Unmasking Type 1.5 Diabetes

You’ve heard of type 1 and type 2 diabetes, but did you know there is another “type?” It’s called type one-and-a-half (1.5), or LADA, which stands for latent autoimmune diabetes in adults. The reason it’s 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 aren’t 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.

Based on my training and experience, I usually prescribe a long-acting insulin to my patients with type 1.5, and it is taken once a day. Some studies suggest this approach slows down the progression of the disease.

If someone has not been diagnosed, they can progress quickly to complete insulin deficiency with complications, such as diabetic ketoacidocis. This is a potentially life-threatening condition where the body is no longer making insulin and blood sugar levels are very high. The body then starts breaking down fats to produce energy, which causes ketones (a type of acid) to be collected in the body.

Common symptoms of any type of diabetes are excessive thirst and excessive urination, and some people may experience vision disturbances because of the effect variations in blood sugar levels has on the eyes. The difference with symptoms of type 1.5 is that the person might be thin or have had unexplained, drastic weight loss and doesn’t have a family history of diabetes; those symptoms are not typical of type 2.

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.