American singer Lance Bass, best known as a former band member of NSYNC, has given fans an unexpected update on his health. He began his note to fans with information regarding his battle against type 2 diabetes, which he got to know about a few years back. But then he told his 1.3 million fans on Instagram that there is a "plot twist" in his diabetes diagnosis. He got to know that instead of type 2 diabetes, he has type 1.5 diabetes or Latent Autoimmune Diabetes in Adults (LADA). It Is a form of diabetes that shares characteristics of both type 1 and type 2 diabetes. While it has features similar to type 2 diabetes, such as its gradual onset and occurrence in adults, LADA is actually an autoimmune condition like type 1 diabetes.

NSYNC's Lance Bass on diabetes diagnosis

Lance Bass, who along with her former bandmates have delivered hits like "Bye Bye Bye" and "It's Gonna Be Me", shared on Instagram there is a "plot twist" in his diabetes diagnosis. “As all of you know, I was diagnosed with type 2 diabetes a few years back,” the singer said in a video. But after that diagnosis, he had a "difficult time getting my glucose levels under control, even though I made adjustments to my diet, my medications and my workout routine.”

He shared: "I recently discovered I was misdiagnosed. I actually have Type 1.5, also known as LADA or latent autoimmune diabetes in adults.”

Check out his post here!

What is type 1.5 diabetes?

Type 1.5 diabetes, or LADA, is an autoimmune form of diabetes that typically occurs in adults over the age of 30, says endocrinologist Dr Mainak Banerjee. Around 10 percent of people who have diabetes have type 1.5 diabetes, according to a research published in Current Diabetes Reviews in 2019. Unlike type 1 diabetes, which generally presents in children or young adults and rapidly progresses to insulin dependency, LADA progresses more slowly.

Cause of type 1.5 diabetes is not known. Image courtesy: Freepik

The exact cause of type 1.5 diabetes is not fully understood, but it is believed to be connected to genetic and environmental factors, says the expert. Similar to type 1 diabetes, LADA occurs when the body's immune system mistakenly attacks the insulin-producing beta cells in the pancreas. This autoimmune response may be triggered by factors such as viral infections, environmental toxins, or certain dietary components. Also, a family history of autoimmune diseases or type 1 diabetes may increase the risk of developing LADA.

What are the symptoms of type 1.5 diabetes?

The symptoms of Type 1.5 diabetes can be subtle and develop over a longer period. Here are some of the common symptoms:

• As blood glucose levels rise, the body tries to expel the excess sugar through urine, leading to frequent urination and increased thirst.
• High blood sugar levels can cause persistent tiredness, as cells are deprived of the energy they need.
• Unintended weight loss may occur despite normal or increased food intake, due to the body's inability to use glucose for energy.
• High blood sugar levels can cause the lenses in the eyes to swell, leading to temporary blurred vision.
• Elevated blood glucose levels can impair the immune system, making the body more susceptible to infections.
• High blood sugar levels can affect circulation and slow down the healing process of cuts and wounds.

What are the challenges in diagnosing type 1.5 diabetes?

Diagnosing Type 1.5 diabetes can be challenging due to its gradual onset and overlapping characteristics with type 2 diabetes, says Dr Banerjee. Many people are initially misdiagnosed with type 2 diabetes because of their age and the slower progression of the disease. However, unlike Type 2 diabetes, which is primarily caused by insulin resistance, LADA is an autoimmune condition where the body's immune system targets the cells that produce insulin.

The diagnosis of type 1.5 diabetes requires a thorough evaluation of symptoms, medical history, and specific tests. Key diagnostic tools include -

1. Blood glucose tests

Initial tests to measure fasting blood sugar levels and HbA1c levels (which reflect average blood sugar levels over the past three months) are commonly used. If these indicate diabetes, further tests are done to differentiate between LADA and type 2 diabetes.

2. Antibody tests

The presence of specific autoantibodies, such as glutamic acid decarboxylase antibodies (GADA), indicates an autoimmune response against the pancreas, confirming a diagnosis of LADA. These tests are crucial for distinguishing LADA from Type 2 diabetes.

3. C-peptide test

This test measures the level of C-peptide in the blood, which indicates how much insulin the body is producing. In LADA, C-peptide levels are often lower than in type 2 diabetes, as the body's insulin production diminishes over time.

What are the differences between type 1.5 and type 1 and type 2 diabetes?

While type 1.5 diabetes shares some features with type 1 and type 2 diabetes, there are key differences that distinguish it -

1. Age of onset

Type 1 diabetes typically presents in childhood or adolescence, while Type 1.5 diabetes usually occurs in adults over 30. Type 2 diabetes generally affects adults over 45, though it is increasingly seen in younger people, says the expert. This because of the connection between obesity and diabetes.

2. Autoimmune nature

Type 1 and type 1.5 diabetes are autoimmune conditions, meaning the body's immune system attacks its own cells. In contrast, type 2 diabetes is primarily characterised by insulin resistance and a relative deficiency in insulin production.

3. Progression

Type 1 diabetes progresses rapidly, leading to a swift decline in insulin production. In type 1.5 diabetes, the progression is slower, and patients may not require insulin therapy for several months or years after diagnosis. Type 2 diabetes progresses more slowly, and many patients manage their condition with lifestyle changes and oral medications for years before requiring insulin.

How to treat type 1.5 diabetes?

Treatment for Type 1.5 diabetes involves managing blood glucose levels and preventing complications. The treatment approach often evolves as the disease progresses -

1. Lifestyle modifications

Early in the disease, people may manage their blood sugar levels through diet, exercise, and weight management. A healthy balanced diet that is low in refined carbohydrates and high in fiber can help regulate blood glucose levels. Regular physical activity improves insulin sensitivity and helps maintain a healthy weight, says Dr Banerjee.

Check what you eat if you have type 1.5 diabetes. Image Courtesy: Shutterstock

2. Oral medications

Initially, oral diabetes medications such as metformin may be prescribed to help control blood sugar levels. However, these medications may become less effective as the disease progresses.

3. Insulin therapy

As LADA progresses and insulin production declines, patients will require insulin therapy to maintain blood glucose levels. People who have type 1.5 diabetes often need insulin within five years of diagnosis, according to a research published in the American Diabetes Association's journal Diabetes Spectrum in 2016.

4. Monitoring

Regular monitoring of blood glucose levels, and HbA1c levels, is essential. This will help to manage the disease effectively and adjust diabetes treatment as needed.

How to prevent type 1.5 diabetes?

Preventing type 1.5 diabetes is challenging due to its autoimmune nature, which is not fully understood. Type 1.5 diabetes may in part be preventable through the same lifestyle changes as type 2 diabetes including weight loss, and physical activity, according to a research published in Current Diabetes Reviews in 2019.

Here's what you can do:

• Maintain a healthy diet, regularly exercise, and a keep healthy weight to help reduce the risk of developing diabetes in general.
• For people with a family history of autoimmune diseases or type 1 diabetes, regular screening for diabetes-related autoantibodies may help detect LADA early, allowing for prompt medical intervention.

Type 1.5 diabetes is a unique form of diabetes that requires careful diagnosis and management. While it shares similarities with both type 1 and type 2 diabetes, it is important to recognise its autoimmune nature and the gradual progression of the disease. Early diagnosis and appropriate treatment are crucial to managing blood glucose levels.

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