Jump to content
Diabetes forums
  • Welcome To Diabetes Forums!

    Registration is fast, simple and absolutely free so please, join our community today to contribute and support the site.

Archived

This topic is now archived and is closed to further replies.

kimbo

what is T1.5 ?

Recommended Posts

DesertDiabetic

Just to jump in here - it is not that easy to just say that you are either one or the other. Many type 2's do not produce any insulin, or very little insulin. That does not make them type 1's. Out of control type 2's will eventually kill off all their beta cells - which sounds a lot like a type 1.

 

Type 1's have no phase one insulin response - type 2's phase one insulin response is limited or not there. There are many things that make the two similar while still being different.

Share this post


Link to post
Share on other sites
Mister Q

I was told at diagnosis that around 1/3 of Type 2's will end up on insulin, but it was never explained if that 1/3 turn into Type 1's or into Type 2 insulin dependant, I suspect its a mix of both.

 

I think that diabetes comes in 3 flavours -

 

1. Diet and Exercise

2. Oral Meds

3. Insulin dependant

 

The T1/T2 label only seems to be important for medical insurance purposes, some jobs or driving licences. It could be due to greater awareness that people are diagnosed earlier than they used to be, so we end up with people who dont fit into the classic T1/T2 mould as the disease is still making its mind up.

Share this post


Link to post
Share on other sites
HelenM

But the diagnosis does matter. The beta cells in a person with type 1.5 (LADA) are gradually being destroyed. In fairly recent times (and sometimes still today)that person would have been treatred as a type 2 with several years of inappropriate treatment, subsequent high glucose levels and consequent complications before being put on insulin. Many of these people were also labelled as non compliant with the unhappiness and depression that could lead to.

Some recent research seems to show that some oral meds (sulfonylureas,metformin) may exacerbate the beta cell destruction, on the other hand taking insulin early when the person is not actually insulin dependent may preserve some function in the beta cells and make the diabetes easier to control.

There is at the moment a large European research project into LADA called ActionLADA which hopefully may lead to better understanding of it.

Share this post


Link to post
Share on other sites
dbc

There is at the moment a large European research project into LADA called ActionLADA which hopefully may lead to better understanding of it.

 

Is there any info/data on this study available yet?

Share this post


Link to post
Share on other sites
Mister Q
But the diagnosis does matter. The beta cells in a person with type 1.5 (LADA) are gradually being destroyed. In fairly recent times (and sometimes still today)that person would have been treatred as a type 2 with several years of inappropriate treatment, subsequent high glucose levels and consequent complications before being put on insulin. Many of these people were also labelled as non compliant with the unhappiness and depression that could lead to.

Some recent research seems to show that some oral meds (sulfonylureas,metformin) may exacerbate the beta cell destruction, on the other hand taking insulin early when the person is not actually insulin dependent may preserve some function in the beta cells and make the diabetes easier to control.

There is at the moment a large European research project into LADA called ActionLADA which hopefully may lead to better understanding of it.

 

Helen to be clear on what I did mean - it doesnt matter what you call it as long as you get the right treatment for whats wrong with you, hence my 3 flavours statement. I was not aware that there was a study going on with LADA right now, this is of interest to me as a Type 2 who was diagnosed at 32, my doc is laready making noises that thre may have been a misdiagnosis.

Share this post


Link to post
Share on other sites
Carpe Diem
The beta cells in a person with type 1.5 (LADA) are gradually being destroyed.

 

Does this mean early on that your fasting BGs are controlled and your post-prandial may be out of spec, or vice-versa, or either/or? I'm asking because I'm of the correct weight (although lost 45 pounds a couple of years ago), have a low fasting insulin level when directly measured (2.0 - normal is considered 6.0 to 26.0), normal fasting BGs, and yet high (but not quite diabetic level - close, but not quite) post-prandial readings when eating high-carb.

Share this post


Link to post
Share on other sites
Funnygrl
Does this mean early on that your fasting BGs are controlled and your post-prandial may be out of spec, or vice-versa, or either/or? I'm asking because I'm of the correct weight (although lost 45 pounds a couple of years ago), have a low fasting insulin level when directly measured (2.0 - normal is considered 6.0 to 26.0), normal fasting BGs, and yet high (but not quite diabetic level - close, but not quite) post-prandial readings when eating high-carb.

That was me to a t. My highest fasting blood sugars were 120s, but post prandially I would spike to 200 or so, and occassionally I got really high readings, like 400+ for no apparent reason. I felt a lot better after getting on fast acting insulin with meals, and shortly after I added basal insulin.

Share this post


Link to post
Share on other sites
Carpe Diem
That was me to a t. My highest fasting blood sugars were 120s, but post prandially I would spike to 200 or so, and occassionally I got really high readings, like 400+ for no apparent reason. I felt a lot better after getting on fast acting insulin with meals, and shortly after I added basal insulin.

 

FunnyGirl, how did they discover you were Type 1.5?

 

And was your fasting insulin level low prior to your diagnosis?

 

My highest reading so far has only been 227, but have been over 200 a few times.

