Subscribe to the Magazine for free.
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.

A Root Cause Medicine Protocol For Patients With Type 1.5 Diabetes: Testing, Therapeutic Diet, and Supportive Supplements

Medically reviewed by 
A Root Cause Medicine Protocol For Patients With Type 1.5 Diabetes: Testing, Therapeutic Diet, and Supportive Supplements

Diabetes mellitus is a metabolic disease involving inappropriately elevated blood glucose levels. Globally, one in 11 adults has diabetes mellitus, with 90% of cases classified as type 2 (34). A less common subclassification, known as type 1.5 diabetes, is commonly misdiagnosed as type 2 diabetes. However, early recognition and treatment of type 1.5 diabetes is important because this form of diabetes has an autoimmune component, leading to the permanent destruction of pancreatic cells responsible for secreting insulin and insulin dependence. This article will discuss the key features of type 1.5 diabetes and how functional medicine doctors address this complex disease. 


What is Type 1.5 Diabetes?

Type 1.5 diabetes is the unofficial name for latent autoimmune diabetes in adults (LADA). This is a form of diabetes that shares characteristics with both type 1 and type 2 diabetes mellitus. It is often misdiagnosed as type 2 diabetes initially because it has a later onset, manifesting in adults. However, LADA is actually an autoimmune condition like type 1 diabetes, where the immune system attacks and destroys the insulin-producing beta cells in the pancreas. Approximately 10% of phenotypic type 2 diabetic patients are positive for at least one of the islet autoantibodies. While LADA has many genetic and immunological similarities with type 1 diabetes, differences in autoantibody clustering, T cell reactivity, and genetic susceptibility distinguish LADA as a distinct variant of type 1 diabetes. (27

Important key features of LADA to recognize include:

  • Age of Onset: LADA typically develops in adults, usually after age 30, although it can occur at any age.
  • Autoimmune Component: LADA involves the immune system producing diabetes-associated autoantibodies that mistakenly attack the beta cells in the pancreas, resulting in a gradual decline in insulin production over time. 
  • Insulin Resistance: Insulin resistance is a physiological condition in which the body's cells become less responsive to the effects of insulin. Insulin is the hormone responsible for regulating blood sugar levels and facilitating glucose uptake into cells for energy. LADA may have some degree of insulin resistance, a hallmark feature of type 2 diabetes. (4, 18)
  • Insulin Requirement: People with LADA typically have a poorer response to oral medications commonly used to treat type 2 diabetes. While these patients may not require insulin treatment at diagnosis, they usually progress to insulin dependence after several months to years. (31

Type 1.5 Diabetes Signs & Symptoms

The broad characteristics of LADA that help in making the diagnosis include:

  • Adult-onset diabetes (age at diagnosis is over 30 years)
  • Family or personal history of autoimmunity
  • Compared to patients with type 2 diabetes, type 1.5 is associated with a reduced frequency of metabolic syndrome: lower HOMA-IR (homeostasis model assessment of insulin resistance) score, BMI (body mass index), blood pressure, and normal HDL cholesterol.
  • C-peptide levels decrease more slowly than in patients with type 1 diabetes.
  • Positivity for diabetes-associated autoantibodies, most commonly anti-GAD65 (glutamic acid decarboxylase 65) and ICA (islet-cell antibodies)
  • Non-insulin requiring at the onset of diabetes

Patients with LADA will complain of similar symptoms as those with type 1 or 2 diabetes:

  • Increased thirst (polydipsia)
  • Urinary frequency (polyuria)
  • Increased appetite (polyphagia)
  • Blurred vision
  • Unexplained weight loss
  • Frequent infections
  • Weakness and fatigue
  • Dry, itchy skin
  • Numbness and tingling in the hands and feet (neuropathy

What Are The Possible Causes of Type 1.5 Diabetes?

