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February 4, 2002

Diagnosis and Symptoms

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Question from New Orleans, Louisiana, USA:

I was diagnosed at age 23, and originally my doctor said I had type 2 diabetes, but now he says I have type 1.5 diabetes. I am 25 years old and in excellent shape! I run four days a week and lift weights three days a week. I have no family history of diabetes, I’m at my ideal weight, and I have always been an athlete, even playing college tennis.

I was successful for a year on Glucophage [metformin] and glyburide with hemoglobin A1cs of less than 6.3% It seemed that overnight, my diabetes got worse. I went from 2.5 mg of Glyburide to 15 mg with pre-meal readings above 150 mg/dl [8.3 mmol/L] most of the time and post-meal blood glucose in the 300-400s mg/dl [16.7-22.2 mmol/L]. My non-fasting C-peptide was 1.8. My doctor said this was not truly accurate, because I had just eaten lunch, and I was on 15 mg of glyburide.

My doctor immediately put me on Lantus (insulin glargine) and two weeks later Novolog. I currently take about 24 units a day. I have pretty good control, but still some highs and lows. I’m working out the kinks. He still says I have type 1.5 diabetes. He says I have a different type of diabetes.

What does this mean? Have you heard of people in my situation? Am I truly a type 1? Have I been in the honeymoon phase? Why do I have this disease? Please give me some answers.

Answer:

From: DTeam Staff

I will try and relate to you what I know about this entity.”Type 1.5″ is not standard nomenclature. I would suggest this is Late-onset Autoimmune Diabetes of Adulthood (LADA). This diagnosis is made in individuals, usually over age 20, who are thin, have no family history, and have autoimmune markers for diabetes. What happens is that diagnosis is diabetes is made before there is a fall off in beta cell function (the beta cells make insulin). If you follow insulin production over time, you will see the insulin secretion fall off to a level that is similar to patients with type 1 diabetes. It just takes a little different time course to get there, compared to type 1 diabetes with its usual stormy onset. I think that insulin therapy is probably a good way to go because the better the control, the better the preservation of function. I think your physician is correct. Keep up the good work.

JTL