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When Phyllisa Deroze was told she had diabetes in a Fayetteville, North Carolina, emergency department years ago, she was handed pamphlets with information on two types of the disease. One had pictures of children on it, she recalled, while the other had pictures of seniors.

Deroze, a 31-year-old English professor at the time, was confused about which images were meant to depict her. Initially, she was diagnosed with Type 2 diabetes, as shown on the pamphlet with older adults. It would be eight years before she learned she had a different form of diabetes one that didnt fit neatly on either pamphlet.

The condition is often called latent autoimmune diabetes of adults, or LADA for short. Patients with it can be misdiagnosed with Type 2 diabetes and spend months or years trying to manage the wrong condition. As many as 10% of patients diagnosed with Type 2 diabetes might actually have LADA, said Jason Gaglia, an endocrinologist at the Joslin Diabetes Center in Boston.

Deroze and three other LADA patients who spoke with KFF Health News, all Black women, are among those who were initially misdiagnosed. Without the correct diagnosis which can be confirmed through blood tests they described being denied the medicines, technology, and tests to properly treat their diabetes. Three of them wonder if their race played a role. Phyllisa Deroze first asked to have her blood tested for antibodies associated with Type 1 diabetes six years after being diagnosed with Type 2 diabetes. Two years later, after two endocrinologists denied her requests, she persuaded her gynecologist to run a test. The results came back positive, showing she indeed had diabetes, but not Type 2.(Kathryn Pitts)

That does seem to happen more frequently for African American patients and for other minoritized groups, said Rochelle Naylor, a pediatric endocrinologist at the University of Chicago who researches atypical forms of diabetes. Doctors, like any other person walking this planet, we all have implicit biases that impact our patient experiences and our patient care delivery.

Black patients have long struggled with bias across the U.S. health care system. In a recent KFF survey, for example, 55% of Black adults said they believed they needed to be careful at least some of the time about their appearances to be treated fairly during medical visits. Hospital software used to treat patients has been investigated for discrimination. Even a common test used to manage diabetes can underestimate blood sugar levels for patients who have sickle cell trait, which is present in nearly 1 in 10 African Americans.

LADA ostensibly has nothing to do with race, but misconceptions about race, weight, and age can all lead doctors to misdiagnose LADA patients with Type 2 diabetes, said Kathleen Wyne, an endocrinologist who leads the adult Type 1 diabetes program at Ohio State University. Email Sign-Up

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Type 2 diabetes develops in people, often over age 45, whose bodies cannot properly regulate their blood sugar levels. Type 2 accounts for at least 90% of diabetes cases in the U.S. and has a high prevalence among African Americans, Native Americans, and Hispanic populations. It can often be managed with lifestyle changes and oral medications.

LADA is more akin to, or even thought to be another form of, Type 1 diabetes, an autoimmune condition once dubbed juvenile diabetes because it was most often diagnosed in children. Type 1 occurs when the body attacks its cells that produce insulin the naturally occurring hormone that regulates blood sugar by helping turn food into energy. Without insulin, humans cant survive.

LADA is difficult to diagnose because it progresses slowly, Gaglia said. Typical LADA patients are over 30 and dont require injectable insulin for at least six months after diagnosis. But, like Type 1 patients, most will eventually depend on injections of pharmaceutical insulin for the rest of their lives. That delay can lead physicians to believe their patients have Type 2 diabetes even as treatment becomes less effective.

If you have someone who comes into your office who is obese and/or overweight and may have a family history of Type 2 diabetes if youre a betting person, you bet on them having Type 2 diabetes, Gaglia said. But thats the thing with LADA: It unmasks itself over time. In the health care system, it’s really hard to vocalize your needs when you are a woman of color because you come off as aggressive, or you come off as a know-it-all, or you come off as disrespectful, Mila Clarke says. My intuition was right this whole time, but nobody believed me. (Brandon Thibodeaux for KFF Health News)

Mila Clarke, who lives in Houston, finally saw an endocrinologist in November 2020, more than four years after being diagnosed with Type 2 diabetes. During that visit, she recounted her struggles to manage her blood sugar despite taking oral medications and making significant changes to her diet and exercise regimens.

What you just explained to me, I believe, is a classic case of LADA, Clarke recalled being told. Has anybody ever tested you for Type 1 antibodies?

Because both Type 1 diabetes and LADA are autoimmune conditions, patients will have antibodies that Type 2 patients typically dont. But, as Clarke recounted, getting tested for those various antibodies isnt always easy.

