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dlewis

confused about the difference between T2 & 1.5

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dlewis

Forgive my cross post. I posted this in the T2 board, but then I thought I should post it here too.

 

OK, I do NOT have high BP, cholesterol, or triglycerides, never have. I do have a family history of type 1 (half sister) as well as lots of T2. I do have some autoimmune stuff going on already: fibromyalgia, hypothyroidism. HOWEVER, I AM very overweight and deal with depression (which, I think, is what has caused a lot of my weight problems).

 

I did have increased thirst, increased urination, blurry vision, and severe foot pain when diagnosed (just recently). However, my BG (in the time I have been testing) never really goes too much over 200 - that I know about. My A1C is only 5.9, however, before I went low carb, I was prone to hypo episodes.

 

I am confused. Can someone enlighten me?

 

Thanks!

 

P.S. I am 46 y/o female, 270# at diagnosis.

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DCaplinger

Type 1.5 diabetes is a subtype of Type 1 diabetes. It is an autoimmune disease in which the body's immune system, for whatever reason, decides that the insulin producing cells in the pancreas are invaders, and attacks and kills them. This process can be very rapid (as with juveniles) or can take course over a very, very long period of time (sometimes years).

 

People who are diagnosed with Type 1.5 diabetes will usually start treatment with traditional Type 2 medications. However, eventually they will become totally insulin dependent. This process can also happen very quickly or can draw out over several years.

 

People with Type 1.5 usually test positive for GAD65 antibodies. The deciding factor in whether you are a Type 2 or a Type 1.5 is the antibody test. Usually, only an Endocrinologist would run this test, however if you are a newly diagnosed diabetic, you should probably request the referral for the test, or ask your physician to order it. If you come back positive for GAD65 antibodies, request the referral to the Endocrinologist, and have them treat your diabetes.

 

Do not mistake insulin dependent Type 2 with Type 1 or Type 1.5. While the treatment is the same, the way you got there isn't. Insulin dependent Type 2's are people who's pancreas' give out over time, because of the stress of the extra insulin production that was required to meet the basic needs of the body. Over time, the pancreas gives out, and the end result is needing insulin replacement therapy just a like a Type 1 would have to do. For simplification when dealing with other people, it's generally accepted to say you are a Type 1 if you are insulin dependent Type 2, so that you don't have to go into detailed explanations about why you are insulin dependent.

 

People with Type 1 or Type 1.5 are also prone to other autoimmune diseases. The most frequent being Hashimoto's Thyroiditis (Hypothyroidism). This is a disease in which your immune system attacks and starts killing off the thyroid. The end result is thyroid hormone replacement therapy. I was diagnosed with Hashimoto's about 6 months after I was diagnosed with Type 1. So far, it's the only additional organ issue I've had since my diagnosis.

 

Hope this answers your question.

 

Regards,

 

D

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foxl

Keep in mind, people with things like MODY and Flatbush also fall into the Type 1.5 category, but do not have autoimmune D.

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Rekarb
What is Flatbush?? Just curious.

 

I guess this is mine. Flatbush Diabetes is just another name for Ketosis Prone Type 2 Diabetes. You can read about it in my signature.

 

Mike

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Danielle

This is really confusing to me too because i have been type 1 for 23 years taking insulin and my endo told me last week that i am now considered a 1.5 because of my insulin resistance which is characterized in type 2's.

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Subby

Don't feel alone in the confusion, I think typology is not only confusing in the first place, but there seem to be competing definitions, just to make things special.

 

School of thought one

1.5, as the name literally suggests, is "in between" classic definitions of type 1 and type 2, in one way or another. therefore the thought that if you are something like insulin dependent like a T1 but with IR like is classically associated with T2, you might be called "1.5". Another example might be if you are insulin dependent, but it comes on late in life, you might be called "1.5".

 

Personally, I think these approaches are all that compelling or helpful, and usually just highlight ignorance about type in the first place. For example, a doc might think that type 1 never comes on after the age of 30 or 40. So the 50 year old who comes down with a relatively straightforward case of Type 1, gets shunted into "type 1.5" by the out of date doctor. Whereas they may well just, be, Type 1.

 

This was not helped by the wonderful term "juvenile diabetes" which gave everyone the impression type 1 is only type 1 if it comes on when you are juvenile. Anyway.

 

School of thought two

That type 1.5 is a specific permutation of diabetes, often similar or perhaps a subset of a type 1 type immune response. It is independent of IR, which may be happening or not at the same time (and IR from weight is more likely to occur as you get older, anyway, so might seem a feature). This is not getting into the possible diagnostic differences of Type 1.5 and LADA, which does have proponents of having a separate set of causes or signs. (Linda seems to know about this). I can't remember what those are. I think IR was indicated in one but not the other. Seems to go that extra step of complication to me.

 

So, in my understanding, a type 1 who develops insulin resistance is either a type 1 with insulin resistance, or perhaps a "double diabetic" or a type 1 + type 2 (I don't think many people bother with those definitions: type 1 with IR seems succinct and descriptive to me at least). Whereas a Type 1.5 does have it's own attributes separate to type 1 and type 2.

 

And just to be clear, I don't think I have all the answers or the right answers. That's the current state of my understanding that seems the most useful out of the jumble of types. I have no doubt there is confusion caused by types, both "the originals" and ones like 1.5: but unlike "anti-labelists" I see it as at least an attempt to get to the heart of good treatment by indicating more about the mechanics that are occurring under the surface. A name is just an attempt to conveniently and usefully indicate a set of occurrences. If only they could be less controversial and up for interpretation, it would be great. And if they can come up with a more useful scheme and can get everyone on the same page, I am all for it.

 

Here are a couple of interesting reads.

http://www.diabetesnet.com/diabetes_types/whatype.php#axzz0vREZroaj

http://www.diabetesnet.com/diabetes_types/diabetes_type_15.php

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NoraWI

I think of *diabetes* as a symptom which has been elevated to *disease.* The symptom is simply high blood sugar levels. The causes are varied. Off hand I can think of at least 4 or 5 different conditions that can cause this symptom we call diabetes. There may be more. I think that this "lumping" together of different diseases by one common symptom is counterproductive to management and search for cures. Wish the medical community would sort things out and move forward.

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foxl

Nora -- now I like the way you are thinking! Diabetes really equates to hyperglycemia. Nobody wants to say they cannot always pinpoint the CAUSE, so they call it a disease.

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