Type 1.5 Diabetes Mellitus

We often hear about Type 1 or 2 Diabetes, but have you heard of Type 1.5 Diabetes?

Yes, Diabetes type 1.5, also referred to as Latent Autoimmune Diabetes in Adults (LADA), is a condition that resembles type 1 and type 2 diabetes mellitus.

To understand it, we will first distinguish between the three. The primary distinction between Type 1 and Type 2 diabetes is that the former requires an external insulin injection because it is an autoimmune disease brought on by the body’s destruction of pancreatic beta cells, which aid in the generation of insulin. Because Type 2 diabetes is primarily caused by genetic and lifestyle factors, our bodies produce less insulin and have resistant effects. Because of this, management strategies for the disease include oral medications and lifestyle changes; if blood sugar levels are consistently out of control, external insulin may also be required (1)

On the other hand, antibodies against insulin-producing cells in the pancreas can cause damage that results in Type 1.5 diabetes same as Type 1. There could also be genetic components at play, such as a family history of autoimmune diseases. Insulin resistance may also be present in an obese or overweight person with type 1.5 diabetes. Although LADA and type 1 diabetes share many genetic and immunological characteristics, LADA is distinguished from type 1 diabetes by variations in autoantibody clustering, T-cell reactivity, and genetic susceptibility. (2)

Since type 1.5 diabetes develops in adulthood, it is frequently confused with type 2 diabetes because of a lack of both awareness and standardized diagnostic criteria. The majority of those who have this kind of diabetes are over 30. Up until your pancreas stops producing insulin, type 1.5 diabetes symptoms can be controlled using type 2 diabetes medications like metformin. Many people realize at that moment that they have been dealing with LADA all along. Compared to type 2 diabetes, the development of insulin demand is typically faster, and the response to oral hypoglycemic medications, which lower blood sugar levels, is generally poor.

Diagnostic characteristics of Type 1, Type 2, and Type 1.5 Diabetes (3):

 
LADA has signs and symptoms that are similar to Type 1 and 2 Diabetes Mellitus, such as:

• Feeling more thirsty than normal
• Urinating more frequently
• Fatigue/ Tiredness
• Unexpected weight reduction
• Tingling in your feet or hands
• Blurry eyesight
• Bruising and cuts more slowly than usual healing

As of yet, there is no set course of treatment for LADA. It can be well managed with treatments that are frequently recommended for the treatment of type 2 diabetes. Such treatments could consist of a mix of a healthy diet and exercise.

Dietary approach for managing LADA:

People with diabetes can improve their general health and better manage their condition by eating a nutritious, well-balanced diet. Limiting the amount of carbohydrates consumed is the main objective when making dietary changes to balance blood sugar. In addition to causing fast peaks and falls in blood sugar following meals, a diet heavy in processed foods, simple carbs, and added sugars also raises the risk of autoimmune and cardiovascular disease, and systemic inflammation. As a result, it’s critical to restrict your consumption of foods high in sugar and carbs, like processed snacks, candies, and sugary drinks.

A diet that prioritizes complex, low-glycemic carbs over simple, refined carbohydrates, together with high-fiber foods including fruits, vegetables, and whole grains, is linked to a lower risk of diabetes, improved weight control, and less inflammatory responses. Lean protein sources like chicken, fish, and tofu, soy as well as consuming more unsaturated fats with meals, can also assist in stabilizing blood sugar by enhancing insulin sensitivity, preserving muscle mass, and encouraging satiety. To avoid blood sugar spikes, it’s crucial to keep an eye on portion sizes and space out meals throughout the day.

