What is a type 1.5 and how is different to

ODAR · #1 (**permalink**) 10-13-2009, 07:11 AM

Sorry for my ignorance but how does one get dx as Type 1.5? what is the difference for T1.5 and T2 - I am curious as am wondering if my daughter could be T1.5 and not T2

Subby · #2 (**permalink**) 10-13-2009, 07:35 AM

Here's my basic understanding, I am sure others will fill in blanks or correct me where I go wrong.

In type 1 an autoimmune response attacks the pancreas and the pancreas quickly fails, leaving a great deficiency of insulin in the body (often pretty soon: total deficiency). We need to replace the hormone with injections, pretty much straight away.

There is often a "honeymoon" period where the pancreas is conking out over a few weeks or some months. One of the main ways that type 1.5 is functionally different from type 1, is that this period may go on for a lot longer, many years for some. This means the person is not quickly or obviously insulin dependent, leading some doctors to put them automatically in the "type 2" category. To make matters worse for misdiagnosis, type 1.5 or LADA will often occur in adults. (T1 can as well... but if it does, my guess is it's likely to be picked up a lot faster and seen as an oddity but a real one nonetheless...)

But of course type 2 is something quite different: it is the body developing insulin resistance, and in fact often the pancreas is acting in the opposite way, pumping out insulin at a heightened rate for many years, (eventually often leading to burnout and a deficiency.... but usually takes quite some time).

So treatment for type 2 is geared towards combating this insulin resistance and helping the body access the excess of insulin in the blood effectively, (such as through drugs, diet and exercise) which in the case of a type 1.5 may be less and less effective as the pancreas progressively fails - type 2 treatment does not address the basic problem of type 1 or 1.5. If they have a gradual decline in insulin, there is likely to be a stage where all the metformin or other drugs in the world are unlikely to replace that absent insulin... leading to a lack of ability to control blood sugars, therapeutic breakdown.

Here is something to read about the subject. Diabetes Types, Type 1.5, Slow Onset Type 1 and LADA.

As mentioned here, c-peptide and GAD antibodies are useful tests for indicating type 1.5.

Experience of members and forums seems to show, that some docs or endos can be skeptical or resistant to the idea of Type 1.5 or LADA. I do know some here who have managed to move past this point with their docs, get the relevant tests done, and have it accepted that the are not type 2 and that treatment should be directed towards insulin deficiency, rather than just insulin resistance.

Or, if docs point blank refuse to look into it, there are always other doctors out there, always worth a second opinion, and even a third...

foxl · #3 (**permalink**) 10-13-2009, 07:39 AM

Yup and I would add, the antibody seems to be different in LADA from Type 1 -- GAD antibodies are predominant in LADA, while ICA and IA2 are more typcially predominant in Type 1.

Also some theorists distinguish between T1.5 and LADA -- using T1.5 only to distinguish those with both autoimmune profile AND insulin resistance; LADA being slow-onset autoimmune only.

My Endo calls me a T2 with antibodies, and only treats clinically, ie as she sees the need. Others may treat LADA preventively with earlier insulin added to slow the deterioration.

mortis505 · #4 (**permalink**) 10-13-2009, 09:17 AM

Submitted for your reading enjoyment.

Latent autoimmune diabetes - Wikipedia, the free encyclopedia

Diabetes Types, Type 1.5, Slow Onset Type 1 and LADA.

lorilei · #5 (**permalink**) 10-13-2009, 06:03 PM

besides..in all fairness..we are super cool too..just kidding!
we late onsetters do tend to ride the bg/insulin rollercoaster for a while (slow deat h of the pancreas?)and sometimes even completely different than each other..is it a journey into a 1? not so sure it is that simple...but then again, diabetes is not all that simple in any of us regardless of type..and we all vary day to day..

foxl · #6 (**permalink**) 10-13-2009, 06:10 PM

yeah, yeah that's it -- we're the COOL group! Come play with us ... hee.

Rekarb · #7 (**permalink**) 10-13-2009, 06:38 PM

Why do you think that your daughter is not a T2. We all are so different. I, for instance, consider myself a 1.5 but not a LADA. I lack the antibodies. Maybe if you give us some examples we could give you some better answers.