The exact cause of LADA is not fully understood, and the specific mechanisms that lead to it are complex and continue to be an area of active research. Both genetic and environmental factors play a role in determining an individual's susceptibility to and likelihood of developing an autoimmune disease. As in type 1 diabetes, certain HLA variants hold the most weight in deciding the genetic risk for LADA. HLA genes code for major histocompatibility (MHC) proteins, which have important immunoregulatory functions; variations in these genes precipitate immune dysregulation. (33

Environmental and lifestyle factors also contribute to the development of LADA in genetically susceptible individuals, including excess body weight, greater waist-hip ratio, low birth weight, intake of two or more sweetened beverages or cups of coffee daily, and smoking. (33

From a functional medicine perspective, it is understood that common underlying triggers for all autoimmune diseases include environmental toxins, physiologic stress, intestinal permeability and dysbiosis, hormonal imbalances, and infection

Functional Medicine Labs to Test for Root Cause of Type 1.5 Diabetes

Diagnosis of LADA includes establishing blood sugar levels within the diabetic range with the presence of diabetes-associated antibodies. A standard laboratory evaluation for LADA should include, at minimum, fasting glucose, hemoglobin A1c, and GAD65 antibodies. Ordering fasting insulin, an oral glucose tolerance test, and C-peptide can also help quantify the degree of insulin resistance and deficiency present.

Once a patient has been diagnosed with LADA, functional medicine providers typically order additional specialty labs that dive deeper to understand the underlying mechanisms contributing to autoimmunity. These results help guide comprehensive and integrative treatment plans to enhance patient response to treatment and positive clinical outcomes.

Hormone Testing

The DUTCH Plus is a comprehensive hormone panel that analyzes 35 hormones and their metabolites, including estrogen, testosterone, DHEA-S, and cortisol. In addition, this test measures the cortisol awakening response (CAR) and organic acids. Together, this panel helps to screen for hormonal imbalances, dysfunction in circadian rhythm, inflammation, and nutrient deficiencies as triggers for autoimmune disease.  

Patients with autoimmune disease and diabetes have a high risk of autoimmune thyroid disease. Thyroid dysfunction has also been implicated in disrupting the stress response, sex hormone balance, gut health and function, and immune balance (8). A comprehensive thyroid panel, including TSH, free T3 and T4, and thyroid antibodies, can detect thyroid disorders and autoimmunity.

Comprehensive Stool Analysis

A comprehensive stool test is a beneficial tool in assessing intestinal dysbiosis and permeability. Using culture, PCR, and microscopic laboratory methods, comprehensive stool tests analyze a  stool sample to detect and quantify the presence of beneficial and harmful bacteria, viruses, parasites, and yeast. Zonulin is a biomarker easily added to the test if not already included. Zonulin is a protein that controls the tight junctions between intestinal epithelial cells; increased levels are associated with enhanced intestinal permeability ("leaky gut"). 

Environmental Toxin Panel

A variety of environmental toxin tests are available, depending on what type of toxic exposure you are screening for. These tests generally require a urine or hair sample to screen for heavy metals, chemicals, and mycotoxins. The body's total toxic load is determined by past and present exposures and the body's ability to effectively detoxify and eliminate those toxins through the gut, kidneys, liver, and skin. Therefore, in addition to the toxin panel, ordering kidney and liver function panels can help assess the health of these organs.

Additional Lab Tests 

Uncontrolled diabetes can lead to health complications, including heart disease, chronic kidney disease, nerve damage, poor wound healing, and problems with oral health and vision. To mitigate and screen for these risks, it is recommended that diabetic patients have an annual foot and neurological exam, dilated comprehensive eye exam, lipid panel, and comprehensive metabolic panel (CMP). 


Conventional Treatment for Type 1.5 Diabetes

Given that LADA shares characteristics with both type 1 and type 2 diabetes, treatment blends strategies from both types of diabetes. Treatment goals are aimed at achieving optimal blood sugar control, minimizing the risk of health complications, and preserving pancreatic insulin-secreting capacity. Treatment options continue to evolve as more evidence is published to explain the complexities of this disease; current recommendations support the use of lifestyle modifications, oral hypoglycemic agents, and insulin therapy to achieve treatment goals. 

