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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Trout vs Carp – Which is Healthier?
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Our Verdict
When comparing trout to carp, we picked the trout.
Why?
Both have their strong points!
In terms of macros, trout has slightly more protein and fat, and/but also has less cholesterol than carp. So, we pick the trout in the macros category.
In the category of vitamins, trout has much more of vitamins A, B1, B2, B3, B5, B6, B7, B12, C, D, E, K, and choline, while carp has slightly more vitamin B9. In other words, an easy win for trout here.
When it comes to minerals, however, trout has more potassium and selenium, while carp has more calcium, copper, iron, magnesium, manganese, phosphorus, and zinc. A fair win for carp this time.
You may be wondering about heavy metals: this will vary depending on location, as well as the age of the fish (younger fish have had less time to accumulate heavy metals than old ones, so if you’re visiting the fishmonger, choose the smaller ones) and the lives they have led (e.g. wild vs farmed), however, as a general rule of thumb, trout will generally have lower heavy metals levels than carp, all other things (e.g. location, age, etc) being equal.
In short, enjoy either or both in moderation, but trout wins on 3/4 categories today.
Want to learn more?
You might like to read:
Farmed Fish vs Wild Caught: Antibiotics, Mercury, & More
Take care!
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Breakfasting For Health?
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Breakfast Time!
In yesterday’s newsletter, we asked you for your health-related opinions on the timings of meals.
But what does the science say?
Quick recap on intermittent fasting first:
Today’s article will rely somewhat on at least a basic knowledge of intermittent fasting, what it is, and how and why it works.
Armed with that knowledge, we can look at when it is good to break the fast (i.e. breakfast) and when it is good to begin the fast (i.e. eat the last meal of the day).
So, if you’d like a quick refresher on intermittent fasting, here it is:
Intermittent Fasting: We Sort The Science From The Hype
And now, onwards!
One should eat breakfast first thing: True or False?
True! Give or take one’s definition of “first thing”. We did a main feature about this previously, and you can read a lot about the science of it, and see links to studies:
The Circadian Rhythm: Far More Than Most People Know
In case you don’t have time to read that now, we’ll summarize the most relevant-to-today’s-article conclusion:
The optimal time to breakfast is around 10am (this is based on getting sunlight around 8:30am, so adjust if this is different for you)
It doesn’t matter when we eat; calories are calories & nutrients are nutrients: True or False?
Broadly False, for practical purposes. Because, indeed calories are calories and nutrients are nutrients at any hour, but the body will do different things with them depending on where we are in the circadian cycle.
For example, this study in the Journal of Nutrition found…
❝Our results suggest that in relatively healthy adults, eating less frequently, no snacking, consuming breakfast, and eating the largest meal in the morning may be effective methods for preventing long-term weight gain.
Eating breakfast and lunch 5-6 h apart and making the overnight fast last 18-19 h may be a useful practical strategy.❞
Read in full: Meal Frequency and Timing Are Associated with Changes in Body Mass Index
We should avoid eating too late at night: True or False?
False per se, True in the context of the above. Allow us to clarify:
There is nothing inherently bad about eating late at night; there is no “bonus calorie happy hour” before bed.
However…
If we are eating late at night, that makes it difficult to breakfast in the morning (as is ideal) and still maintain a >16hr fasting window as is optimal, per:
❝the effects of the main forms of fasting, activating the metabolic switch from glucose to fat and ketones (G-to-K), starting 12-16 h after cessation or strong reduction of food intake❞
~ Dr. Françoise Wilhelmi de Toledo et al.
So in other words: since the benefits of intermittent fasting start at 12 hours into the fast, you’re not going to get them if you’re breakfasting at 10am and also eating in the evening.
Summary:
- It is best to eat breakfast around 10am, generally (ideally after some sunlight and exercise)
- While there’s nothing wrong with eating in the evening per se, doing so means that a 10am breakfast will eliminate any fasting benefits you might otherwise get
- If a “one meal a day, and that meal is breakfast” lifestyle doesn’t suit you, then one possible good compromise is to have a large breakfast, and then a smaller meal in the late afternoon / early evening.
One last tip: the above is good, science-based information. Use it (or don’t), as you see fit. We’re not the boss of you:
- Maybe you care most about getting the best circadian rhythm benefits, in which case, prioritizing breakfast being a) in the morning and b) the largest meal of the day, is key
- Maybe you care most about getting the best intermittent fasting benefits, in which case, for many people’s lifestyle, a fine option is skipping eating in the morning, and having one meal in the late afternoon / early evening.
