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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The Not-So-Sweet Science Of Sugar Addiction
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One
LumpMechanism Of Addiction Or Two?
In Tuesday’s newsletter, we asked you to what extent, if any, you believe sugar is addictive; we got the above-depicted, below-described, set of responses:
- About 47% said “Sugar is chemically addictive, comparable to alcohol”
- About 34% said “Sugar is chemically addictive, comparable to cocaine”
- About 11% said “Sugar is not addictive; that’s just excuse-finding hyperbole”
- About 9% said “Sugar is a behavioral addiction, comparable to video gaming”
So what does the science say?
Sugar is not addictive; that’s just excuse-finding hyperbole: True or False?
False, by broad scientific consensus. As ever, the devil’s in the
detailsdefinitions, but while there is still discussion about how best to categorize the addiction, the scientific consensus as a whole is generally: sugar is addictive.That doesn’t mean scientists* are a hive mind, and so there will be some who disagree, but most papers these days are looking into the “hows” and “whys” and “whats” of sugar addiction, not the “whether”.
*who are also, let us remember, a diverse group including chemists, neurobiologists, psychologists, social psychologists, and others, often collaborating in multidisciplinary teams, each with their own focus of research.
Here’s what the Center of Alcohol and Substance Use Studies has to say, for example:
Sugar Addiction: More Serious Than You Think
Sugar is a chemical addiction, comparable to alcohol: True or False?
True, broadly, with caveats—for this one, the crux lies in “comparable to”, because the neurology of the addiction is similar, even if many aspects of it chemically are not.
In both cases, sugar triggers the release of dopamine while also (albeit for different chemical reasons) having a “downer” effect (sugar triggers the release of opioids as well as dopamine).
Notably, the sociology and psychology of alcohol and sugar addictions are also similar (both addictions are common throughout different socioeconomic strata as a coping mechanism seeking an escape from emotional pain).
See for example in the Journal of Psychoactive Drugs:
On the other hand, withdrawal symptoms from heavy long-term alcohol abuse can kill, while withdrawal symptoms from sugar are very much milder. So there’s also room to argue that they’re not comparable on those grounds.
Sugar is a chemical addiction, comparable to cocaine: True or False?
False, broadly. There are overlaps! For example, sugar drives impulsivity to seek more of the substance, and leads to changes in neurobiological brain function which alter emotional states and subsequent behaviours:
The impact of sugar consumption on stress driven, emotional and addictive behaviors
However!
Cocaine triggers a release of dopamine (as does sugar), but cocaine also acts directly on our brain’s ability to remove dopamine, serotonin, and norepinephrine:
The Neurobiology of Cocaine Addiction
…meaning that in terms of comparability, they (to use a metaphor now, not meaning this literally) both give you a warm feeling, but sugar does it by turning up the heating a bit whereas cocaine does it by locking the doors and burning down the house. That’s quite a difference!
Sugar is a behavioral addiction, comparable to video gaming: True or False?
True, with the caveat that this a “yes and” situation.
There are behavioral aspects of sugar addiction that can reasonably be compared to those of video gaming, e.g. compulsion loops, always the promise of more (without limiting factors such as overdosing), anxiety when the addictive element is not accessible for some reason, reduction of dopaminergic sensitivity leading to a craving for more, etc. Note that the last is mentioning a chemical but the mechanism itself is still behavioral, not chemical per se.
So, yes, it’s a behavioral addiction [and also arguably chemical in the manners we’ve described earlier in this article].
For science for this, we refer you back to:
The impact of sugar consumption on stress driven, emotional and addictive behaviors
Want more?
You might want to check out:
Beating Food Addictions: When It’s More Than “Just” Cravings
Take care!
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The Power Foods Diet – by Dr. Neal Barnard
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First, what this is not: it’s not a cookbook. There are recipes, more than a hundred if we consider such things as “barbecue sauce” as a standalone recipe, and if we overlook such things as how “perfect hot oatmeal” is followed on the next page by a recipe for “perfect hot oatmeal with berries”.
However, as we say, it’s not a cookbook; it’s first and foremost an educational text on the topic of nutrition.
Here we will learn about good eating for general health, which foods are natural appetite-suppressants, which foods reduce our body’s absorption of sugars from foods (not merely slowing, but flushing them away so they cannot be absorbed at all), and which foods actually boost metabolism for a few hours after the meal.
Dr. Barnard also talks about some foods that are more healthy, or less healthy, than popularly believed, and how to use all this information to craft a good, optimized, dietary plan for you.
