Blood sugar control crucial in living longer with diabetes

sugars were over 500 when diagnosed, I was very healthy and that’s why nothing was “destroyed.” My vision was off for about a month, but no permanent damage was done. Any reassurance would be appreciated! — M.W.

A: Most people are familiar with Type 1 diabetes, with a typical onset in childhood and at a normal weight. It is caused by an autoimmune destruction of the insulin-making cells in the pancreas. Most also know about Type 2 diabetes, usually adult-onset and diagnosed in someone who is overweight; it is caused by resistance to insulin. But there are other subtypes of diabetes, including latent autoimmune diabetes in adults (LADA). In the U.S. and Canada, it accounts for a small fraction of diabetes cases, but is more common in Scandinavian countries. It has characteristics of both Type 1 and Type 2 diabetes, but most experts think it is closer to Type 1.

The change in life expectancy from diabetes relates to how long you have had diabetes and how well controlled it has been. With outstanding diabetes control (normal or near-normal blood sugar levels), the effect on overall mortality is modest, at best. In one model, the reduction in life expectancy is less than a year. However, it certainly is possible to have life expectancy drop by 20 years with very poorly controlled, longstanding diabetes. For most people with diabetes, their potential to live longer (and healthier) can be improved by better blood sugar control.

For new-onset autoimmune diabetes (both Type 1 and LADA), early and aggressive blood sugar control with insulin may reduce the amount of damage and improve long-term prognosis. Studies are in progress to evaluate this.