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Author Topic: Diabetes Type 1.5 !  (Read 3863 times)

Yowbarb

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Diabetes Type 1.5 !
« on: March 06, 2013, 07:04:41 AM »

Yowbarb

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Re: Diabetes Type 1.5 !
« Reply #1 on: March 06, 2013, 07:22:37 AM »
Pls Note: I am not an expert in Diabetes.
My second oldest daughter was diagnosed with diabetes last year and it was something I needed to learn more about. The only diabetes I knew of in our family was my aunt, and that hit her in her early 60s.
My daughter's father we do not think is alive and we do not have his medical history so I assumed she inherited it from him...but it was a little bit puzzling.
I had just been thinking about the fact it hit her in her thirties...then soon thereafter she found this website and this article! I think this will help some people.
- Yowbarb   BTW putting the long artilce in tiny print but if you print it out you can always increase the type size as you do.

Site Main page:
  http://www.diabetesnet.com/welcome

Article page:  http://www.diabetesnet.com/about-diabetes/types-diabetes/what-type

Yowbarb

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Re: Diabetes Type 1.5 !
« Reply #2 on: March 06, 2013, 07:23:10 AM »
Site Main page:  http://www.diabetesnet.com/welcome

Article page:  http://www.diabetesnet.com/about-diabetes/types-diabetes/what-type

What Type of Diabetes Do I Have?

When you were diagnosed, you were probably told you had either Type 1 or Type 2 diabetes. Clear-cut and tidy. Since diabetes occurs in two types, you have to fit into one of them. Many people do fit clearly into one of these categories, but some do not. Those who clearly fit a type at diagnosis may find the clear lines begin to smudge over time. Are there really only two types? Are you really the type you were told you were? Could you even have more than one type of diabetes, and is your original diagnosis still correct after all these years?
 
A Short History Of Types
 
Described and treated since ancient times, diabetes has certain characteristics that have long been recognized. Before the discovery of insulin, people found to have sugar in their urine under the age of 20 usually died in their youth, while those diagnosed when over the age of 40 could live for many years with this condition.
 
Beginning in the mid 1920s, those who got diabetes when young (juvenile onset) were put on insulin, and those who got it when older (adult onset) often were not. However, the mechanisms that led to this difference in treatment were unknown. The only marker that differentiated the two types at that time was the presence in the urine of moderate or large levels of ketones when blood sugars were high. If significant ketones were present, the person could not make enough insulin, needed injected insulin to control the blood sugar, and was called insulin-dependent.
 
In the early 1980s a breakthrough was made in understanding childhood onset diabetes. It became clear that this early onset form was actually an autoimmune disease in which the body destroyed its own beta cells. The antibodies that the immune system put out during this attack distinguished it from adult onset diabetes. For the first time, one type of diabetes had a clear cause that made it different.

Definitions became clearer. Type 1, called IDDM (insulin-dependent diabetes mellitus), now was recognized as an autoimmune disease that appeared primarily in childhood or adolescence. Near the final phases of the attack, the person stops producing insulin and requires injected insulin. At the time of diagnosis, such a person often has excessive thirst and urination, has lost a lot of weight, and has an extremely high blood sugar. This person is normal weight or thin when Type 1 diabetes starts and may stay relatively trim through life. Type 1 occurs in about 10% of all people who have diabetes. Treatment for this type revolves around adjusting the dosages and number of insulin injections to match diet and exercise.
 
Type 2 or NIDDM or non-insulin-dependent diabetes mellitus, on the other hand, was described as high blood sugars occurring in a person over 40 who is overweight and sedentary and also has a family history of this type of diabetes. At the time of diagnosis, there may be no symptoms, or the person may have mild symptoms, such as blurred vision or more than normal thirst and urination. The person continues to make insulin, but the insulin production is not sufficient to keep blood sugars normal. Treatment for Type 2 diabetes revolves around varied combinations of diet, exercise, medications, and/or insulin injections.
 
Note that the use of insulin does not make someone "insulin-dependent" or a Type 1! Some 30 to 40% of those with Type 2 use insulin, but even when insulin is used, this type of diabetes continues to be non-insulin dependent diabetes mellitus or NIDDM, because death will not occur if insulin is discontinued. Some 90% of people with diabetes are considered to have Type 2.
 
