Type 1.5 diabetes or Lada Diabetes
Diabetes 1.5 is one of the names that are now being used for those cases of adult patients who are diagnosed with diabetes and do not require insulin principle for treatment and generally have no overweight and do not have or have very littleInsulin resistance.
When special immunology tests are performed, it is observed that they have antibodies that attack beta cells and especially the GAD65 type. This type of diabetes is also frequently known as lada diabetes that corresponds to the acronym in English of autoimmune diabetes in adults “latent autimmuneDiabetes in adults ”.
About 15-20% of people diagnosed as type 2 diabetes actually have type 1.5 diabetes.They are badly diagnosed because they are adults and at first they usually respond to treatments with oral antidiabetics because they still produce a sufficient amount of insulin.
As insulin resistance is minimal or non -existent drugs that decrease insulin resistance as avandia and acts are not effective.Other drugs that stimulate insulin secretion or endentize the absorption of carbohydrates, reduce the overproduction of glucose of the liver can be effective for some time in these patients.
A study in Italy and published in diabetes in October 1998 that 84 % of people diagnosed as type 2 had insulin resistance but another 16 % did not have it and suggested that they could be cases of type 1.5 diabetesMany other studies that have found similar results and many of them include results of positive antibodies especially GAD65 type.
The diagnostic error is easy to commit when the patient is adult and responds well to the beginning to oral antidiabetics treatments.If someone does not fit the type 1 patient prototype then it is treated with oral antidiabetics even if it has a decreased insulin segregation capacity.The attack of the autoimmune system in these cases is slow and that is what makes the response to treatment look like the correct at first.As Middle begins to need insulin within the first 4 years in almost 50% of cases in contrast to an average of 10 years for patients with true type 2 diabetes. (Endocrine Practice, V7 N5, Sept/Oct 2001,PGS 339-345).
The exact knowledge of the type of diabetes will facilitate the understanding of the changes that will occur over time and with the evolution of the disease.For example, if you have had insulin resistance for years and lately it has seen control difficulties with the sulfanilureas that it had been taking and the level of its-C peptide is low (it is a laboratory test that measures insulin production) isA proof that you will need insulin, but if the control is poor and its C peptide is normal, perhaps adding another oral antidiabetic and paying more attention to the feeding plan and physical exercise may be sufficient.
At the end of the 90s Dr. David Bell, a Birmingham doctor and researcher, Alabama, wanted to check if he could remove the insulin from a group of patients with type 2 diabetes treated with insulin or in combination with oral antidiabetics.These patients were often placed with insulin treatment without trying before with oral antidiabetics because at that time there was no variety of oral treatments that we now have.
Dr. Bell measured the C peptide levels and took only to those patients who had a normal level.A total of 130 patients with C -peptide C entered the study, and in 100 patients it was possible to completely eliminate insulin and control their diabetes with the help of sulfanilureas andMetformin and what he observed is that his diabetes control measured by A1C levels improved compared to when they were with 2 daily insulin doses.Other patients in the study improved their A1C using a combination of sulfanilureas and a single nightly insulin dose.
Researchers have concluded that patients with type 2 diabetes that will probably be controlled with the combination of oral antidiabetics are those that are less obese with BMI of less than 30, with less years of evolution of diabetes and normal or slightly diminished levels of peptide C.
As insulin secretion decreases, it begins to be necessary to maintain control.A clue that the patient can have type 1.5 diabetes instead of type 2 diabetes is their appearance, which is generally thin.Luckily the treatment in these first phases of this type 1 diabetes of a slow start of those who have the patients with true resistant insulin diabetes of type 2. The only difference is that the drugs that increase the sensitivity of insulin such as glitazonsThey work as insulin sensitivity in these patients is normal.
One of the greatest advantages of this type of diabetes is that once glycemia levels are controlled do not present the high risk of heart problems presented by patients with type 2 diabetes that often have high levels of cholesterol and tension levelsarterial.
