed that type 1diabetes is an autoimmune disease where the body’s immune system attacks the beta cells in the pancreas, the makers of insulin.
The researchers to their surprise also found that at least 10% of type 2 diabetics had these autoantibodies in them (type 2 diabetes is not an autoimmune disease). The proteins were absent in the general population. This discovery strongly suggested that a subset of type 2 patients had a different pathogenesis and cause for there disease despite having almost identical symptoms to those with type 2 diabetes.
Some named the new variant ‘LADA’ while others termed it ‘type 1.5 diabetes’. The new diabetes has autoantibodies in blood, has onset in adults, and does not require insulin therapy initially. Genetically LADA has features of both type 1 and type 2 diabetes. Type 1.5 diabetes or LADA should be suspected in the leaner type 2 diabetic patients with symptoms of rapid loss of weight and excessive thirst. Blood should be sent to check for autoantibodies to the pancreas. The treating physician should be alert to the fact that conventional oral anti-diabetic may quickly turn ineffective as more and more beta cells are destroyed. LADA is often misdiagnosed as type 2 diabetes because of age. LADA however is not associated with insulin resistance or family history. There is gradual need for insulin mirrored by decreasing ability of making insulin as indicated by low C-peptide levels.
A recent study confirmed that C-peptide level; an indicator of insulin production by the pancreas was less in LADA as compared to type 2 diabetes but significantly more than type 1. Patients with LADA were defined as aged between 30-70 years at time of diagnosis who did not require insulin for at least 6 months after diagnosis, and were positive for glutamic acid decarboxylase (GAD) autoantibody or tyrosine phosphatase autoantibody.
There has been little success in countering autoantibodies that wreck beta cells of the pancreas as yet but the idea is tantalizing because this would considerably benefit patients of LADA or type 1.5 diabetes also. An alum formulated GAD has been tried to reverse recent type 1 diabetes in patients 10-18 years of age. Seventy patients of type 1 were randomly assigned to receive subcutaneous injections of GAD-alum or placebo. The fasting C-peptide levels declined significantly less over 30 months in the treated group of patients. All patients had GAD antibodies present at baseline. The researchers concluded that GAD-alum despite not altering dose of insulin might have preserved insulin secretion in patients with recent onset type 1 diabetes.
Mrs. May too was misdiagnosed initially as type 2 diabetes but her rapid loss of weight and absence of family history prompted check for autoantibodies in her blood. She was found to be positive for GAD. Her precipitous fall in weight in fact had sparked cruel conspiracy theories in Westminster of toppling Cameron according to an interview she gave to the Daily Mail in 2013. Her problems began with cold and cough for a few weeks in November of 2012; her blood sugars done by the GP revealed high sugar levels. Mrs. May suffered from symptoms of tiredness, drinking lots of water and loss of weight. She was compelled to munch nuts while in parliament without the speaker realizing she was doing so because of the insulin shot she had administered herself in the morning.
So now we have the first world leader with a variant of type 1 diabetes, who needs to draw on all her talent and reserves to steer Britain through some of the most turbulent and perilous times seen on the planet. It shall be far more arduous than winning Wimbledon or a gold medal in the Rio Olympics.