What is type 1.5 diabetes? It’s a bit like type 1 and a bit like type 2 – but it’s often misdiagnosed
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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.
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Vit D + Calcium: Too Much Of A Good Thing?
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Vit D + Calcium: Too Much Of A Good Thing?
- Myth: you can’t get too much calcium!
- Myth: you must get as much vitamin D as possible!
Let’s tackle calcium first:
❝Calcium is good for you! You need more calcium for your bones! Be careful you don’t get calcium-deficient!❞
Contingently, those comments seem reasonable. Contingently on you not already having the right amount of calcium. Most people know what happens in the case of too little calcium: brittle bones, osteoporosis, and so forth.
But what about too much?
Hypercalcemia
Having too much calcium—or “hypercalcemia”— can lead to problems with…
- Groans: gastrointestinal pain, nausea, and vomiting. Peptic ulcer disease and pancreatitis.
- Bones: bone-related pains. Osteoporosis, osteomalacia, arthritis and pathological fractures.
- Stones: kidney stones causing pain.
- Moans: refers to fatigue and malaise.
- Thrones: polyuria, polydipsia, and constipation
- Psychic overtones: lethargy, confusion, depression, and memory loss.
(mnemonic courtesy of Sadiq et al, 2022)
What causes this, and how do we avoid it? Is it just dietary?
It’s mostly not dietary!
Overconsumption of calcium is certainly possible, but not common unless one has an extreme diet and/or over-supplementation. However…
Too much vitamin D
Again with “too much of a good thing”! While keeping good levels of vitamin D is, obviously, good, overdoing it (including commonly prescribed super-therapeutic doses of vitamin D) can lead to hypercalcemia.
This happens because vitamin D triggers calcium absorption into the gut, and acts as gatekeeper to the bloodstream.
Normally, the body only absorbs 10–20% of the calcium we consume, and that’s all well and good. But with overly high vitamin D levels, the other 80–90% can be waved on through, and that is very much Not Good™.
See for yourself:
- Hypercalcemia of Malignancy: An Update on Pathogenesis and Management
- Vitamin D-Mediated Hypercalcemia: Mechanisms, Diagnosis, and Treatment
How much is too much?
The United States’ Office of Dietary Supplements defines 4000 IU (100μg) as a high daily dose of vitamin D, and recommends 600 IU (15μg) as a daily dose, or 800 IU (20μg) if aged over 70.
See for yourself: Vitamin D Fact Sheet for Health Professionals ← there’s quite a bit of extra info there too
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Cottage cheese is back and all over TikTok. Two dietitians explain why social media’s obsessed
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You might remember cottage cheese from your childhood. Back then, it was considered “diet food”. You ate it out of the tub, with celery or spread it on crackers for a low-calorie snack. Then cottage cheese went out of fashion.
But cottage cheese is having a resurgence. In recent months, Google searches for “cottage cheese” have risen to the highest levels since 2004.
Social media influencers have been promoting its benefits on TikTok and Instagram with hashtags such as #cottagecheese, #cottagecheeseforlife, and #cottagecheeserecipe. Sales of cottage cheese around the world have skyrocketed.
Let’s see why cottage cheese is having such a moment.
Karolina Kaboompics/Pexels What is cottage cheese?
Cottage cheese is a fresh dairy cheese product with a mild flavour and a slightly tangy taste. It is made by curdling cow’s milk, then draining the whey, leaving behind the curds. These curds are usually small and lumpy, and the texture can vary from creamy to dry, depending on the amount of whey left in the cheese.
The term “cottage cheese” is said to have originated because the cheese was generally made in cottage-type houses from leftover milk, after making butter.
Cottage cheese is cheap, costing about A$12 per kilogram in the supermarket, similar to ricotta cheese.
It’s also surprisingly simple to make at home using freely available recipes. All you need is milk, salt and a splash of vinegar.
We’re using cottage cheese in new ways
It’s difficult to know what started the latest cottage cheese trend. But the creativity of social media means people are sharing alternative ways to use cottage cheese, changing people’s views from it being boring and lacking flavour to it being versatile and healthy.