Clarke, now 34, had leaned into her Type 2 diagnosis when she received it in 2016 at age 26. She started a blog with nutrition and lifestyle tips for people with diabetes called Hangry Woman, and garnered tens of thousands of followers on Instagram. Clarke said she wanted to fight the stigma around Type 2 diabetes, which stereotypes often associate with being overweight.

Some of the harshest comments that I had gotten were from people with Type 1 who were like, We’re not the same. I didn’t cause this. I didn’t do this to myself, Clarke said. Well, neither did I.

Clarke also felt her initial doctor thought she just wasnt working hard enough.

When she learned about continuous glucose monitors, wearable electronic devices that allow patients to track their blood sugar around the clock, she asked her primary care doctor to prescribe one. The monitors are recommended for patients with Type 1 and, more recently, some with Type 2. He flat-out told me, No. Its going to be too much information, too much data for you, she recalled.

Clarke switched to a different primary care doctor who she felt listened better and who prescribed a continuous glucose monitor. (Clarke later became a paid ambassador for the company that manufactures her device.) The new doctor eventually referred Clarke to the endocrinologist who asked if shed been tested for antibodies. The test came back positive. Clarke had LADA.

In the health care system, it’s really hard to vocalize your needs when you are a woman of color because you come off as aggressive, or you come off as a know-it-all, or you come off as disrespectful, Clarke said. My intuition was right this whole time, but nobody believed me. Mila Clarke inserts a syringe into a vial of insulin, which she uses to treat her diabetes.(Brandon Thibodeaux for KFF Health News)

Immediately, Clarke noticed an eye-opening difference in how she was treated. She started insulin injections and was referred to a dietitian and a diabetes educator. She wondered: Why wasnt it easier to get tested for antibodies?

Those tests are imperfect and can have false positives, said Gaglia of the Joslin center. Still, Ohio States Wyne argued that every diabetes patient should be tested for at least the most common antibody associated with Type 1.

Aren’t you saving lives if you’re identifying the Type 1 before they come in with DKA and die? Wyne asked, referring to diabetic ketoacidosis, a serious complication of diabetes most commonly associated with Type 1.

Deroze started asing her doctor for antibodies tests in 2017 after reading about a Type 2 bloggers experience being newly diagnosed with LADA.

Her endocrinologist denied her requests. She thinks the doctor thought it was impossible for her to have an autoimmune form of diabetes because of her race and weight. She sought a second opinion from a different endocrinologist, who also refused to test her.

I just felt unseen, Deroze said.

After a bout with diabetic ketoacidosis in 2019, Deroze finally persuaded her gynecologist to test her for antibodies. The results came back positive. One of the endocrinologists apologetically prescribed insulin and, later, an insulin pump, another ubiquitous piece of technology for people with Type 1.

And for the first time, she encountered the words diabetes is not your fault while reading about Type 1 diabetes. It felt like society was caring for her in a way it hadnt when she was misdiagnosed with Type 2. Thats troubling, she said, and so is how long it took to get what she needed.

My PhD didnt save me, said Deroze, who now lives in the Miami area. You just see the color of my skin, the size of my body, and it negates all of that.

Bram Sable-Smith: brams@kff.org, @besables Related Topics Health Care Costs Health Industry Race and Health States Diabetes Florida North Carolina Texas Contact Us Submit a Story Tip

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Florida regroups, sends LSU to 3rd straight loss

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Florida regroups, sends LSU to 3rd straight loss

GAINESVILLE, Fla. — DJ Lagway threw for a touchdown and set up another with a long completion in his return from a strained left hamstring, and Florida upset No. 21 LSU 27-16 on Saturday to give the Gators their first series victory since 2018.

Jadan Baugh‘s 55-yard scoring scamper with 3:48 remaining essentially sealed it and put the Gators (5-5, 3-4 Southeastern Conference) on the verge of becoming bowl-eligible. Florida had dropped eight in a row against ranked opponents and was 1-10 under coach Billy Napier in rivalry games.

Former Florida coach Steve Spurrier suggested all week that fans should rush the field named after him if the Gators win. But it didn’t happen.

Florida’s defense, though, deserved to be celebrated. The unit sacked Garrett Nussmeier seven times — one more than LSU (6-4, 3-3) had allowed in its first nine games combined.

Lagway provided the big plays on offense for Florida. After sitting out most of the past two losses with the injury, he connected with Elijhah Badger for a 23-yard score in the first quarter. Lagway never scrambled but was mobile enough to create extra time by moving around the pocket.

He completed 13 of 26 passes for 226 yards. Badger caught six for 131 yards.

“Elite play,” Florida coach Billy Napier said of Lagway. “God blessed that young man.”

