Other Forms Of Diabetes
Other types of diabetes besides classical T1DM and T2DM also exist. A third form of diabetes often exists that has been called variably T1.5 diabetes mellitus , double diabetes or LADA, latent autoimmune diabetes in adults. This can also occur in adolescents. This is sometimes thought to be a combination of obesity-related T2DM but with more insulin deficiency and some -cell autoimmunity . Such patients can present with incidental hyperglycaemia or insulin resistance or even in DKA. They seem to require insulin at diagnosis more like T1DM patients but are not as thin and emaciated, respond more quickly to DKA management and may come off insulin therapy and change to oral hypoglycaemic agents like metformin for quite some time if they can manage some weight loss with a balanced nutrition and increased activity each day. They also seem to eventually need insulin sooner than others with more classical, older-onset T2DM. In populations with larger African, Asian, Latino or indigenous ancestry either in their countries or continents of origin or in whatever land they currently reside, T1.5DM and T2DM are increasing in prevalence.
Diabetes associated with severe malnutrition also occurs . This group includes fibrocalculous pancreatic diabetes.
Joel Faintuch, Salamao Faintuch, in, 2020
How Much Damage Have Your Beta Cells Accumulated Over Time
Knowing how much damage has been done to your beta cells over time is an important determinant of whether your body requires exogenous insulin or not.
If your beta cells are still functioning properly, a low fat, plant-based, whole-food diet combined with frequent exercise and adequate sleep can help you achieve non-diabetic blood glucosewithout the need for medications or insulin injections.
If your C-peptide test reveals significant destruction of your pancreatic beta cells, it is unlikely that you will be able to achieve non-diabetic blood glucose values without the use of exogenous insulin, regardless of how strict you are with your diet and exercise regimen.
If you have been diagnosed with type 2 diabetes on the assumption that you are insulin resistant, even though your C-peptide value was never measured, then taking a C-peptide test can help you avoid unnecessary oral diabetes medications and years of unnecessary side effects.
Are You Living With Autoimmune Diabetes
If you are living with an autoimmune version of diabetes , then your C-peptide value will most likely be significantly lower than if you are living with prediabetes or type 2 diabetes.
But what exactly is type 1.5 diabetes? Type 1.5 diabetes is increasing in prevalence around the world, and often referred to as Latent Autoimmune Diabetes in Adults .
Once considered rare conditions, type 1 diabetes and LADA have been on the rise since the 1950s .
Living with type 1.5 diabetes means that your pancreas is still capable of producing insulin, but the presence of one or more autoantibodies against beta cells leads to a slow destruction of beta cells over time.
LADA has characteristics of both type 1 diabetes and type 2 diabetes and is often misdiagnosed as other forms of diabetes, resulting is the wrong treatment .
It is currently unknown how many type 1.5 patients are misdiagnosed with other forms of diabetes, but some estimate it could be as many as 1 out of every 10 diabetes patients , and some researchers believe that type 1.5 diabetes is the most prevalent form of autoimmune diabetes in general .
Its important to note here that medical scientists are now recognizing that type 1.5 diabetes is not really one type of diabetes. The condition occurs on a spectrum and each patient must be treated as an individual and not as a generic type.
It turns out that people with LADA are often misdiagnosed with type 2 diabetes for three main reasons:
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Type 15 Diabetes Treatment
Type 1.5 diabetes results from your body not producing enough insulin. But since its onset is gradual, oral medication that treats type 2 diabetes can work, at least at first, to treat it.
People who have type 1.5 diabetes also may test positive for at least one of the antibodies that people who have type 1 diabetes tend to have. As your body slows down its production of insulin, youll need insulin as part of your treatment. People who have LADA often require insulin within five years of diagnosis.
Insulin treatment is the preferred treatment method for type 1.5 diabetes. There are many different types of insulin and insulin regimens. The dosage of insulin that you need may vary daily, so monitoring your glucose levels through frequent blood sugar testing is essential.