Share this post


Link to post
Share on other sites
Funnygrl
FunnyGirl, how did they discover you were Type 1.5?

 

And was your fasting insulin level low prior to your diagnosis?

 

My highest reading so far has only been 227, but have been over 200 a few times.

Eh, they haven't really discovered anything. It was mostly a self applied label. My official diagnosis is type 1 at the moment, but I feel I am more likely 1.5 since I seem to have an easier time controlling blood sugars than most people with type 1 and have never been in ketoacidosis.

 

I'm not likely to be type 2, since I was 19 when diagnosed and use small amounts of insulin.

 

My fasting insulin level was measured a few times and has been all over the board. I get it done again soon, so I will let you know.

 

I've definately had some pretty high readings though.

Share this post


Link to post
Share on other sites
seacomp
normal fasting BGs, and yet high (but not quite diabetic level - close, but not quite) post-prandial readings when eating high-carb.

I would suspect some problem with phase I insulin response - that is the release of stored insulin from the pancreas when "challenged" by a rise of blood glucose.

Drifting down to normal levels along with a normal FBG would indicate that Phase Ii response, continuous secretion, is not effected.

Share this post


Link to post
Share on other sites
Carpe Diem
I would suspect some problem with phase I insulin response - that is the release of stored insulin from the pancreas when "challenged" by a rise of blood glucose.

Drifting down to normal levels along with a normal FBG would indicate that Phase Ii response, continuous secretion, is not effected.

 

Thanks Seacomp;

 

Only thing is, if I've eaten high carb, it can take me 5 hours to get back down to normal. I end up going up then coming down (to a still rather high level of about 135 to 140), then going BACK up to a second high peak, before coming back down (slowly, over the next couple of hours) to a more normal level of around 100.

 

And what of my low fasting insulin? That's what I'm having a lot of trouble figuring out. Officially, I'm "Impaired Glucose Intolerant" at this point. Just trying to figure out if my dropping "fasting insulin" (dropping to way below normal) level is signaling something else to me (i.e., is there anything to be worried about). My doctor (family practice) doesn't seem to indicate any cause for alarm, but I just can't figure out why it continues to drop over such a short period of time, in particular with no real change in diet (i.e., have been low-carbing for over 2 years already, with very few high-carb "incidents" thrown in).

 

The reason for posting on the Type 1.5 board is because I know this to be a type where the insulin response gives way quickly, in a different manner than Type 2 (do I have this correct?).

Share this post


Link to post
Share on other sites
lottadata
I'm wondering now if there is a combination of LADA and type II. Does an LADA have a normal C-peptide level and a positive antibody test? My C-peptide level was normal last time I had it tested. Just wondering since both of my grandparents had diabetes as young adults and were not overweight.

 

If you have a negative antibody test, normal C-peptide with normal weight and insulin resistance and high post-meal blood sugars can point to MODY, which is another genetic form of diabetes inherited in a dominant fashion (a parent must have it for you to have it, but it may be mild enough in the parent that they elude diagnosis.)

 

Doctors are very ignorant about these kinds of diabetes. You may not find out that you have one until you go on insulin at which time you'll find you only need very low doses of insulin.

 

http://www.phlaunt.com/diabetes/14047009.php discusses this further.

Share this post


Link to post
Share on other sites
Lynne1
If you have a negative antibody test, normal C-peptide with normal weight and insulin resistance and high post-meal blood sugars can point to MODY, which is another genetic form of diabetes inherited in a dominant fashion (a parent must have it for you to have it, but it may be mild enough in the parent that they elude diagnosis.)

 

Doctors are very ignorant about these kinds of diabetes. You may not find out that you have one until you go on insulin at which time you'll find you only need very low doses of insulin.

 

http://www.phlaunt.com/diabetes/14047009.php discusses this further.

 

My doctor wasn't interested in finding out exactly what kind of diabetes I have since the treatment wouldn't change.

Share this post


Link to post
Share on other sites
Funnygrl
My doctor wasn't interested in finding out exactly what kind of diabetes I have since the treatment wouldn't change.

That's a pretty common thought process. My doctor ordered a c-peptide, and siad that even if it is totally normal, I'm staying on insulin and still being treated like type 1. He called me "pseudo type 1, if nothing else."

Share this post


Link to post
Share on other sites
angelic
5. The first sign of MODY may be gestational diabetes in someone of normal weight. In my case, I weighed about 118 when I got pregnant and developed gestational diabetes within the first two months.

 

6. If your mother has the gene you may have a worse case of MODY than if your father has, because you would be the product of a diabetic pregnancy which stresses the developing pancreas.

 

7. Insurance won't cover the genetic testing which costs $500 per gene and there are currently 6 genes that can be tested for. To make it worse, the person at Joslin told me that a large number of people who appear to have MODY won't test positive on any of the current gene tests. The researchers at Joslin are looking for "dozens" of new MODY genes in their current study.