The game started to turn in Florida’s favor when T.J. Searcy sacked Nussmeier late in the third quarter. Nussmeier fumbled, one of his linemen scooped it out of the air then fumbled again. Caleb Banks recovered in what was one of several huge plays for the defensive tackle.

The Gators went backward from there despite the solid field position and ended up punting. But Jeremy Crawshaw pinned the Tigers inside the 10-yard line.

Florida then forced a punt and started another drive in LSU territory. This time, Lagway found Badger for a 36-yard gain that set up Ja’Kobi Jackson‘s 1-yard scoring run.

LSU dominated time of possession in the first half and doubled up Florida in plays. But Nussmeier struggled to find time in the second half. He completed 27 of 47 passes for 260 yards with a touchdown and the fumble, and the Gators’ defense frustrated him in bouncing back from a subpar effort the week before in a blowout loss at Texas.

“Last week was unacceptable, and they took ownership of that,” Napier said of his defense. “There was no moping around.”

Losing three in a row — to Texas A&M, Alabama and now Florida — makes it impossible for LSU coach Brian Kelly to continue his streak of 10-win seasons, which will end at seven. Kelly won double-digit games in each of his last five seasons at Notre Dame and extended it with consecutive 10-win campaigns in Baton Rouge.

“This is a simple exercise of do you want to fight or not?” Kelly said after the loss. “Do you want to fight and take responsibility as coaches and players that we’re not playing well and we’re struggling right now? … There’s a rough spot here that we have to fight through, and we have to do it together.”

As Napier left the field following handshakes and postgame interviews, he was cheered by the fans hovering at the team’s tunnel.

“You’ve got to be a tough guy, and you got to be up for the challenge,” Napier said. “This group has proven they’re up for that. It’s harder than ever in my opinion. These guys could have pointed fingers and splintered a long time ago. That’s what I’m most proud of.”

The Associated Press contributed to this report.

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8-2 Buffs roll, still looking for ‘our best game’

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8-2 Buffs roll, still looking for 'our best game'

BOULDER, Colo. — Deion Sanders watched his Colorado offense put up 49 points on the top scoring defense in the Big 12 on Saturday, but he isn’t satisfied. The coach expects dominance in all three phases of the game.

The Buffaloes outplayed Utah in two out of three phases and eventually got rolling on offense in a 49-24 victory, extending their win streak to four games and ensuring they’ll remain in the Big 12 championship race the rest of the way. Afterward, Sanders delivered a critique that sounded a little more like a warning to others.

“We haven’t even put it all together yet,” Sanders said. “Like, we haven’t even played our best game. That should be, in itself, scary. Like, man, when I said we comin’, we still comin’. We never stopped comin’. We are comin’. And we ain’t nearly there yet.”

Colorado (8-2, 6-1) got a strong start from its defense, which held the Utes (4-6, 1-6) to 83 yards on 33 plays in the first half, and a 76-yard punt return touchdown from receiver LaJohntay Wester to help make up for a bumpy start on offense. Quarterback Shedeur Sanders was intercepted on his first pass and later fumbled a snap for another turnover.

It may not have been the Buffaloes’ finest performance of the season, but it was a 25-point win over the preseason Big 12 front-runner, snapping a seven-game losing streak against a program whose last win at Folsom Field came by a score of 63-21.

“I think that speaks a lot about the program and where we are,” Deion Sanders said. “We’ve got to tighten some things up and get some things together, but you see we’re trending in the right direction.

“We started off rough. That wasn’t indicative to who Shedeur is, and I thought he was kind of OK all game long. Then I look at the stats and he’s 30-for-41 for 340 [yards] and three [touchdowns]. Like, c’mon man. I guess I’m just a hard dad to please at times, as well as a hard head coach.”

Sanders praised Utah’s defense and the problems it presented throughout the contest and said he was thankful for the challenge. It took complementary football to overcome the two first-half turnovers, with Colorado’s defense holding Utah to field goals after both takeaways. The Buffaloes didn’t surrender a touchdown until midway through the third quarter.

“Those type of things can’t happen,” Shedeur Sanders said, “and I’m going to have a talk with the whole offense and apologize for my performance out there at the very beginning, because I can’t put the team in that type of situation. I’m thankful for the defense. I may have to take them out to dinner this week for saving me and saving the team.”

Sanders responded after the fumble by guiding an 85-yard touchdown drive that featured another highlight-reel moment for Travis Hunter. Sanders threw deep to Colorado’s two-way star on a fourth-and-8, and Hunter made a leaping grab over two Utah defenders for a 25-yard gain. Sanders hit Will Sheppard for an 8-yard score on his next throw to extend Colorado’s lead to 21-6.

