|
[ Diabetes Archive ] [ Main Archives Page ] [ Glossary/Index ] [ FAQ ] [ Recommended Books ] [ Bulletin Board ] |
Search this site! | |
Types of Diabetes
What Type You Have Type 1 Type 1.5 Type 2 Pre-Diabetes Syndrome X
--------------------------------------------------------------------------------
Type 1.5 Diabetes
aka Slow Onset Type 1 and LADA
Type 1.5 is one of several names now applied to those who are diagnosed with diabetes as adults, but who do not immediately require insulin for treatment, 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 or Latent Autoimmune Diabetes in Adults or LADA.
About 15% to 20% of people diagnosed as "Type 2" actually have this type. 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 treatment the person is first put on may be 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 meds that stimulate the pancreas to produce insulin, slow digestion of carbs, or reduce excess glucose production by the liver are often effective in controlling the blood sugar for a few years.
One study done in Bruneck, 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.
A misdiagnosis is easy to make when the person is older and responds well at first to treatment with oral medications. If someone does not clearly fit the model for Type 1, they may be mistakenly placed on oral agents even though limited capacity for insulin production remains. The immune system's slower and more selective attack on the beta cells allows these cells to function to a high degree for a few years. On average, insulin is required in half of those with Type 1.5 diabetes within four years of diagnosis, compared to over ten years in those with true Type 2 (Endocrine Practice, v7 n5, Sept/Oct 2001, pgs 339-345).
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, a clinician and researcher in Birmingham, Alabama, 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 were not available when they were diagnosed.
Dr. Bell first tested C-peptide levels and chose only those who had normal levels. Of the 130 people with adequate C-peptide levels in his study, 100 were 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. Others in the study were able to improve their hemoglobin levels by using glyburide and metformin with a single dose of insulin at dinner or bedtime.
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 the Syndrome X cluster of high TGs, low HDL or high blood pressure. Luckily, in these early stages, diabetes treatment is not significantly different for slow-onset Type 1s compared to truly insulin-resistant Type 2s. 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.
In Reply to: DIABETES- type one and a half !!! posted by ANN [1003.516] on June 26, 2005 at 13:24:21:
My parent's were told, in the early 80's, when my father was diagnosed with diabetes, that stat's show that 50% of his children will develop it.
Is this true?
In Reply to: DIABETES- type one and a half !!! posted by ANN [1003.516] on June 26, 2005 at 13:24:21:
Do you think that could be the underlying situation with women who are thin women with the prediabetic PCOS?
In Reply to: DIABETES- type one and a half !!! posted by ANN [1003.516] on June 26, 2005 at 13:24:21:
This is very interesting. My husband was diagnosed with Type II about 5 yrs. ago. We think that he had probably had it for some time. For about a year or more, he controlled it pretty well with just diet and exercise. Then he was put on Metformim because it was beginning to be harder to control. About 6 mos ago he was put on Starlix as his levels were not what the doctor felt were good. He is not overweight and exercises (weights and cardio, plays golf) religiously. He eats fairly well, but sometimes cheats. I had read that the Starlix was actually not good because it would eventually cause his pancreas to stop producing insulin. He was a little overweight when he was younger so has the typical build which tends to gain weight in the middle;however, he is almost a little too thin now. I have noticed since he went on Starlix that his weight has gone up a little especially in the midsection. He also experiences readings or 140-160 in the early morning. (dawn phenomena) It might appear that he may be one of these types that is described here.
In Reply to: Q for you posted by Michele [6.829] on June 26, 2005 at 13:46:34:
can't remember if it's one or two parents with type 2 that mean there's a 50% chance of the kids getting it. Type 2 is the lifestyle one. You have some control over whether you get type 2, starting with keeping your weight near what's considered normal. Read The Glucose Revolution, and avoid high glycemic effect foods.
Type 1 and 1.5 are the viral, auto-immune type. Those types don't general run in families. And there's not alot you can do to prevent it. Take B vitamins if you're stressed and get checked for celiac disease if you're super thin, then avoid gluten if you have celiac. No other possible preventatives known yet.
I'm assuming your dad had type 2?
In Reply to: Re: DIABETES- type one and a half !!! posted by P [6.1841] on June 26, 2005 at 13:49:26:
don't know-best indicator might be getting yourself checked for antibodies to pancreatic islet cells- it's thought that might be the indicator that you're on the way to type 1.5
In Reply to: Re: DIABETES- type one and a half !!! posted by Cindy [1744.1351] on June 26, 2005 at 14:02:14:
don't know how old your husband is, but some adults are being mis-daignosed with type 2. I read about several of them in a type 1 community on the internet. They received the right diagnosis after being tested for antibodies to pancreatic islet cells. One mentioned also being tested for c-peptide in the rocess of the new diagnosis.