Bottom line: there’s a lot of good information here, and the recipes are simply a bonus.
Click here to check out The Power Foods Diet, and optimize yours!
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Are You A Calorie-Burning Machine?
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Burn, Calorie, Burn
In Tuesday’s newsletter, we asked you whether you count calories, and got the above-depicted, below-described set of answers:
- About 56% said “I am somewhat mindful of calories but keep only a rough tally”
- About 32% said “I do not count calories / I don’t think it’s important for my health”
- About 13% said “I rigorously check and record the calories of everything I consume”
So what does the science say, about the merits of all these positions?
A food’s calorie count is a good measure of how much energy we will, upon consuming the food, have to use or store: True or False?
False, broadly. It can be, at best, a rough guideline. Do you know what a calorie actually is, by the way? Most people don’t.
One thing to know before we get to that: there’s “cal” vs “kcal”. The latter is generally used when it comes to foodstuffs, and it’s what we’ll be meaning whenever we say “calorie” here. 1cal is 1/1000th of a kcal, that’s all.
Now, for what a calorie actually is:
A calorie is the amount of energy needed to raise the temperature of 1 liter of water by 1℃
Question: so, how to we measure how much food is needed to do that?
Answer: by using a bomb calorimeter! Which is the exciting name for the apparatus used to literally burn food and capture the heat produced to indeed raise the temperature of 1 liter of water by 1℃.
If you’re having trouble imagining such equipment, here it is:
Bomb Calorimeter: Definition, Construction, & Operation (with diagram and FAQs)
The unfortunate implication of the above information
A kilogram of sawdust contains about a 1000 kcal, give or take what wood was used and various other conditions.
However, that does not mean you can usefully eat the sawdust. In other words:
Calorie count tells us only how good something is at raising the temperature of water if physically burned.
Now do you see why oils and sugars have such comparably high calorie counts?
And while we may talk about “burning calories” as a metaphor, we do not, in fact, have a little wood stove inside us burning the food we eat.
A calorie is a calorie: True or False?
Definitely False! Building on from the above… We will get very little energy from sawdust; it’s not just that we can’t use it; we can’t store it either; it’ll mostly pass through as fiber.
(however, please do not use sawdust to get your daily dose of fiber either, as it is not safe for human consumption and may give you diseases, depending on what is lurking in it)
But let’s look at oil and sugar, two very high-calorie categories of food, because they’re really easy to physically burn and they give off a good flame.
A bomb calorimeter may treat them quite equally, but to our body, they are metabolically very different indeed.
For a start, most sugars will get absorbed and processed much more quickly than most oils, and that can overwhelm the liver (responsible for glycogen management), and lead to non-alcoholic fatty liver disease, diabetes, and more. Metabolic syndrome in general, and if you keep it up too much and you may find it’s now a lottery between dying of NAFLD, diabetes, or heart disease (it’ll usually be the heart disease that kills).
See also:
- Which Sugars Are Healthier, And Which Are Just The Same?
- 10 Ways To Balance Blood Sugars
- How To Unfatty A Fatty Liver
Meanwhile, we know all about the different kinds of nutritional profiles that oils can have, and some can promote having high energy without putting on fat, while others can strain the heart. Not even “a fat is a fat”, so “a calorie is a calorie” doesn’t get much mileage outside of a bomb calorimeter!
See also:
A calorie-controlled / calorie-restricted diet is an effective weight loss strategy: True or False?
True, usually! Surprise!
- On the one hand: calories are a wildly imprecise way to reckon the value of food, and using them as a guide to health can be dangerously misleading
- On the other hand: the very activity of calorie-counting itself promotes mindful eating, which is very good for the health
There is a strong difference between the mind of somebody who is carefully logging their pre-bedtime piece of chocolate and reflecting on its nutritional value, vs someone who isn’t sure whether this is their second or third glass of wine, nor how much the glass contained.
So if you want to get most of the benefits of a calorie-controlled diet without counting calories, you may try taking a “mindful eating” approach to diet.
However! If you want to do this for weight loss, be aware, that you will have to practice it all the time, not just for one meal here and there.
You can read more on how to do “mindful eating” here:
Dr. Rupy Aujla: The Kitchen Doctor | Mindful Eating & Interoception
Take care!
