Between the Lines: Diabetes 1.5
What is Diabetes 1.5?
Diabetes 1.5 is a term unofficially coined by the diabetic community to refer to we who have diabetes that is not classifiable as Type 1 or Type 2. Our diabetic conditions are unique and unrecognized even by the mainstream endocrinologists (doctors who deal with hormones). Clear diagnosis is important for the proper management.
Because Diabetes 1.5 is under-recognized, we must take action as patients to educate ourselves and find practitioners who can help us manage our conditions and live a long healthy life.
Moreover, many of the Diabetes 1.5 conditions are autosomal dominant. This means they are strongly genetic from parent to child and will turn on at birth or in childhood. For our children's sake, we must educate ourselves and empower ourselves with knowledge that is not readily available.
What Types of Diabetes are included in Diabetes 1.5?
MODY: Mature Onset Diabetes of the Youth
Monogenic Diabetes of Infants
Latent Autoimmune Diabetes in Adults
Type 3C Pancreas related - Hemachromatosis, Cystic Fibrosis
Medication induced diabetes - statins, steroids
Who Might have Diabetes 1.5?
If you have any of the above medical conditions, if you are young, if you are healthy and you have a strong family history of diabetes with traceable multiple generations, you should get tested with a HgbA1c. However, even then, it becomes difficult to test and fasting blood sugar should also be donen. You may have high fasting blood sugar about 100's or 110's that your doctor does not pick up on as abnormal. Early in the disease expression, fasting blood sugars will also be normal and a glucose challenge test using a continuous glucose monitor will show abnormal spikes in blood glucose.
You may be dismissed by your healthcare provider. I was dismissed by multiple endocrinologists who told me that I had Type 2 pre-diabetes and "to just go exercise and eat right". This is not an appropriate response. If you are young and healthy and exercise, then additional laboratory work up should be conducted and ideally there should be monitoring with a continuous glucose monitor for a short duration to see how you are responding to foods. Genetic counseling should be conducted and genetic testing should be pursued if history and labs warrant suspicion.
How can you get more answers?
Dr. Wang can work with you to figure things out. Dr. Wang will work with you to develop a roadmap that is tailored to your individual physiology. We will go through a detailed history and physical examination. We will track your blood sugars using a continuous glucose monitor and observe how you respond to foods and exercise over a couple of weeks. We will run the necessary labs. These will guide us with a thorough and tailored, individualized life style management solution based on your body and unique response. Dr. Wang will work with you and your doctor or Endocrinologist to help you find ways to take back control over a seemingly uncontrollable situation.
Dr. Wang's Story
Dr. Wang realized that she had diabetes when she put on a continuous glucose monitor to use glucose responses as a metric for health optimization. 3 monitors and a ton of disbelief and denial later, she realized she had an atypical form of diabetes. Dr. Wang is an MD board specialized in PM&R, a field edicated to exercise and diet and how it relates to the management of medical conditions. She has worked for years monitoring and managing Type 1/2 diabetics in the inpatient and outpatient physical rehabilitation ward and clinic. She quickly realized that her diabetes was not responding in the typical manner. 5 physicians, 3 endocrinologists, and taking a dear friend out to dinner, she finally had an answer- MODY (Mature Onset Diabetes of the Young). This started her quest for non-medication management of atypical forms of diabetes. Taking sulfonylureas to pump out more insulin from her pancreas and transitioning to insulin once her pancreas was exhausted was not an acceptable answer. She started looking for answers herself building on the basis of her knowledge base as a PM&R specialist.