Hunter added to his Heisman Trophy résumé Saturday with 55 receiving yards on five catches, a 5-yard rushing touchdown on a reverse and his third interception of the season while playing 132 snaps.

When asked if he had a message for undecided Heisman voters, Deion Sanders did not hold back.

“If they can’t see, they can’t see,” Sanders said. “It is what it is. I mean, Travis is who he is. It’s supposed to go to the best college football player. I think that’s been a wrap since, what, Week 2? So we ain’t petitioning for nobody. We ain’t doing that. We’ve got a wonderful display of cameras here and I think we’re on national television every week. If they can’t see it, there’s a problem.

“Don’t allow their hatred for me to interfere with our kids’ success. They gotta stop that. Y’all gotta stop. Some of y’all are like that. Y’all gotta stop that, man. Give the kids what they deserve, man. I had my turn. I played 14 years. You had 14 years to hate me. Now let it go.”

Hunter was the Heisman front-runner in ESPN BET odds entering Week 12 at +125, ahead of Oregon quarterback Dillon Gabriel, Boise State running back Ashton Jeanty and Miami quarterback Cam Ward.

Colorado’s defense was able to constantly pressure freshman quarterback Isaac Wilson, forcing four sacks and three interceptions, and Utah finished with a mere 31 rushing yards, their fewest in a game since 2011. The preseason No. 12 Utes were considered the Big 12 favorites entering their first season in the conference but are now in danger of their first losing campaign since 2013.

“I’m in the twilight zone,” Utah coach Kyle Whittingham said. “… It’s the most difficult year of my coaching career, hands down, not even close.”

Colorado continues to control its destiny in chasing a Big 12 championship game bid, as the lone team in the 16-member conference that has lost just one conference game entering Saturday. The Buffaloes’ four-game win streak since a 31-28 home loss to Kansas State on Oct. 12 is the longest of Sanders’ two-year tenure.

After a 4-8 debut season, he has this once struggling program right where he planned to be for Year 2. In a league known for dramatic games decided by one-score margins, Sanders isn’t just trying to survive and advance to Arlington, Texas. He says he’s aiming for “flawless.”

“We expect to be here,” Sanders said. “A lot of y’all didn’t expect us to be here, and don’t think we don’t know that. But we expected to be where we are. Matter of fact, we expected to be a little better.”

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Pulp’s fan club president dished out Jarvis Cocker’s trouser scraps – and his car – to fans. Then he joined the band

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Pulp's fan club president dished out Jarvis Cocker's trouser scraps - and his car - to fans. Then he joined the band

Mark Webber’s role as Pulp’s fan club manager started simply enough, writing newsletters and posting out small bits of memorabilia such as postcards, stickers and badges. But, just like the band he loved, he wanted to do things a little differently.

A balloon launch to drum up publicity in their hometown of Sheffield didn’t attract too many people, he recalls, but one did make it all the way to Slovenia. The following year, he cut up a pair of Jarvis Cocker‘s trousers into 500 pieces, “all put in individually numbered envelopes and sent out to fans”.

It was 1993, a decade on from the release of Pulp‘s debut album, but still two years before they were to achieve huge mainstream success. A few years later, they decided to offer Cocker’s old Hillman Imp car, no longer roadworthy, as a competition prize. “It was crushed, compacted into a cube, someone won it, and we delivered it in a truck to their garden.”

It was genius silliness, indicative of the time. Nowadays, if you’re a young fan who loves a band or an artist, you assemble on social media – but back in the 1990s, it was all about signing up to the official fan club.

Scraps of Jarvis Cocker's trousers were once sent to Pulp fans. Pic: Mark Webber
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Some 500 Pulp fans were once treated to scraps of Cocker’s trousers in the post. Pic: Mark Webber

For Webber, who started out as a Pulp fan himself, it was a dream job which eventually led to him becoming the band’s tour manager – and then, just before they hit the height of their fame, joining as guitarist.

Following the group’s second and long hoped-for reunion in 2023, he is now telling his story – from super fan to joining the band – in I’m With Pulp, Are You?.

It’s not an autobiography as such, but a scrapbook of moments told mainly through ephemera collected over the last five decades, from photographs and flyers to set lists and press clippings, as well as other notes and scribblings kept through the years.

Webber went through his hoard during the pandemic lockdown. “It was in disarray at the time,” he says. “I hadn’t looked at it for so long I was finding things I couldn’t even remember what they were.”

