How does adult onset Type I diabetes work? Is it “burnout” of the body’s ability to make insulin? Why isn’t it noticed sooner? Does good lifestyle prevent symptom development?
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It works the same way it does in pediatric-onset (kids) autoimmune diabetes. There’s a (presumed) pre-existing genetic predisposition (some gene variants have been identified as having higher risk, but they are not always present), and then some environmental insult to the immune system pulls the trigger. The immune system then attacks the cells that make insulin, eventually killing them off.
The big difference is that as a general rule, your immune system gets weaker as you age, so onset of symptoms is likely to be slower the older the person is. When you combine that with the previous incorrect assumption that autoimmune diabetes ONLY developed in children (or at the absolute latest in the early 20s), you get LOTS of misdiagnosed adults.
Medications for T2D typically DO work initially, and can compensate for declining insulin production by increasing sensitivity to insulin, but eventually fail, which further contributes to incorrect assumptions by medical professionals about the cause of the elevated blood sugars.
I realize that’s not really an ELI5, but it’s a complicated subject, and diabetes (in general) happens/develops via a number of different mechanisms, with most people having aspects of more than one. They can exacerbate each other, with lots of interplay, so even the current definitions of types (with a few exceptions) are not 100% for almost anyone.
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