In the early 1990s the definition of Type 2 was further refined to distinguish those with and without Syndrome X. Syndrome X is strongly associated with insulin resistance and with high total cholesterol (over 200), high triglycerides (also over 200), low HDL (under 40 mg/dl), high blood pressure, and gout.
 
Those with an apple figure, who carry excess weight predominantly in their abdomen, are at the highest risk of developing Syndrome X. The cholesterol and blood pressure problems associated with Syndrome X trigger accelerated cardiovascular disease, which can lead to heart attack, stroke, and kidney disease.
 
Syndrome X includes all those people who have resistance to insulin. Some 25% of Americans fall into this high risk category, although only about 30% of them will develop Type 2 diabetes at some time in their lives. Type 2 diabetes occurs when the body can no longer produce enough insulin to keep up with the increased need for insulin. People with Syndrome X also tend to develop high blood pressure because of this insulin resistance.
 
Not all of those typically classified as Type 2 have insulin resistance and Syndrome X, however. As evidence of this, a study of people with Type 2 was done in Bruneck, Italy, and published in October, 1998. Eighty-four percent of the people in the study had insulin resistance, while 16% did not. Are these 16% nonetheless to be called Type 2?
 
When "Type 2" occurs without insulin resistance, it may be referred to as Type 1.5 or Type 2-s (for insulin sensitive) or Type 2-d (for insulin deficient). Type 1.5 occurs in adults who usually are lean or normal weight. These people have normal insulin sensitivity but, like other people with Type 1, their insulin production is deficient. When their blood sugars are controlled, they usually do not have the high risk for cholesterol, blood pressure, or cardiac and vascular problems typically found in true Type 2 diabetes. This type of diabetes shares characteristics of both Type 1 and Type 2. Of all the people with diabetes, roughly 10% will have classic Type 1, 75% will have Type 2 (insulin resistant), and another 15% will have Type 1.5.
 
In their book, Diabetes, Type 2 and What To Do (revised October, 1998), Virginia Valentine, June Biermann and Barbara Toohey relate that in their 1993 edition of the book, they described June who developed diabetes in her sixties as a lean Type 2-d.  She was similar to the many people in the 16% group in the Italian study described earlier. In 1998, they defined June as a Type 1 who got diabetes later in life. They feel this description more closely follows the American Diabetes Association revised system, as published in Diabetes Care, January 1998, in which Type 1's are insulin deficient and Type 2s are basically insulin resistant. I prefer to keep the third category, Type 1.5, which clearly defines a group that represents a sizable portion (about 16%) of those who have diabetes but are neither ketosis-prone nor insulin-resistant.
 
Other forms of insulin resistant diabetes also can be seen in gestational diabetes, polycystic ovary disease, acanthosis nigricans, and maturity-onset diabetes of the young or MODY. Insulin resistant diabetes can also be unmasked by medications like prednisone. In rare cases, nonresistant forms of diabetes may also be seen following trauma to the pancreas or pancreatic surgery. This last form is insulin dependent because no insulin can be produced once the pancreas is removed or severely damaged.
 
Most people with diabetes have Type 1, Type 1.5 or Type 2. As more is known about the causes of diabetes and more treatments are developed, more types or sub types are certain to be defined.

Why Is Knowing Your Type Important?
 
Properly understanding your type of diabetes lets you know whether you have been correctly diagnosed, but more importantly, it makes you aware of whether or not you are receiving correct treatment. For example, a person diagnosed with Type 1 diabetes needs insulin right away since destruction of beta cells has been going on for awhile. Not until about 90% of the beta cells are destroyed does someone typically begin to have symptoms. If the person does not clearly fit the model for Type 1, a diagnosis of Type 2 may be made and oral agents may be prescribed, even though little insulin production capability remains.
 
If they are lucky, these agents might stimulate the few active beta cells to produce more insulin for a short time, and the blood sugar may be controlled temporarily. However, soon an oral agent will fail, and injected insulin will be needed. If the oral agent does not work, the person will continue to be very sick until insulin is started. If Type 1 had been recognized right away through an antibody test, using insulin immediately might lead to fewer problems with control, since this often allows insulin production to continue for a longer period of time. Blood sugar control is easier when beta cells continue to work.
 
Knowing your diabetes type can also 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 and it has become harder to control on a sulfonylurea medication, you may find that your C-peptide level is now low, and insulin may now be required. If your C-peptide is normal, adding another oral agent and paying closer attention to your food and exercise choices may be all that is needed. Both situations can occur as the disease progresses and are not necessarily a result of poor practices on your part.
 
