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Type 1.5

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Elliegirl

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4
why is it so difficult to find out info in the uk on this type of diabetes,even your forum registration site only has type 1 or 2. The USA seems to have lots of info and member registered on their forums who are 1.5's (and from the UK). Is this type of diabetes just not recognised in the UK?. I am desperately seeking other people in similar situation to compare notes and see if the problems in controlling levels are typical of 1.5's. (type 2 with classic type one symptoms). I would love to hear from anyone understands anything about this.
 
Hi Elliegirl,

The reason you won't find much information on it in the UK is that type 1.5 is not officially recognised, largely because there is no common agreement on what it actually is. Some bodies claim that type 1.5 is where the pancreas is gradually failing, and therefore the patient has symptoms common to both type 1 and type 2. Also where there is pancreatic damage (e.g. following pancreatitis) is claimed to be type 1.5. Other bodies claim that LADA is type 1.5.

Even in the States, although you will find more information on websites, they also use 1.5 to describe a number of different conditions. Its not that it isn't officially recognised in the UK - it isn't officially recognised anywhere in the world.
 
Hi Dennis,

I have been diagnose T2 for the last 2 1/2 years and started off on metformin. I then progressed to rosiglitazone/metformin combined but recently had an A1c of 10.6. Also was suffering from vomiting, extreme exhaustion, ketones, dry mouth, blurred vision etc and on checking my bs was averaging around 16 - 20. Dr started me on gliclazide which we have now changed to 160mg at night and 40mg in he morning combined with the met/rosi. Still finding my morning reading between 9 and 12. Occasionally I get an abnormally low of around 3.5 - 4 but this is rare and normally if I've missed a meal. Normally now ranging from 8 - 16.

My father was T2 so I do have a history and I am slightly overweight particularly around my mid region.

They are contemplating insulin for me now but having read about your Byetta I think that sounds perfect for me.

Do you think that the reason I still can't get my bs into range could be because of LADA or is my T2 just progressively getting worse. Would value your comments.

Thanks Michelle.
 
Hi Michelle,

Have you altered your diet in any way to bring you blood glucose into line? Meds are one way of doing it, of course, but an appropriate dietary strategy can be at least as effective, and quite possibly more effective. With diet and meds combined you might very well have it licked.

What do you eat in a typical day?

All the best,

fergusc
 
Hi Fergusc

Have made real changed to my diet, cut out all **** and eating much more salad, cold meats and basically paying a lot more interest in it all but to no avail. Even on the very rare occasion that I sucspamb to a piece of chocolate it doesn't seem to raise my bs, in fact on occasion it has been lower after choc. There seems no rhyme nor reason to it at the moment.

Michelle.
 
Hi Michelle,

LADA is a possibility, but that would mean that your autoimmune system is damaging the beta cells of the pancreas. When that happens your insulin production is reduced to whatever amount the remaining beta cells are able to produce.

Since gliclazide has been added to the mix your BG levels seem to be reducing (sometimes a bit too much but then that is a side effect of sulphonylureas like gliclazide). Sulphonylureas force the pancreas to produce more insulin, but the pancreas can only do that if the beta cells are still functioning. The fact that your pancreas is able to respond to the gliclazide would seem to indicate that your pancreas does not have autoimmune damage, otherwise the gliclazide would have very little effect.

The fat layer around your middle could be contributing to insulin resistance and losing weight should certainly help. For people who are overweight, just losing 10% of your bodyweight will, without any other medication, reduce your HBA1C by 1.0%. The rosiglitazone won't be hepling you there because its most common side effect is that it encourages fluid retention and weight gain.

Also you could help by reducing your carbohydrate intake as much as you can. Try a really low carb diet for a month and you should see the weight starting to come off as well as a steady reduction in your BG levels.

Last but not least, yes, in my opinion (and remember I have no medical qualifications) Byetta could certainly help you. When I started on it I also had too much fat round my middle, and HBA1C of 8.6%, and BG readings that averaged between 9 and 11 before breakfast and 8 to 10 before supper. My HBA1C is now down to 7.9 and falling fast, my pre-breakfast readings usually between 6 and 8 and evening readings between 5 and 7. The byetta has also helped me to lose 5 kilos in the last 6 months.
 