Functional Medicine Treatment Protocol for Type 1.5 Diabetes

Using functional medicine labs to uncover the underlying reasons behind autoimmunity, a functional medicine provider will incorporate additional modalities to correct immune dysregulation and use pharmacologic and natural interventions to manage blood sugar. 

Therapeutic Diet and Nutrition Considerations for Type 1.5 Diabetes

Reducing carbohydrate intake is a primary goal in dietary modifications for balancing blood sugar. The Standard American Diet (SAD) is high in processed foods, simple carbohydrates, and added sugars. Not only does this diet contribute to blood sugar dysregulation, characterized by rapid peaks and dips in blood sugar after meals, but this nutrient-poor diet also contributes to systemic inflammation and higher rates of cardiovascular and autoimmune disease. Eating a diet that emphasizes low glycemic, complex carbohydrates over simple and refined carbohydrates is associated with reduced risk of diabetes, better weight management, and reduced levels of inflammation. Ensuring adequate protein intake by eating lean protein and increasing intake of unsaturated fats with meals is also helpful in stabilizing blood sugar and improving insulin sensitivity. (13, 19, 25

Making dietary changes can be challenging and feel overwhelming. To simplify matters and help patients make healthy nutritional choices regarding blood sugar management, the American Diabetes Association developed the Diabetes Plate Method as a practical and visual approach to meal planning to help individuals promote balanced nutrition and portion control.

Another important aspect of treating Type 1.5 diabetes is dampening inflammation to address the autoimmune component. Anti-inflammatory diets focus on eliminating foods that promote inflammation and incorporating foods that reduce it. Diets that emphasize the consumption of whole fruits, vegetables, lean proteins, unsaturated fats, whole grains, legumes, tea, coffee, herbs, and spices are considered anti-inflammatory. The Mediterranean, DASH, and plant-based diets are all considered anti-inflammatory and have also been shown to support healthy blood sugar levels (14).  

Supplements Protocol for Type 1.5 Diabetes

The following supplements can be considered part of an integrative treatment plan to improve blood sugar levels and insulin sensitivity and modulate the immune system. 


Chromium is a trace mineral that plays a role in insulin action and glucose metabolism. Studies investigating chromium supplementation's effects on diabetes have shown benefits in terms of improved glycemic control, reduced insulin resistance, and lower fasting blood sugar levels.

Dose: 200 mcg three times daily

Duration: 4-25 weeks


Magnesium is an essential mineral involved in over 300 enzymatic reactions in the body. Magnesium deficiency has been shown to increase the risk of diabetes, and supplementation can protect against inflammation, improve markers of blood glucose control and insulin sensitivity, and lower blood pressure. (20, 38

Dose: 300 mg daily

Duration: 3 months

Vitamin D

Vitamin D deficiency has been associated with autoimmune diseases, including type 1 diabetes, and supplementation has been proven helpful in treating autoimmunity (16). This systematic review calculated a diabetes risk reduction of 15% with vitamin D supplementation.

Dose: 4,000 IU daily

Duration: Ongoing


Ashwagandha is an adaptogenic herb used historically to assist with stress, neuroprotection, and inflammation. Studies have shown that its administration effectively treats chronic stress and hypothyroidism, known contributors to autoimmune disease. Additionally, its immunomodulatory effects have been shown to balance the immune system by inducing changes in the circulating amounts of immunoglobulins and cytokines.

Dose: 500-600 mg daily, in split dosing

Duration: 8 weeks

When To Retest Labs

At-home daily self-monitoring of fasting and post-prandial glucose levels is essential to monitor how well the treatment works and adjust insulin doses for patients requiring insulin replacement therapy. HbA1c should be monitored every three months until the patient consistently meets blood sugar goals. Other specialty labs can be reordered to monitor treatment efficacy, typically anywhere from 3-12 months after initiating a treatment protocol specific to that lab.



The diagnosis and root-cause treatment of type 1.5 diabetes, or LADA, presents a multifaceted approach to address the complex interplay between genetics, autoimmune factors, and metabolic dysregulation. As our understanding of LADA continues to evolve, integrating functional medicine principles into its management holds great promise. Personalized therapeutic strategies focus on identifying and addressing root causes, optimizing nutrition, promoting gut health, and modulating the immune response.

