Type 1.5 Diabetes

If you don’t quite fit the profile of someone with type 2, if diabetes pills don’t seem to be working well, or if you show some of the characteristics of type 1, maybe you have Type 1.5 diabetes LADA.

Jan 6, 2009

Type 1.5 diabetes, also known as Latent Autoimmune Diabetes in Adults (LADA), is an autoimmune disease that falls between Type 1 and Type 2 diabetes because it has characteristics of both. 

According to an article in The Beacon News, approximately 10 percent of patients with type 1.5 are misdiagnosed with type 2. If you're over 35 when you develop diabetes, and especially if you are overweight, your healthcare provider may assume that you have type 2 diabetes. 

But if you don't quite fit the profile of someone with type 2, if diabetes pills don't seem to be working well, or if you show some of the characteristics of type 1, maybe you have LADA. People with LADA have antibodies in their blood, which show that the immune system is attacking beta cells. LADA is type 1 diabetes that progresses slowly. 

According to one study (Diabetes Care 29:970-975, 2006), you probably have LADA (rather than type 2 diabetes) if two or more of the following fit:

  • You were under age 50 when you were diagnosed with diabetes.
  • You had "acute" symptoms at diagnosis, that is, symptoms typical of type 1 diabetes. 
  • Your BMI is less than 25. (See our Risk Assessment form to measure your BMI.) (But you can be overweight and have LADA.)
  • You have a personal history of autoimmune disease (such as thyroid disease, celiac sprue, Addison's disease, and others).
  • You have a family history of autoimmune disease.

The symptoms of type 1.5 are the same as the more well-known types of diabetes. They include increased thirst, increased urination, weight loss, and blurred vision.

Source: The Beacon News

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Categories: Diabetes, Diabetes, Eye Care (Retinopathy), Type 1 Issues, Type 1.5 Issues, Type 2 Issues, Weight Loss

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Posted by rosiolady on 6 January 2009

It's so nice to see even a simple article on this subject. I did know there was a type 1.5 diabetes but haven't been able to get any doctor to tell me exactly what that is. It sure does turn out that's what I am! I was diagnosed at age 29 and was obese. This was in 1970 and so it was assumed I was type 2 even though I needed some insulin from the beginning. My need for insulin grew over time, in spite of weight loss, diet, etc. Pills were never sufficient. Your small article makes a lot of sense to those of us whose history of diabetes has not quite fit what seems to be the norm. Thank you! After 38 years, I am now treated in all ways as a type 1.

Posted by ndocroth on 6 January 2009

Good to see articles here that point to the connection between LADA and celiac disease, gluten-sensitivity.
It appears that by going on a gluten-free and low-carb diet many "in between" (1.5)diabetics can rebalance their system without or with minimal doses of insulin.
Here is the possible connection: in those genetically predisposed, gluten affects the duodenum (intestinal discomfort, bloating, loose stool, diarrhea or constipation). Since the duodenum, among other functions, controls enzymatic release from the pancreas and influences insulin production as well as bile release from liver and gallbladder, eliminating the small intestinal inflammation can make all the difference.

author of "At Risk? Avoid Diabetes by Recognizing Early Risk - A Natural Medicine View" and the DIABETES-Series Little Books.

Posted by whimsy2 on 6 January 2009

I was diagnosed with documented LADA at the age of 60 so I didn't fit the age profile. I wasn't overweight at all; I was even losing weight on diagnosis (typical of type 1).

You should have mentioned that there's a definitive test for "type 1.5". It's called the GAD antibody test. It seems that most doctors haven't even heard of it, though. It's not a routine office test.

Posted by lemarq on 7 January 2009

I am another one who must have been a type 1.5 when diagnosed but our totality inept medical system missed that. I was 56 when I was diagnosed as a type 2 with hypothyroidism and within a year and a half was on insulin. I finally got a doctor last year to prescribe a C peptide test and the results showed no insulin production. So for the last 11 years I thought I was a type 2 but it appears I was a type 1 or 1.5 all along. Had I known right from the start that I was a type 1 or 1.5 I would have gone on insulin right away in the hopes of preserving my beta cells. No beta cells left now.

