How is this possible? Could i really be Type 1.5

[tiffanyfaith86]

This man at work thats a True Type 2 weighs more then 300lbs and has leg problems and never does any workouts, and is late 30s, diagnosed 4 years or more ago now, he is only having to take metformin 500mg twice a day and actos 45mg and even if he ate more then 100carbs at lunch, you know, 2 hamburgers and fries and a regular coke he still has a 101 around 3pm. So im thinking geez im almost half of him and im having to take double metformin, the actos and insulin. How does that work if i am a type 2 and have lost 50lbs, and only 22.:mad: He says his morning numbers are sometimes between 140 and 180 but thats only time they are high with the meds, once he takes them he's fine during the day.

My boss is even a type 2 and he can eat 4 bribe donuts for breakfast and he will test later and be maybe 140 highest that ive seen him. He said he's only had 247 one day after a buffet and he piled up on the sweets. Oh and he is well over 300lbs as well and in his late 40s.

Another coworker i just found out has diabetes also through my sister talking to him the day of my doc appt., he is pry in his 50s almost 60. He dont look that much overweight, just that beer belly look even tho he dont drink much(that i know of). Ive never seen what he eats but i know he's usually getting whatever they have on the menu upstairs, so usually mexican food, filled with carbs and fat. He told my sister he's only taking metformin. And asked which i was, 1 or 2, and my sister was like um i dont know, he asked if i take insulin and she said yea that i do know. So he was all oh shes pry 1.

So im having to take double metformin, the actos and insulin. How does that work if i am a type 2 and have lost 50lbs, and only 22years old just diagnosed June 5, 2007. :mad: Could i really be a type 1.5 or 1, just slow onset.

[BlueSky]

... if i am a type 2 and have lost 50lbs, and only 22years old just diagnosed June 5, 2007. :mad: Could i really be a type 1.5 or 1, just slow onset.

The only way to know is to have the antibody test done. If the result is positive, you are definitely T1.5. If it is negative, you are most probably T2. Having said that, as long as the treatment is working, the diagnosis doesn't really matter. ;)

[mazea]

It's a bit hard to tell just from that information. Like Bluesky said, an antibody for insulin test would be a good way to find out if your type 1.5 as type 2 do not have antibodies.
I don't have antibodies and am type 1 (I think type 1.5) but 96 % have the antibodies. I was diagnosed with type 1 because I had extremely high blood sugars of HBAC1 20 on onset and this is not common with early type 2 and I had low c peptide. You could also get c peptide test which if low would indicate type 1.5/1 and if high would indicate type 2.

[lorilei]

yes, the important part is the insulin dependent part and how your med combo works for you....it just can get a bit tricky with insurance if pursuing a pump...it is such a shame that there is so much stigma for type 2 bc I hear more ppl upset about the connotation vs whether their regime is working

[Ategeler]

The antibody/cpeptide test should put your mind at rest about whether you are Type 1.5 or 2. Even though the medical plan may be the same, sometimes it is just affirming to know what it is that you have. Good luck!

[EeyoreButterfly]

Every body is different and reacts differently. There are people who are physically fit, young, and still have Type 2. One thing I have learned is that comparing yourself to somebody else is simply not helpful. You're right, somebody can be old, very overweight, and not have diabetes at all or be well controlled with little effort. That does not mean that somebody who is younger and "healthier" cannot have diabetes or cannot find it harder to control.

[angelsbridges]

I agree with Jessi...every body is different.

Maybe because they're bigger than you, it less condensed glucose, and that's why they have a lower number...

Haha, that was supposed to be a joke :)

[DCaplinger]

Um, if you do end up with a positive antibody test, you will not be considered a Type 1.5... you are only 22... you'd be considered Type 1. Type 1.5's are people that are usually diagnosed with Type 1 after they've reached their mid-30's. It is not uncommon for a true Type 1 to be diagnosed into their late 20's.

Regards,

D

[EeyoreButterfly]

Actually, it could be type 1.5. Many people think of Type 1.5 as being after age 25. From my understanding the major difference between LADA and true type 1 is that LADA has a slower onset. A true type 1 would have much higher sugars and be in DKA. In the early stages LADA is easily misdiagnosed as type 2 because initally the person may respond to oral medications and/or diet and exercise (my guess is that as diet and exercise often accompany oral meds this is why oral meds appear to work) but quickly progress to needing insulin. In fact, type 1.5 used to be called 'slow onset' type 1.