In Reply to: Re: Q for you posted by ANN [1003.516] on June 26, 2005 at 20:15:48:
I'm not sure; he didn't get it until he was in his 50's...and it was mostly due to his weight (which wasn't all that high to be honest..maybe 20 pounds over)
In Reply to: Re: Q for you posted by Michele [15.829] on June 26, 2005 at 22:44:18:
PROBABLY type 2, but hard to say- ots of adults are being diagnosed with type 2 and, later, when treatment proves to be ineffective, are found to have type 1 (now called 1.5, if diagnosed in adulthood and having pancreas stopping producing insulin instead of insulin resistance. If he got good control of his blood glucose levels with oral meds instead of insulin, he'd definitely be a type 2, otherwise , hard to say- have both your parents passed on? Aunts or uncles might know what he had (or you might be able to legally access medical records of deceased parents, I don't know (even if the doctor doesn't give you full records, he might answer specific questions like if your dad was type 2 (again, though, diagnostics is changing-no one tested presumed type 2's for type 1 until recently, because there wasn't a test they could do. And it's also possible for a person to have type 2 and develop type 1, since it's probably viral. One possibility for type 1 is that it's viral and lies latent until there's a lot of stress and/or impaired nutritional status (which can happen from stress, celiac, or other causes). Pertussis, rubella, and mumps vaccines are possible varil causes- not sure if any of those vaccines can give the child a contagion to pass along to older people (I know polio and smallpox vaccines can).
In Reply to: DIABETES- type one and a half !!! posted by ANN [1003.516] on June 26, 2005 at 13:24:21:
Thanks, Ann.
From a syndrome X person.
Walt
In Reply to: Re: DIABETES- type one and a half !!! (Archive.) CLASSIFICATION. posted by Walt Stoll [93.1889] on June 27, 2005 at 08:34:00:
Calvin and Agatha Thrash, MDs, in their book, Diabetes and the ypoglycemic Syndrome, refer to it as "Accelerated Aging Syndrome" and basically suggest that earlier puberty is part of this and intimate that this will also mean earlier death. They attribute earlier puberty to the increasing proportion of refined carbs in the diet, cite stats on peoples who had a rapid change in diet- Yemenite Jews who moved to Israel en masse, pacific islanders who started trading with the west as a result of WW2, and Eskimos whose diet changed due to opening of an Alaskan highway. They said eskimo girls went from age 19 to age 13 onset of puberty in about 15 years after diet change.
The 'early puberty leading to earlier death' seems sensible, from a common sense viewpoint. Does it make any sense from a medica viewpoint.
The Thrashes are Adventists, so they promote veg eating, but I had to wonder, since the 3 societies they named were all fish eaters, whether the reduction of fish oil in the diet as these people ate more carbs would also be contributory to their earlier puberty and changing health status (the Yemenite jews had a big increase in type 2 diabetes, after being on an Israeli diet for a while (I don't know off hand wat Israelis eat, but, since it was largely settled by Ashkezani jews from Europe, I would expect it to be a fairly western diet-don't know, but Thrashes said it was higher in refined carbs.
In Reply to: Re: Q for you posted by ANN [1003.516] on June 27, 2005 at 07:45:30:
He was on pills but was able to go off after about 2-3 years, and it was controlled well.
Later, when he got cancer and was on hospice, his sugar went through the roof (years, years later..over 18-25 years had lapsed)
In Reply to: Re: Q for you posted by Michele [20.829] on June 27, 2005 at 20:57:35:
a type 2 who loses weight can sometimes eiminate meds and ust be controlled by diet.
A rarer cause of diabetes is damage to the pancreas that causes it to stop producing insulin, or lose of the pancreas (like from cancer or from a car accident). If your dad's cancer happened to be pancreatic, he might've developed type 1 (besides his type 2) from that cause.
In Reply to: Re: DIABETES- type one and a half !!! (Archive.) CLASSIFICATION. posted by ANN [1003.516] on June 27, 2005 at 10:51:02:
Thanks, Ann.
The proof of what you say here started with the studies of the military on Guam, during and after the second world war.
Walt
|
[ Diabetes Archive ] [ Main Archives Page ] [ Glossary/Index ] [ FAQ ] [ Recommended Books ] [ Bulletin Board ] |
Search this site! | |