S2E13: The Biggest Myths About Type 1 Diabetes (and the Truth Behind Them)
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Type 1 diabetes isn't just a childhood disease, and it isn't caused by sugar, weight, or lifestyle. In this episode, Dr. Komal Patil-Sisodia breaks down why type 1 diabetes is so often missed in adults, especially in people mislabeled as type 2, and introduces LADA (latent autoimmune diabetes in adults), a slow-moving form of type 1 that may account for up to a quarter of adult diagnoses. She walks through the clues that should prompt testing, the two blood tests that can change a diagnosis, and how perimenopause and menopause complicate blood sugar control for women living with type 1. The episode also covers pregnancy planning, the real (and often overstated) genetic risk to children, the underappreciated heart disease risk in women with type 1, and why needing insulin is never a sign of failure.
The Biggest Myths About Type 1 Diabetes (and the Truth Behind Them)
By Dr. Komal Patil-Sisodia, MD | Eastside Menopause & Metabolism
A woman walks into my office in her mid-40s, not living with overweight or obesity, exercising one to two hours a day, eating a diet full of vegetables and fiber, with no family history of diabetes. She's had a “type 2 diabetes” diagnosis for a decade. Her A1C is stuck at 8%, no matter what she does. And her care team keeps telling her the same thing: try harder.
She brought her mother and both sisters to our first visit, because she needed people who'd watched her do the work to back her up. That's how much shame she'd absorbed from a diagnosis that, it turned out, was wrong. She didn't have type 2 diabetes. She had type 1.
This isn't a rare story. It's a pattern, and it's one worth understanding whether or not diabetes is part of your own life.
Myth #1: Type 1 diabetes is caused by sugar or weight gain
It isn't, not even a little. Type 1 diabetes is an autoimmune disease: the immune system mistakenly attacks the insulin-producing beta cells in the pancreas. Once those cells are gone, the body can't make insulin, and blood sugar can't get into cells for energy. That's the disease. It’s a combination of genetics and an environmental trigger, possibly a virus, not a food or a body size.
Ninety percent of people diagnosed with type 1 diabetes have no parent, sibling, or child with the disease. It doesn't run neatly through families, and it isn't something anyone did to themselves. Type 2 diabetes does have lifestyle contributors; type 1 does not. Conflating the two causes real harm.
Myth #2: Only kids get type 1 diabetes
Type 1 shows up most often in children and teens, but it can develop at any age, including in your 40s, 50s, and beyond. An estimated 20–25% of adults diagnosed with diabetes may actually have a slower-progressing form of type 1. More adults are living with type 1 diabetes today than children. This is largely because people diagnosed young are living long, full lives, yet the childhood-disease image persists, in clinical training and in public imagination alike.
LADA: the type 1 diabetes hiding inside “type 2” diagnoses
LADA (latent autoimmune diabetes in adults, sometimes called type 1.5) is type 1 diabetes that progresses slowly. The immune system is still destroying beta cells, just gradually, so pills may work for a while before the underlying autoimmune process catches up. Estimates put LADA at 2–12% of adult diagnoses, with some studies suggesting figures as high as 20–25%.
LADA tends to appear between ages 30 and 60 (squarely within the perimenopause window) and it clusters with other autoimmune conditions, especially autoimmune thyroid disease. A woman in her 40s with a normal body weight, a history of Hashimoto's, and a rising A1C that isn't responding to treatment should prompt a very specific kind of pattern recognition.
Why perimenopause makes this harder to catch
As estrogen declines, so does the hormone's natural insulin-sensitizing effect, which means blood sugar control gets harder for everyone in midlife. Add disrupted sleep and rising cortisol from hot flashes and night sweats, and a woman with previously well-managed LADA can suddenly seem to fall apart. This is a shift that's easy to misattribute to menopause or lifestyle rather than to the underlying autoimmune process. In one patient, hormone therapy brought blood sugars back down close to baseline alongside adjustments to her insulin regimen.
When to ask for testing
Three signals deserve a second look: a normal body weight at diagnosis, diabetes that stops responding to pills despite no change in lifestyle, and the presence of another autoimmune condition such as Hashimoto's, rheumatoid arthritis, or celiac disease. Two tests can clarify the picture: a C-peptide test, which measures how much insulin the body is still producing, and a GAD antibody test, which detects whether the immune system is attacking the pancreas. Neither is routinely ordered, but in the scenarios above, both are reasonable to request.
Pregnancy, genetics, and heart health
Two myths shape a lot of decisions around having children: that pregnancy is too dangerous with type 1 diabetes, and that children will inevitably inherit it. Neither holds up. With planning, preconception counseling through maternal-fetal medicine, and modern insulin delivery technology, women with type 1 diabetes can have healthy pregnancies. The genetic risk to a child is roughly 3–8% if a parent has type 1, compared with under 0.5% in the general population; real, but far from inevitable.
Heart disease risk deserves more attention than it gets. Adults with type 1 diabetes carry two to four times the cardiovascular risk of people without diabetes, and that risk builds starting in young adulthood. Women typically have some hormonal protection against heart disease before menopause; for women with type 1 diabetes, that protection is largely absent, and it erodes further once estrogen declines at menopause. The heart health conversation shouldn't wait for symptoms.
Insulin was never the last resort
In type 1 diabetes, insulin isn't a sign that something went wrong. It's the only treatment, from day one, because the cells that would otherwise make insulin no longer exist. There's no food plan or willpower that substitutes for it, and carbohydrate restriction isn't the goal. The shame often projected onto people with type 2 diabetes who eventually need insulin gets unfairly layered onto people with type 1 who never had another option.
The bottom line
If you've been told you have type 2 diabetes but your blood sugar isn't responding the way it should, especially if you're at a normal weight, have a history of autoimmune disease, or the picture just doesn't add up, it's reasonable to ask your doctor for a GAD antibody and C-peptide test. And if you're living with type 1 diabetes heading into perimenopause, look for an endocrinologist who understands both. That combination of expertise exists, and you deserve access to it.
Follow Dr. Komal Patil-Sisodia:@drpatilsisodia on Instagram and TikTok
This content is for educational purposes only and does not constitute personalized medical advice. Please discuss your specific health concerns with your own healthcare provider.