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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Avocado vs Jackfruit – Which is Healthier?
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Our Verdict
When comparing avocado to jackfruit, we picked the avocado.
Why?
In terms of macros, avocado is higher in fats (famously healthy ones, including a good dose of omega-3), fiber (nearly 5x more), and protein (despite jackfruit being more often used as a meaty element in recipes, avocado has slightly more). Meanwhile, jackfruit is about 3x higher in carbs. All in all, a clear win for avocado.
Looking at vitamins, avocado has more of vitamins A, B2, B3, B5, B7, B9, E, K, and choline, while jackfruit has more of vitamins B1, B6, and C. Another win for avocado in this category.
In the category of minerals, avocado has more copper, iron, manganese, phosphorus, potassium, selenium, and zinc, while jackfruit has more calcium. One more win for avocado.
Adding up the sections makes for an easy overall win for avocado, but by all means enjoy either or both; diversity is good!
Want to learn more?
You might like:
Jackfruit vs Durian – Which is Healthier? ← including some fun durian facts (such as how to pick a good one, and what happens if you eat durian and drink alcohol)
Enjoy!
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Chicken or Fish – Which is Healthier?
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Our Verdict
When comparing chicken to fish, we picked the fish.
Why?
To understand the choice, we have to start a bit earlier on the decision tree. For most people most of the time, when it comes to a diet high in plants or high in animals, the plant-centric diet will generally be best:
Do We Need Animal Products To Be Healthy?
When it comes to animal meats, red meat is a fairly uncontroversial first thing to strike off the list:
…with pork and some other meats not being much better.
But chicken? Poultry in general appears to be quite health-neutral. The jury is out and the science has mixed results, but the data is leaning towards “it’s probably fine”.
See for example this huge (n=29,682) study:
this same paper shows that…
❝higher intake of processed meat, unprocessed red meat, or poultry, but not fish, was significantly associated with a small increased risk of incident CVD, whereas higher intake of processed meat or unprocessed red meat, but not poultry or fish, was significantly associated with a small increased risk of all-cause mortality❞
So, since poultry isn’t significantly increasing all-cause mortality, and fish isn’t significantly increasing all-cause mortality or cardiovascular disease, fish comes out as the hands-down (fins-down?) winner.
One more (this time, easy) choice to make, though!
While fish in general (please, not fried, though!) is generally considered quite healthy, there is a big difference (more than you might think, and for reasons that are quite alarming), between…
Health Risks & Nutrition: Farmed Fish vs Wild-Caught
Enjoy, and take care!
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The Lifestyle Factors That Matter >8 Times More Than Genes
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We’ve said before that “genes predispose; they don’t predetermine”. It can be good to know one’s genes, of course, and we’ve written about this here:
Genetic Testing: Health Benefits & Methods
…which can include some quite contemporary risks, such as:
Genetic Risk Factors For Long COVID
And yet…
Nurture Over Nature
A very large (n=492,567) study looked into the impact of 25 lifestyle/environmental factors, of which 23 are considered modifiable, and found that lifestyle/environmental factors accounted for 17% of the variation in mortality risk, while genetic predisposition accounted for less than 2%.
Which is good news, because it means we can improve our lot.
But how?
The strongest negative factors (that increased mortality the most) were:
- Smoking
- Not owning your home (interestingly, “live in accommodation rent-free vs own” performed just as badly as various kinds of “renting home vs own”, while “own house with mortgage, vs own outright” had only a marginal negative effect)
- Sleeping more than 9 hours per day (performed even worse than sleeping under 7 hours per day, which also increased mortality risk, but not by as much as oversleeping)
- Financial difficulties in the past two years
- Homosexuality
- Unemployment
- Being an evening person
- Lonely lifestyle
- Frequent napping
We may hypothesize that homosexuality probably makes the list because of how it makes one more likely to have other items on the list, especially unemployment, and the various poverty-related indicators that come from unemployment.
Being an evening person, whatever its pathology, is a well-established risk factor that we’ve talked about before:
Early Bird Or Night Owl? Genes vs Environment ← this is also, by the way, an excellent example of how “genes predispose; they don’t predetermine”, because there is a genetic factor involved, and/but we absolutely can switch it up, if we go about it correctly, and become a morning person without trying to force it.
