Is LADA = Type 1.5?
I don’t want to start a “word war” but I think clarity helps when talking to doctors. The issue might be how Dr’s discuss Diabetes in other countries or just a great deal of confusion due to the limited % of LADAs. I just want to discuss what others have heard from their experiences as there are >100 members on this forum and >200 tu-d members listed as T1.5.
To step in it… (so to speak)
I somewhat disagree with Manny’s video and the notion that LADA and T1.5 are the same. I’m in Chicago and go to a great endo that usually spends all the time I request. I asked about T1.5 and he stated (not in quotes as it’s not word for word):
LADA is 99% T1. T1 can arrive slowly or quickly. T1 has no clear path before someone loses all beta cell production. For adults is seems slower than children but that is even hard to prove.
T1.5: Is (in his words) people that exhibit BOTH symptoms of poor insulin production AND reception as in T2. T1.5 can be difficult to treat
IMHO - I have T1. Just because I got it late in life is either good or bad luck depending on your view of the world. My C-Pep and Anti-G are enough for me.
Hi Mike: WHO and the Expert Committee on the Diagnosis and Classification of Diabetes state that “Although the specific etiologies of [Type 2] diabetes are not known, autoimmune destruction of beta cells does not occur.” Furthermore, the Expert Committee’s definition of Type 1 diabetes clearly encompasses all autoimmune diabetes, regardless of age, which includes LADA (“Type 1 diabetes results from a cellular-mediated autoimmune destruction of the beta-cells of the pancreas. In Type 1 diabetes, the rate of beta-cell destruction is quite variable, being rapid in some individuals (mainly infants and children) and slow in others (mainly adults).”) So Type 1.5 and LADA are “slang” terms that aren’t officially recognized. There’s not really a limited percentage of LADA–the vast majority of new onset Type 1 autoimmune diabetes is seen in adults. We just don’t get the attention that children get, and it is a real problem because of the frequency of misdiagnosis as having Type 2 diabetes (a different disease altogether). A new book, “Type 1 Diabetes in Adults: Principles and Practice” (Informa Healthcare, 2008) says that adult-onset autoimmune diabetes is two to three times more common than classic childhood onset autoimmune diabetes (p. 27).
It all gets very complicated, because a recent scientific article also pointed out that many individuals with childhood onset Type 1 diabetes have some degree of insulin resistance (a characteristic of Type 2 diabetes).
I prefer to just say I have Type 1 diabetes. No slang terms for me. My disease was never latent (blatent, yes) and I am not somewhere between 1 & 2. What I think needs to change is the perception that Type 1 is a childhood disease. It is not, and never has been.
Thanks Melitta! I guess my confusion is that mathematically 1.5 is between 1 and 2 somewhat indicating that it is both or somewhere in the middle. Since LADA seems to be just … late to the party T1 BUT may have different characteristics AND we don’t get the attention … why don’t we call it T3? It’s alll slang anyway. Why do we have to jam ourselves between the other two disease that most people don’t understand already?.. We could start a “media revolution” and introduce T3 to the world! - Sorry it’s Monday and if your going to start a revolution … It should be on Monday!
Although I wasn’t diagnosed until my mid-twenties, I consider myself a T1 diabetic. I didn’t experience a slow onset; quite the opposite - it was fast and furious.
I wrote, in response to another discussion, the following post. It describes my thoughts on the whole Type 1.5 business:
According to my endo, a positive GAD test (combined with an elevated A1c or fasting BG) ALWAYS indicates type 1. There are other antibodies that also indicate type 1, but ALL type 1s are autoimmune. If antibody tests are negative, a diagnosis of type 2 is usually given. Genetic testing can look for MODY, but it is very different from LADA. LADA has been given the label type 1.5, but this seems to indicate that it has characteristics of both type 1 and type 2. Since most LADAs are actually insulin sensitive, the type 1 connection is clear. However, it doesn’t share any characteristics with type 2 (other than the typical age at diagnosis for type 2s). I believe that the type 1.5 label is not accurate. LADA is type 1.
I am too new to the T1 rolls for an educated response to this discussion, having spent two and a-half years as a T2 and only seven weeks on the other side of the fence. However, I would like to share a thought with regard to identity.
It occurred to me over the past weekend that I’ve spent a good deal of my life trying to determine where along a spectrum I fit. First it was whether I should identify as Japanese American or American Japanese; later it was straight or gay (and then all of the subcategories – some would say “sub-classes” – within), and now either LADA or T1. Really, I’ve wondered more than once whether the labels are more for self or if they simply serve as a framework by which a person determines how to “deal with” someone. I guess I’ve grown to despise labels for their concomitant stereotypes…
But I agree with Melitta insofar as use of terms not yet accepted as industry standards, and working instead toward modifying perceptions that are no longer valid.
I agree that the labels we use are often a problem.
It was a very enlightening day for me when I realized that it “doesn’t matter” what kind of diabetic a person is. Of course that’s an exaggeration, but really, as long as we are using whatever treatment we need and staying in control, it’s kind of a wash what technical definition of diabetes any of us have.
I’m somewhere between type 1, 1.5 and LADA. Roll the dice and pick one.
Hi Mike: Type 3 is now used to describe the significant other of a diabetic, so that term is taken!
Type 1 autoimmune diabetes describes a single disease, at whatever age of onset, and it has a single basic treatment, exogenous insulin. I don’t think there is any reason to give a different name just because a person is diagnosed as a child or an adult–it is the same disease. There are some very well known people diagnosed as adults: Gary Hall Jr. (age 24), Mary Tyler Moore (age 33), and former acting U.S. Surgeon General Ken Moritsugu (age 49). In 1934 Dr. Elliot Joslin noted that the incidence of diabetes in lean individuals was relatively constant in each decade of life. The U.S. medical community clings to its traditions (Type 1 = childhood disease) rather than following evidence-based medicine (the majority of new-onset Type 1 autoimmune diabetes is actually seen in adults). My own personal opinion is that it’s better to try to change the perception that Type 1 is a childhood disease. But of course changing perceptions is not easy!
I 100% agree that labels create pre-conceptions in people’s minds BUT when discussing disease and standard forms of treatment for that variant, I would submit “slang” has no place and creates confusion.
I also agree in changing perception that T1 is not just a childhood disease but creating a new “category” makes that difficult.
So folks, is the question … Why does tudiabetes.org have a T1.5 in the profile selection? There are >200 people listed as T1.5 are we adding to the confusion?
On the sidebar it says there are over 12,000 members on tudiabetes.org. It would be a good place to start!
To go one further, Mike, most insurance companies REQUIRE a label before they cover certain equipment/treatments. I went through quite a battle in my initial mis-diagnosis to get coverage for the things I needed (enough test strips to test 10x per day, an insulin pump, CGM, etc.), and without the official Type 1 label, I’d still be fighting that fight.
I definitely don’t think we need another label. It’s hard enough getting people to understand the difference between types 1 and 2. I can’t imagine trying to explain type 5 (or some other number) to them.
Besides, I think part of the reason for the switch from “juvenile diabetes” to “Type 1 diabetes” was because there are many type 1 adults. After all, those juveniles do grow up, and diabetes doesn’t go away.
Personally, I would like to see the type 1.5 designation go away. It’s inaccurate and misleading.