Take care!
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Getting Your Messy Life In Order
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Getting Your Messy Life In Order
We’ve touched on this before by recommending the book, but today we’re going to give an overview of the absolute most core essentials of the “Getting Things Done” method. If you’re unfamiliar, this will be enough to get you going. If you’re already familiar, this may be a handy reminder!
First, you’ll need:
- A big table
- A block of small memo paper squares—post-it note sized, but no need to be sticky.
- A block of A4 printer paper
- A big trash bag
Gathering everything
Gather up not just all your to-dos, but: all sources of to-dos, too, and anything else that otherwise needs “sorting”.
Put them all in one physical place—a dining room table may have enough room. You’ll need a lot of room because you’re going to empty our drawers of papers, unopened (or opened and set aside) mail. Little notes you made for yourself, things stuck on the fridge or memo boards. Think across all areas of your life, and anything you’re “supposed” to do, write it down on a piece of paper. No matter what area of your life, no matter how big or small.
Whether it’s “learn Chinese” or “take the trash out”, write it down, one item per piece of paper (hence the block of little memo squares).
Sorting everything
Everything you’ve gathered needs one of three things to happen:
- You need to take some action (put it in a “to do” pile)
- You may need it later sometime (put it in a “to file” pile)
- You don’t need it (put it in the big trash bag for disposal)
What happens next will soothe you
- Dispose of the things you put for disposal
- File the things for filing in a single alphabetical filing system. If you don’t have one, you’ll need to get one, so write that down and add it to the “to do” pile.
- You will now process your “to dos”
Processing the “to dos”
The pile you have left is now your “inbox”. It’s probably huge; later it’ll be smaller, maybe just a letter-tray on your desk.
Many of your “to dos” are actually not single action items, they’re projects. If something requires more than one step, it’s a project.
Take each item one-by-one. Do this in any order; you’re going to do this as quickly as possible! Now, ask yourself: is this a single-action item that I could do next, without having to do something else first?
- If yes: put it in a pile marked “next action”
- If no: put it in a pile marked “projects”.
Take a sheet of A4 paper and fold it in half. Write “Next Action” on it, and put your pile of next actions inside it.
Take a sheet of A4 paper per project and write the name of the project on it, for example “Learn Chinese”, or “Do taxes”. Put any actions relating to that project inside it.
Likely you don’t know yet what the first action will be, or else it’d be in your “Next Action” pile, so add an item to each project that says “Brainstorm project”.
Processing the “Next Action” pile
Again you want to do this as quickly as possible, in any order.
For each item, ask yourself “Do I care about this?” If the answer is no, ditch that item, and throw it out. That’s ok. Things change and maybe we no longer want or need to do something. No point in hanging onto it.
For each remaining item, ask yourself “can this be done in under 2 minutes?”.
- If yes, do it, now. Throw away the piece of paper for it when you’re done.
- If no, ask yourself:”could I usefully delegate this to someone else?” If the answer is yes, do so.
If you can’t delegate it, ask yourself: “When will be a good time to do this?” and schedule time for it. A specific, written-down, clock time on a specific calendar date. Input that into whatever you use for scheduling things. If you don’t already use something, just use the calendar app on whatever device you use most.
The mnemonic for the above process is “Do/Defer/Delegate/Ditch”
Processing projects:
If you don’t know where to start with a project, then figuring out where to start is your “Next Action” for that project. Brainstorm it, write down everything you’ll need to do, and anything that needs doing first.
The end result of this is:
- You will always, at any given time, have a complete (and accessible) view of everything you are “supposed” to do.
- You will always, at any given time, know what action you need to take next for a given project.
- You will always, when you designate “work time”, be able to get straight into a very efficient process of getting through your to-dos.
Keeping on top of things
- Whenever stuff “to do something with/about” comes to you, put it in your physical “inbox” place—as mentioned, a letter-tray on a desk should suffice.
- At the start of each working day, quickly process things as described above. This should be a small daily task.
- Once a week, do a weekly review to make sure you didn’t lose sight of something.
- Monthly, quarterly, and annual reviews can be a good practice too.
How to do those reviews? Topic for another day, perhaps.
Or:
Check out the website / Check out GTD apps / Check out the book
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How To Make Your Doctor’s Appointment Do More For You
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Doctor: “So, how are you today?”
