what is diabetes?

Type one-and-a-half diabetes

Dr. Bill Quick Health Pro March 08, 2009
  • For years, we have had terminology dividing diabetes into subgroups: there's "type 1" and "type 2" diabetes (type 1 is autoimmune diabetes with positive antibodies, typically showing up in children or teenagers, previously called IDDM or childhood-onset diabetes) (type 2 is insulin-resistant diabete...

19 Comments
  • Dr. Fran Cogen
    Health Pro
    Mar. 09, 2009

    Hi Bill: I just wanted to comment re my thoughts about the differences between type 1.5 diabetes and LADA from the pediatric perspective. In our practice at Children's National, we deal with multiple types of diabetes: type 1 (autoimmune), type 1 (idiopathic), type 2, cystic fibrosis related diabetes, medication induced diabetes (steroids, chemotherapy) and...

    RHMLucky777

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    Hi Bill: I just wanted to comment re my thoughts about the differences between type 1.5 diabetes and LADA from the pediatric perspective. In our practice at Children's National, we deal with multiple types of diabetes: type 1 (autoimmune), type 1 (idiopathic), type 2, cystic fibrosis related diabetes, medication induced diabetes (steroids, chemotherapy) and type 1.5 diabetes. We define type 1.5 diabetes as characteristics of both type 1 and type 2 DM. Typically, our patients present phenotypically like type 2 (high BMI, obese, acanthosis nigricans etc.) along with autoimmunity with prescence of GAD-65 antibodies. They even can present in DKA. We try to treat with oral medication such as Metformin after stabilization; but often have to add insulin. So, it would seem to me that LADA would tend to present in the adult population whereas type 1.5 could present in either adult or pediatric patients. Just my thoughts.

    BTW, I love your posts.

    Fran Cogen

    • Ann Bartlett
      Health Guide
      Mar. 09, 2009

      Dr. Cogan,

      How often do you see type 1.5 in pediatrics?  And is it also on the rise?

    • Dr. Fran Cogen
      Health Pro
      Mar. 09, 2009

      Yes, Ann, it appears that type 1.5 is on the rise. These kids often "look" like type 2's in terms of obesity etc and can present initially in DKA.. or not. Upon evaluation of type 2 patients, we will get c-peptides and GAD-65 antibodies if we think they might be a type 1.5. We sort of treat them as hybrid patients: orals and if we must: insulin (usually Lantus...

      RHMLucky777

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      Yes, Ann, it appears that type 1.5 is on the rise. These kids often "look" like type 2's in terms of obesity etc and can present initially in DKA.. or not. Upon evaluation of type 2 patients, we will get c-peptides and GAD-65 antibodies if we think they might be a type 1.5. We sort of treat them as hybrid patients: orals and if we must: insulin (usually Lantus or basal insulin) to start. I believe the rise in type 1.5 patients is associated with the rise in type 2 patients who have autoimmune features.

       

  • Subrata
    Mar. 02, 2012

    Very interesting and informative article.

    I think, we should name primary diabetes as type 1 or type 2 diabetes. If GAD and ICA are positive, then let us call it type 1 diabetes, whatever the age of onset.

    Is there a 'Tertiary diabetes'?

    • Dr. Bill Quick
      Health Pro
      Mar. 02, 2012

      Hi.

      I have not previously heard of "tertiary diabetes." Your definitions of primary and secondary (at http://www.ideaas.eu/health-ideaas_blog.html) are correct.

       

      I Google'd "tertiary diabetes" and come up with several obvious uses: 

      1) a tertiary care center (that is, one that handles referrals of problem cases.

      2) in describing prevention methodology,...

      RHMLucky777

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      Hi.

      I have not previously heard of "tertiary diabetes." Your definitions of primary and secondary (at http://www.ideaas.eu/health-ideaas_blog.html) are correct.

       

      I Google'd "tertiary diabetes" and come up with several obvious uses: 

      1) a tertiary care center (that is, one that handles referrals of problem cases.

      2) in describing prevention methodology, the prevention strategy can be described as Primary, Secondary, or Tertiary Diabetes Prevention.

       

      Hope this helps.

      Bill

      William W. Quick, MD, FACP, FACE

       

      Coming March 26, 2012:

      A fabulous website for people with diabetes to learn and to share. By health professionals. For beginners, experts, and everyone in between! 

      D-is-for-Diabetes

      http://www.D-is-for-Diabetes.com

       

    • Subrata
      Mar. 02, 2012

      Many thanks for your time.

