I was slim, fit and a full-time GP with a healthy diet… but then I discovered I had ‘Type 1.5’ diabetes. So many haven’t heard of it – or even realise they have it: DR DAWN HARPER
I was exhausted after a long day of filming, getting ready to drive home, when one of the researchers sidled up to me, looking grave.
‘I just wanted to flag, Dawn, that some of your test results came back a bit strange,’ she said. ‘It’s probably a lab error, but you might want to get your blood sugar levels checked. According to this, you’re prediabetic.’
I stared at her, shocked. The producers of the Channel 4 series Embarrassing Bodies, that I co-hosted for nine years, loved putting us through the wringer with blood, stool and fitness tests, to measure our own health alongside the patients we treated.
That day I’d undergone the same series of medical examinations as the subject of our episode – a woman my exact age, 44, and height, 5ft 4in, and who had three children, just like me, the same age as my own.
The only difference was our weight – she was morbidly obese, while I came in at a trim eight stone, giving me a BMI of just 19.5.
‘It seemingly made no sense that my blood sugar would have been an issue, placing me in the no-man’s-land of prediabetes,’ writes Dr Dawn Harper
We’d had our fat cells examined under a microscope, our gut flora compared and our blood sugar measured by an HbA1c test. This measures the amount of glucose attached to red blood cells, and is considered one of the most reliable indicators of a person’s average blood sugar levels over the previous two to three months – and their risk of developing type 2 diabetes.
And the results had, for the most part, come back as expected.
My healthy diet, consisting mainly of wholegrains and lots of fruit and vegetables, and exercise habits – weekly 30-mile cycles and daily walks with my dogs – meant my gut microbiome was flourishing and my fat cells were less than half the size of my companion.
So it seemingly made no sense that my blood sugar would have been an issue, placing me in the no-man’s-land of prediabetes, where levels are higher than normal but not yet high enough for a diagnosis of type 2 diabetes.
I was hardly the classic diabetes patient – and was very, very busy, so I ignored it.
Until, 15 years later, I received a phone call from another concerned, and equally confused, diabetes nurse. I’d just moved house with my husband, and registered at a new GP surgery which summoned me in for an NHS health check.
This time, the results were less easily dismissed. ‘You need to take this seriously,’ she urged me, booking me in for a follow-up blood sugar test three months later.
Yet despite my best efforts to kick myself into even better shape – heading off for a yoga retreat and juice cleanse just before the second Hb1Ac test – the results were even more damning.
What is diabetes? And why is it not just type 1 or type 2?
Diabetes is a lifelong condition that causes blood sugar levels to become too high.
People with it cannot make or use enough insulin, a hormone created by the pancreas that allows the body’s cells to convert sugar into energy.
Without it, glucose begins to build up rapidly in the blood, causing extreme thirst and frequent urination as the body tries to flush out the excess sugar. If left untreated, high blood sugar gradually damages blood vessels and nerves, raising the risk of severe long-term complications, including blindness, kidney failure and heart disease.
Historically, diabetes has been considered to have two forms: type 1 in which the immune system attacks and destroys the cells that produce insulin, and type 2, in which the body becomes unable to produce enough of the hormone, or the body’s cells stop reacting to it.
But recent research suggests there may be numerous other forms. Gestational diabetes develops during pregnancy due to hormonal changes that reduce the body’s sensitivity to insulin, while monogenic diabetes is caused by a single gene mutation, and usually runs in families. Another form can be triggered by the use of steroid medications.
The ratio of sugar in my blood had crept up to 6.5 per cent. Detoxed and glowing, I was in the best shape of my life. But I was officially a diabetic.
Working as an NHS GP for nearly three decades, I’ve diagnosed countless patients with type 2 diabetes.
I know how severe the condition – if left untreated – can become. Unchecked diabetes damages blood vessels, nerves and major organs, increasing the risk of stroke, heart disease and even blindness.
It’s a potentially deadly disease. And it’s becoming ever more common.
Today, almost five million people in the UK are living with diabetes, according to estimates. A further 1.3 million likely have the condition without knowing it, while another 6.3 million are affected by prediabetes. Many, like me, will have no idea.
The condition occurs when the body becomes resistant to insulin, leading to damagingly high levels of sugar in the blood.
