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TheBigNewt

What the heck is a Type 1.5 diabetic anyway?

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jwags

Type 1.5 is late onset Type 1. Your doctor will do a GAD antibody test and a c-peptide test to confirm a 1.5 dx. Your GAD will be positive aand c-peptide will be on the low side, You have an autoimmune attack on your pancreas , just like Type 1. SOmetimes at first while you still have pancreatic function you can get away with type 2 drugs, but eventually you will need insulin.

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Kit

Type 1.5 is late onset Type 1. Your doctor will do a GAD antibody test and a c-peptide test to confirm a 1.5 dx. Your GAD will be positive aand c-peptide will be on the low side, You have an autoimmune attack on your pancreas , just like Type 1. SOmetimes at first while you still have pancreatic function you can get away with type 2 drugs, but eventually you will need insulin.

 

With the addition that's its usually a slower onset, which adds to the reason its often misdiagnosed.

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Cora

Type 1.5 = LADA = Latent AutoImmune Diabetes of Adults.

 

It's basically T1, but unlike in kids, the onset is quite slow (it can take 6 years or more of honeymooning before insulin is required, unlike the 6 months or less it takes kids) and it's often misdiagnosed as T2. Some T1.5s have IR, but again, it's not actually part of the "official" diagnosis. It's believed that as many as 20% of type 2s on insulin may actually be misdiagnosed LADAs.

 

The bottom line is that it is typical T1 in the sense that it is an autoimmune attack on the pancreas, but unlike diagnosis in kids, it's slow and sometimes it's too late and people no longer show positive for antibodies. Just like all things D, it can be confusing

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Uff Da

The unofficial designation of "type 1.5" is frequently used to refer to those of us with LADA, latent autoimmune diabetes of adults. But the same phrase is also used to refer to people with MODY, maturity onset diabetes of the young. 

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DeusXM

The type of your diabetes refers to the believed cause, not the treatment method. T1 and T1.5 refer to specifically autoimmune diabetes (although confusingly, those with pancreas issues caused by surgery/cancer could also legitimately be considered T1). whereas T2 refers to diabetes caused by insulin resistance/underproduction.

 

All T1s and T1.5s will require insulin. Some T2s will also require insulin, but that doesn't change what type of diabetes they have.

 

Please don't take this the wrong way, but I'm a little worried that you're asking this question given you refer to yourself as a physician in your sig...

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GrammaBear

The type of your diabetes refers to the believed cause, not the treatment method. T1 and T1.5 refer to specifically autoimmune diabetes (although confusingly, those with pancreas issues caused by surgery/cancer could also legitimately be considered T1). whereas T2 refers to diabetes caused by insulin resistance/underproduction.

 

All T1s and T1.5s will require insulin. Some T2s will also require insulin, but that doesn't change what type of diabetes they have.

 

Please don't take this the wrong way, but I'm a little worried that you're asking this question given you refer to yourself as a physician in your sig...

 

Especially since he can't spell correctly the name of the insulin he takes. 

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Hammer

Just to add to the confusion, a type 1, who produces little to no insulin which makes them a type 1, is insulin dependent, but can also develop insulin resistance.  A type 2 means they have insulin resistance, but can also be insulin dependent, like me.  I can't take oral diabetes meds because they upset my stomach.....every class of oral diabetes meds.  Since I can't take oral meds, I am forced to use insulin.  That makes me a type 2 who needs insulin to control my diabetes.

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TheBigNewt

As I suspected, you're either Type 1 or Type 2, and to the so-called "Type 1.5" is a Type 1. If you don't take insulin you go DKA. Your immune system guts your Islet cells. That's what happened to me. Took about 2 months from the "cold" to glycosuria and ketonuria. I didn't end up in the hospital, I diagnosed myself before I got very sick .But I dropped about 15 lbs. I was in my last year of medical training actually. And FYI Type 1.5 is a term that isn't used in the medical field. It may have some meaning, but we don't use it. That's why I asked because I hadn't heard about it until this forum.

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Fraser

I was diagnosed a T2 in 2009 and the woman in the office next to me was diagnosed a1.5 the same week.

Actually the big discussion at that time was that the medical community did not accept the term LADA..

So if you reference both on line, the have a similar definition now. There was a need to differentiate between the very quick progression of the traditional T1. And the slower progression of LADA, which requires a different protical. 1.5 was a more accepted term than LADA

Which I assume is used today.

Another point. T1 or LADA is an auto immune disease. If you loose a pancreas due to accident that does not make you a T1.

It makes you insulin dependent but you do not have an auto immune desease, again different protocol.

 

Your question could have been answered very quickly on line.

 

Since I was a non obese, active t2 who did not over indugle in poor food choices, and an A1c of 12, I went through all the test to determine if I was a t1. I was not, still not taking any meds.

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GrammaBear

As I suspected, you're either Type 1 or Type 2, and to the so-called "Type 1.5" is a Type 1. If you don't take insulin you go DKA. Your immune system guts your Islet cells. That's what happened to me. Took about 2 months from the "cold" to glycosuria and ketonuria. I didn't end up in the hospital, I diagnosed myself before I got very sick .But I dropped about 15 lbs. I was in my last year of medical training actually. And FYI Type 1.5 is a term that isn't used in the medical field. It may have some meaning, but we don't use it. That's why I asked because I hadn't heard about it until this forum.

