Diet for diabetes may be different than you thought—20 percent are “type 1.5”

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.