‘We were in a bubble – suddenly the world caught up’

Pulp's Jarvis Cocker performing in Wolverhampton in 1992
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Jarvis Cocker on stage in Wolverhampton in 1992. Pic: Mark Webber

His story with Pulp starts in 1985, when he was an “obsessive” teenage music fan hanging out at a small independent record store in Chesterfield “where all the weird kids would go”. Back then, the band’s fan base was small, he says, and they were “amused” by the “daft, psychedelic kids” who followed them. They got to know them.

Webber eventually started helping out with stages sets before taking on the fan club duties. Then his role morphed again as he was called on to play guitar and keyboards at live shows, and began to contribute to songwriting.

He became an official member in 1995 – just before they became one of the biggest bands in the UK with their fifth album, Different Class, thanks to songs such as Disco 2000, Sorted For E’s and Whizz, and signature track Common People.

Pulp People kept fans up to date with the band's news
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In the days before social media, Pulp People kept fans up to date. Pic: Mark Webber

“Do you think it’s a coincidence that happened just as I joined?” Webber asks, laughing. “There was this trajectory. There was such a momentum building that it just became clear that, like, every next thing the group did was going to be more successful.”

It was a strange feeling, he says. “Because we were in the bubble at the time, just doing our thing, and suddenly the world had caught up and kind of realised how great Pulp was.”

I’m With Pulp documents some of the milestone moments in the band’s history, such as the 1995 Glastonbury headline set, before the release of Different Class, which came about at short notice after The Stone Roses were forced to pull out. Webber recalls how the band spent the night camping backstage.

“That was horrible because I hate camping,” he says. “And the concert, at the time it didn’t feel like such a great show. But everyone seemed to love it.”

Headlining Glastonbury – but camping in tents

British band Pulp perform on the Arena Stage as 'surprise guests' at Glastonbury Festival in Glastonbury, England on Saturday June 25, 2011. (AP Photo/Mark Allan)
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Pulp played a secret set at Glastonbury when they first reunited in 2011 – but didn’t camp that time. Pic: AP/ Mark Allan


Looking back at the roster of recent Glastonbury headliners – Elton John, Paul McCartney, Adele, Dua Lipa, The Killers – it’s hard to imagine any of them pitching a tent in the mud before performing to 100,000 people.

“Well, I’ve never spent the night in a tent since then,” says Webber. “So it changed my life.”

A more infamous incident in Pulp’s history was Cocker rushing the stage during Michael Jackson’s performance of Earth Song at the Brits the following year.

At the time, it didn’t feel as significant a moment as it has become in popular culture, Webber says. “There was disbelief in the moment, that he actually dared to do it. And that it was so easy to do. That’s the thing none of us could really understand, that there was no security or anything stopping anyone getting on the stage that easily.”

Pulp's Jarvis Cocker invaded the stage during Michael Jackson's performance of Earth Song at the Brit Awards in 1996. Pic: Reuters
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Cocker invaded the stage during Michael Jackson’s performance of Earth Song at the Brit Awards in 1996. Pic: Reuters

The aftermath was more concerning. “Like, ‘is Jarvis going to go to prison?’ Because we were starting a tour the next day.”

Ultimately, says Webber, most awards ceremonies and industry events are “boring – you have to do something to amuse yourself”.

After splitting in 2002, Pulp reunited for the first time in 2011, and then again for shows last year.

The response was “kind of amazing”, Webber says. It’s “quite likely we will play in England before we disappear again”, he hints. “There’s nothing confirmed yet but we expect there’ll be more concerts next year.”

‘I probably should have enjoyed it more’

Pulp's Mark Webber says his tour manager briefcase is one of his favourite pieces from his early days before joining the band. Pic: Mark Webber
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Webber says his tour manager briefcase is one of his favourite items from his early days. Pic: Mark Webber

The book documents Webber’s story. The item he was most happy to rediscover, he says, was the briefcase he used during his time as tour manager, adorned with a vintage ‘I’m With Pulp, Are You?’ sticker, which provided inspiration for the title.

“I knew I had it somewhere, but what I didn’t expect when I opened it up was that it still contained some contracts, to do lists, itineraries, a Bic biro, a packet of Setlers, and the business cards of various guest houses,” he says. “I used to carry this around everywhere, and in the days before we all had mobile phones, it had to contain everything we’d need for a concert or tour.”

After taking the time to look back, is there anything he would change?

Well, I mean, I probably should have enjoyed it more.” Webber laughs. “I’m always like the slightly glass half-full, grass is always greener type outlook… I did maintain quite a normal life, I didn’t have an address book full of celebrities that I’d go and hang out with – not that that’s something to aspire to, but, you know, maybe I should have been a bit more wild at the time when I had the chance.”

I’m With Pulp, Are You, published by Hat & Beard, is out now, with a launch night at the ICA in London on 27 November

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