The information provided is not intended to be a substitute for professional medical advice. Always consult with your doctor or other qualified healthcare provider before taking any dietary supplement or making any changes to your diet or exercise routine.
Learn More
No items found.

Lab Tests in This Article


1. Arango, M.-T., Shoenfeld, Y., Cervera, R., et al. (2013). Infection and autoimmune diseases. In El Rosario University Press.

2. Asbaghi, O., Fatemeh, N., Mahnaz, R. K., et al. (2020). Effects of chromium supplementation on glycemic control in patients with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials. Pharmacological Research, 161, 105098.

3. Auddy, B., Hazra, J., Mitra, A., et al. (2008). A Standardized Withania Somnifera Extract Significantly Reduces Stress-Related Parameters in Chronically Stressed Humans: A Double-Blind, Randomized, Placebo-Controlled Study. Undefined.

4. Behme, M. T., Dupré, J., Harris, S. B., et al. (2003). Insulin Resistance in Latent Autoimmune Diabetes of Adulthood. Annals of the New York Academy of Sciences, 1005(1), 374–377.

5. Blake, K. (2023, May 22). Anti Inflammatory Diet 101: What to Eat and Avoid Plus Specialty Labs To Monitor Results. Rupa Health.

6. Buzzetti, R., Tuomi, T., Mauricio, D., et al. (2020). Management of Latent Autoimmune Diabetes in Adults: A Consensus Statement From an International Expert Panel. Diabetes, 69(10), 2037–2047.

7. Castro, M. R. (2019). Latent autoimmune diabetes in adults (LADA): What is it? Mayo Clinic.

8. Chaunt, L. A. (2023, April 25). Complementary and Integrative Medicine for The Treatment of Autoimmune Diseases. Rupa Health.

9. Christie, J. (2023, February 8). How Chromium Deficiency Affects Our Metabolism. Rupa Health.

10. Cloyd, J. (2022, September 16). 9 Health Benefits of the DASH Diet.

11. Cloyd, J. (2023, February 28). A Functional Medicine Protocol for Leaky Gut Syndrome. Rupa Health.

12. Cloyd, J. (2023, May 19). The Impact of The Gut Microbiome on Autoimmune Diseases. Rupa Health.

13. Cloyd, J. (2023, June 27). Utilizing Functional Medicine Labs In Practice To Help Individualize Nutrition Options for Type 2 Diabetics. Rupa Health.

14. Cloyd, J. (2023, July 5). Integrative Approaches to Managing High Blood Sugar: Specialty Testing, Lifestyle Modifications, and Natural Remedies. Rupa Health.

15. Cloyd, J. (2023, July 7). Integrative Approaches to Reducing Toxin Exposure in Everyday Life. Rupa Health.

16. Cox, A. D. (2022, September 8). Type 1 Diabetes: Conventional And Functional Medicine Treatments. Rupa Health.

17. Desai, M. K., & Brinton, R. D. (2019). Autoimmune Disease in Women: Endocrine Transition and Risk Across the Lifespan. Frontiers in Endocrinology, 10(265).

18. Greenan, S. (2021, October 11). 7 Early Signs Of Insulin Resistance. Rupa Health.

19. Institute of Medicine (US) Committee on Examination of Front-of-Package Nutrition Rating Systems and Symbols, Wartella, E. A., Lichtenstein, A. H., & Boon, C. S. (2010). Overview of Health and Diet in America.; National Academies Press (US).

20. Lauer, M. (2021, November 23). Top 7 Benefits of Magnesium. Fullscript.

21. Li, L., Liu, S., & Yu, J. (2020). Autoimmune thyroid disease and type 1 diabetes mellitus: same pathogenesis; new perspective? Therapeutic Advances in Endocrinology and Metabolism, 11, 204201882095832.