Dr. David Bell, a clinician and researcher in Birmingham, Alabama, wanted to see if he could take a group of people with Type 2 diabetes who were already on insulin and eliminate insulin use by substituting a combination of oral medications. He first tested C-peptide levels and chose only those who had normal levels. Of the 130 people with adequate C-peptide levels in his 1997 study, 100 were able to discontinue insulin use altogether and control their diabetes on various doses of glyburide and metformin, medications that were not available when many of the patient's insulin use was begun. Dr. Bell found that their overall control, measured by a HbA1c level, was better on these two oral medications than it had been on two doses of insulin a day. Other people in the study were able to improve their hemoglobin levels by using glyburide, metformin, and one dose of insulin at dinner or nighttime.
 
Researchers have determined that the Type 2 patients who are most likely to control their blood sugars on a combination of oral agents alone are those least overweight (BMI of 30 or less), with shortest duration of insulin use, and C-peptide levels normal or only slightly low.

Who Is Most Likely To Be Misdiagnosed?
 
Many people with Type 2 diabetes are not diagnosed at all. This rampant problem means some 8 million Americans do not know they have this disease. Symptoms are usually minimal or nonexistent, sometimes for years, and so the person is simply not treated for diabetes. An elevated blood sugar is only picked up when the person goes in for a routine physical exam or visits the doctor for another problem, like a cold or a flu.
 
Among people who are diagnosed with diabetes, misdiagnosis of the type happens most often when the person does not have the body type or age expected for Type 1 or Type 2. For example, a person who is 38 and slender has mildly elevated blood sugars. Is this person Type 1 or Type 2? He is older and his blood sugar may not be as high as a typical Type 1, but he is too thin for a true Type 2. Perhaps he has Type 1.5 with diminished insulin production but no insulin resistance. If the older person who is slim has very high blood sugars when diagnosed, the type more likely will be thought to be Type 1.
 
Or consider a child of 14 who is 40 pounds overweight and has high blood sugars. Does this child have Type 1, Type 2, or MODY (a different type of diabetes genetically predetermined)? Due to overeating, poor nutrition habits and a sedentary lifestyle, more and more children are now developing Type 2 at an early age. In fact, Dr. Gerald Bernstein, president of the American Diabetes Association, says one-fourth of new cases in people under age 20 are now Type 2. In the Journal of the AMA, November, 1998,   researchers are recommending that diabetes screening be considered for sedentary, overweight people as young as 15 as a way to prevent the complications that years of high blood sugars can cause.
 
What about the person who is 50 years old, has high blood sugars, is 15 pounds overweight, but has a pear shaped body? Is she Type 1 or Type 2? She could be an older-than-usual Type 1 or she could be a Type 2 with a strong family background of diabetes, meaning that a modest weight gain is all that was needed for diabetes. This is especially true if body fat is high and deposited intraperitoneally (in the gut).
 
These cases indicate that people often do not fit into clear profiles. When the traditional profile does not match the person, understanding what may have caused the diabetes and determining how it should be treated is often problematic.
 
Does Your Type Ever Change?
 
Blurring of the lines between Type 1 and Type 2 diabetes is becoming increasingly common. Due to aging or the general progress of the disease, people with one type of diabetes tend to take on characteristics of the other. As a result, some people with diabetes may have characteristics of both types.
 
If Type 1's begin to exercise less and gain weight around the middle, as many people do when they age, they may become not only insulin deficient but also insulin resistant. They then can develop the cardiac risks associated with Syndrome X and require medications to lower cholesterol and blood pressure. They will require more insulin to control their blood sugars, and certain medications typically used in Type 2 diabetes, such as Glucophage, may help in their control.
 
On the other hand, as Type 2 diabetes progresses, especially if it is not well-controlled and the pancreas is placed under additional stress, insulin production may diminish to a point where it can no longer keep up with need. A sulfonylurea may no longer be able to stimulate the beta cells to produce enough insulin. Medications in addition to sulfonylurea, such as Precose or Prandin, may be needed. As insulin production falls further, injected insulin will be required to keep blood sugars from rising. Some people with Type 2 eventually become totally dependent on insulin and can go into ketoacidosis if insulin injections are stopped.
 
How Can You Know Your Type At Any Age Or Stage?
 
