I found a study in the latest edition of the journal Diabetes which found that people with LADA (which they define as autoimmune diabetes diagnosed after age 35) tend to have both variations in the HLA (autoimmune) genes like those of people with Type 1 diabetes and variations in the TCF7L2 gene which has been linked to producing Type 2 diabetes.
Sorry, I meant to paste in the link!
Genetic Similarities Between Latent Autoimmune Diabetes in Adults, Type 1 Diabetes, and Type 2 Diabetes.
I guess that pretty much justifies the “Type 1.5” label!
I just blogged about the problem with all the “Type” labels on my main blog, Diabetes Update..
As someone with a form diabetes that isn’t any of the Types (it has its own paragraph in the ADA Diagnostic Criteria document) but which shares features of both I’m really sensitive to this issue.
The terms “Type 1” and “Type 2” are an oversimplification of a complex issue. But a few corrections: Jenny’s blog says that 20% of Type 2’s are not overweight, but that is an old and outdated statistic. Included in that 20% (1 in 5) are all the slow-onset Type 1’s (antibody positive) who have been misdiagnosed as having Type 2, so in fact about 90-95% of Type 2’s are overweight. Another distinction: Type 1 (autoimmune) is not a preventable disease, but Type 2 (insulin resistance) is preventable (granted, not easy to prevent it, but it is preventable). If you have adult-onset Type 1 diabetes, you cannot stop the immune-mediated pancreatic beta cell destruction, but you can do basic things such as exercise and stress reduction to increase your sensitivity to insulin.
I went to a get together of friends with diabetes last year who were people I’d met on the web. They all had Type 2. NONE of them was overweight and ALL of them are still insulin resistant and diabetic.
The idea that you can “prevent” Type 2 is a misunderstanding. The people with the genetic make up that develop Type 2 can postpone the need for meds it with diet and exercise, but eventually the IR catches up with them. And don’t forget, it is that intense IR that packs the weight on them, not gluttony.
And the kind of insulin resistance they have is such that a person can be 120 lbs, exercise, and still need 45 units of basal insulin while eating no more than 60 grams of carbs a day! I know people like that.
So don’t fall for what you read in the media about how Type 2 is completely preventable. It isn’t true and it really harms people who have inherited that set of bad genes.
That was in informative article, Jenny. I understand why it’s a sensitive issue for you.
Even though I was initially diagnosed as Type 2 and later as Type 1 - a typical course for many LADA’s, I have also been guilty of viewing Type 2s as more ‘culpable’ for their conditions.
The more I read here and elsewhere, the more I learn about the gradations and infinite variables involved in this disease.
Hi Jenny–You are certainly correct, there are exceptions and I should have been more careful and not made a blanket statement! Type 2 is quite complex (as is Type 1). I do think that our modern lifestyle is much to blame. For example, the Pima Indians of Arizona have the highest rates of Type 2 in the world (and extremely high rates of obesity), but the Pima Indians across the border in Mexico living a traditional lifestyle (being very physically active as part of their daily lives) have almost no Type 2 diabetes (1 to 2%) and almost no obesity. And going back to the study that you cited, again it is possible for most people with autoimmune diabetes (LADA and rapid onset Type 1) to prevent insulin resistance by exercise and stress reduction. And yes I am biased–I am a lifelong athlete and fitness fanatic, but there are plenty of studies to support the benefits of exercise. But I am also going to be more careful and not make blanket statements!
It is worth mentioning, however, that the genes that have been identified as causing the extreme obesity and diabetes in Pima Indians are NOT the ones more commonly found in European populations, and in addition, the characteristics of their diabetes in terms of the complication profile is not the same as that of the European populations either.
This is also true of the Pacific Islanders who have the highest rate of diabetes in the world. Different gene malfunctions and most importantly, different patterns of onset and complications.
Type 2 is not a preventable disease. You can reduce your risk with diet and exercise. But some people can do all the right things and still get type 2 if their genetic predisposition is large enough. For example, you mention the 1 to 2% diabetes rates among the Mexican Pima. Despite their traditional lifestyle and diet, some still get type 2.
Type 1 is sometimes triggered by a viral infection. So in a sense, type 1 is also preventable if you can avoid getting the infections. And some day they’ll learn how to prevent the autoimmune attack.