Patient: “Can’t complain; how about you?”Hopefully your medical appointments don’t start quite like that, but there can be an element of being “along for the ride” when it comes to consultations. They ask questions, we answer, they prescribe something, we thank them.
In principle, the doctor should be able to handle that; ask the right questions, determine the problem, and not need too much from you. After all, they have been trained to deal with an unconscious patient, so the fact you can communicate at all is a bonus.
However, leaving it all to them isn’t really playing the field.
Before the appointment
Research your issue, as best you understand it. Some doctors will be very averse to you telling them about having done this (taking it as an affront to their expertise), but here’s the thing:
You don’t have to tell them.
You just have to understand as much as possible, so that you will be as “up to speed” as possible in the conversation, and not be quickly out of your depth.
Have an agenda, based on the above. Literally, have a little set of bullet-points to remind you what you came in to discuss, so that nothing escapes you in the moment. This should also include:
- If you have additional reasons for a particular concern (e.g. family history of a certain problem), make them known
- If you plan to request any specific tests or treatments, be able to clearly state your reasons for the specific tests or treatments
- If you plan to write off any specific tests or treatments as something to which you will not consent, have your reasons ready—in a way that makes it clear it’s something more than “don’t want it”, for example, “I’ve already decided that this treatment would make a sufficient hit to my quality of life, as to make it not worthwhile for me personally” (or whatever the reason may be for you). It needs to be something they can write on their notes instead of simply “patient refused treatment”.
Compile a record of your symptoms (as appropriate), and any previous tests/treatments (as appropriate), in chronological order. If you take all this with you, perhaps in a nice folder, you will enjoy the following advantages:
- not forgetting anything
- ability to answer questions accurately
- give the (correct) impression you take your health seriously, which means they are more likely to do so also—especially because they will now know that if they fob you off and/or mess something up, you’ll be taking a record of that to your next appointment.
Plan your outfit. No, you don’t have to dress for the red carpet, but you want to satisfy two main conditions:
- Accessibility for examination (for example, if you are going in with a knee pain, maybe don’t wear the tight jeans today; if they’re going to take blood, be either sleeveless or have sleeves that are easily moved out of the way, etc)
- General presentability (it’s a sad fact that doctors are not immune to biases, and will treat people better if they respect them more)
During the appointment
Be friendly; doctors (like most people) will respond much better to that than to grumpiness—even if you have good reason for grumpiness and even if the doctor has been trained to help grumpy patients.
Be confident: when we say “be friendly”, that doesn’t mean to necessarily be so agreeable as to not advocate for yourself. In particular:
- If they explain something and it isn’t clear to you, ask them to clarify
- If you disagree with them about a value judgement, say so. By “a value judgement” here we mean things in the realm of subjectivity. If the doctor says you are prediabetic, then you won’t get much mileage out of arguing otherwise; the numbers have the final say on that one. But if the doctor says “the side effects of the treatment you’re requesting will make it not worthwhile for you” and you have understood the side effects and you still disagree, then your opinion counts for more than theirs—it is your decision to make.
- If they dismiss a concern, ask them to put in writing that they dismissed your concern of X, despite you providing evidence that Y, and it being well-known that Z. Often, rather than doing that, they’ll just fold and actually address your concern instead.
Writer’s example in that last category: I recently made a request for a bone density scan. I expect my bone density is great, because I do all the right things, however, as both of my parents suffered from osteoporosis and assorted resultant crushed bones and the terrible consequences thereof, I a) have reasonable grounds for extra concern, and b) I believe that even if my bone density is fine now, it’s good to establish a baseline so I can know, in 5, 10, 20 years etc, whether there has been any deterioration. Now, happily the doctor I saw agreed with my assessment at first presentation and so I got the referral, but had she not been, I would have said “Could you please put in writing that I asked for a bone density scan, and you refused, on the grounds that [details about what happened with my parents], and that osteoporosis is known to have a strong genetic component is not, in your opinion, any reason to worry?”
Be honest, and/but err on the side of overstating your symptoms rather than understating. For example, if it is about a chronic condition and the doctor asks “are you able to do xyz”, take the question as meaning “are you able to do xyz on your worst days?”. You can clarify that if you like in your answer, but you need to include the information that xyz is something that your condition can and sometimes does impede you from doing.
Leave your embarrassment at the door. To the doctor (unless they are a very unprofessional one), you really are just one more patient with symptoms they have (unless your condition is very rare) seen a thousand times before. If your symptom is embarrassing, it will not faze them and you definitely should not hold back from mentioning it, for example. This goes extra in the case of discussions around sexual health, by the way, in which field the details you’d perhaps rather not share with anybody, are the details they need to adequately treat you.