When a person does not fit into a clear profile, a diagnosis of Type 1, Type 1.5, or Type 2 is not obvious. A variety of lab tests and clinical signs help to provide the critical information needed to correctly determine which type of diabetes the person has.
 •Ketones: Ketones are a byproduct produced when the body uses large amounts of fat as fuel. This occurs when carbohydrate is no longer available as fuel due to a lack of insulin. When a urine or blood test shows large amounts of ketones, that person definitely has Type 1 or insulin dependent diabetes. (One rare exception is young, black males who can have ketones at diagnosis but regain insulin production.) If insulin is injected before the ketone test is administered, the opportunity to find large amounts of ketones may have passed. The urine can easily be tested for ketones at home with Ketostix or Ketodiastix anytime the blood sugar levels are high.
 •Antibodies:  Type 1 diabetes is an autoimmune disease, so 80 to 90% of the time when Type 1 exists, the person is producing antibodies characteristic of Type 1, such as the islet cell antibodies and GAD 64 antibodies. The blood can be tested to see if any of these antibodies are present. If antibodies specific to Type 1 are detected, the person already has or is likely to develop Type 1 diabetes. These tests are currently used in the DPT-1 trial to test relatives of those with Type 1 diabetes and detect who will develop this disease.
 •High triglyceride and low HDL:  Cholesterol problems characterized by high triglycerides and low HDL are typical of insulin resistance. These markers for Syndrome X are commonly found in Type 2 diabetes. A detailed cholesterol test or lipid profile test will determine this.
 •Uric Acid:  The high uric acid level often found in people with gout is a component of Syndrome X. If a person has a high uric acid level and high blood sugars, he usually has insulin-resistant, Type 2 diabetes.
 •C-peptide: If other tests fail to indicate the type of diabetes, a C-peptide test can reveal how much insulin the person is producing. C-peptide is half of the precursor molecule to insulin that is split off when insulin is produced by the body. If C-peptide is normal or high, Type 2 diabetes is likely. If the level is significantly low, Type 1 diabetes is likely. If the level is near normal but low, the results are inconclusive. This person may have early Type 1, Type 1.5, or long-term Type 2. When external insulin is controlling the blood sugar, the C-peptide may read low due to suppression of insulin production by the beta cells. This test should be done after insulin has been reduced or discontinued, and the blood sugar has risen to 200 mg/dl or over.
 
When should these tests be used, since lab tests increase health care costs, and no one wants unnecessary tests? Use them when a person who is not a clear type is diagnosed with diabetes or when treatment is not working for unclear reasons. Although these tests often do not tell everything needed for a complete understanding, they can provide more of the clarification needed to properly diagnose and treat diabetes.
 
In summary, our understanding of diabetes and the lab tests useful to us continues to evolve. To understand your situation as information changes, you want to ask specific questions about your diagnosis and treatment. An informed, questioning approach will increase your likelihood of receiving the best care.
 
Mis-Typing Is Common
 
Misdiagnosis or an unclear diagnosis of diabetes can lead to problems in treatment and health. Misunderstanding changes in the disease as you age can also lead to mistreatment. The lack of a way to clearly define the different types of diabetes has allowed people to be misdiagnosed, especially if clarification is based on the typical body type or age. Today we have better lab tests to differentiate Type 1 and Type 2, but they often are not done and even when they are, the diagnosis may not be definitive.
 
When a person does not match a typical profile, mistakes can be made in creating a treatment plan. People who have Type 1 diabetes must have injected insulin to live because they produce little or no insulin themselves. People who have Type 2 will need oral medications or insulin, depending on their lifestyle and the severity of their disease. Although they make take insulin for good control, they are not insulin dependent as is the person with Type 1.
 
In fact most people who use insulin are not actually insulin dependent. The number of people with Type 2 diabetes who use insulin is two or three times as large as those with true insulin dependence or Type 1. Some 30 to 40% of people with Type 2 diabetes require insulin to maintain control, but even when insulin is used, this type of diabetes continues to be non-insulin dependent diabetes mellitus or NIDDM, because death will not occur over a few days if insulin is discontinued.
 
--------------------------------------------------------------------------------
Many thanks to Helen Oswalt, editor of the Scripps Whittier Keeping In Touch Newsletter, for her many helpful editing suggestions.

Yowbarb

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Re: Diabetes Type 1.5 !
« Reply #3 on: March 06, 2013, 07:34:53 AM »
I can't duplicate the chart here. Important info. It will have to be copied into a document and printed from there. Good Luck with it.
Yowbarb
.............................