  • Natalie
    Dec. 13, 2011

    Hi, Dr. Quick,

     

    At least one of the replies I saw was from a person who might have MODY. It is now becoming apparent that MODY is not only for the very young, but also appears in middle-aged people, too. Might you consider doing a column on the latest news about MODY?

     

    Thanks,

     

    Natalie ._c-

  • clk
    clk
    Mar. 25, 2011

    Dr Bill, I found the information in the article timely and interesting.  I am still confused about what my type really is.

    Background:  I was diagnosed with T2 in 2004 and was diet controlled for a few months then added metformin, followed by byetta, lantus, and finally humalog.  Skip forward to Sept 2010, I was taking metformin...

    RHMLucky777

    Read More

    Dr Bill, I found the information in the article timely and interesting.  I am still confused about what my type really is.

    Background:  I was diagnosed with T2 in 2004 and was diet controlled for a few months then added metformin, followed by byetta, lantus, and finally humalog.  Skip forward to Sept 2010, I was taking metformin (max dose), byetta 10mcg?? twice a day, lantus 186 units/day, and humalog 28 units/day.  I had a Proximal RNY on 9-10-2010.  I stopped metformin (could not handle taste of crushed pill), byetta, and humalog. Humalog tends now to make me hypoglycemic.  Even my exercise does not seem to lower my bg anymore.  I have been taking Lantus 12 units twice a day.  Now in September before surgery my A1c was 6.0 and (3 months earlier it was 5.8).  Now both in December 2010 and March 2011 it has gone up to 6.6.  My surgeon is concerned about my A1c and says he thinks I may be T1 and not T2 because after the RNY my diabetes should have been better and my A1c should be lower not higher. He is sending notes to my endo dr.   When I had my 5.8 reading I weighed 228 and now I weigh 174.   I will be discussing this in April with my Endo Dr but would like your comment on why my A1c is not going down?  What should I be researching about this issue to be prepared for my April meeting with my endo Dr?   

     

    cindy

  • maggie9701
    May. 01, 2010

    Thanks so much for this article!  I was diagnosed with T2 at the age of 22 (2002).  I had been a College cheerleader and blown out my knee my senior year so all activity stopped while I was on the mend.  Yes I gained weight and was stressed out with a new job and they attributed my T2 diabetes to that.  In July of 09 i found out that my...

    RHMLucky777

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    Thanks so much for this article!  I was diagnosed with T2 at the age of 22 (2002).  I had been a College cheerleader and blown out my knee my senior year so all activity stopped while I was on the mend.  Yes I gained weight and was stressed out with a new job and they attributed my T2 diabetes to that.  In July of 09 i found out that my husband and I were expecting out first child.  in Sept of 09 we lost our first child due to complications with diabetes.  Shortly after the loss I started seeing a great endoconologist.  She did the all the right tests and we found out that I was actually T1.5.  Had we known sooner it could have been prevented, but we have now been cleared to start trying again.  Funny thing is I actually work with several medical professionsals who dont believe me and think I should find another DR.

  • steph
    Mar. 14, 2009

    Just to comment, I was diagnosed with type two in Jan. 2005.   I was 59 years old, and didn't fit the profile of type 2. My AIC just kept going up and I didn't respond much to oral drugs.  I had a heart attack in May 2007. , then started Byetta,  which made me very sick.  The endocrinologist started me on insulin in 2008,and just...

    RHMLucky777

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    Just to comment, I was diagnosed with type two in Jan. 2005.   I was 59 years old, and didn't fit the profile of type 2. My AIC just kept going up and I didn't respond much to oral drugs.  I had a heart attack in May 2007. , then started Byetta,  which made me very sick.  The endocrinologist started me on insulin in 2008,and just now drew blood for GAD antibodies, which were positive. He sent me a copy with the notation: elevated antibodies against the insulin secreting cells of pancreas confirms type 1 diabetes.  I'm glad to know what I am, finally.

     

    My mother was also diagnosed with type 1 at age 50 in 1970 by an endo from the international diabetes center in Minneapolis.  Thanks

  • Anonymous
    Lanar
    Mar. 13, 2009

    I was diagnosed with T2 May of '07 wound up in the ER 07/08 and was told by the ER DR. that I was a T1.5  I thought the DR was crazy at first and then he explained exactly what you said in your article. I have been to the DRs Office many times since the ER and when I am asked what Type I am I say T1.5 and they have said to me there is no such thing, I...