Type 15 Diabetes Screening
Some researchers suggest screening anyone newly diagnosed with type 2 diabetes for GAD antibodies. In the United Kingdom Prospective Diabetes Study , most study subjects with type 2 diabetes between 35 and 45 years old who tested positive for antibodies against both GAD and islet cells progressed rapidly to insulin dependency. Some researchers have also suggested that anyone who tests positive for GAD antibodies be screened for autoantibodies to thyroid and adrenal cells, because like people with type 1 diabetes, people with type 1.5 diabetes seem to be at higher risk of having other autoimmune diseases.
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Causes Of Type 15 Diabetes
No one knows exactly why antibodies which normally guard against foreign invaders decide instead to destroy the body’s own insulin-producing cells. Genetics plays a role in all forms of diabetes. The first genome-wide association study of type 1.5 diabetes found that the genetic signature overlapped both type 1 and type 2 diabetes but had more in common with type 1 than with type 2.
Even when genes are involved, an environmental trigger usually sets the process in motion, regardless of what the disease is. “You have to have the right genetic predisposition, but something has to set your immune system off on a course to destroy the cells that make insulin,” explains Dr. Buse. “It’s unclear what those are.”
Researchers have discovered links with weight gain, viral infections and stress but nothing is certain. It’s also possible that type 2 diabetes morphs into type 1.5. “Some patients with type 2 diabetes who are not well-controlled for. Years may develop ‘beta cell burnout’ over time where their pancreas produces less insulin,” says Deena Adimoolam, MD, a specialist in endocrinology and preventative medicine in New Jersey.
Type 15 Diabetes: Similarities And Differences To With Type 2
Aside from the metabolic impact, type 1.5 diabetes resembles type 2 when it comes to symptoms, which include excessive thirst, frequent urination, weight loss, and blurred vision.
Type 1.5 typically occurs in people over 30 years old. Although the most common age group for a type 2 diabetes diagnosis is 45 to 64, the prevalence amongst young adults is increasing, so the difference in typical age-of-onset between the two variations is getting smaller.
In a clinical environment, it is easy to see how a person over the age of 30, reporting the previously mentioned symptoms, and whose blood sugar levels are high, might be diagnosed with type 2 diabetes. Especially if that person happens to tick other boxes for risk factors associated with type 2, such as being overweight, having high blood pressure, and high cholesterol.
An estimated 10% of type 2 diagnoses are actually type 1.5. That figure is believed to be as high as 25% in people diagnosed with type 2 diabetes between 25 and 35 years old.
Perhaps the most famous misdiagnosis was that of British Prime Minister, Theresa May. Mrs. May Home Secretary at the time was diagnosed with type 2 diabetes in 2013, aged 56. Her diagnosis was changed two months later after she did not respond to treatment.
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Type 15 Diabetes Prevention
Like type 1 diabetes, there is currently no research that consistently shows how type 1.5 diabetes can be prevented. However, certain individuals are more likely to develop type 1.5 diabetes than others.
In the case of type 1.5 diabetes, the best prevention is preparation. Whether this type of diabetes onsets or not, the goal is to keep your body insulin sensitive for as long as possible.
This is best done by avoiding conditions like prediabetes, keeping an ideal BMI, and calibrating your diet and lifestyle for insulin sensitivity. In this way, if you do develop type 1.5 diabetes, you are already in ideal health, and able to immediately control your blood glucose and insulin use easily.
With proper diet and lifestyle strategies, type 1.5 diabetes is a chronic condition that can be effectively and easily managed.
Diagnosing Type 15 Diabetes
Caraline McLeod wasn’t the only one surprised by tests confirming she had an uncommon type of diabetes she’d read about on the internet.
I’d heard there was a new woman GP in town, so, at my doctor-husband’s urging, I booked an appointment for a routine check-up. I was feeling well and had no need to suspect anything was amiss.
