At 57, the last thing Marjorie Poche expected when she went to see her doctor about a cough was finding out she had Type 1 diabetes.
"Had I not gone to the doctor, who knows what would have happened?"
She says she was told that her untreated diabetes could have led to a coma.
"I figured my exhaustion was due to lack of fitness," she says from her home in Plano, Texas.
Her diagnosis puts her in the midst of a disturbing trend - the rise of Type 1 diabetes. Experts are struggling to comprehend the reasons, but the answers may hold the key to a new understanding and treatment of the disease.
Type 1 diabetes was thought to affect a fixed portion of the population. The increase suggests that environment or behavior may play a role. That means there may be things we can do to prevent it or at least lower the risk.
About 25.8 million people in the United States have diabetes, including about 7 million whose illness is undiagnosed, according to the American Diabetes Association.
There are two types of the disease, both of which are related to the body's use of insulin, which transports sugar from the blood into cells.
Type 2 diabetes is the most common form. With Type 2, the body does not produce enough insulin, or the cells fail to use the hormone efficiently. Being overweight has long been known as a risk factor, and the disease, which used to be associated primarily with older patients, now increasingly strikes younger ones as well.
Type 1 diabetes is an autoimmune disorder that affects about 5 percent of those with diabetes. With Type 1, the body's immune system destroys the pancreas' ability to generate insulin. While it used to be associated primarily with younger patients, about half of the cases are diagnosed for the first time at 20 and older.
A recent study funded by the Centers for Disease Control and Prevention and the National Institutes of Health shows that Type 1 is rising. The study looked at data from 20,000 children over eight years ending in 2009. During that time, the annual rate of Type 1 cases for youths older than 10 jumped from 18.6 per 100,000 to 19.7 per 100,000. Non-Hispanic white youths had the highest rate of new cases.
Dr. Kathryn Sumpter, an assistant professor of pediatrics at the University of Texas Southwestern Medical Center and medical director of the diabetes program at Children's Medical Center, says that in many ways, the increase in Type 1 helps correct common misconceptions about the disease and offers new ways of understanding it.
"We're learning that the distinctions between Type 1 and Type 2 are not as black and white as we thought they were," says Sumpter, who was 20 when she learned she had Type 1. "There are some differences, but the brick walls we built before in terms of one being totally autoimmune and the other totally about lifestyle factors aren't as physiologically relevant. We have some patients where we can't decide if it's Type 1 or Type 2."
The search has led experts to explore a possible connection with another medical mystery - the overall increase in autoimmune disorders, such as lupus, celiac disease and thyroid disorder, particularly because patients with one autoimmune disorder are more likely to have others.
Sumpter says two theories for explaining the increase in Type 1 are gaining traction.
The accelerator hypothesis suggests a link between obesity, once thought to be a factor only in Type 2 diabetes, and Type 1. In the case of Type 1, the thinking goes, the excess weight may lead to inflammation and stress on the cells, which could trigger the autoimmune response.
The hygiene hypothesis puts the blame on an exposure to fewer bacteria and viruses in our increasingly well-scrubbed lives. The hypothesis suggests that change may cause our autoimmune systems to overreact and go after cells that are not only not a threat but serving vital functions in the body. The hypothesis has also been linked to the rise in asthma and allergy cases.
Other theories point to pollution and toxins in the environment as culprits. Additional studies offer conflicting data about a vitamin D deficiency or a too-early introduction of cow's milk or gluten into a baby's diet. Sumpter says she welcomes all these ideas because they're getting people thinking of Type 1 in fresh ways that could lead to new cures.
"Intellectually, it's an exciting time for doctors and patients," she says. "I think we're getting closer to clues that can help us reduce the risk of developing diabetes and can lead to much better treatment for Type 1 and Type 2 and potentially even a cure for Type 1."