So while it is more common in people over 30, it can happen to those who are younger ,just like type 2.

[DCaplinger]

Technicalities. LOL. Actually, I believe the most accepted test of Type 1 v Type 1.5, is that with Type 1.5 the is that the GAD65 antibody is typically the only one found. That isn't to say that GAD65 is always the only one (as in my case).

At 22 years of age, I don't know of any doctor that would consider a patient to have LADA, because they simply aren't old enough.

As far as DKA, I know several Type 1's that never had DKA during or prior to diagnosis.

Oh, and heya neighbor. I'll be up in the St Louis area next week. How far NE are you? I've got family in Hannibal.

Regards,

D

[mortis505]

http://www.diabetesnet.com/images/frombook/diffindiab.jpg

Typically LADA will be diagnosed in a patient who is 35 or older. But there are cases of people diagnosed younger than that. The big determinate factor will be the other tests. ICA, IA2, and IAA which are Islet Cell Antibodies and 2 types of Insulin Antibodies tests.

Having said that there are also T1s that are diagnosed at ages older than the 25-35 years of age range normally associated with LADA. As I said, it all comes down to the tests.

[foxl]

http://www.diabetesnet.com/images/frombook/diffindiab.jpg

As I said, it all comes down to the tests.

And even those can be equivocal. Human physiology, like human personality, is infinitely VARIABLE.

[DCaplinger]

This is why I have a problem with them trying to separate Type 1 and Type 1.5. The treatment is the same. The cause is the same (auto-immune). The major difference is age of onset and how quickly it progresses. Why bother making it something different that people argue about? My Endo doesn't recognize Type 1.5.

Regards,

D

[mazea]

I disagree, about there being no type 1.5, but you are quite welcome to have the opinion that there should be no type 1.5 DC CAplinger.

The main difference with difference of treatment is with it is the remission/ depletion cycle. I found the remission/ depletion cycle in LADA much more difficult to manage than the diabetes type 1 itself. The instability of the remission/depletion cycle did my head in and I actually got councelling for the instability of my blood sugars because it was doing my head in. SO the difference is not so much physical, as it is mental. You have no idea how distressing it is like to have your insulin to carb ratio drop in HALF every few weeks without warning until you have actually experienced it. One day your taking 8 units of novorapid for lunch, the next day you have 8 units of novorapid and you drop to 1.5 and nearly pass out and the next day you are taking 4 units of novorapid for lunch. It really is very frightening.

Because the pancreas is still working, you also have natural insulin spikes in the day time. It adds an extra component of instability when your blood sugar drops 5 mmol between 12 and 12.30 even if you haven't had insulin. The psychological effects of LADA are different. The councelling for the instability is one treatment I wouldn't have got if I had only type 1.

[DCaplinger]

I completely respect that, mazea. I didn't say I had a problem with the differences. I said I had a problem with the arguments it has caused (and by that, I mean in the medical profession). I've seen doctors in the same office completely disagree over the T1.5 diagnosis.

Sometimes, I forget the plight of most LADA's. My progression was so rapid from the time of diagnosis to the time of total insulin dependence (a whole month), I forget that there are those who are constantly regenerating new beta cells. It's one of those rare times that I'm really kind of glad that I am completely dependent, so I don't have to go through that yo-yo. I sincerely apologize for seeming dismissive. Again, I only have a problem with the disagreements that the diagnosis has caused in the medical community. It's all about education, and it seems that those who need to know it the most, are the ones that know the least about it.

Regards,

D

[mazea]

That's ok. We all have different opinions and appreciate your frankness.

I think another difference is that LADA tend to have have antibodies to the insulin and not the beta cells, where as type 1 have antibodies to both the insulin and beta cells. I can be corrected if I'm wrong. That is why often LADA take very low doses of insulin during their diabetic life and only have GAD antibodies. I think that someone with LADA is more likely to pass the LADA gene rather than a type 1 gene onto the next generation. My dad was LADA too. He survived with diabetes for a month in hospital without treatment in 1960. It took a month for them to diagnose him and has now has no complications in his 60's, so I think he might be LADA.

[lorilei]

well geez, that puts me flatly in type 1 instead...and I thought rikki was just trying to convert me and that my endo was daft...

