Diabetes mellitus, or diabetes, is a disease affecting blood glucose (sugar) levels. An organ called the pancreas creates the hormone insulin, which helps keep blood sugar levels in a healthy range.
With diabetes, the pancreas either doesn’t make enough insulin, or the body doesn’t respond to it well. Without proper insulin function, blood sugar levels rise and can lead to health problems if left untreated.
Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes.
Unfortunately, more than 1 in 4 people with diabetes don’t know they have it. Having undiagnosed diabetes increases the risk of complications from lack of prompt treatment.
Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a major risk factor for eventually developing type 2 diabetes. The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.
The majority of people with diabetes have type 2, which typically affects older adults and can be related to multiple known risk factors, including race, weight, and some lifestyle factors.
Type 1 diabetes is rarer as it’s an autoimmune disorder. There is still another type of diabetes less well-known being called “type 1.5” diabetes.
Type 1.5 symptoms
Type 1.5 diabetes, also called Latent Autoimmune Diabetes in Adults (LADA), is often misdiagnosed as type 2 diabetes at first. This is because it impacts adults, whereas type 1 diabetes typically presents during childhood and teenage years, earning it the name “juvenile diabetes.”
Another subset of type 1.5 diabetes is MODY, which stands for “maturity-onset diabetes of the young” and is quite rare. It impacts adolescents and young adults, whereas the type 1.5 diabetes discussed here is LADA, which usually shows up in adults over the age of 30.
The symptoms of type 1, type 1.5, and type 2 diabetes are all similar because they all result from inadequate insulin production (or insulin resistance), which results in high blood glucose levels. High blood sugar levels aren’t normal or healthy for the body, so distinct symptoms arise when high blood sugar is chronic (lasting a long time).
Type 1.5 diabetes is considered an autoimmune condition that impacts older adults. An autoimmune condition is one in which the immune system mistakenly attacks the body’s own cells. Normally the immune system works to defend against potentially harmful bacteria and viruses such as the flu. However, when the body mistakenly identifies the body’s own healthy cells as foreign, it works to destroy those cells.
In the case of type 1.5 diabetes, the immune system targets the pancreas’ beta cells, which are responsible for producing insulin. Insulin is a hormone responsible for transporting blood sugar from the bloodstream into the cells, where it’s used as fuel for energy. Without enough insulin, blood sugar accumulates in unhealthy levels in the bloodstream, unable to enter the body’s cells.
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Symptoms of type 1.5 diabetes include:
- Excessive urination (polyuria): Elevated blood glucose levels cause an imbalance of dissolved particles in the urine. When there is a lot of sugar in the urine, the body attempts to dilute it by pulling fluid from the body. The result is increased urine volume due to less water being absorbed by the kidney and more being excreted through the bladder. People usually notice polyuria when they wake up several times per night to urinate, especially without increasing their fluid intake.
- Excessive thirst (polydipsia): Excessive thirst is connected to increased urination. When someone is losing more fluids due to increased urination, it can be dehydrating. Dehydration stimulates thirst, which then contributes to the increased urination from increased urine volume. Because the thirst is due to high blood sugar levels and dehydration, drinking more water may not quench thirst as it does in people without undiagnosed diabetes. These two symptoms have a cyclic effect and feed off of each other, worsening both symptoms.
- Unintentional weight loss: Cells require sugar (glucose) for energy; glucose is the preferred energy source over other sources. Cells have insulin receptors, which insulin attaches to in order to let the sugar in. An easier way to think of it is that the cells have doors, the insulin receptors are the doorknobs, and insulin is the key to open the doorknob to allow sugar in to feed the cells.
Without enough insulin to provide glucose to feed the cells, the body starts burning fat and muscle for energy instead. This leads to unintentional weight loss and can also result in increased hunger to try to provide enough energy for the body to function.
- Blurred vision & tingling nerves. High blood sugar can impact the fluid balance in the eyes, which means vision may be blurred. Chronic high blood sugar can also cause nerve damage, also known as neuropathy, which can present as numbing and tingling of the hands and feet.