The GP detected nothing out of the ordinary and, with the exception of slightly elevated cholesterol levels, my blood tests came back normal. My GP told me to try to lower my cholesterol levels with diet and exercise and she’d see me again in six months.
I embarked upon a calorie-controlled, low-fat diet and worked out most nights for 45 to 60 minutes on my treadmill and weights machine. I was feeling fit and healthy and was close to my ideal weight when the time arrived for my follow-up visit.
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What Is The Difference Between A Fasting And Stimulated C
There are two types of C-peptide tests:
- Fasting C-peptide test, performed after an overnight fast of at least 8 hours, and before any food or non-water beverages are consumed
- Stimulated C-peptide test, used to measure the amount of insulin your pancreas is capable of manufacturing in response to a high-carbohydrate meal
The fasting C-peptide test is self explanatory. A stimulated C-peptide test can be performed in one of 3 ways:
- Method #1: Drink a mixed meal shake, which is a standardized liquid meal
- Method #2: The patient receives an injection of glucagon
- Method #3: Eat a high-carbohydrate meal or drink containing at least 75 grams of carbohydrate energy
The purpose of the stimulated C-peptide test is to measure how much insulin your pancreas produced in the hour after a carbohydrate challenge. The amount of C-peptide in your blood reveals how effective your pancreas is at secreting insulin and C-peptide in response to rising blood glucose.
The Immunology of Diabetes Society currently recommends using both the fasting and stimulated c-peptide tests at diagnosis and annually .
Reference ranges for the stimulated C-peptide test are shown below .
Type 15 Diabetes: Similarities And Differences To Type 1
Type 1.5 is also referred to as latent autoimmune diabetes in adults or simply adult-onset type 1 diabetes.
As both terms suggest, type 1.5 diabetes is similar to type 1 insomuch as it is an autoimmune disease that destroys the beta cells that produce insulin. In fact, some researchers consider type 1.5 to be a subtype of type 1.
A recent study investigating the genetic make-up of type 1.5 diabetes found the strongest genetic signals in LADA were mainly shared with established variants known to be linked to type 1 diabetes.
While the mechanisms of type 1.5 resemble that of type 1, it can take between two and six years for an individual to become insulin-deficient and possibly require insulin treatment. This is much slower than type 1 typically progresses.
During that period a careful diet and healthy lifestyle may suffice in controlling blood sugar levels.
The study also found evidence that variants of a gene linked with type 1.5 impacts metabolism, which is a key marker of type 2 rather than type 1.
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What Are The Symptoms Of Lada
The symptoms of LADA are the same as type 1 and type 2 diabetes:
- passing urine a lot
- getting really tired
- getting thinner.
But they generally come on much slower than they do with type 1, over months rather than weeks. And the symptoms are more obvious and often come on more quickly than youd expect with type 2.
And whereas being overweight is a major risk factor for type 2 diabetes, people with LADA tend to have a healthy weight.
Unmasking Type 15 Diabetes
Youve heard of type 1 and type 2 diabetes, but did you know there is another type? Its called type one-and-a-half , or LADA, which stands for latent autoimmune diabetes in adults. The reason its called 1.5 is because it shares features with both type 1 and type 2, but is somewhere in between. The patient is not obese or overweight, and there is no significant family history, both of which are typically associated with type 2.
Most of the time, patients I suspect who have type 1.5 have been diagnosed with type 2 diabetes but arent responding well to oral medications that are usually prescribed for type 2. In fact, some of these medications might worsen their condition if they are the type that stimulate the pancreas, the organ that secretes insulin, to create more insulin. This would cause the patient to become dependent on insulin more quickly. Statistics tell us within 5 to 10 years they may progress to full insulin requirement, which is what we see with type 1.
In these cases, I will screen the patient with a simple blood test to check them for antibodies. LADA includes the term autoimmune in its name, which means the body is making antibodies against the pancreas. The antibodies cause a slow destruction of the cells in the pancreas that create insulin, which in turn leads to relative insulin deficiency.