[burnt]

So im having to take double metformin, the actos and insulin. How does that work if i am a type 2 and have lost 50lbs, and only 22years old just diagnosed June 5, 2007. :mad: Could i really be a type 1.5 or 1, just slow onset.



I hear ya TF - I am currently taking 160 units of Lantus and still can't get the baseline down to 140. the doggone pens only deliver 80 units - so I am thinking all kinds of wild things. The big injections hurt like a bugger, so I take lots of little ones. (5 x)

[jwags]

Life is not fair. i had gained extra weight with each of my pregnancies and kept 10 pounds on with each kid ( 6 kids). In my mid 50's I decided to get healthy and took most of that weight off. I worked out in the gym 2-3 hrs a day and played tennis 4-6 hrs a week. Two years ago after I had lost 60 lbs I was diagnosed with diabetes. when I told people they were in shock. they said no way. It took me a while to process this and realise it has to do with my pancreas and liver and not with my body type. I can eat well and exercise and take my meds but the rest is up to body. Before when I lost weight I did it to fit into a size 4. Now I eat healthy and eat low carbs to stay alive. that is my motivation.

[lorilei]

Life is not fair. i had gained extra weight with each of my pregnancies and kept 10 pounds on with each kid ( 6 kids). In my mid 50's I decided to get healthy and took most of that weight off. I worked out in the gym 2-3 hrs a day and played tennis 4-6 hrs a week. Two years ago after I had lost 60 lbs I was diagnosed with diabetes. when I told people they were in shock. they said no way. It took me a while to process this and realise it has to do with my pancreas and liver and not with my body type. I can eat well and exercise and take my meds but the rest is up to body. Before when I lost weight I did it to fit into a size 4. Now I eat healthy and eat low carbs to stay alive. that is my motivation.

well said...mine kind of girl...keep spreading the good word..

[livesugarfree]

My doctor also has the same opinion of 1.5, but yet she has labeled me as one of her tougher cases, cause she couldn't get me stablized using oral meds. I was diagnosed 3 years ago at the age of 52 and she has insisted I am type 2. I have always watched my weight by counting carbs and am pretty active. She finally put me on lantus (once a day) and novalog before meals. I just went on the omnipod pump and love it. We have some tweaking to do on my basil rates but my numbers are looking so much better and no more 3-4 shots a day. I would like to get her to agree to taking a GAD65 testing.

[zoelula]

The main difference with difference of treatment is with it is the remission/ depletion cycle. I found the remission/ depletion cycle in LADA much more difficult to manage than the diabetes type 1 itself. The instability of the remission/depletion cycle did my head in and I actually got councelling for the instability of my blood sugars because it was doing my head in. SO the difference is not so much physical, as it is mental. You have no idea how distressing it is like to have your insulin to carb ratio drop in HALF every few weeks without warning until you have actually experienced it. One day your taking 8 units of novorapid for lunch, the next day you have 8 units of novorapid and you drop to 1.5 and nearly pass out and the next day you are taking 4 units of novorapid for lunch. It really is very frightening.

Because the pancreas is still working, you also have natural insulin spikes in the day time. It adds an extra component of instability when your blood sugar drops 5 mmol between 12 and 12.30 even if you haven't had insulin. The psychological effects of LADA are different. The councelling for the instability is one treatment I wouldn't have got if I had only type 1.[/QUOTE]

I am very interested in your experience. I'm currently wondering if I am Type 1.5 primarily because I have been so unstable. The short-acting insulin sent me immediately into a dangerous hypoglycemia. I am struggling with post prandial peaks. Your post and the one responding to it seemed to imply this is a period that happens early and then stabilizes? Did you just naturally stabilize or was something changed in your regimen?

[zoelula]

Sorry I'm still trying to figure out how to quote someone else's post, not to mention put colors in my post. I just get HTML code.