Risk factors for type 1.5 diabetes
Unlike type 2 diabetes, the causes of type 1 and type 1.5 diabetes are less well-known. Type 1.5 usually impacts people above the age of 30, which is why it’s often misdiagnosed as type 2 at first.
People with type 1.5 may still have some functioning of their pancreas, meaning their body makes some insulin on its own but not enough to keep blood sugar levels in a healthy range.
Some possible risk factors for type 1.5 diabetes include:
- Family history of autoimmune disorders
- Being over the age of 30
People with type 1.5 diabetes often don’t present as overweight or obese. They may have been unable to control their blood sugar levels through lifestyle changes and even the use of some diabetes medications.
Many medications for type 2 diabetes don’t work for people with type 1.5 diabetes because the medications target insulin resistance, which is common for type 2 diabetes but not with type 1.5. Insulin resistance can lead to weight gain, which is why many people with type 1.5 aren’t overweight or obese. They can even be underweight from the weight loss due to high blood sugar.
Diagnosing type 1.5 diabetes
- Hemoglobin A1c: This test measures the average blood sugar over the last 60-90 days. It’s reported in a percentage, with a normal A1c being less than 5.7%. Diabetes is diagnosed with a hemoglobin A1c of 6.5% or higher.
- Fasting blood sugar: Blood sugar is tested when the person hasn’t eaten anything for at least eight hours. A normal fasting blood sugar is below 100 mg/dL. Diabetes is diagnosed when the fasting blood sugar is greater than or equal to 126 mg/dL.
- Random plasma glucose test: A blood sugar level of 200 mg/dL or greater at any time can be used to diagnose diabetes, though most providers prefer to order a hemoglobin A1c as well to ensure it wasn’t a one-time high blood sugar.
- Oral glucose tolerance test: The individual being tested drinks a solution with 75 grams of glucose in it. A blood test measures how much glucose is in the blood 2 hours after consuming the drink. A normal result is 139 mg/dL or lower, whereas diabetes is diagnosed when the result is 200 mg/dL or higher.
- Antibody tests: Because type 1.5 diabetes is considered an autoimmune disease, there are specific antibody tests that can be ordered, including C-peptide, IAA, IA-2A, ZnT8Ab, ICA, GADA, or anti-GAD.
Treatment options
The treatment options for type 1.5 diabetes typically include insulin use since there is very little to no insulin resistance occurring. Other diabetes medications often target insulin resistance or help stimulate the pancreas to release more insulin.
These medications might not work in type 1.5 diabetes since there usually isn’t any insulin resistance present, but rather a true insulin deficiency.
Various types of insulin therapy can be combined for an individually-tailored to create a customized treatment plan. Insulin regimens usually include a slow- or long-acting insulin as well as a combination of intermediate, short- or rapid-acting insulins.
- Long-acting or basal insulin works the slowest out of all of the different insulins. It is usually injected once or twice a day. Long-acting insulin mimics the body’s natural ability to release a very little amount of insulin constantly, like a faucet dripping. Examples of long-acting insulin include Lantus and Levemir. Newer concentrated and ultra-long-acting insulin such as Toujeo, Tresiba, and Basaglar are also considered basal insulins.
- Intermediate-acting insulin treatment works more slowly than fast-acting but is faster than basal insulin. Examples of intermediate insulins are Novolin N and Humulin N, or NPH insulin.
- Short-acting insulins, such as regular insulin, are typically taken around 30 minutes before starting a meal to help with blood sugar levels rising after eating.
- Rapid-acting insulin starts working within 5-10 minutes of being injected, so it’s taken right when starting a meal. If it’s taken too early before eating, it can cause low blood sugar.
Insulin doses can overlap, which increases the risk of hypoglycemia. For example, taking a morning dose of NPH insulin as well as a dose of rapid-acting insulin before lunch can cause a “stacking up” of insulin levels in the body.