For type 1 diabetics, insulin resistance is caused by an autoimmune reaction, where the body mistakenly attacks and destroys the insulin-producing cells in the pancreas. It tends to develop in childhood or adolescence, and symptoms develop quickly and severely, requiring immediate insulin therapy.
Those with type 2 diabetes, who make up the vast majority of cases in the UK, tend to have lifestyle-related risk factors that cause the condition to mostly develop in adulthood.
Being overweight or obese, physically inactive, and consuming a diet high in fat and sugar, can all raise one’s risk of developing the condition, as excess fat and increased inflammation reduce the body’s ability to process insulin.
‘Being overweight or obese, physically inactive, and consuming a diet high in fat and sugar, can all raise one’s risk of developing the condition’
Dr Dawn Harper on Channel 4’s Embarrassing Bodies, alongside Dr Pixie McKenna and Dr Christian Jenssen
Over time, this can present as extreme fatigue, increased thirst, unexplained weight loss, tingling in the hands and feet and dark patches of skin, amongst other things. But for others, there may be no signs – or visible risk factors – at all.
As a doctor, I’m trained to pick up the early symptoms of diabetes. So how could I have missed my own?
As it turned out, there was more to the story.
After a series of further tests, I was diagnosed with a little-known, though pervasive, form of diabetes that primarily affects slim people like me in midlife.
Called latent autoimmune diabetes in adults, or LADA, the condition sits somewhere between type 1 and type 2 diabetes and was only discovered in the 1990s.
The condition occurs when the immune system targets and destroys insulin-producing beta cells in the pancreas. LADA can also often be managed with diet and lifestyle changes for months, if not years after diagnosis, without needing insulin treatment, much like type 2 diabetes.
It’s often referred to colloquially as type 1.5 diabetes. And because of this, it’s also the most misdiagnosed form of the disease. In fact, experts estimate that as many as 12 per cent of type 2 diabetes patients actually have LADA – that’s a stunning 350,000 Britons.
The issue is, LADA patients tend to fall outside of the typical picture of diabetics that many doctors are trained to recognise. We’re more likely to be slim and fit, and our symptoms are slow to develop and vague – or, as in my case, don’t appear at all.
As a result, many people with LADA will go undiagnosed for years, leading to a range of devastating health complications – from heart disease to diabetic ketoacidosis, which sees the blood become dangerously acidic. Others may receive a diagnosis but the wrong one – told to lose a few pounds or put on type 2 diabetes treatments such as metformin, only to find it ineffective.
Researchers still don’t know what causes LADA, but as we continue to learn more about the condition, one thing is certain; we need to get better at detecting it, and quickly.
‘I use a continuous glucose monitor (CGM), which takes readings of my blood sugar every three minutes, and has transformed the way I eat’
‘As a doctor, I’m trained to pick up the early symptoms of diabetes. So how could I have missed my own?’
As I was correctly urged by my diabetes nurse, patients must also take their own higher-than-normal blood sugar readings seriously – however well they feel and look.
In my case, I’ve been able to manage my diabetes through diet changes so far – though my doctor assures me I will, one day, need to start taking insulin.
I use a continuous glucose monitor (CGM) , which takes readings of my blood sugar every three minutes, and has transformed the way I eat.
Mine is from Yuwell Anytime – a company I now work for as medical ambassador. It’s been so helpful, in fact, I think every diabetes and prediabetes patients should be offered one on the NHS for a few weeks, to see how their diet actually impacts their glucose levels.
For me, there was no obvious trigger for my high blood sugar. But my foible, my CGM has since revealed, is bread.
My daily lunch of a ham and cheese sandwich – which I ate for years while on the road with Embarrassing Bodies – had been slowly eroding my body’s insulin levels. Even my weekend treat of a slice of sourdough with Marmite was sending my blood sugar haywire, I quickly discovered, much to my chagrin.
So I’ve cut out the bread, and even some fruit, from my daily routine – though I do allow myself the occasional treat, of course.
I miss it, but it’s a small price to pay for keeping me healthier for longer. Instead, I pack my diet with fresh vegetables, and when I do eat carbs I make sure to choose wholegrain options.
But what works for me won’t work for everyone.
In fact, I think my story is proof that generic advice doesn’t go nearly far enough.
You don’t have to be overweight to develop diabetes, nor will exercise and eating healthily work for everyone (though it will almost certainly help). But one thing is clear: ignoring the signs, like I did, can only be harmful.
