Most of us would put down sudden unexpected and unintended weight loss to stress or overwork. Just as we believe constant tiredness, thirst, irritability and a frequent urge to pee is almost prescription behaviour for people wired up as they go about their day.
These diffused signs together point to a diagnosis that even doctors may miss.
British Prime Minister Theresa May, 59, was lucky that her doctor didn’t. She was 57 when she went to a doctor with a cold and was instead diagnosed with type 1 diabetes, sometimes referred to as ‘juvenile diabetes’ because it is usually diagnosed in children and young adults.
It also strikes older adults, though rarely. Former Pakistan cricket captain Wasim Akram, now 50, was diagnosed with type 1 diabetes at the age of 31 while playing a Test series in 1997. The bowling whiz was at the peak of his career, and stayed there after the diagnosis, going on to become the first bowler to take more than 400 wickets in both Test and one-day internationals.
What’s vital is getting diagnosed and optimally treating this disease, which has no cure. People with diabetes cannot adequately process blood sugar because their pancreas produces little or no insulin, which is the hormone that converts sugar (glucose) from food into energy or stores it for future use. People with type 1 diabetes cannot produce insulin at all, while those with type 2 diabetes don’t produce enough.
Type 1 diabetes is less common but more deadly because it strikes without warning. It’s an autoimmune disease that occurs when the body’s immune system mistakes insulin-producing beta cells in the pancreas as foreign and destroys them. Unable to produce insulin, type 1 diabetics become clinically dependent on insulin to live. Though most cases are diagnosed between ages 10–14 – the peak age of diagnosis in India is 12 years, it’s 14 years in the US – type 1 diabetes can occur at any age.
UK’s National Diabetes Audit data puts the numbers of those diagnosed with type 1 after age 40 at a high 20%. The analysis, done by Diabetes UK, found that of the 8,952 people diagnosed with Type 1 diabetes in 2011–12, 2,035 were over 40 years at the time of diagnosis, and more than 500 were aged over 69.
There is no data for type 1 diabetes diagnosis in adults in India, but going by clinical practice in public and private hospitals, endocrinologists put the numbers at a lower 10%. “There is good Indian data. There is information in youth (onset of type-1 diabetes in ages <25 years, but I would say less than 10% cases are diagnosed over 40 years,” says Dr Nikhil Tandon, the head of the department of endocrinology, metabolism and diabetes at the All India Institute of Medical Sciences.
Agrees Dr Ambrish Mithal, chairman, division of endocrinology and diabetes, Medanta - the Medicity: “Only if you take type-2 patients below 25 or 30 will you get figures as high as the UK numbers. Overall, figures vary from 2-12%. One study from India by Bhatia put the figure for antibody positivity in type 2 diabetes at around 1.5%, which means these people who were diagnosed with type 2 diabetes could actually have type 1 diabetes.”
Globally, 415 million people have diabetes, of which roughly 10% is type 1. Each year, around 70,000 young people are diagnosed with type-1 diabetes globally, estimates the International Diabetes Federation. Of India’s close to 70 million people with diabetes, less than 5% are type 1, but the diagnosis of type 1 is increasing by 3-5% per year. The Indian Council of Medical Research puts the annual incidence rate of type 1 diabetes in young people at 4.2/ 100,000/year.
Endocrinologists across hospitals, both public and private, in India agree the numbers are going up, partly because of more people getting diagnosed and partly because of a combination of genetic, environmental or immune-regulatory mechanism disorders. “When people with type-2 diabetes need progressively higher amounts of medicine to control their blood sugar in the first few years after diagnosis and respond poorly despite high doses, they should be screened for type-1 diabetes,” says Dr Mithal.
So, if your energy levels suddenly plummet (because you cannot convert glucose to energy), you have a frequent urge to pee (the kidneys go on an overdrive to get rid of the excess sugar in the blood) and feel thirsty all the time (your body tries to replenish fluids lost from frequent trips to the toilet ), get your blood sugar levels checked even if you are otherwise healthy and active.