[va.mom]

I am learning through this forum that I was likely a type 1.5. Onset at age 29, after birth of my son. Lost weight, high A1C, treated as type 2 with oral meds, up and down like a yo-yo, Dr. used the term "brittle", after 1 year of battling, went on insulin. That was in 92'. 3 years after diagnoses, while trying to get into a study at Georgetown Univ. I was told my pancreas was 99.8% non producing and that I was definately a type 1. Until going on pump, last year, I continued to battle with low low's and high high's. A1C's between 12-16 for all of these years. Since being on the pump, my A1C's are coming down....9.5/9.3/9.2. I just started using a CGM last week and am completely confident that I will finally honestly get my A1C's in the 7's. Now if I can get rid of these blisters caused by the adhesive. :)

[Therese]

I am not sure you are correct about the auto antibody thing. LADA can have antibodies to islet cells as well as the GAD antibody but typically they develop the GAD first. GADs also destroy the beta cells. GADs also diminish hence at the begining you can be positive but at later stages the antibody will have gone. I am not sure that this is so in everyone case. The islet cell antibodies however stay for life. LADA and Type 1 are one in the same in that they are both auto immune Diabetes. Type 2 is not. 70% of typical type 1s also have GAD. It really is the same disease however it just surfaces at different ages and LADA is slower in manifestation. People that have a fast onset of LADA maybe have had it for years without knowing it so only sought help when they were in the end stage and were actually getting sick.
I am a typical LADA. Initial problems in pregnancies atributed to Gestational and i was anti islet cell negative. Post the last pregnancy my sugar levels didnt go back to normal and was diagnosed with type 2 a year later. The Dr decided to test for GAD just as a precaution as i am not overweight, am in excellent health and have no family history of type 2. Bingo GAD positive. Now 18 months later my GADs are at a lower level but i am anti islet positive. The whole process has been 7 years long and i am still producing some insulin. Cpeptide is 0.18. I work in pathology as a scientist but had never heard of type 1.5 or LADA but there you go we cant know everything. I was just as shocked as everyone else to hear this can happen. I hate the feeling of the yoyo state we seem to be in constantly. I have decided to try low carb as then i can take less insulin thus hopefully stop the swings. I dont mind so much being high but the lows suck.
Just one more thing. Auto immune disorders can go hand in hand with each other so if you have an autoimmune thyroid disorder it would be worth getting tested for autoimmune diabetes. I noticed it in you blog. (have i got the right person)

[lorilei]

"The main difference with difference of treatment is with it is the remission/ depletion cycle. I found the remission/ depletion cycle in LADA much more difficult to manage than the diabetes type 1 itself."

agreed..sometimes i would pray for the pancreas to just stop and sometimes i would pray for it to work forever...

[mazea]

Ah the remission depletion cycle. I went from 10 1/2 units Levemir insulin 2 weeks ago to 3 units of Levemir today. I haven't had unbroken sleep for 2 weeks because of hypos. I have no idea how long the 3 units of Levemir will last before it goes up again.

Your post and the one responding to it seemed to imply this is a period that happens early and then stabilizes? Did you just naturally stabilize or was something changed in your regimen?
Hormones. Pregnancy. The contraceptive pill are all things that effect my blood sugars.

Also I am doing a therapy called psychodynamic therapy for Post Traumatic Stress Disorder(like the veterans form war) and it brings me into a depletion remission cycle too. The therapy gets you into a state where you feel the emotions at the time of a trauma, links them and a memory you had forgotton comes back. It's not like a full memory, it's like a partial memory of only the grief at the time as I already have the physical memory of what happened usually.At the moment it is pregnancy and the just getting a partial memory back about the grief I felt during my dad's violent rage when I was 9. My blood sugar levels always go up the 2nd week I get a partial memory back and then drop in the fifth week after I get a memory back. So at the moment pregnancy and the therapy. I won't be doing any more therapy until after the baby is born now as I want to keep my blood sugar levels, which are good from having hypos.

I find it interesting that the therapy effects my blood sugar levels the way it does.

[mazea]

When my blood sugar levels stabilise they stay the same for up to weeks at at time. I think my blood sugar levels have been stable for 5 weeks once.
[quote]agreed..sometimes i would pray for the pancreas to just stop and sometimes i would pray for it to work forever...
It's a bit like having a blessing and and a woe at the same time. I like it when my insulin needs are low as I can eat things I can't normally eat when my insulin needs are high.

[tiffanyfaith86]

i have still been unstable until this week, kept having to adjust my insulin, but now i think im finally able to use only 10u of Lantus and 2-3 for Humalog. a1c went down .2 since march :( wish it was down to 5.5 again

[soso]

That depletion/remission cycle is making my life pretty difficult at the moment.
I could do with some counseling, it is depressing and distressing.