If you are experiencing any of the above symptoms or have concerns about your health, be sure to schedule an appointment with your healthcare provider.
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The Danger Of A Misdiagnosis
Taking all of the above into account, the name type 1.5 diabetes seems entirely apt, as the condition shares characteristic of both type 1 and 2. It is pathologically closer to type 1, but clinical features resemble type 2.
This is a dangerous combination. A 2013 study found mortality in type 1.5 was as high as in type 2, despite those living with it having a favorable risk profile.
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The researchers attributed the results to poor glycemic control in people living with type 1.5. In particular, this increases the risk of cardiovascular diseases.
While a consensus on the ideal treatment model for type 1.5 is yet to be reached, it will differ significantly to typical treatment for type 2. Healthy lifestyle changes and medication such as metformin may have a seemingly positive effect in the short-term. As the disease progresses, and insulin levels are depleted, however, it soon becomes ineffective.
Lack of effective treatment will likely result in worsening symptoms and could even lead to potentially life-threatening ketoacidosis, which is caused by excessively high blood sugar and ketones. The symptoms may eventually lead to a correct diagnosis, but in the meantime significant damage can be caused.
Correct treatment from the beginning helps those living with type 1.5 manage blood sugar levels effectively and mitigate the risk of complications.
How Is Mody Diagnosed
If a blood sugar test shows you have diabetes, a doctor might suspect that you have MODY for reasons such as:
- You were diagnosed with diabetes in adolescence or early adulthood.
- You have several generations of people in your family who have had diabetes.
- You don’t have the typical features of type 1 or type 2 diabetes such as obesity or high blood pressure.
Your doctor may suggest you get a genetic test to confirm you have MODY. This is usually done with a blood or saliva sample that gets checked in a lab.
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Influences On Mental And Physical Health
There are many factors that can influence mental and physical health, especially in terms of type 1.5 diabetes. Some of these factors include socioeconomic status , culture, ethnicity, gender, and spirituality. See the current state of diabetes rates. Is there a connection between SES and diabetes? That answer is largely unknown. While there is no clear cut evidence at this time that the two are related, what is known is that individuals with a lower SES are less likely to go to their yearly check-ups, they are less likely to comply with their medications, and their health suffers the consequences of these actions . “Culture, unlike instinct, is learned is distributed within a group in that not everyone possesses the same knowledge, attitudes, or practices enables us to communicate with one another and behave in ways that are mutually interpretable and exists in a social setting” . It is known that childhood obesity is a predisposing factor of diabetes. The culture that a child grows up in may lead them to this unfortunate outcome. Ethnicity and environment also play a similar role. When tied in with SES, it is easy to see how a child can be predisposed to the disease. The American Diabetes Association states that, “the reasons for the differences in prevalence of childhood obesity among groups are complex, likely involving genetics, physiology, culture, socioeconomic status , environment, and interactions among these variables as well as others not fully recognized” .
Symptoms Of Type 15 Diabetes
There are usually no symptoms in the beginning of type 1.5. That’s because the beta cells are destroyed so gradually, life seems to continue as normal. Adults diagnosed with autoimmune diabetes usually develop symptoms when they’re down to about 10% of the normal number of beta cells, says Dr. Buse.
Once symptoms do appear, they are similar to those for other forms of diabetes. “They’re all related to high levels of blood glucoseâblurred vision, increased urination, increased thirst, increased yeast infections , weight loss, feeling hungry and feeling tired,” says Dr. Adimoolam.
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The first symptom of type 1.5 and type 1 can be diabetic ketoacidosis , when stratospherically high blood sugar levels lead to dangerously high levels of acid in your bloodstream.
Long-term complications of diabetes are also similar for all forms of diabetes and include heart disease. People with type 1.5 or adult autoimmune diabetes are more likely to develop microvascular complications such as neuropathy. Diabetes complications in general, says Dr. Buse, “generally develop over decades.”
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