The strongest positive factors (that decreased mortality the most) were:
- The inverse of all of the various above things, e.g. never having smoked, owning your own home, etc
- Household income, specifically
- Living with a partner
- Having oil central heating
- Gym use
- Sun protection use
- Physical activity, especially if in leisure time rather than as part of one’s work
- Glucosamine supplements
- Family visit frequency
- Cereal fiber intake (i.e. whole grains)
We may hypothesize that having oil central heating is simply a more expensive option to install than many, and therefore likely one enjoyed by homeowners more often than renters.
We may hypothesize that glucosamine supplementation is an indication of the type of person who takes care of a specific condition (inflammation of the joints) without an existential threat; notably, multivitamin supplements don’t get the same benefit, probably because of their ubiquity.
We may hypothesize that “family visit frequency” is highly correlated to having a support network, being social (and thus not lonely), and likely is associated with household income too.
You can see the full list of factors and their impacts, here:
Environmental architecture of mortality in the UKB ← that’s the UK Biobank
You can read the paper in full, here:
Integrating the environmental and genetic architectures of aging and mortality
Practical takeaways
The priorities seem to be as follows:
Don’t smoke. Ideally you will never have smoked, but short of a time machine, you can’t change that now, so: what you can do is quit now if you haven’t already.
See also: Which Addiction-Quitting Methods Work Best?
Note that other factors often lumped in with such, for example daily alcohol consumption, red meat intake, processed meat intake, and salt intake, all significantly increased mortality risk, but none of them in the same league of badness as smoking.
See also: Is Sugar The New Smoking? ← simply put: no, it is not. Don’t get us wrong; added sugar is woeful for the health, but smoking is pretty much the worst thing you can do for your health, short of intentionally (and successfully) committing suicide.
Be financially secure, ideally owning your own home. For many (indeed, for most people in the world) this may be an “easier said than done” thing, but if you can make decisions that will improve your financial security, the mortality numbers are very clear on this matter.
Be social, as loneliness indeed kills, in numerous ways. Loneliness means a lack of a support network, and it means a lack of social contact (thus increased risk of cognitive decline), and likely decreased ikigai, unless your life’s purpose is something inherently linked to solitude (e.g. the “meditating on top of a mountain” archetype).
See also: What Loneliness Does To Your Brain And Body
And to fix it: How To Beat Loneliness & Isolation
Be active: especially in your leisure time; being active because you have to does convey benefits, but on the same level as physical activity because you want to.
See also: No-Exercise Exercises (That Won’t Feel Like “Having To Do” Exercise)
Use sunscreen: we’re surprised this one made the list; it’s important to avoid skin cancer of course, but we didn’t think it’d be quite such a driver of mortality risk mitigation as the numbers show it is, and we can’t think of a clear alternative explanation, as we could with some of the other “why did this make the list?” items. At worst, it could be a similar case to that of glucosamine use, and thus is a marker of a conscientious person making a regular sustained effort for their health. Either way, it seems like a good idea based on the numbers.
See also: Do We Need Sunscreen In Winter, Really?
Enjoy whole grains: fiber is super-important, and that mustn’t be underestimated!
See also: What Matters Most For Your Heart? ← hint: it isn’t about salt intake or fat
And, for that matter: The Best Kind Of Fiber For Overall Health?
Take care!
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28-Day FAST Start Day-by-Day – by Gin Stephens
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We have previously reviewed Gin Stephens’ other book, “Fast. Feast. Repeat.”, so what’s so special about this one that it deserves reviewing too?
This one is all about troubleshooting the pitfalls that many people find when taking up intermittent fasting.
To be clear: the goal here is not a “28 days and yay you did it, put that behind you now”, but rather “28 days and you are now intermittently fasting easily each day and can keep it up without difficulty”. As for the difficulties that may arise early in the 28 days…
Not just issues of willpower, but also the accidental breaks. For example, some artificial sweeteners, while zero-calorie, trigger an insulin response, which breaks the fast on the metabolic level (avoiding that is the whole point of IF). Lots of little tips like that peppered through the book help the reader to stop accidentally self-sabotaging their progress.