[DCaplinger]

I thank God I don't have that issue. My production is nil, and has been for a while. I think I agree with earlier comments, I'd pray for either healing or for complete lost of indiginous production so I could move on with my treatment.

SoSo... lean on is, kiddo. That's what we are here for. :)

Regards,

D

[soso]

I have been having such a lousy time with it lately I can barely talk about it. Started with lows on lows on lows about 5 weeks ago, I suspected my basal and cut it back which helped at least with the before meal lows (which weren't deep, but hard to work efficiently with) In fact I got so I was only using 3u of Lantus, so I decided to stop as it was such a small amount maybe I could just do without fora little holiday.. no prob for a week then waking higher than I like so have re introduced it..
Last week I had normal bf results and then insane, unexplainable highs after lunch, which would then drop like a stone if I finally did a 1 unit correction..
I tested meter on meter, tested with diff meters so it really was happening.. for example one day i was 10.6 nearly 3 hours after lunch I corrected with 2 units and 75 mins later was 4 and 10 mins after that was 3.2...
If that happened to me once I just put it down to experience and move on, but similar scenarios happened 3 days out of 5, I can find all kinds of explanations for A led to B etc, but my normally reasonably reliable control seems to be having a freak out... I suspect that I am up and down other times of the day as when I randomly test about half the times I am having numbers that while not unduly high, are not at all what I expect and I feel odd sometimes and don't test (prolly as a result of depression about it)
Even my DH who likes to always pretend I am fine (I don't mean that in a bad way) agrees that something is fishy...

So I have just dialed everything back and logging and things are a little better, but it is still happening just smaller swings and I managed to get through yesterday without a high or a low.....it is sucking my energy and clients keep saying how tired I look.... I try not to bleed all over them..lol
Thanks for listening...

[Ategeler]

I am in the same boat as you. It is so frustrating when dealing with the inconsistencies in insulin production! I never know what to expect from day to day sometimes.

Hope things get better soon for you.

[tiffanyfaith86]

same here, just lastnight i was 167 before dinner, did 4u Humalog(been doing 1-3 lately, but had a medium fry from Mc D's) and 2 1/2 hours later at 10 something i was 109 so i was pleased. I did my Lantus 12u. And before breakfast at 9am, my FBG was 191. How is that possible?

[Ategeler]

Well I am no expert on this but I am going to venture a guess which could be totally wrong. But could it have something to do with the Dawn Phenomenon?

[tiffanyfaith86]

thats what i was thinking, but if i was 107 and did my 24hr shouldnt i of only been like maybe 130 or so.. not close to 200. I would say thats to high even for dawn phenom.

[Ategeler]

I am just too new at this whole thing myself. It is a bit of a mystery to me too. Hopefully, one of the more seasoned members can shed some light on your overnight increase in BG!

[kingleonidas]

My c-peptide is 1.6, islet cell negative, gad-65 negative, binding proteins negative, insulin serum is 7.

Does this look like type 2?

[foxl]

My c-peptide is 1.6, islet cell negative, gad-65 negative, binding proteins negative, insulin serum is 7.

Does this look like type 2?

LADA CAN look like T2. By most definitions (not all), Type 2 CAN, or not, involve a certain amount of insulin resistance as well as autoimmune process.

My C-pep is 1.3, low-middle normal range. LADA is just about any combination of positive antibodies, and insulin resistance is present or absent.

[kingleonidas]

So what. Would you put your money on with my numbers? Just an opinion.

[foxl]

Didn't you say you had ICAs? (Islet Cell Antibodies?).

Looks to me like you have some characteristics of both. What is your weight/BMI?

[kingleonidas]

Islet cell ab was negatIve,m no antibodies and gad was also negative. Totally normal. After losing 25@ounds I am now 5 foot 9 inches and 170 pounds.

[kingleonidas]

No islet cell ab, negatIve gad, all normal. After losing 25 pounds I am now 170 pounds and 5 foot 9 inches tall.

[Ategeler]

The higher the number in a C-Peptide the more insulin resistance you have. Your number looks lower than what I would expect from a Type 2. Also, some people are Type 1 w/o showing antibodies. Maybe yours haven't shown up yet? I am by no means an expert on this but I do know that postive GAD are very common in LADA diagnosis.