DIABETIC LIFESTYLE
- on 04.30.09
- diabetes, type 1.5 diabetes, type I diabetes, type II diabetes
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By Adam Garcia
A NEW Type of Diabetes-Slow Onset Type 1
Type 1.5 is one of a number of names now applied to those who are diagnosed with diabetes as adults, but who do not immediately require insulin for treatment. They are often not overweight and have little or no resistance to insulin. When special lab tests are done, they are found to have antibodies, especially GAD65 antibodies that attack their beta cells. This sort of diabetes is sometimes called Slow Onset Type 1, Type 1.5, or Latent Autoimmune Diabetes in Adults or LADA.
About 20% of people diagnosed as Type 2 actually have Type 1.5. They are often diagnosed as Type 2 because they are older and will initially respond to diabetes medications because they have adequate insulin production. The usual treatment is diet, exercise, and standard Type 2 medications.
Since insulin resistance is minimal or non-existent, medications designed to reduce insulin resistance such as Avandia and Actos are not effective. Other medications that stimulate the pancreas to produce insulin, slow digestion of carbohydrates, or reduce excess glucose production by the liver are often effective in controlling the blood sugar for a few years.
One study in Italy, published in the October, 1998, issue of Diabetes, found that 84% of the people diagnosed as Type 2 had insulin resistance, but the other 16% did not, suggesting these individuals had Type 1.5. Several other studies have shown similar results, and these studies also often show the presence of antibodies, especially those against glutamic acid decarboxylase or GAD, characteristic of Type 1 in this group of people diagnosed with Type 2.
Knowing your diabetes type can give you a better understanding of the changes that may occur to you as you age and your disease progresses. For example, if you have had insulin-resistant diabetes for several years that has become harder to control on a sulfonylurea medication and your C-peptide level, a lab test that measures insulin production, is now low, the addition of insulin will be needed. But if your control is poor and your C-peptide is normal, adding another oral agent and paying closer attention to your food and exercise choices may be all that’s needed.
In the late 1990′s, Dr. David Bell wanted to see if he could eliminate insulin use in a group of people with Type 2 diabetes who were already on insulin by using a combination of oral medications. These people often had been put on insulin without first trying oral medications because today’s array of medications was not available when they were diagnosed.
Dr. Bell first tested C-peptide levels and chose only those who had normal levels. 100 of the 130 people with adequate C-peptide levels in his study was able to discontinue insulin use altogether and control their diabetes on various doses of glyburide and metformin. He found that their overall control, measured by their HbA1c levels, was actually better on two oral medications than it had been previously on two daily doses of insulin.
Researchers have determined that the Type 2 patients most likely to control their blood sugars on combination oral agents are those least overweight (BMI of 30 or less), with shortest duration of diabetes, and C-peptide levels normal or only slightly low.
As insulin production falls, insulin becomes necessary to maintain control. One clue that people have Type 1.5, rather than Type 2, is their appearance, which is more likely though not always slender and physically fit. They often do not have other signs of Type 2 diabetes, such as low HDL or high blood pressure. Fortunately, in these early stages, diabetes treatment is not significantly different for Latent Autoimmune Diabetes in Adults or LADA compared to truly insulin-resistant Type 2 patients. The only exception is that drugs designed to increase insulin sensitivity like the glitazones do not work because insulin sensitivity is normal.
One major benefit to this type is that when their blood sugars are controlled, people with Type 1.5 usually do not have the high risk for heart problems more often found with the high cholesterol and blood pressure seen in true Type 2 diabetes.
If you have any questions about this topic or a comment please leave a reply below or email us at diabeticcookbook@gmail.com.