Mike

ODAR · #8 (**permalink**) 10-14-2009, 09:06 PM

My daughter was dx at 16 as type 2 - but for sometime before that I was worried about the amount of food she ate( particularly carbs) and although very atheletic - was always representing her school in swimming carnivals, soccer etc etc - her weight was ballooning. She was dx her GTT level was 22 and 24 Fasting was 15. She has been on metformin for 3 months now and still her levels are extemely high.. got to 18 at one point after meals. I make sure she exercises for an hour at least every day.. no mean feat so we both end arguing. Because she is 16 she is under the care of an endo and the local Govt Hospital. This past week she has not been under 9 for FBS and her post meals were between 11 and 15. Nothing seems to be bringing her BS down quick enough!

foxl · #9 (**permalink**) 10-15-2009, 07:17 AM

ODAR, she could be a T1 (roller coaster blood sugars leading to eating more?), a T2, a LADA, a MODY ... look into testing!

GAD antibodies. C-peptide. Possbily genetic testing for a MODY.

Even if you are told that they treat clinically (ie if seh needs insulin then they give it), press for the testing!

Rekarb · #10 (**permalink**) 10-15-2009, 09:08 PM

I agree with Linda. You need some tests - quickly.
I would suggest two things in the interim.
Cut back on the carbs she's eating. You might want to have her walk as a form of excercise. I ride a bike and when my numbers are high, cycling would push them higher. Walking, however, seems to bring them down when they are up.

I hope things work out.

Mike

imac · #11 (**permalink**) 10-16-2009, 07:05 PM

It is rather unusual these types of diabetes. Diabetes australia gives a description of the types but 1.5 is not in it. You should ask to see the diabetes educator at your local hospital, they may be able to offer some advice. Oral meds do not work for everyone.

tealas · #12 (**permalink**) 10-16-2009, 07:22 PM

I would echo the good advice given so far - if metformin is not working for your daughter, try to work with her on temporary diet changes (reduce carbs, no high gylcemic carbs etc) that can at least bring blood sugars down. There are also acupuncture points that can quickly lower blood sugars if you have access to a good practioner (email me for info if you need it). Try to reassure her that eating more green vegetables and moderate amounts of protein will probably help her feel like her motor is racing less. I've had that feeling of needing to eat and eat because I wasn't really getting much out of the food I was eating.

And then press for testing - I would say the most important is to find out if she has any the Type 1 or Type 1.5 (LADA) distinguishing antibodies. From my experience with MODY, it does not seem likely she is one of the two most common forms of MODY (MODY2 and MODY3), MODY's are usually underweight. But if there are no antibodies, and some level of c-peptide, then MODY is the next door to knock on. Do you have diabetes in every generation of your family? MODY conditions have dominant inheritance patterns.

foxl · #13 (**permalink**) 10-17-2009, 08:41 AM

Quote:

Originally Posted by imac

It is rather unusual these types of diabetes. Diabetes australia gives a description of the types but 1.5 is not in it. You should ask to see the diabetes educator at your local hospital, they may be able to offer some advice. Oral meds do not work for everyone.

Not so unusual -- see my signature. Joslin's is one of perhaps 4 accepted, comprehensive textbooks on Diabetes, by the way.

Unusual to get a diagnosis still -- yes. Sadly. I was told, "We treat clinically, only. If you need insulin to control your blood sugars, you use it."

HelenM · #14 (**permalink**) 10-17-2009, 10:18 AM

Quote:

Originally Posted by imac

It is rather unusual these types of diabetes. Diabetes australia gives a description of the types but 1.5 is not in it. You should ask to see the diabetes educator at your local hospital, they may be able to offer some advice. Oral meds do not work for everyone.

They are doing some research on it in Australia though and there are some information links on this page

Diabetes Research Centre Victoria

ODAR · #15 (**permalink**) 10-19-2009, 10:57 PM

Thanks Everyone - and sorry I hav'nt responded sooner to the thread I posted but my daughter has kept me busy! So we had Ultrasounds done on Friday on the ovaries and confirmed that yes she does have PCOS. On Saturday she complained of back pain (over her kidneys). Lucky I had some keto stixs so made her use one - but it came back normal. By Sunday, both her kidneys were aching so off to emergency we go - and after 5 hours they gave her panadine forte and told her to get in touch with our own GP for ultrasound on kidneys. Earliest appointment I go get into see doc is on Thursday afternoon! Her Kidney pain has subsided but will still take her to GP. Her endo appointment is on Monday 26th so will keep this forum posted on her progress - and hopfully will know more where we are at with her diabetes/cushings/pcos etc etc