    RHMLucky777

    Read More

    I was diagnosed with T2 May of '07 wound up in the ER 07/08 and was told by the ER DR. that I was a T1.5  I thought the DR was crazy at first and then he explained exactly what you said in your article. I have been to the DRs Office many times since the ER and when I am asked what Type I am I say T1.5 and they have said to me there is no such thing, I am very confused and when thinking of all of the complications I have had in my 38 years I wonder if I have been Diabetic all along.  When ever I went to the DR my Husband would ask if they were going to test me for Diabetes and the DRs would say mind your business she not young enough for T1 and not old enough for T2 and not heavy enough for T2.  I am now on 5 insulin shots per day two shots of levemir and 3 shots of Novolog and I am still having a very hard time. Since I was started on the insulin I am gaining weight. I am very unhappy with the lack of knowledge from the DRs including the Endos

  • Manny Hernandez
    Health Guide
    Mar. 09, 2009

    As a LADA patient, thanks for writing about this very important topic, as LADA tends to be overlooked!

     

    Here is a video about LADA (or type 1.5 diabetes) I did a while back that goes well with your great post.

    • Anonymous
      Anonymous
      Mar. 12, 2009

      I would like to second this comment.  After diagnosis, I must have heard "... but you aren't overweight, how can you have diabetes?" 50 times. If I hadn't had 2 brothers who had been diagnosed with LADA (and 1 brother with childhood onset type 1) , I probably would not have insisted on the antibody test.

    • nannymm
      Mar. 12, 2009

      Both my sister and I, ages 44 and 43, have been diagnosed with Type 2 within the past 3yrs. Neither one of us is obese; in fact we're both quite thin (5'4' and less than 110lbs). I had been diagnosed with gestational diabetes 30yrs ago but that resolved itself after delivery. Neither my sister nor I has ever heard of Type 1.5. We are both well controlled (A1C...

      RHMLucky777

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      Both my sister and I, ages 44 and 43, have been diagnosed with Type 2 within the past 3yrs. Neither one of us is obese; in fact we're both quite thin (5'4' and less than 110lbs). I had been diagnosed with gestational diabetes 30yrs ago but that resolved itself after delivery. Neither my sister nor I has ever heard of Type 1.5. We are both well controlled (A1C less than 5.6)  through diet, excercise and metformin. I also take januvia. Should we request additional testing?

    • Dr. Bill Quick
      Health Pro
      Mar. 12, 2009

      Well, that fits with atypical onset for T2DM, so yes, I think you should talk to your physician about getting diabetes antibody testing (as should your sister!). If your doctor pooh-poohs this idea, perhaps you should ask for a referral to an endocrinologist.

       

      Hope this helps!

    • nannymm
      Mar. 12, 2009

      Thanks, Bill. I will be seeing my doctor next week and will definitely bring this up. She is generally very open to looking at different things so I don't anticipate any problems. Thanks for your input.

    • Davis Skye
      Mar. 16, 2010

      Interesting. I've always felt my diabetes was a little different. Maybe I should push for the GAD test. I've been diagnosed T2 for a little over a year. No weight, chloresterol, blood pressure or other issues. In fact in everyway, save my T2, I'm the poster child of health. My dad has T2, with the other risk factors. I'm managing without Meds at the moment....

      RHMLucky777

      Read More

      Interesting. I've always felt my diabetes was a little different. Maybe I should push for the GAD test. I've been diagnosed T2 for a little over a year. No weight, chloresterol, blood pressure or other issues. In fact in everyway, save my T2, I'm the poster child of health. My dad has T2, with the other risk factors. I'm managing without Meds at the moment.

  • Anonymous
    Scott Strange
    Mar. 08, 2009

    Is there really a physiological difference between T1 and T1.5?  It seems that the main difference that the age of onset is different.  The scenario where a T1.5 goes on insulin a year or so after the inital T2 diagnosis seems pretty analogous to the "honeymoon" period a lot of T1's go thru

    • Dr. Bill Quick
      Health Pro
      Mar. 08, 2009

      You hit on a very important, and argued, point: is T1.5 merely a late-onset version of T1, or is it something different? It's still unclear, but I suspect there are indeed differences in the etiology of T1.5.

       

      Whether the long-term outlook for people with T1.5 is different than for folks with T1 hasn't been addressed, to the best of my knowledge, and...

      RHMLucky777

      Read More

      You hit on a very important, and argued, point: is T1.5 merely a late-onset version of T1, or is it something different? It's still unclear, but I suspect there are indeed differences in the etiology of T1.5.

       

      Whether the long-term outlook for people with T1.5 is different than for folks with T1 hasn't been addressed, to the best of my knowledge, and that seems to be the most important question to me, as well as to folks with T1.5.