Differences In The Three Major Types Of Diabetes

http://www.diabetesnet.com/about-diabetes/types-diabetes/what-type 

................................


Yowbarb

  • Guest
Re: Diabetes Type 1.5 !
« Reply #4 on: March 06, 2013, 07:48:43 AM »
My understanding thus far is, Type 1.5 Diabetes is the most about insulin deficiency (caused by an auto immune response) It is about insulin deficiency rather than insulin resistance....
- Yowbarb
..................................................................................................

http://en.wikipedia.org/wiki/Latent_autoimmune_diabetes 

Latent autoimmune diabetes
From Wikipedia, the free encyclopedia

Diabetes type 1.5 redirects here. For the other kind of intermediate diabetes, see ketosis-prone diabetes.
 
Latent autoimmune diabetes of adults (LADA), sometimes called diabetes type 1.5,[1] is a concept introduced in 1993 to describe slow-onset type 1 autoimmune diabetes in adults.[2] Adults with LADA are often initially misdiagnosed as having type 2 diabetes, based on age, not etiology.

Nomenclature
 
LADA may be diagnosed using any of the following terms:
 latent autoimmune diabetes of adulthood
 late-onset autoimmune diabetes of adulthood
 latent autoimmune diabetes of aging[3]
 slow onset type 1 diabetes, or
 type 1.5 (type one-and-a-half) diabetes
 
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus does not recognize the term LADA; rather, it includes LADA in the definition of Type 1 autoimmune diabetes.[4] The National Institutes of Health (NIDDK) defines LADA as “a condition in which Type 1 diabetes develops in adults.” LADA is a genetically-linked, hereditary autoimmune disorder that results in the body mistaking the pancreas as foreign and responding by attacking and destroying the insulin-producing beta islet cells of the pancreas. Simply stated, autoimmune disorders, including LADA, are an "allergy to self.”
 
Diagnosis
 
It is estimated that 20% of persons diagnosed as having non-obesity-related type 2 diabetes may actually have LADA. Islet cell, insulin, and GAD antibodies testing should be performed on all adults who are not obese that appear to present with type 2 diabetes.[5] Not all people having LADA are thin, however—there are overweight individuals with LADA but who are misdiagnosed because of their weight. Moreover, it is now becoming evident that autoimmune diabetes may be highly underdiagnosed in many individuals who have diabetes, and that the body mass index levels may have rather limited use in connections with latent autoimmune diabetes. Also, many physicians or diabetes specialists don't recognize LADA or probably don't know the condition actually exists, and so LADA is misdiagnosed as or mistaken for Type 2 diabetes highly often.
 
C-peptide
 
This test measures residual beta cell function by determining the level of insulin secretion (C-peptide). Persons with LADA typically have low, although sometimes moderate, levels of C-peptide as the disease progresses. Patients with insulin resistance or type 2 diabetes are more likely to, but will not always, have high levels of C-peptide due to an over production of insulin.
 
Autoantibody panel
 
Glutamic acid decarboxylase (GAD) autoantibodies, radioimmunoassay (RIA) and insulin antibodies, radioimmunoassay, RIA.
 
Glutamic acid decarboxylase antibodies are commonly found in diabetes mellitus type 1.
 
Islet cell antibodies (ICA) tests
 
Islet Cell IgG Cytoplasmic Autoantibodies, IFA; Islet Cell Complement Fixing Autoantibodies, Indirect Fluorescent Antibody (IFA); Islet Cell Autoantibodies Evaluation; Islet Cell Complement Fixing Autoantibodies - Aids in a differential diagnosis between LADA and type 2 diabetes. Persons with LADA often test positive for ICA, whereas type 2 diabetics only seldom do.[7]
 
Glutamic acid decarboxylase (GAD) antibodies tests
 
Microplate ELISA: Anti-GAD, Anti-IA2, Anti-GAD/IA2 Pool - In addition to being useful in making an early diagnosis for type 1 diabetes mellitus, GAD antibodies tests are used for differential diagnosis between LADA and type 2 diabetes[7][9][10] and may also be used for differential diagnosis of gestational diabetes, risk prediction in immediate family members for type 1, as well as a tool to monitor prognosis of the clinical progression of type 1 diabetes.
 