Many people with type 1 diabetes utilize insulin pumps that deliver insulin under the skin. Depending on the individual and insurance coverage, some people with type 1.5 diabetes may opt to use an insulin pump to manage their diabetes.
Outlook
People with type 1.5 diabetes can live a healthy life, just as people with type 1 and type 2 diabetes can. Managing blood sugars is the best way to prevent diabetes complications, so maintaining a good diabetes care plan is essential for promoting health and wellness.
People with type 1.5 diabetes are encouraged to have a series of regular health tests and checkups to get an accurate picture of their overall health and help reduce the likelihood of developing complications. The following tests are recommended for people with type 1.5 diabetes:
- Microalbumin: This test measures protein in the urine, which is a sign of kidney damage. It’s recommended to check for microalbuminuria at diagnosis and then annually for type 2 diabetes. For type 1 diabetes, it should be tested 5 years after diagnosis and then annually. There are no specific guidelines for the frequency of this test for type 1.5 diabetes, so it should be discussed between the person with diabetes and their healthcare provider.
- Hemoglobin A1c: The American Diabetes Association (ADA) recommends checking the A1c at least twice yearly for those meeting blood sugar goals and quarterly for those not meeting blood sugar goals.
- Cholesterol and blood lipids: People with diabetes often have elevated cholesterol levels and an increased risk of heart disease. Therefore, it’s recommended to have a cholesterol screening annually in those with diabetes.
- Eye exam: Having diabetes increases the risk of retinopathy, which damages the eye vessels. Retinopathy can increase the risk of blindness. For type 1 diabetes, a dilated eye exam is recommended 5 years after diagnosis and then annually. For type 2 diabetes, it’s recommended at diagnosis and then annually.
- Foot exam: According to the ADA, patients with diabetes should have their feet inspected during every visit to assess signs of neuropathy and other complications. However, healthcare providers may only perform foot checks annually.
- Comprehensive health exam: People with diabetes should visit with their healthcare provider for a preventative visit at least annually, similar to people without diabetes.
- Routine blood glucose monitoring: Depending on the type, severity, and duration of diabetes, different regimens for checking your blood glucose level at home exist. Some people with diabetes may not check their blood sugar at home, whereas people with type 1.5 diabetes may check their blood sugar more frequently, especially when they’re on insulin. Blood sugar levels are checked at home using a glucometer kit, which uses a fingerstick blood sample versus a venous blood draw at a doctor’s office.
If any issues are detected with regular screening tests, referrals are often made to specialists for further treatment or medication.
Some examples of common specialists for diabetes-related referrals include nephrologists for kidney health, dermatologists for skin health, cardiologists for heart health, endocrinologists for more fine-tuned insulin adjustments and tests, and ophthalmologists for eye concerns.
Conclusion
Type 1 diabetes is an autoimmune disease that destroys the pancreas’ beta cells, leading to high blood sugars. It typically affects people during childhood, leading to its being called juvenile-onset diabetes. Type 2 diabetes is usually caused by a combination of lifestyle factors and genetics and usually is a result of insulin resistance.
Type 1.5 diabetes, or “Latent Onset Diabetes in Adults” (LADA), is often mistaken for type 2 diabetes because it impacts people in their adult years, usually after age 30. Type 1.5 diabetes is a result of the immune system falsely mistaking healthy human cells as foreign and attacking them, leading to the destruction of the pancreas’ beta cells.
Some of the ways type 1.5 sets itself apart from type 2 are that people impacted by type 1.5 are often not overweight or obese but can instead be thin from the weight loss associated with high blood sugars and limited to nonexistent insulin production. People with type 1.5 diabetes usually aren’t impacted by insulin resistance, which is one of the reasons people with type 2 diabetes tend to be overweight.
Similar to type 1 and type 2, type 1.5 diabetes can be effectively managed through routine healthcare checks and other aspects of a customized diabetes self-management plan to promote health and wellness.
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