The author does talk about psychological issues too, and also how it will feel different at first while the liver is adapting, than later when it has already depleted its glycogen reserves and the body must burn body fat instead. Information like that makes it easier to understand that some initial problems (hunger, getting “hangry”, feeling twitchy, or feeling light-headed) will last only a few weeks and then disappear.
So, understanding things like that makes a big difference too.
The style of the book is simple and clear pop-science, with lots of charts and bullet points and callout-boxes and the like; it makes for very easy reading, and very quick learning of all the salient points, of which there are many.
Bottom line: if you’ve tried intermittent fasting but struggled to make it stick, this book can help you get to where you want to be.
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STI rates are increasing among midlife and older adults. We need to talk about it
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Globally, the rates of common sexually transmissible infections (STIs) are increasing among people aged over 50. In some cases, rates are rising faster than among younger people.
Recent data from the United States Centers for Disease Control and Prevention shows that, among people aged 55 and older, rates of gonorrhoea and chlamydia, two of the most common STIs, more than doubled between 2012 and 2022.
Australian STI surveillance data has reflected similar trends. Between 2013 and 2022, there was a steady increase in diagnoses of chlamydia, gonorrhoea and syphilis among people aged 40 and older. For example, there were 5,883 notifications of chlamydia in Australians 40 plus in 2013, compared with 10,263 in 2022.
A 2020 study of Australian women also showed that, between 2000 and 2018, there was a sharper increase in STI diagnoses among women aged 55–74 than among younger women.
While the overall rate of common STIs is highest among young adults, the significant increase in STI diagnoses among midlife and older adults suggests we need to pay more attention to sexual health across the life course.
Fit Ztudio/Shutterstock Why are STI rates rising among older adults?
STI rates are increasing globally for all age groups, and an increase among midlife and older people is in line with this trend.
However, increases of STIs among older people are likely due to a combination of changing sex and relationship practices and hidden sexual health needs among this group.
The “boomer” generation came of age in the 60s and 70s. They are the generation of free love and their attitude to sex, even as they age, is quite different to that of generations before them.
Given the median age of divorce in Australia is now over 43, and the internet has ushered in new opportunities for post-separation dating, it’s not surprising that midlife and older adults are exploring new sexual practices or finding multiple sexual partners.
People may start new relationships later in life. Tint Media/Shutterstock It’s also possible midlife and older people have not had exposure to sexual health education in school or do not relate to current safe sex messages, which tend to be directed toward young people. Condoms may therefore seem unnecessary for people who aren’t trying to avoid pregnancy. Older people may also lack confidence negotiating safe sex or accessing STI screening.
Hidden sexual health needs
In contemporary life, the sex lives of older adults are largely invisible. Ageing and older bodies are often associated with loss of power and desirability, reflected in the stereotype of older people as asexual and in derogatory jokes about older people having sex.
With some exceptions, we see few positive representations of older sexual bodies in film or television.
Older people’s sexuality is also largely invisible in public policy. In a review of Australian policy relating to sexual and reproductive health, researchers found midlife and older adults were rarely mentioned.
Sexual health policy generally targets groups with the highest STI rates, which excludes most older people. As midlife and older adults are beyond childbearing years, they also do not feature in reproductive health policy. This means there is a general absence of any policy related to sex or sexual health among midlife or older adults.
Added to this, sexual health policy tends to be focused on risk rather than sexual wellbeing. Sexual wellbeing, including freedom and capacity to pursue pleasurable sexual experiences, is strongly associated with overall health and quality of life for adults of all ages. Including sexual wellbeing as a policy priority would enable a focus on safe and respectful sex and relationships across the adult life course.
Without this priority, we have limited knowledge about what supports sexual wellbeing as people age and limited funding for initiatives to engage with midlife or older adults on these issues.
Midlife and older adults may have limited knowledge about STIs. Southworks/Shutterstock How can we support sexual health and wellbeing for older adults?
Most STIs are easily treatable. Serious complications can occur, however, when STIs are undiagnosed and untreated over a long period. Untreated STIs can also be passed on to others.
Late diagnosis is not uncommon as some STIs can have no symptoms and many people don’t routinely screen for STIs. Older, heterosexual adults are, in general, less likely than other groups to seek regular STI screening.
For midlife or older adults, STIs may also be diagnosed late because some doctors do not initiate testing due to concerns they will cause offence or because they assume STI risk among older people is negligible.