Insulin antibodies (IAA) tests
 
RIA: Anti-GAD, Anti-IA2, Anti-Insulin; Insulin Antibodies - These tests are also used in early diagnosis for type 1 diabetes mellitus, and for differential diagnosis between LADA and type 2 diabetes, as well as for differential diagnosis of gestational diabetes, risk prediction in immediate family members for type 1, and to monitor prognosis of the clinical progression of type 1 diabetes. Persons with LADA may test positive for insulin antibodies; persons with type 2, however, rarely do.
 
Other characteristics of LADA that may aid in differential diagnosis include:
Onset usually at 25 years of age or older
 Initially mimics non-obese type 2 diabetes (patients are usually thin or of normal weight, although some may be overweight to minimally obese)
 Oftentimes, but not always, a lack of family history for T2DM (family history for type 2 diabetes is sometimes involved regarding a latent autoimmune diabetic adult)
 Persons with LADA are insulin resistant like, but at prevalence levels less than, Type 2
 Human leukocyte antigen (HLA) genes associated with type 1 diabetes are seen in LADA but not in type 2 diabetes
 Although some people having type 2 diabetes may inject insulin, this only rarely happens; in contrast, people with LADA require insulin injections around three to 12 years after so called type 2 diabetes diagnoses
 
Prevalence
 
It is estimated that approximately 20% of all persons diagnosed with type 2 diabetes might actually have LADA. This number accounts for an estimated 5%-10% of the total diabetes population in the U.S. or, as many as 3.5 million persons with LADA.
 
Treatment
 
LADA often does not require insulin at the time of diagnosis and may even be managed with changes in lifestyle in its early stages such as exercise, eating right, and, if optional, weight loss. However, some clinicians believe that insulin should be started at onset or as soon as possible, rather than using sulfonylureas or other diabetes pills for initial treatment. Moreover, it is not clear whether early insulin therapy is of benefit to the remaining beta islet cells.[11][22]
 
Initially, a person with LADA may respond to oral diabetes medications, eating right and lifestyle changes, although beta cells continue to be destroyed and LADA patients should be closely monitored. Some studies have demonstrated that the use of sulfonylureas and the insulin-sensitizing drug metformin, may increase the risk of severe metabolic disorder in persons with LADA. When blood glucose can no longer be managed through lifestyle and medications, daily insulin injections will be required.
 
80% of persons initially diagnosed with type 2 but test positive for GAD (an indication of LADA) progress to insulin dependency within 6 years (some sources say between 3–12 years after diagnosis).[23] Those who test positive for both GAD and IA2, however, will progress more rapidly to insulin dependence.[7][9
 
Living with any chronic illness is stressful, and patients with diabetes, let alone LADA, may be more prone to depression and eating disorders as a result.[24] Counseling, therapy, and participation in support groups can play an important and positive role in the lives of persons with LADA.[24]
 
Part of diabetes therapy should include patient education about diet, exercise, stress management, and handling their diabetes on "sick" days. Patients need to understand how to manage their diabetes, as well as how to recognize, treat, and prevent hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) and how to give injections of insulin and glucagon. Blood glucose levels should be checked not less than 3-4 times per day when a patient is insulin dependent and, often, at least once during the night.
 
Hyperglycemia
 
Hyperglycemia (high blood glucose levels) occurs when too much food is eaten for insulin that was taken, not enough insulin, stress, dehydration, or illness are present. Hyperglycemia, if untreated, can lead to a deadly state called diabetic ketoacidosis (DKA). If insufficient insulin is present the body cannot use blood glucose as energy, and a combination of things happen, one of which is the body turning to fat stores for energy. Burning of fat causes a ketonic state that may result in an excess of ketones. Persons with high blood glucose levels should use a test strip to check their urine for ketones anytime their glucose levels are 240 mg/dL (13.3 mmol/L) or higher. Patients should call their doctor if ketones measure in the moderate-to-high range as DKA may require hospitalization.
 
A person in DKA requires immediate medical attention and should not attempt to simply administer more insulin independent of a physician's recommendation. Doing so (self-treating) could lead to serious health risks, even death. DKA can lead to heart failure, cerebral edema, coma, and death.

Long-term complications

 
The long-term complications of LADA are the same as for those with type 1 (formerly juvenile diabetes) and with type 2. According to one major study, the Diabetes Control and Complications Trial (DCCT), the risk of long-term problems are directly related to how well the blood glucose levels are managed. The American Diabetes Association recommends LADA patients strive for a HbA1c test of 7.0 or lower.
 