After the appointment
Follow up on anything that doesn’t happen as promised (e.g. referrals, things ordered, etc), to make sure nothing got lost in a bureacratic error.
Get a second opinion if you’re not satisfied with the first one. Doctors are fallible, and as a matter of professional pride, it’s likely the second doctor will be glad to find something the first doctor missed.
See also: Make Your Negativity Work For You
Take care!
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Do You Know Which Supplements You Shouldn’t Take Together? (10 Pairs!)
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Dr. LeGrand Peterson wants us to get the most out of our supplements, so watch out for these…
Time to split up some pairs…
In most cases these are a matter of competing for absorption; sometimes to the detriment of both, sometimes to the detriment of one or the other, and sometimes, the problem is entirely different and they just interact in a way that could potentially cause other problems. Dr. Peterson advises as follows:
- Vitamin C and vitamin B12: taking these together can reduce the absorption of Vitamin B12, as vitamin C can overpower it.
- Vitamin C and copper: high amounts of vitamin C can decrease copper absorption, especially in those who are severely copper deficient.
- Magnesium and calcium: these two minerals compete for absorption in the intestines, potentially reducing the effectiveness of both.
- Calcium and iron: calcium can decrease iron absorption, so they should not be taken together, especially if you are iron deficient.
- Calcium and zinc: calcium also competes with zinc, reducing zinc absorption; they should be taken at different times.
- Zinc and copper: zinc and copper compete for absorption, so they should be taken at separate times.
- Iron and zinc: iron can decrease zinc absorption, and thus, they should not be taken together.
- Iron and green tea: perhaps a surprising one, but green tea can reduce iron absorption, so they should not be taken simultaneously.
- Vitamin E and vitamin K: vitamin E increases bleeding risk, while vitamin K promotes clotting, making them opposites and risky to take together.
- Fish oil and ginkgo biloba: both are anticoagulants and can increase the risk of bleeding, especially if taken with blood thinners like warfarin.
If you need to take supplements that compete (or conflict or otherwise potentially adversely interact) with each other, it’s recommended to separate them by at least 4 hours, or better yet, take one in the morning and the other at night. If in doubt, do speak with your pharmacist or doctor for personalized advice
You may be thinking: half my foods contain half of these nutrients! And yes, assuming you have a nutritionally dense diet, this is probably the case. Foods typically release nutrients more slowly than supplements, and unlike supplements, do not usually contain megadoses (although they can, such as the selenium content of Brazil nuts, or vitamin A in carrots). Basically, food is in most cases safer and gentler than supplements. If concerned, do speak with your nutritionist or doctor for personalized advice.
For more information on all of these, enjoy:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to learn more?
You might also like to read:
Do We Need Supplements, And Do They Work?
Take care!
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The Lies That Depression Tells Us
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In this short (6:42) video, psychiatrist Dr. Tracey Marks talks about 8 commonly-believed lies that depression often tells us. They are:
- “I don’t measure up”
- “No one cares about me”
- “I’m better off alone”
- “No one understands”
- “It’s all my fault”
- “I have no reason to be depressed”
- “Nothing matters”
- “I’ll never get better”
Some of these can be reinforced by people around us; it’s easy to believe that “no one understands” if for example the few people we interact with the most don’t understand, or that “I have no reason to be depressed” if people try to cheer you up by pointing out your many good fortunes.
The reality, of course, is that depression is a large, complex, and many-headed beast, with firm roots in neurobiology.
There are things we can do that may ameliorate it… But they also may not, and sometimes life is just going to suck for a while. That doesn’t mean we should give up (that, too, is depression lying to us, per “I’ll never get better”), but it does mean that we should not be so hard on ourselves for not having “walked it off” the way one might “just walk off” a broken leg.
Oh, you can’t “just walk off” a broken leg? Well then, perhaps it’s not surprising if we don’t “just think off” a broken brain, either. The brain can rebuild itself, but that’s a slow process, so buckle in:
Click Here If The Embedded Video Doesn’t Load Automatically!
Want to know more?
You might like these previous articles of ours about depression (managing it, and overcoming it):
- The Mental Health First-Aid That You’ll Hopefully Never Need
- Behavioral Activation Against Depression & Anxiety
- The Easiest Way To Take Up Journaling
- Antidepressants: Personalization Is Key!
Take care!
Don’t Forget…
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