Reducing inflammation to address the autoimmune component of Type 1.5 diabetes is another crucial part of the treatment. In such cases, Anti-inflammatory diets can work like magic. The main goal of these diets is to replace meals that aggravate inflammation with ones that soothe it. Diets that prioritize the intake of whole fruits, fresh vegetables, whole grains, legumes and pulses, low-fat dairy products, lean meats, unsaturated fats, herbs, and spices are regarded as anti-inflammatory. Plant-based, DASH and Mediterranean diets are all regarded as anti-inflammatory because they promote less oxidative stress, healthy blood sugar levels, a better gut microbiota composition, and stronger immune systems. (4)

There are some specific dietary supplements that can be used in an integrative treatment plan to enhance insulin sensitivity, lower blood sugar, and strengthen the immune system:

1) Chromium: A trace mineral, chromium affects how insulin functions and how glucose is metabolized. Research on the benefits of chromium supplementation for diabetes has demonstrated improvements in insulin resistance, glycemic management, and fasting blood sugar levels. A few of the richest sources of Chromium include Beef, Brewer’s yeast, Broccoli, bananas, Grape juice, potatoes, eggs, and whole-grain cereals.

2) Magnesium: The body uses magnesium, an important mineral, in more than 300 enzymatic processes. It has been demonstrated that a magnesium shortage increases the risk of diabetes. Supplementing with magnesium helps reduce blood pressure, enhance insulin sensitivity and blood glucose control markers, and prevent inflammation. Magnesium sources are dark chocolate, Pumpkin seeds, Cashews and Almonds, Beans, and Green leafy vegetables.

3) Vitamin D: Vitamin D deficiency has been linked to autoimmune disorders, such as type 1 diabetes, and treating autoimmune diseases with supplements has been shown to be beneficial. As all of us are aware that, sunlight is the most efficient source of vitamin D, but some of the food sources include mushrooms, eggs, and organ meat like liver, salmon, soy milk, and cow’s milk.

4) Flaxseed: It has been observed that whole flaxseed rather than flaxseed oil helps in lowering insulin resistance and increases insulin sensitivity, which eventually lowers average blood glucose. Flax seeds provide lignan, a potent antioxidant, in addition to significant levels of dietary fiber. It is thought that antioxidants increase insulin sensitivity and delay the onset of diabetes.

5) Ashwagandha: Traditionally, ashwagandha has been utilized as an adaptogenic herb to help with inflammation, stress, and neuroprotection. Research has demonstrated that its treatment effectively targets hypothyroidism and chronic stress, two conditions that are known to aggravate autoimmune diseases (5). Furthermore, by altering the levels of cytokines and immunoglobulins in the blood, its immunomodulatory effects have been demonstrated to balance the immune system.

Talking about immunity, exercise is also one of the most important factors to strengthen your immune system. Your muscles can better utilize insulin that is available to them to take up glucose both during and after exercise because of the increased sensitivity to insulin. Getting at least 30 minutes a day of moderate exercise is an excellent place to start because being active can help naturally balance blood sugar levels.

As new research clarifies the complexity of this condition, therapeutic alternatives are continually being developed; current guidelines support the use of insulin therapy, oral hypoglycemic medications, and lifestyle changes to meet the goals of treatment. Type 1.5 diabetes is a treatable condition if proper care is given and blood sugar is closely monitored. Living a long and healthy life after being diagnosed with type 1.5 diabetes is achievable. 

References:

1. https://www.healthline.com/health/type-1-5-diabetes#causes
2. Naik, R. G., Brooks-Worrell, B. M., & Palmer, J. P. (2009). Latent autoimmune diabetes in adults. The Journal of clinical endocrinology and metabolism, 94(12), 4635–4644. https://doi.org/10.1210/jc.2009-1120
3. O’Neal, K. S., Johnson, J. L., & Panak, R. L. (2016). Recognizing and Appropriately Treating Latent Autoimmune Diabetes in Adults. Diabetes spectrum: a publication of the American Diabetes Association, 29(4), 249–252. https://doi.org/10.2337/ds15-0047
4. https://www.rupahealth.com/post/a-root-cause-medicine-protocol-for-patients-with-type-1-5-diabetes-testing-therapeutic-diet-and-supportive-supplements
5. Tharakan, A., Shukla, H., Benny, I. R., et al. (2021). Immunomodulatory Effect of Withania somnifera (Ashwagandha) Extract—A Randomized, Double-Blind, Placebo Controlled Trial with an Open Label Extension on Healthy Participants. Journal of Clinical Medicine, 10(16), 3644. https://doi.org/10.3390/jcm10163644