 

Learning about MODY made sense of features of my diabetes which were completely like what I heard other people describe. Exercise and weight loss did nothing for me. In fact, a prolonged period of daily exercise lead to deterioration of my blood sugars. Low carbing at the most stringent level did not completely normalize my blood sugaer. The top dose of Metformin lowers my post prandial blood sugar about 20 mg/dl after a meal but does nothing for my fasting blood sugars. This suggests it is fixing up the normal IR of menopause, but does nothing else. Additional oral drugs did nothing.

 

I respond very strongly to doses of insulin that are more typical of what you'd give a diabetic house cat rather than a person: 4 units a day of basal and no more than 1 unit of Humalog. This is with eating at most 80 grams a day of carbohydrate, with most of the carbs timed to coincide with the insulin peak. Unfortunately, the insulin that just about normalized me is Ultralente, which is discontinued, and none of the analogs gives me anywhere near as good control.

 

Anyway, I hope this is helpful to anyone who finds themselves dealing with a wierd kind of diabetes. Even my endocrinologist wasn't aware of the recent findings about MODY and thought I couldn't have it if neither parent did and my family doctor thought I was nuts when I told him I was hypoing on 6 units of Lantus. (I was. Waking up with sweats, heartbeat of 120 and rebound blood sugar rise.)

 

HI LottaData,

thanks for posting excellent info on MODY. Although I have heard it first time the symptoms match exactly what I have.

1) Diabetes onset at age 24 2nd month in pregnancy.

2) Controlled after child birth with exercise and diet for 5 years.

3) Got on Glipizide 10mg XR - two per day.

4) Currently on Glipizide XR 10mg 1 - a day, Metformin XR 500mg - 2 a day, 15 units of levemir once a day.

I have to visit my endo tommorrow as the post meal sugars are totally bonkers. goes to 300 after two hours and is around 150 fasting next morning.

Your info has been very useful and will talk about MODY to my doc.

Share this post


Link to post
Share on other sites
shanda

This whole thread is incredible! I've learned so much here. I originally looked at this board because I'd never heard of Type 1.5 and meant to come in and ask what it was. Thank you all for the education :)

 

shanda

Share this post


Link to post
Share on other sites
lilituc
Here is a brief summary of what I learned about the latest information about MODY . I have written it up in more detail with citations to the literature at http://www.phlaunt.com/diabetes/14047009.php

 

Thank you so much for posting this. After reading the website, I am starting to think that this fits me pretty well. I was lucky to get an endo who listened to me, so I am pretty well-controlled now, but this could explain why I didn't respond to any of the other, usual treatments they tried. Wonderful information!

Share this post


Link to post
Share on other sites
grace girl

Latent Autoimmune Diabetes in Adults (LADA)

Autoimmune diabetes (Type 1A diabetes) occurring in individuals who are older than the usual age of onset of type 1 diabetes (that is, over 30 years of age at diagnosis). Sometimes, patients with LADA are mistakenly thought to have Type 2 diabetes, based on their age at the time of diagnosis. However, positive antibody tests would help make the diagnosis of LADA.

 

This is what I was told by my endo last month when he decided that I was type 1.5. Originally diagnosed as type 2 (age...I was 32)....then diagnosed as type 1 (c-peptide test results....trace amounts).....

The endo also stated that the fact that I've never had ketoacidosis (it's been 6 years..I'm 38 now) was part of the 1.5 diagnosis. Positive anitbody tests sealed the deal.

Hope perhaps this helps.

Share this post


Link to post
Share on other sites
Goldrun
Strange how the Drs use T1.5 as a defined/accepted category, but try getting your insurance to do so!! My insurance only covers test strips for T1, not T2, and seeing as I'm T1.5 but not yet on insulin, guess who pays for the strips...

 

Maybe we should redefine the categories - if you are a diabetic, you are either insulin dependant or oral-medication dependant/lifestyle management??

 

 

So your doctor gave you a firm diagnosis at T1.5? Maybe he can adjust to help you out with your test strips and insurance. Does that mean you have to pay for your insulin out of pocket too? Gross.

 

I was 37 at diagnosis, when I went to the endo (about 3 mos after being on a 70/30 mix which is what my GP immediately put me on) we had a discussion about what Type I was (my GP didn't label it.)

 

I had all the classic signs of a T-1 except the age....he decided to try me on meds to see if that would affect my bg levels....and it didn't lower them at all. So the assumption is that I'm not making any insulin and am T-1. But I always assumed I was LADA....and didn't realize that is T-1.5.....so now I'm confused.

 

All I know is insulin works for me...pills don't!

Share this post


Link to post
Share on other sites
Goldrun

oh wait dbc...I see you're not yet on insulin....so I'm guessing no one pays for that....sorry for being so unobservant!

Share this post


Link to post
Share on other sites
statdeac

It is outrageous that insurance doesn't pay for strips because you are classed as a T1.5. I was originally mistyped 2, then retyped as 1 due to antibodies. On the forms, they always write Type 1.

 

I would contact you doctor about this and see if they could do the same for you so you could be covered.

 

That your insurance company wouldn't pay for strips for T1 or T2 is shameful IMO.

Share this post


Link to post
Share on other sites

×

Important Information

By using this site, you agree to our Terms of Use.