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Young Mind Young Body – by Sue Ziang
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This is a very “healthy mind in a healthy body” book, consistent with the author’s status as a holistic health coach. Sometimes that produces a bit of a catch-22 regarding where to start, but for Ziang, the clear answer is to start with the mind, and specifically, one’s perception of one’s own age.
She advocates for building a young mind in a young body, and yes, that’s mind-building much like body-building. This does not mean any kind of wilful self-delusion, but rather, choosing the things that we do get to choose along the way.
The bridge between mind and body, for Ziang, is meditation—which is reasonable, as it’s very much mind-stuff and also very much neurological and has a very real-world impact on the body’s broader health, even simply by such mechanisms as changing breathing, heart rate, neurotransmitter levels, endocrine functions, and the like.
When it comes to the more physical aspects of health, her dietary advice is completely in line with what we write here at 10almonds. Hydrate well, eat more plants, especially beans and greens and whole grains, get good fats in, enjoy spices, practice mindful eating, skip the refined carbohydrates, be mindful of bio-individuality (e.g. one’s own personal dietary quirks that stem from physiology; some of us react differently to this kind of food or that for genetic reasons, and that’s not something to be overlooked).
In the category of exercise, she’s simply about moving more, which while not comprehensive, is not bad advice either.
Bottom line: if you’re looking for an “in” to holistic health and wondering where to start, this book is a fine and very readable option.
Click here to check out “Young Mind Young Body”, and transform yours!
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Natural Tips for Falling Asleep
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Questions and Answers at 10almonds
Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!
This newsletter has been growing a lot lately, and so have the questions/requests, and we love that! In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
How to get to sleep at night as fast and as naturally as possible? Thank you!
We’ll definitely write more on that! You might like these articles we wrote already, meanwhile:
- Beating The Insomnia Blues ← this one is general advice and tips
- Time For Some Pillow Talk ← this one compares and reviews some popular sleep apps
- Insomnia? High Blood Pressure? Try these! ← this one tackles the matter from a dietary angle
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Tribulus Terrestris For Testosterone?
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(Clinical) Trials and Tribul-ations
In the category of supplements that have enjoyed use as aphrodisiacs, Tribulus terrestris (also called caltrop, goat’s head, gokshura, or puncture vine) has a long history, having seen wide use in both Traditional Chinese Medicine and in Ayurveda.
It’s been used for other purposes too, and has been considered a “general wellness” plant.
So, what does the science say?
Good news: very conclusive evidence!
Bad news: the conclusion is not favorable…
Scientists are known for their careful use of clinical language, and it’s very rare for a study/review to claim something as proven (scientists leave journalists to do that part), and in this case, when it comes to Tribulus’s usefulness as a testosterone-enhancing libido-boosting supplement…
❝analysis of empirical evidence from a comprehensive review of available literature proved this hypothesis wrong❞
Strong words! You can read it in full here; they do make some concessions along the way (e.g. mentioning unclear or contradictory findings, suggesting that it may have some effect, but by an as-yet unknown mechanism if it does—although some potential effect on nitric oxide levels has been hypothesized, which is reasonable if so, as NO does feature in arousal-signalling), but the general conclusion is “no, this doesn’t have androgen-enhancing properties”:
Pro-sexual and androgen enhancing effects of Tribulus terrestris L.: Fact or Fiction
That’s a review though, what about taking a look at a representative RCT? Here we go:
❝Tribulus terrestris was not more effective than placebo on improving symptoms of erectile dysfunction or serum total testosterone❞
As a performance-enhancer in sport
We’ll be brief here: it doesn’t seem to work and it may not be safe:
Insights into Supplements with Tribulus Terrestris used by Athletes
From sport, into general wellness?
Finally, a study that finds it may be useful for something!
❝Overall, participants supplemented with TT displayed significant improvements in lipid profile. Inflammatory and hematological biomarkers showed moderate beneficial effects with no significant changes on renal biomarkers. No positive effects were observed on the immune system response. Additionally, no TT-induced toxicity was reported.
In conclusion, there was no clear evidence of the beneficial effects of TT supplementation on muscle damage markers and hormonal behavior.❞
About those lipids…
Animal studies have shown that it may not only improve lipid profiles, but also may partially repair the endothelial dysfunction resulting from hyperlipidemia:
Want to try some?
In the unlikely event that today’s research review has inspired you with an urge to try Tribulus terrestris, here’s an example product on Amazon
If on the other hand you’d like to actually increase testosterone levels, then we suggest:
Topping Up Testosterone? ← a previous main feature did earlier this year
Take care!
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