 

If the term Type 1.5 is not used in the medical field, perhaps you need to inform John Walsh who wrote "Pumping Insulin" that he has an error in his book.  I'm sure he would want to correct such an error, wouldn't he?

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TheBigNewt

If the term Type 1.5 is not used in the medical field, perhaps you need to inform John Walsh who wrote "Pumping Insulin" that he has an error in his book.  I'm sure he would want to correct such an error, wouldn't he?

The reason it's not important is that you can call it Type 1, or Type 1.5, or as stated above some call it LADA, or as it used to be called juvenile onset diabetes. It's all the same thing, with essentially the same underlying cause and underlying metabolism in contrast to Type 2. And another post said that it HAS to be autoimmune, or it's not Type 1. Well then, I guess if ones pancreas is surgically removed they can take metformin right?

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Fraser

Dear Doctor

Please do some research into the subject., as noted above.

To my knowledge the underlying cause of any auto ammune diabetes has not yet been discovered.

Metformin is used to treat insulin resistance which can occur in both type 1 and 2 diabetes.

 

You might look up Manny Hernandez, one of the founders of TuDiabetes, and read about

His experience of being misdiagnosed and treated as T2 and his difficulties.

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Cora

No. T1 and T1.5 are not quite the same thing. Especially given that honeymooning for T1.5s can last for 6 years or more. And as a result of that, often antibody testing is unreliable. At the very least, doctors should know and remember about this lag and not automatically diagnose people with T2 based on their age.

 

And then, we get into type 3c. Which involves insulin dependence, and is preceded (typically by about 10 years) by multiple attacks of pancreatitis. Typically no antibodies, but often seen in later years together with MS, so some autoimmune issues possibly going along.

 

As most of us have realized over the years, most doctors are not the least up to date on diabetes knowledge and terminology. My Endo knows and understands T1.5 and has been aware of it for quite some time. So the term is used by docs who are up to date in the field.

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DeusXM

In Newt's defence, I think (but I'm not sure) that T1.5/LADA are not official terms...but that doesn't mean that they're not in use or that the labels don't have relevance. Or that they're exactly the same disease.  We still don't really know what actually causes T1 or T1.5 other than that the immune system is involved, but the difference between the speed at which the conditions develop certainly suggests they don't share the exact same process, or indeed the same protocol in the initial stages of treatment.

 

I may be wrong but I imagine that after 20 years of T1.5 there's probably no meaningful distinction between T1 and T1.5. There is probably a heck of a lot of a difference at the point of diagnosis though. I'd imagine in the early stages, the focus is much more on preserving and maximising what's left of the patient's own glucose control system, rather than having to teach them to do it all manually with extraneous insulin.

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TheBigNewt

And how many of you so-called Type 1.5's have had your intrinsic insulin levels measured? I had mine measured in 1984 after a seizure from hypoglycemia. The term "autoimmune" refers to your body's immune system "attacking" your own Islet cells, similar to what happens in my field's viral cardiomyopathy. We quit measuring the acute and convalescent Ab levels a long time ago because it really didn't matter what they were which is probably the case in "Type 1.5" diabetes. But doctors like to do blood work, right? What matters is you got a disease that needs to be treated or bad mojo can happen. And I think DeusXM is right, they aren't official medical terms which is probably why I never can across it. This is the only diabetes forum I've ever been on and I only got on it recently.

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TheBigNewt

But he HAS been T1 since 1984. I guess even some physicians are slow learners.

 

 

Typical doctor response - evade the question.

So, trolls show up here too eh? Nice.

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NoraWI

Trolls, huh? Thank you, DOCTOR BigNewt! You certainly have a way with words. Why don't you fix the spelling of the insulin that you have been using for bolus for all those years. It is misspelled in your signature. It is Humalog not Humulog.

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adiantum

Strewth ....................its tough being a girl sometimes.

 

I hate seeing my friends being called trolls.

 

I hate seeing so many people with diabetes , no matter what type.

 

I even hate it that a cardiologist from Arizona should  have diabetes.

 

I hate it even more that a fellow diabetic names his equal as "a bunch of yohos on a forum".

 

Tomorrow is another day & I hope it's filled with peace, love or  best wishes  for each of us.

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TheBigNewt

Trolls, huh? Thank you, DOCTOR BigNewt! You certainly have a way with words. Why don't you fix the spelling of the insulin that you have been using for bolus for all those years. It is misspelled in your signature. It is Humalog not Humulog.

I fixed it Nora. By trolling I mean posts that are meant to be critical of someone, and have no contribution to the thread, in which I honestly ask: What is a Type 1.5 diabetic? And the reason I asked is because it's not a type of diabetic that is referred to in the medical field. I never heard of it referred to, I thought it might be a Type 2 who requires insulin, which I'd say half the Type 2's I see are taking (Lantus usually). And DeusXM was kind enough to point out the reason it's not referred to in the medical field and to point out it's essentially a Type 1 diabetic, perhaps with a more gradual onset as their Islet cells go away, which has been known for decades just not given a fancy name so somebody can publish a book about it or something. I get it now. It's akin to "pre-diabetic", which refers to someone who isn't a diabetic, but may get diabetes someday (or not), whose doctor probably scares them into losing weight and exercising and to stop eating ice cream or else they'll have to start poking themselves with needles and spend their money on Januvia instead of Fruit Loops. Right?

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