People are spreading cottage cheese on toast and using it to make dishes such as porridge, dips, salads, bread and flatbreads. They’re using it in cakes and scones, and in desserts such as mousse and ice cream.
Is cottage cheese healthy?
Compared with other cheeses, cottage cheese is low in fat and therefore energy (kilojoules or kJ). This makes it a smart choice for people looking to cut down on their daily energy intake.
For example, 100 grams of cottage cheese contains about 556kJ. The same amount of cheddar contains 1,254kJ and parmesan 1,565kJ.
Many cheeses are rich in protein but they often contain higher amounts of kilojoules due to their fat content. But cottage cheese has substantial amounts of protein with fewer kilojoules.
This makes cottage cheese an ideal option for people aiming to maximise their protein intake without eating large amounts of kilojoules.
Some 100g of cottage cheese provides 17g protein. This is about the same found in three eggs, 60g chicken breast or 320 millilitres (about 300g) full-fat yoghurt.
People are sharing images of their cottage cheese creations on TikTok and Instagram. New Africa/Shutterstock Cottage cheese also contains high levels of vitamin B12 (important for healthy brain function), riboflavin (supports healthy skin and eyes), phosphorus (helps build strong bones and teeth) and folate (essential for cell growth).
However, cottage cheese is lower in calcium compared with other cheeses. It contains just 89 milligrams per 100g. This compares with parmesan (948mg), haloumi (620mg) and ricotta (170mg).
You’ve convinced me. How can I use cottage cheese?
Beyond its excellent nutrition profile, the resurgence of cottage cheese is enabling people to experiment in the kitchen. Its neutral flavour and varied textures – ranging from smooth to chunky – makes it suitable for a range of dishes, from sweet to savoury.
TikTok and Instagram have some great recipes. You could start with an old faithful recipe of celery and cottage cheese, and work your way towards new options such as cottage cheese ice cream.
The healthiest recipes will be those that combine cottage cheese with wholefoods such as fruits, vegetables, nuts and seeds, and lean protein sources.
For instance, you can make a cottage cheese wrap then fill it with vegetables and a lean source of protein (such as chicken or fish).
Other combinations include cottage cheese salad dressings, vegetable dips and egg salads.
Cottage cheese’s rise in popularity is well deserved. Including more cottage cheese in your diet is a smart choice for getting a high dose of protein without adding processed ingredients or too much energy. Embrace the trend and get creative in the kitchen.
Lauren Ball, Professor of Community Health and Wellbeing, The University of Queensland and Emily Burch, Accredited Practising Dietitian and Lecturer, Southern Cross University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Codependency Isn’t What Most People Think It Is
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Codependency isn’t what most people think it is
In popular parlance, people are often described as “codependent” when they rely on each other to function normally. That’s interdependent mutualism, and while it too can become a problem if a person is deprived of their “other half” and has no idea how to do laundry and does not remember to take their meds, it’s not codependency.
Codependency finds its origins in the treatment and management of alcoholism, and has been expanded to encompass other forms of relationships with dependence on substances and/or self-destructive behaviors—which can be many things, including the non-physical, for example a pattern of irresponsible impulse-spending, or sabotaging one’s own relationship(s).
We’ll use the simplest example, though:
- Person A is (for example) an alcoholic. They have a dependency.
- Person B, married to A, is not an alcoholic. However, their spouse’s dependency affects them greatly, and they do what they can to manage that, and experience tension between wanting to “save” their spouse, and wanting their spouse to be ok, which latter, superficially, often means them having their alcohol.
Person B is thus said to be “codependent”.
The problem with codependency
The problems of codependency are mainly twofold:
- The dependent partner’s dependency is enabled and thus perpetuated by the codependent partner—they might actually have to address their dependency, if it weren’t for their partner keeping them from too great a harm (be it financially, socially, psychologically, medically, whatever)
- The codependent partner is not having a good time of it either. They have the stress of two lives with the resources (e.g. time) of one. They are stressing about something they cannot control, understandably worrying about their loved one, and, worse: every action they might take to “save” their loved one by reducing the substance use, is an action that makes their partner unhappy, and causes conflict too.
