From the desk of Dr. Adams
Twenty percent of diabetics have “type 1.5” diabetes
Although insulin resistance and type 2 diabetes get pinned
on diet and lifestyle choices, in some cases these disorders
could be associated with an autoimmune reaction, which is
the mechanism behind type 1 diabetes. If so, this changes
the diet for diabetes to manage the autoimmune condition.
It is estimated that 20 percent of people with type 2
diabetes also have an autoimmune reaction against the
cells of their pancreas, prompting researchers to dub this
“type 1.5 diabetes.” Type 1.5 diabetes may be even more
prevalent than type 1 diabetes.
Insulin resistance (pre-diabetes) and diabetes are typically
linked with a long-standing diet heavy in sweet, starchy
foods and processed fats, as well as overeating and a lack
of exercise. This is often referred to as “adult-onset
diabetes,” although it’s becoming more common in
younger people as their obesity rates rise. In these cases a
diet for diabetes would involve managing blood sugar.
Type 1 diabetes, referred to as “juvenile diabetes,” is an
autoimmune disease in which the immune system attacks
and destroys pancreatic beta cells, which produce insulin.
A person with type 1.5 diabetes may have aspects of both:
diet and lifestyle affect pancreatic function, as does an
autoimmune reaction which may or may not have been
identified. In this case a diet for diabetes would address
blood sugar and autoimmune management.
Are you a slender, healthy diabetic or pre-diabetic?
Consider type 1.5
Some individuals are at a healthy body weight, exercise
regularly, and eat a healthy diet yet can’t seem to control
their consistently high blood sugar levels. With type 1.5
diabetes an autoimmune reaction destroys cells of the
pancreas, but the pancreas still secretes insulin—
autoimmune damage is not advanced enough to shut down
insulin function. In type 1 diabetes, on the other hand,
more than 90 percent of the insulin-producing cells have
been destroyed. Because a person with type 1.5 diabetes
has not sustained pancreatic damage to such a great degree
he or she is often misdiagnosed.
Identifying type 1.5 diabetes
If a diet for diabetes that is lower in carbohydrates begins
moving blood sugar toward a normal range, it may be that
your insulin resistance or type 2 diabetes does not have an
autoimmune component. However, if insulin resistance or
type 2 diabetes are stubborn despite a diet for diabetes, or
if you are slender and active, it’s worth screening for
antibodies against pancreatic beta and islet cells.
Additionally, some people have antibodies against the
glutamic acid decarboxylase (GAD) enzyme, which is
involved in the release of insulin from the pancreas. GAD
is also found in areas of the brain, and an autoimmune
reaction to GAD may be associated not only with a blood
sugar disorder but also with such neurological symptoms
as obsessive-compulsive disorder, dizziness, or problems
with balance.
A diet for type 1.5 diabetes
Because type 1.5 diabetes is autoimmune, these
individuals will want to go beyond a diet for diabetes that
manages blood sugar to include managing the immune
system. This means strictly avoiding immune-reactive
foods, which for most people includes gluten and dairy.
The GAD enzyme may cross-react with gluten so that
eating gluten can stimulate an immune attack against
GAD. Additional foods that trigger autoimmune reactions
can be ferreted out by adhering to an autoimmune diet for
a period of time. With type 1.5 diabetes, a diet for diabetes
should be an autoimmune diet that also manages blood
sugar.
Beyond a diet for diabetes, a number of nutritional
compounds have been shown to regulate the immune
system and dampen autoimmunity. Ask my office for
advice on managing autoimmunity.