Uncontrolled diabetes of all types results in high blood glucose levels (hyperglycemia) which over time may cause diabetic neuropathy, diabetic retinopathy, eye trouble, kidney failure, heart disease, high blood pressure, stroke, peripheral arterial disease (PAD), chronic infections and wounds that may not heal, erectile and other urological dysfunction, gastroparesis (delayed emptying of stomach contents), gangrene, blindness, amputation, lactic acidosis, diabetic ketoacidosis (DKA).
 
Prognosis
 
According to one study—"Similar as in prediabetic relatives of type 1 diabetic patients the risk for beta cell failure in adult 'type 2 diabetic' patients increases with the number of antibodies positive."[25]
 
Eventually, the latent autoimmune diabetic adult will become dependent upon injecting insulin in order to maintain glucose control. They will require daily injection of insulin and need to be diligent in following their diabetes care plan provided by their physician.
 
Diabetes, including latent autoimmune diabetes of adults, is a chronic illness that can have devastating complications. However, it is possible for most persons with diabetes to actively participate in their daily health care needs and dramatically reduce the risk of diabetes complications.
 
Patient education, motivation, and state of mental health all play an important role in how well a person with LADA will be able to manage their disease.
 
Comparison
 
LADA is slow-onset Type 1 autoimmune diabetes in adulthood (NIDDK - National Institute of Diabetes and Digestive and Kidney Diseases ).
 Onset: Type 1 diabetes onsets rapidly and at a younger age than does LADA.
 Family history: There is often a family history of autoimmune conditions (for example, rheumatoid arthritis, thyroid diseases, etc.). Furthermore, some individuals with LADA may have a family history of T2DM.
 Antibodies: Persons with type 1 diabetes and LADA usually test positive for certain (same) antibodies (GAD, ICA, IA-2) that are not present in type 2 diabetes. Moreover, there are also TCF7L2 genes associated with Type 2 diabetes involved in latent autoimmune diabetes of adults.[13]
 GAD antibodies: Persons with LADA usually test positive for GAD antibodies, whereas in type 1 diabetes these antibodies are more commonly seen in adults rather than in children.[7][26]
 Lifestyle and excess weight: People with LADA typically have a normal BMI or may be underweight due to weight loss prior to diagnosis. But some people with LADA may be overweight to mildly obese.[27] LADA (Type 1 diabetes) is an autoimmune disease that cannot be prevented.
 Prognosis: About 80% of all persons initially diagnosed with type 2, who also have GAD antibodies, will become insulin dependent within 3 to 12 years (according to differing LADA sources).[23] Those with both GAD and IA2 antibodies, however, will become insulin dependent sooner. LADA occurs slowly, but progresses towards insulin dependency.[9]
 Treatment: Although LADA may appear to initially respond to similar treatment (lifestyle and medications, sometimes weight loss if needed) as type 2 diabetes, it will not halt or slow the progression of beta cell destruction, and people with LADA will eventually become insulin dependent.

enlightenme

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Re: Diabetes Type 1.5 !
« Reply #5 on: March 07, 2013, 06:22:31 AM »
Very interesting Barb, Thanks for posting!  This subject interests me because my Dad was diagnosed with diabetes quite a few years ago.  We were told at the time, that it was due to the experimental treatment he had been receiving while in the hospital (he was there for about two months as an inpatient due to Chrones Disease, and trying to save his colon).  It does not run in our family, and we were told it should not ever effect any other family members, that it was only due to this treatment he received.  Very strange and unusual case for sure, and you always have to wonder whether you are actually getting the complete truth.

Yowbarb

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Re: Diabetes Type 1.5 !
« Reply #6 on: March 07, 2013, 10:18:19 AM »
Very interesting Barb, Thanks for posting!  This subject interests me because my Dad was diagnosed with diabetes quite a few years ago.  We were told at the time, that it was due to the experimental treatment he had been receiving while in the hospital (he was there for about two months as an inpatient due to Chrones Disease, and trying to save his colon).  It does not run in our family, and we were told it should not ever effect any other family members, that it was only due to this treatment he received.  Very strange and unusual case for sure, and you always have to wonder whether you are actually getting the complete truth.

Enlightenme, so sorry he developed diabetes.  That is an unusual story... Yes it's hard to know if you have the whole truth or not. I looked up 1.5 in wikipedia and found all manner of lab tests to diagnose... I told my daughter about it...her doc is really pretty good but lacking all that knowlege. 
It's hard to know everything, eh?

 

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