Note: codependency is often a thing in romantic relationships, but it can appear in other relationships too, e.g. parent-child, or even between friends.
See also: Development and validation of a revised measure of codependency
How to deal with this
If you find yourself in a codependent position, or are advising someone who is, there are some key things that can help:
- Be a nurturer, not a rescuer. It is natural to want to “rescue” someone we care about, but there are some things we cannot do for them. Instead, we must look for ways to build their strength so that they can take the steps that only they can take to fix the problem.
- Establish boundaries. Practise saying “no”, and also be clear over what things you can and cannot control—and let go of the latter. Communicate this, though. An “I’m not the boss of you” angle can prompt a lot of people to take more personal responsibility.
- Schedule time for yourself. You might take some ideas from our previous tangentially-related article:
How To Avoid Carer Burnout (Without Dropping Care)
Want to read more?
That’s all we have space for today, but here’s a very useful page with a lot of great resources (including questionnaires and checklist and things, in case you’re thinking “is it, or…?”)
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Take These To Lower Cholesterol! (Statin Alternatives)
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Dr. Ada Ozoh, a diabetes specialist, took an interest in this upon noting the many-headed beast that is metabolic syndrome means that neither diabetes nor cardiovascular disease exist in a vacuum, and there are some things that can help a lot against both. Here she shares some of her top recommendations:
Statin-free options
Dr. Ozoh recommends:
- Bergamot: lowers LDL (“bad” cholesterol) by about 30% and slightly increases HDL (“good” cholesterol), at 500–1000mg/day, seeing results in 1–6 months
- Berberine: prevents fat absorption and helps burn stored fat, as well as reducing blood sugar levels and blood pressure, at 1,500mg/day
- Silymarin: protects the liver, and lowers cholesterol in type 2 diabetes, at 280–420mg/day
- Phytosterols: lower cholesterol by about 10%; found naturally in many plants, but it takes supplementation to read the needed (for this purpose) dosage of 2g/day
- Red yeast rice: this is white rice fermented with yeast, and it lowers LDL cholesterol by about 25%, seeing results in around 3 months
For more information on all of the above (including more details on the biochemistry, as well as potential issues to be aware of), enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
- Statins: His & Hers? Very Different For Men & Women
- Berberine For Metabolic Health
- Milk Thistle For The Brain, Bones, & More ← this is about silymarin, which is extracted from Silybum marianum, the milk thistle plant
Take care!
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Healing After Loss – by Martha Hickman
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Mental health is also just health, and this book’s about an underexamined area of mental health. We say “underexamined”, because for something that affects almost everyone sooner or later, there’s not nearly so much science being done about it as other areas of mental health.
This is not a book of science per se, but it is a very useful one. The format is:
Each calendar day of the year, there’s a daily reflection, consisting of:
- A one-liner insight about grief, quoted from somebody
- A page of thoughts about this
- A one-liner summary, often formulated as a piece of advice
The book is not religious in content, though the author does occasionally make reference to God, only in the most abstract way that shouldn’t be offputting to any but the most stridently anti-religious readers.
Bottom line: if this is a subject near to your heart, then you will almost certainly benefit from this daily reader.
Click here to check out Healing After Loss, and indeed heal after loss
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Chiropractors have been banned again from manipulating babies’ spines. Here’s what the evidence actually says
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Chiropractors in Australia will not be able to perform spinal manipulation on children under the age of two once more, following health concerns from doctors and politicians.
But what is the spinal treatment at the centre of the controversy? Does it work? Is there evidence of harm?
We’re a team of researchers who specialise in evidence-based musculoskeletal health. I (Matt) am a registered chiropractor, Joshua is a registered physiotherapist and Giovanni trained as a physiotherapist.
Here’s what the evidence says.
Dmitry Naumov/Shutterstock Remind me, how did this all come about?
A Melbourne-based chiropractor posted a video on social media in 2018 using a spring-loaded device (known as the Activator) to manipulate the spine of a two-week-old baby suspended upside down by the ankles.
The video sparked widespread concerns among the public, medical associations and politicians. It prompted a ban on the procedure in young children. The Victorian health minister commissioned Safer Care Victoria to conduct an independent review of spinal manipulation techniques on children.