Many doctors are reluctant to discuss sexual health with their older patients unless the patient explicitly raises the topic. However, older people can be embarrassed or feel awkward raising matters of sex.
Resources for health-care providers and patients to facilitate conversations about sexual health and STI screening with older patients would be a good first step.
To address rising rates of STIs among midlife and older adults, we also need to ensure sexual health promotion is targeted toward these age groups and improve accessibility of clinical services.
More broadly, it’s important to consider ways to ensure sexual wellbeing is prioritised in policy and practice related to midlife and older adulthood.
A comprehensive approach to older people’s sexual health, that explicitly places value on the significance of sex and intimacy in people’s lives, will enhance our ability to more effectively respond to sexual health and STI prevention across the life course.
Jennifer Power, Associate Professor and Principal Research Fellow, Australian Research Centre in Sex, Health and Society, La Trobe University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Heart Health vs Systemic Stress
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At The Heart Of Good Health
This is Dr. Michelle Albert. She’s a cardiologist with a decades-long impressive career, recently including a term as the president of the American Heart Association. She’s the current Admissions Dean at UCSF Medical School. She’s accumulated enough awards and honors that if we list them, this email will not fit in your inbox without getting clipped.
What does she want us to know?
First, lifestyle
Although Dr. Albert is also known for her work with statins (which found that pravastatin may have anti-inflammatory effects in addition to lipid-lowering effects, which is especially good news for women, for whom the lipid-lowering effects may be less useful than for men), she is keen to emphasize that they should not be anyone’s first port-of-call unless “first” here means “didn’t see the risk until it was too late and now LDL levels are already ≥190 mg/dL”.
Instead, she recommends taking seriously the guidelines on:
- getting plenty of fruit, vegetables, whole grains, lean protein
- avoiding red meat, processed meats, refined carbohydrates, and sweetened beverages
- getting your 150 minutes per week of moderate exercise
- avoiding alcohol, and definitely abstaining from smoking
See also: These Top Five Things Make The Biggest Difference To Health
Next, get your house in order
No, not your home gym—though sure, that too!
But rather: after the “Top Five Things” we linked just above, the sixth on the list would be “reduce stress”. Indeed, as Dr. Albert says:
❝Heart health is not just about the physical heart but also about emotional well-being. Stress management is crucial for a healthy heart❞
~ Dr. Michelle Albert
This is where a lot of people would advise mindfulness meditation, CBT, somatic therapies, and the like. And these things are useful! See for example:
No-Frills, Evidence-Based Mindfulness
…and:
However, Dr. Albert also advocates for awareness of what some professionals have called “Shit Life Syndrome”.
This is more about socioeconomic factors. There are many of those that can’t be controlled by the individual, for example:
❝Adverse maternal experiences such as depression, economic issues and low social status can lead to poor cognitive outcomes as well as cardiovascular disease.
Many jarring statistics illuminate a marked wealth gap by race and ethnicity… You might be thinking education could help bridge that gap. But it is not that simple.
While education does increase wealth, the returns are not the same for everyone. Black persons need a post-graduate degree just to attain similar wealth as white individuals with a high school degree.❞
~ Dr. Michelle Albert
Read in full: AHA president: The connection between economic adversity and cardiovascular health
What this means in practical terms (besides advocating for structural change to tackle the things such as the racism that has been baked into a lot of systems for generations) is:
Be aware not just of your obvious health risk factors, but also your socioeconomic risk factors, if you want to have good general health outcomes.
So for example, let’s say that you, dear reader, are wealthy and white, in which case you have some very big things in your favor, but are you also a woman? Because if so…
Women and Minorities Bear the Brunt of Medical Misdiagnosis
See also, relevant for some: Obesity Discrimination In Healthcare Settings ← you’ll need to scroll to the penultimate section for this one.
In other words… If you are one of the majority of people who is a woman and/or some kind of minority, things are already stacked against you, and not only will this have its own direct harmful effect, but also, it’s going to make your life harder and that stress increases CVD risk more than salt.
In short…
This means: tackle not just your stress, but also the things that cause that. Look after your finances, gather social support, know your rights and be prepared to self-advocate / have someone advocate for you, and go into medical appointments with calm well-prepared confidence.
Take care!
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