Posted by seashore on 7 January 2009

Regardless of the type of diabetes, all diabetics should limit daily carb intake ideally to 30 grams (about 1 ounce). The American Diabetes Association (ADA) recommends 5 to 7 times this amount. With the ADA high-carb diet, it is extremely difficult, if not impossible, for any diabetic (type 1, 1.5, or 2) to achieve effective blood-sugar control, and so the pancreatic beta cells (which generate insulin) steadily degrade. In Sept 2007, the International Diabetes Federation reported that significant diabetic damage occurs when PEAK blood sugar exceeds 140 mg/dL.

If a type-1.5 or 2 diabetic follows the high-carb dietary recommendations of the ADA, the beta cells will steadily degrade, and so insulin will eventually be required for both types. If a type-1.5 diabetic follows a low-carb diet, and carefully controls blood glucose, insulin might never be required.

Posted by Melitta on 9 January 2009

It's incredibly irresponsible to say that someone with Type 1.5 diabetes (autoimmune diabetes diagnosed in adulthood) might not require insulin. In Type 1 diabetes, exogenous insulin is always required, or death occurs. This is not about some low-carb diet, this is about what is required for survival.

Posted by seashore on 11 January 2009

All diabetics should use whatever medication is needed, including insulin, to keep blood sugar in a healthy range. In Sept. 2007, the International Diabetes Federation reported that significant diabetic complications can occur whenever blood glucose exceeds 140 mg/dL, and so this should be a firm upper limit.

All diabetics should eat a diet that is much lower in carbs than the 150 grams of carbs per day recommended by the ADA. A low-carb diet allows insulin requirements to be minimized. A type-1 can achieve accurate balance between injected insulin and carb consumption, because he is matching small numbers. Diabetics who still produce insulin require less medication. Besides, excessive insulin in the blood is harmful to the body.

Posted by dandbcollier on 12 January 2009

Regarding the post by "whimsy2" about an antibody test...I believe that an antibody test is still not difinitive proof of type 1. I am a type 1, and I tested negative for antibodies. My doctor told me that about 20% of type 1s test negative for them. A positive result would, of course, mean type 1, but a negative result doesn't necessarily rule out type 1.

A more revealing test would probably be the C-peptide, but that one has some problems as well. If a person's blood sugar is relatively low when the blood is drawn, their pancreas will not really be producing insulin, whether they are a diabetic or not. On the other hand, if blood sugar is slightly elevated when the test is performed, the C-peptide will be a good indicator of whether the body is producing any endogenous insulin.

Posted by Anonymous on 14 January 2009

I agree with Melitta. To even write that a type 1.5 Diabetic may never need insulin (which I am) is unethical and misguided. Also, on 30 carbs per day, are you taking into account your other organs that require carbohydrates in order to function (Ahem... your BRAIN)? While taking medication is never ideal, the alternative (not taking prescribed medication in favor of starving your body of essential nutrients) is much worse.

Posted by Inez on 9 February 2009

I have type 1.5 diabetes. If I exercise after consuming my lunch or dinner with maximum 15
gramm carbs I do not need insulin. If I do not exercise ( at least 1/2 hour ) I need 1 or
1.5 unit insulin. My BRAIN has enough glycogen
(carbs) from the protein my liver converted in to glycogen.

Posted by Anonymous on 9 February 2010

I regards to the suggestion that a maximum of 30g of carbs per day would be ideal for all diabetics ... that would require a greater consumption of protein. Does this not put some strain on your kidneys and cause constipation, somewhat like an Atkins diet? How do you consume your fiber - eat celery all day? How do you give your body the vitamins and minerals that it needs - by eating multivitamins? When you refer to carbs, are you speaking only about starches or are you including milk, fruit and vegetables as well? One apple is about 24g of carbs. A glass of milk is 12g of carbs. I would be interested to see a sample of 'seashore's daily diet and understand how he/she is able to satisfy his/her hunger with only 30g of carbs per day.

BTW - I have been a Type 1.5 diabetic for nearly 5 years with a total daily insulin need of about 22 units (11 for meals and 11 for slow-acting insulin). I consume, on average, 75g of carbs per meal as well as 1 snack between each meal. I have a BMI of 21.

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