Recently, the Chiropractic Board of Australia reinstated chiropractors’ authorisation to perform spinal manipulation on babies under two years old. But this week, it backflipped, following heavy criticism from medical associations and politicians.
What is spinal manipulation?
Spinal manipulation is a treatment used by chiropractors and other health professionals such as doctors, osteopaths and physiotherapists.
It is an umbrella term that includes popular “back cracking” techniques.
It also includes more gentle forms of treatment, such as massage or joint mobilisations. These involve applying pressure to joints without generating a “cracking” sound.
Does spinal manipulation in babies work?
Several international guidelines for health-care professionals recommend spinal manipulation to treat adults with conditions such as back pain and headache as there is an abundance of evidence on the topic. For example, spinal manipulation for back pain is supported by data from nearly 10,000 adults.
For children, it’s a different story. Safer Care Victoria’s 2019 review of spinal manipulation found very few studies testing whether this treatment was safe and effective in children.
Studies were generally small and were of poor quality. Some of those small, poor-quality studies, suggest spinal manipulation provides a very small benefit for back pain, colic and potentially bedwetting – some common reasons for parents to take their child to see a chiropractor. But overall, the review found the overall body of evidence was very poor.
Spinal manipulation doesn’t seem to help young children with an ear infection. MIA Studio/Shutterstock However, for most other children’s conditions chiropractors treat – such as headache, asthma, otitis media (a type of ear infection), cerebral palsy, hyperactivity and torticollis (“twisted neck”) – there did not appear to be a benefit.
The number of studies investigating the effectiveness of spinal manipulation on babies under two years of age was even smaller.
There was one high-quality study and two small, poor quality studies. These did not show an appreciable benefit of spinal manipulation on colic, otitis media with effusion (known as glue ear) or twisted neck in babies.
Is spinal manipulation on babies safe?
In terms of safety, most studies in the review found serious complications were extremely rare. The review noted one baby or child dying (a report from Germany in 2001 after spinal manipulation by a physiotherapist). The most common complications were mild in nature such as increased crying and soreness.
However, because studies were very small, they cannot tell us anything about the safety of spinal manipulation in a reliable way. Studies that are designed to properly investigate if a treatment is safe typically include thousands of patients. And these studies have not yet been done.
Why do people see chiropractors?
Safer Care Victoria also conducted surveys with more than 20,000 people living in Australia who had taken their children under 12 years old to a chiropractor in the past ten years.
Nearly three-quarters said that was for treatment of a child aged two years or younger.
Nearly all people surveyed reported a positive experience when they took their child to a chiropractor and reported that their child’s condition improved with chiropractic care. Only a small number of people (0.3%) reported a negative experience, and this was mostly related to cost of treatment, lack of improvement in their child’s condition, excessive use of x-rays, and perceived pressure to avoid medications.
Many of the respondents had also consulted their GP or maternity/child health nurse.
What now for spinal manipulation in children?
At the request of state and federal ministers, the Chiropractic Board of Australia confirmed that spinal manipulation on babies under two years old will continue to be banned until it discusses the issue further with health ministers.
Many chiropractors believe this is unfair, especially considering the strong consumer support for chiropractic care outlined in the Safer Care Victoria report, and the rarity of serious reported harms in children.
Others believe that in the absence of evidence of benefit and uncertainty around whether spinal manipulation is safe in children and babies, the precautionary principle should apply and children and babies should not receive spinal manipulation.
Ultimately, high quality research is urgently needed to better understand whether spinal manipulation is beneficial for the range of conditions chiropractors provide it for, and whether the benefit outweighs the extremely small chance of a serious complication.
This will help parents make an informed choice about health care for their child.
Matt Fernandez, Senior lecturer and researcher in chiropractic, CQUniversity Australia; Giovanni E. Ferreira, NHMRC Emerging Leader Research Fellow, Institute of Musculoskeletal Health, University of Sydney, and Joshua Zadro, NHMRC Emerging Leader Research Fellow, Sydney Musculoskeletal Health, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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