Type 1.5: The Third Type of Diabetes
Even nurses get sick and need help sometimes. When Guardian Nurses Team Lead Andrea Spector, RN, MSN, started having a lot of trouble seeing clearly, she went to the eye doctor. The ophthalmologist told her that there was nothing wrong with her eyes except that she needed a much, much stronger prescription. Given that she also had a constant thirst, the doctor suggested that get her blood tested for diabetes.
Nurse Spector was surprised. Though blurry vision and thirst are both symptoms of diabetes (along with frequent urination, excessive hunger, fatigue, frequent yeast infections, slow healing, unexplained weight loss, numbness, tingling, and changes in the skin), she didn’t fit the expected profile. She was active and maintained a healthy weight. She had no family history of diabetes.
Even so, when tested, her fasting blood sugar was 325 (normal is between 70 and 100), and her A1c, a marker of blood sugar over three months, was 10.5 (a healthy range is below 5.6).
Understanding Type 1.5 Diabetes
Nurse Spector’s endocrinologist introduced her to the concept of Type 1.5 diabetes, or LADA. This autoimmune form of diabetes doesn’t neatly fit into the traditional categories of Type 1 or Type 2, and has elements of both variations.
For the first six months or so, LADA can be treated like Type 2 diabetes, but over time, those medications will no longer work, and the patient will need insulin replacement therapy for the rest of their lives, like people with Type 1 do.
Type 1 is also called juvenile diabetes, as it typically beings in children. Type 2 is also call adult onset diabetes because it usually is diagnosed in adulthood.
Unlike Type 2, which often results from lifestyle factors, LADA arises from an autoimmune attack on insulin-producing cells.
Like other autoimmune conditions, LADA can be triggered by a viral infection. Given the timing, it’s likely that in Nurse Spector’s case, COVID-19 was the culprit. Her bout with the viral illness may have set off an autoimmune reaction against her pancreatic cells, damaging her ability to make her own insulin.
Adjusting to a New Lifestyle
Now, she uses a continuous glucose monitor and an insulin pump, which offers real-time blood sugar monitoring and adjusts her insulin levels automatically.
She quickly discovered that her “healthy” diet included larger portions and more carbs than she realized. Portion control and meticulous carb counting became essential parts of her routine. She also had to learn how to balance her insulin needs with her varied schedule, especially since her job at Guardian Nurses requires her to be on the road.
Nurse Spector’s Advice: As a nurse with prior experience caring for both Type 1 and Type 2 diabetic patients, I thought I knew all about diabetes management and I didn’t go right away to the diabetic educator. Ultimately, when I did, I learned that I didn’t know much about LADA (Type 1.5 diabetes) at all. I then went to a nutritionist. I think diabetes management is an “education disease” — it requires understanding, adaptation, and continuous support.
It’s important for people with new a diabetes diagnosis to advocate for themselves, seeking the education and support necessary to manage their condition.
I also encourage doctors to remember that you may have diagnosed diabetes 1,000 times, but each of those diagnoses is a person getting the news for the first time that they are ill and that their life going to change drastically. Instead of assuming patients understand diabetes management, providers must guide them through every step, and do so compassionately.