22. Maholy, N. (2023, March 9). Integrative Medicine Protocol For Reversing Type 2 Diabetes. Rupa Health.

23. Maholy, N. (2023, May 23). A Functional Medicine Treatment Protocol for Metabolic Syndrome: Testing, Nutrition, and Supplements. Rupa Health.

24. Maholy, N. (2023, June 8). The Impact of Stress on Autoimmune Diseases: Exploring the Potential of Stress-Reduction Techniques. Rupa Health.

25. Manzel, A., Muller, D. N., Hafler, D. A., et al. (2013). Role of "Western Diet" in Inflammatory Autoimmune Diseases. Current Allergy and Asthma Reports, 14(1).

26. Merger, S. R., Leslie, R. D., & Boehm, B. O. (2013). The broad clinical phenotype of Type 1 diabetes at presentation. Diabetic Medicine, 30(2), 170–178.

27. Naik, R. G., Brooks-Worrell, B. M., & Palmer, J. P. (2009). Latent Autoimmune Diabetes in Adults. The Journal of Clinical Endocrinology & Metabolism, 94(12), 4635–4644.

28. Neibling, K. (2023, March 22). Molecular Mimicry as a Mechanism of Autoimmune Disease. Rupa Health.

29. Orbeta, R. (2022, June 6). 10 Type 2 Diabetes Risk Factors You May Not Know About. Rupa Health.

30. Pittas, A. G., Kawahara, T., Jorde, R., et al. (2023). Vitamin D and Risk for Type 2 Diabetes in People With Prediabetes. Annals of Internal Medicine, 176(3).

31. Poudel, R. R. (2012). Latent autoimmune diabetes of adults: From oral hypoglycemic agents to early insulin. Indian Journal of Endocrinology and Metabolism, 16(Suppl1), S41–S46.

32. Prevent Diabetes Complications. (2019). Centers for Disease Control and Prevention.

33. Rajkumar, V., & Levine, S. N. (2020). Latent Autoimmune Diabetes. In StatPearls Publishing.

34. Sapra, A., & Bhandari, P. (2023, May 29). Diabetes Mellitus. PubMed; StatPearls Publishing.

35. Sharma, A. K., Basu, I., & Singh, S. (2018). Efficacy and Safety of Ashwagandha Root Extract in Subclinical Hypothyroid Patients: A Double-Blind, Randomized Placebo-Controlled Trial. Journal of Alternative and Complementary Medicine (New York, N.Y.), 24(3), 243–248.

36. Sweetnich, J. (2023, June 15). What is the Diabetes Plate Method? Rupa Health.

37. Tharakan, A., Shukla, H., Benny, I. R., et al. (2021). Immunomodulatory Effect of Withania somnifera (Ashwagandha) Extract—A Randomized, Double-Blind, Placebo Controlled Trial with an Open Label Extension on Healthy Participants. Journal of Clinical Medicine, 10(16), 3644.

38. Veronese, N., Dominguez, L. J., Pizzol, D., et al. (2021). Oral Magnesium Supplementation for Treating Glucose Metabolism Parameters in People with or at Risk of Diabetes: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials. Nutrients, 13(11), 4074.

39. Weinberg, J. L. (2022, November 16). What is The Mediterranean Diet? Rupa Health.

40. Weinberg, J. L. (2023, March 7). An Integrative Medicine Approach to Diabetic Neuropathy. Rupa Health.

41. Williams, S. C. P. (2023, March 4). Uncommon Diabetes Types: Symptoms and Treatment. WebMD.

42. Withania somnifera. (2020, May 15). Fullscript.

43. Yoshimura, H. (2023, May 23). The Impact of Environmental Toxins on Autoimmune Diseases and The Use of Detoxification Protocols to Manage Symptoms. Rupa Health.

Subscribe to the Magazine for free. to keep reading!
Subscribe for free to keep reading, If you are already subscribed, enter your email address to log back in.
Thanks for subscribing!
Oops! Something went wrong while submitting the form.
Are you a healthcare practitioner?
Thanks for subscribing!
Oops! Something went wrong while submitting the form.