While you’re likely familiar with type 1 and type 2 diabetes, you’ve probably heard less about type 1.5 diabetes.

Also known as latent autoimmune diabetes in adults (LADA), type 1.5 diabetes has features of both type 1 and type 2 diabetes.

More people became aware of this condition after Lance Bass, best known for his role in the iconic American pop band NSYNC, recently revealed he has it.

So, what is type 1.5 diabetes? And how is it diagnosed and treated?

There are several types of diabetes

Diabetes mellitus is a group of conditions that arise when the levels of glucose (sugar) in our blood are higher than normal. There are actually more than ten types of diabetes, but the most common are type 1 and type 2.

Type 1 diabetes is an autoimmune condition where the body’s immune system attacks and destroys the cells in the pancreas that make the hormone insulin. This leads to very little or no insulin production.

Insulin is important for moving glucose from the blood into our cells to be used for energy, which is why people with type 1 diabetes need insulin medication daily. Type 1 diabetes usually appears in children or young adults.

Type 2 diabetes is not an autoimmune condition. Rather, it happens when the body’s cells become resistant to insulin over time, and the pancreas is no longer able to make enough insulin to overcome this resistance. Unlike type 1 diabetes, people with type 2 diabetes still produce some insulin.

Type 2 is more common in adults but is increasingly seen in children and young people. Management can include behavioural changes such as nutrition and physical activity, as well as oral medications and insulin therapy.

How does type 1.5 diabetes differ from types 1 and 2?

Like type 1 diabetes, type 1.5 occurs when the immune system attacks the pancreas cells that make insulin. But people with type 1.5 often don’t need insulin immediately because their condition develops more slowly. Most people with type 1.5 diabetes will need to use insulin within five years of diagnosis, while those with type 1 typically require it from diagnosis.

Type 1.5 diabetes is usually diagnosed in people over 30, likely due to the slow progressing nature of the condition. This is older than the typical age for type 1 diabetes but younger than the usual diagnosis age for type 2.

Type 1.5 diabetes shares genetic and autoimmune risk factors with type 1 diabetes such as specific gene variants. However, evidence has also shown it may be influenced by lifestyle factors such as obesity and physical inactivity which are more commonly associated with type 2 diabetes.

What are the symptoms, and how is it treated?

The symptoms of type 1.5 diabetes are highly variable between people. Some have no symptoms at all. But generally, people may experience the following symptoms:

• increased thirst
• frequent urination
• fatigue
• blurred vision
• unintentional weight loss.

Typically, type 1.5 diabetes is initially treated with oral medications to keep blood glucose levels in normal range. Depending on their glucose control and the medication they are using, people with type 1.5 diabetes may need to monitor their blood glucose levels regularly throughout the day.

When average blood glucose levels increase beyond normal range even with oral medications, treatment may progress to insulin. However, there are no universally accepted management or treatment strategies for type 1.5 diabetes.

Type 1.5 diabetes is often misdiagnosed

Lance Bass said he was initially diagnosed with type 2 diabetes, but later learned he actually has type 1.5 diabetes. This is not entirely uncommon. Estimates suggest type 1.5 diabetes is misdiagnosed as type 2 diabetes 5–10% of the time.

There are a few possible reasons for this.

First, accurately diagnosing type 1.5 diabetes, and distinguishing it from other types of diabetes, requires special antibody tests (a type of blood test) to detect autoimmune markers. Not all health-care professionals necessarily order these tests routinely, either due to cost concerns or because they may not consider them.

Second, type 1.5 diabetes is commonly found in adults, so doctors might wrongly assume a person has developed type 2 diabetes, which is more common in this age group (whereas type 1 diabetes usually affects children and young adults).

Third, people with type 1.5 diabetes often initially make enough insulin in the body to manage their blood glucose levels without needing to start insulin medication. This can make their condition appear like type 2 diabetes, where people also produce some insulin.

Finally, because type 1.5 diabetes has symptoms that are similar to type 2 diabetes, it may initially be treated as type 2.

We’re still learning about type 1.5

Compared with type 1 and type 2 diabetes, there has been much less research on how common type 1.5 diabetes is, especially in non-European populations. In 2023, it was estimated type 1.5 diabetes represented 8.9% of all diabetes cases, which is similar to type 1. However, we need more research to get accurate numbers.

Overall, there has been a limited awareness of type 1.5 diabetes and unclear diagnostic criteria which have slowed down our understanding of this condition.

A misdiagnosis can be stressful and confusing. For people with type 1.5 diabetes, being misdiagnosed with type 2 diabetes might mean they don’t get the insulin they need in a timely manner. This can lead to worsening health and a greater likelihood of complications down the road.

Getting the right diagnosis helps people receive the most appropriate treatment, save money, and reduce diabetes distress. If you’re experiencing symptoms you think may indicate diabetes, or feel unsure about a diagnosis you’ve already received, monitor your symptoms and chat with your doctor.

Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University and Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

When you finally receive a neurodevelopmental diagnosis that reflects your strengths and the challenges you face, it can be life-changing.

But for people with both autism and attention-deficit hyperactivity disorder (ADHD) – known colloquially as AuDHD – getting the right diagnosis can be difficult.

People with AuDHD (pronounced awe-D-H-D) often find their traits and experiences don’t always neatly fit into either category. Sometimes the two conditions contradict each other and appear to act in opposite ways. Other times they exacerbate or increase a trait or difficulty.

This can delay diagnosis and support.

What are these conditions and how common are they?

Autism is a condition that affects social communication. Autistic people often have significant sensory sensitivities and need certainty and repetition. Around 1-2% of children and adults are autistic.

ADHD impacts either the ability to flexibly focus and sustain attention, or results in hyperactivity and impulsivity – or both. Around 5–8% of children and 3% of adults have ADHD.

Around 30% to 50% of autistic people also have ADHD. But despite them commonly occurring together, autism and ADHD have only been able to be diagnosed together since 2013, when the Diagnostic and Statistical Manual of Mental Disorders received its fifth update in the the DSM-5.

What’s usually diagnosed first?

Autism is usually diagnosed at an earlier age than AuDHD and ADHD in childhood.

This may related to autistic traits – social difficulties – often being apparent in preschool, whereas ADHD traits may not become apparent or problematic until school age, when concentration abilities are needed to learn.

But some people can mask their autistic differences through strategies, such as learning explicitly how to socialise, following scripts, copying and mirroring others and hiding autistic traits.

Sometimes, accessing ADHD medication treatment can reveal autistic traits that may not have been obvious and were overshadowed by ADHD. After taking ADHD medications, some people can achieve their preference for being highly structured and organised, when ADHD traits of disorganisation and inconsistency in attention are reduced.

For others, ADHD medication will treat impulsivity that manifests as talkativeness or extroversion, to reveal a deeper introversion and preference for solitary activities.

In recent years, some people who have one existing diagnosis have learned about the other condition on social media and realised they might have AuDHD.

Some difficulties are exacerbated

Maintaining friendships and socialising

For autistic people, maintaining friendships is a core difficulty and can make social interaction draining and overwhelming. Autism makes it difficult to pick up social cues, know what to do or say in social situations, and identify non-verbal signals from others.

ADHD can make it hard to organise social events, stay in touch with friends and respond to texts and calls. When socialising, attention difficulties can make it harder to focus on conversations and remember what was said. Hyperactivity and impulsivity can mean interrupting and talking over others or being overly talkative.

Together, AuDHD can mean a person experiences all these differences in social interactions, resulting in more unintended “social mistakes”.

Stims

Repetitive behaviours in autism (stims) are often ways to regulate or express emotions through repeated movements or vocalisations. They could be repetitive noises such as squeaks or humming, or movements such as rocking back and forth or finger flicking.

ADHD hyperactivity often involves fidgeting and not being able to be still or relax.

Together, movement from stims and fidgets can be more obvious and frequent.

Other traits pull people in different directions

Organisation

Autistic traits include the need for order, systems, categorisation and organisation around the house, at work and with hobbies.

ADHD traits of inattention include significant difficulties with organisation.

The result for people with AuDHD is often internal frustration and discomfort: wanting to be organised but not being able to maintain it.

Special interests

Autistic special interests are usually long-standing (over years) and limited to a few subjects.

ADHD involves seeking novelty and quickly becoming bored and moving on to the next interest once something is no longer stimulating. This might mean buying new things for a hobby but never actually using them.

AuDHD tends to follow the pattern of ADHD. So someone may have intense interests but be exhausted by them sooner than they would with autism alone.

Routine

Autism wants certainty, plans and routine. ADHD wants spontaneity and novelty. Together, autism often seems to win.

People with AuDHD may follow routines due to the anxiety uncertainty causes them, but they may feel bored or dissatisfied as their ADHD needs aren’t met.

Unique strengths

Many late-diagnosed people with AuDHD are highly intelligent and have developed elaborate compensation strategies for their difficulties. Many have found ways to leverage and maximise their strengths.

Strengths in AuDHD can be related to either condition. This can include common autistic strengths such as being highly focused, having meticulous attention to detail and subject matter expertise.

ADHD strengths can include creativity and the ability to develop novel solutions, strategise, quickly research to a deep level, have a high level of focus, and take quick action in highly stressful situations.

Knowing you have AuDHD can result in self-acceptance and understanding, and replace a lifetime of self-criticism. This can lead to developing a life that is right for each individual person with AuDHD rather than trying to fit in with what might be socially and culturally expected.

It also means you can access treatments and supports to support both autism and ADHD needs. This might include ADHD medication, neuro-affirming education and therapy adjusted for autism and ADHD, occupational therapy, ADHD coaching, as well as workplace and academic accommodations.

Tamara May, Psychologist and Research Associate in the Department of Paediatrics, Monash University

This article is republished from The Conversation under a Creative Commons license. Read the original article.