I Dennis

I have joined the forum on behalf on my mother who is a type 1.5. (her diabetic nurses description not mine!) She has got totally frustrated with the situation and feels she is the only person in the UK who has this diagnoses!

I was hoping to be able to put her in touch with other people so that she did not feel so alone. She has been diabetic for 5 years and injecting for 4 years.

She is currently using 4 units of levemir in the morning with 8-9 units of novorapid with each meal and 10 units of levemir before bed. She is having real problems with erratic bg readings with can vary for Hypo (2) up to 20+. She is very strict with herself and follows what she should be doing to the letter (far too scared of the consequences). She is not overweight and never has been, is active and does adjust her insulin depending on level of activity. She also takes thyroxine for an underactive thyroid gland and has a history of autoimmune conditions in the family

I was wondering if she has problems keeping her levels fairly constant due to natural production of insulin. The research I have says that a 1.5 type still produces some natural insulin, if this is the case could it be the levels she produces varies, thus making tight control difficult. She is now thinking about carb counting but think she is a bit overwelmed by it. I think she is doing well, given the fact she has always been terrified of needles and injections and now injects 5 times a day. Her previous HB1ac started at 16, then, 11 and the last was 9 (still too high I know but heading in the right direction). She is due for her next test in a couple of weeks so it will be interesting to see what the results are.

She beats herself up constantly about her levels, which then causes her to become depressed, I am sure this doesn't help!!

What do you think

Elliegirl
 
Type 1 and type 2 are not mutually exclusive. Upto 50% type 2 go onto insulin and many long term type 1 develop insulin resistance. I am type 2 with Beta cell failure and currently take 100 units Levemir and 60-80 units novorapid a day with metformin on top. I wonder if I may be a MODY as well but the definition is quite strict.

I would have thought that advice from both the type 1 and type 2 groups to be useful. I have no idea if LADA behaves radically different from the more common forms with regard to food effects, pre and post food BS profiles and drug regimes.

Different people define 1.5 differently. Some refer to it as gestational, some define people like me as 1.5, but I think LADA often used as well. I am sure you have tried different drug regimes since diagnosis. From reading some doctors forums, it seems that in the elderly, minimising hypo and hyperglycaemia symptoms is one of the main targets. Hopefully witht that the HBA1C level also drops.

Advice from the specialist diabetic teams is essential.

Marty B
 
Elliegirl,

I would hazard a guess that it is your mother's erratic BG levels that leads the nurse to suspect she is still producing some natural insulin, hence the 1.5 suggestion. Your mother is showing great determination and she should be really proud of the way her HBA1C has been coming down.

What it needs now is some fine-tuning, which is certainly what the carb counting would give her. That allows the correct dose of insulin to be applied to whatever you have eaten so would be of enormous benefit in smoothing out the peaks and troughs in her BG. There are some links to Carbs information in the Sticky "General Links for Diabetes" that you will see above this topic. One of these is a carb counter that might help her.
 
Thanks for your reply, nothing was mentioned to my mother by the diabetic nurse with reference to producing her own insulin.

I don't want to be misleading, my own research in to type 1.5 got me thinking that it is possible if she does produce a small amount this could vary.

I will look into the carb counting for her.

Elliegirl
 
Hi Dennis,

Thanks once again for your valued advice. Will certainly start monitoring my carb intake and see if I can improve things. Am now getting an appt with the consultant to discuss Byetta so will keep at it in the mean time.

Regards Michelle.
 
Hi Elliegirl,

How often does your mother test? The way I got my bg levels well controlled is by continually testing - up to 20 times a day to see how I react to all the different foods and combinations of foods. I take 12 units of Lantus (Glargine) at midday or so and various amounts (3-10) of Humalog with every meal. I'm LADA - I only need 3 for breakfast (bowl of cereal & orange juice) because my body produces more insulin in the morning. I still find I need to have a slice of bread 1 hour afterwards to prevent me going low. (But if I only took 2 units I would go higher than I'd like before coming down again!)
I've created a special spreadsheet to help me. Eg. I might test every 10-15 mins for for a couple of hours after eating and plot a graph. This might suggest I split the injection into 2 doses. Now I've got it sussed, I have reduced testing to 5 or 6 times a day, mostly afternoon and evening, when my levels are less predictable.

Best wishes,

Philip.
 
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