[k_dub]

Hello. I'm Kelly. I'm from Wyoming. I was diagnosed about 2 weeks ago. I've been lurking, but I decided to finally introduce myself. Really just trying to absorb info.

I'm an athletic 6'1'' 28yo F who is a healthy weight and who works out regularly and eats healthfully (low fat, high fiber/good carb, lean protein). No primary relative with diabetes of any kind, but I do have a secondary relative who was a T2.

My symptoms began very abruptly on Memorial day. Polyuria, excessive thirst, lethary, abrupt weight loss, and just general malaise. BS was 276 during my visit 4 days later at the Urgent Care. PA tells me "you have Type II go see this primary care doc" (just moved here and previously healthy so I didn't have a HCP).
So I go to see the regular doc three days later - he gives me a monitor, tells me to check my BS 3times a WEEK and puts me on Glyburide 5mg one time a day. I'm an epidemiologist, and I thought this all sounded crazy, so I did my research and I started looking for an endocrinologist (1 in the town I live in).

Meanwhile, I progressively feel worse and end up in the ER 4 days after seeing the PCP with severe kidney pain. Luckily, no pyelonephritis or other infection - just really high BS. Glyburide obviously not working. Finally get the referral I need to see the endo.

See endo last Friday, and thankfully he switches me to Lantus 15units at bedtime and Metformin 2 500mg twice a day. And he did request GAD and C-peptide (both tests I requested from HCP#1 and he LAUGHED when I asked!). Endo said check BS whenever I felt like it but at least 3 times a day.

So...still taking Metformin and Lantus. Morning fasting BS has been normal since starting Lantus, but my postprandial readings shoot up into the high 200s no matter what I eat. Only way I can get my postprandial readings down is if I hardly eat. I've read that Metformin can take a few weeks to start working.

I have my follow-up appt with endo mid-July. And I'm hoping that the Metformin will start helping my postprandial readings (should work if I'm truly a Type II).

I'm wondering how long it takes to get results for GAD and C-peptide? Should I call and request results before my next appointment?

I've been doing a lot of literature review. At this point (without the results of my tests), I feel like the clinical picture here is more LADA?
1) I have a BMI of <25
2) I'm <50yo
3) I have a family history of autoimmune disease (not diabetes)
4) I'm not convinced the oral medications are helping
5) My symptoms came on very abruptly

Sorry for the long introduction. I guess I'm anxiously awaiting my GAD and C-peptide results.

Also, some of you may know jen_slc. She's a good friend of mine, and she recommended me to this forum.

[BlueSky]

Originally Posted by k_dub

... See endo last Friday, and thankfully he switches me to Lantus 15units at bedtime and Metformin 2 500mg twice a day. And he did request GAD and C-peptide (both tests I requested from HCP#1 and he LAUGHED when I asked!). ... Morning fasting BS has been normal since starting Lantus, but my postprandial readings shoot up into the high 200s no matter what I eat. Only way I can get my postprandial readings down is if I hardly eat. I've read that Metformin can take a few weeks to start working....

Sounds like yet another misdiagnosis of LADA as T2. I wonder why the endo didn't put you straight on to a basal/bolus insulin regimen ...

Metformin won't bring your post-prandials down. Its main action is to inhibit the supply of hepatic glucose. While metformin does improve insulin sensitivity somewhat, it is not much use if you aren't producing enough insulin to start with.

Phone and ask for the results of the GAD/antibody and c-peptide test. Bear in mind that not all T1/T1.5s test positive for the antibodies, and while your c-pep/insulin levels may be in the normal range during the early stages of onset, the fact that aren't high precludes insulin resistance (T2). From what you have said, I suspect that you are not going to be able to get your post-prandial numbers down until you start injecting rapid acting insulin before meals.

Anyway, welcome to the forum. And, yes, we all know jen-slc

[mortis505]

Its a common misconception among medical practitioners that T1 ONLY effect children, and that since you are an adult you MUST be a T2.

From what you posted above, it sounds to me as though you are a T1/1.5(LADA) Call your endos office and ask if the results are in.

As BlueSky stated above, metformin is for insulin resistance, It wont do anything to help with post-prandial spikes. Talk to the endo about a rapid acting insulin, and get on a carb plan to get your bolus ratios sorted.

Welcome to DF!

[NoraWI]

At the age of 62 I was misdiagnosed as T2. BMI was 23. I have other autoimmune issues as well, all very slow progressing like the diabetes... quick onset like yours but very slow beta cell deterioration (probably due in part to eating low carb). It took me over 2 years to get to an endo who would order a GAD65 antibody test and also prescribe insulin. I discontinued metformin (on my own) once I started on the MDI regimen because it made no sense to inhibit my body from bringing me out of a hypo if necessary. A lower carb diet helps immensely to keep my post prandial numbers down and my insulin need at a minimum. My goal is a bG range between 70 and 110 while using a TDD under 30 units (usually about 25). Exercise helps. Last A1c was 5.9% and working to bring it down lower yet. I agree that in addition to Lantus you should be using a fast acting insulin for meals. You seem to have a good handle on the situation. You will do well.

[bluesgirl102]

I would agree it sounds like LADA. When I had the GAD testing done, my blood got sent to Mayo clinic I believe and it took about a month to get the results. IF you are truly LADA, the metformin most likely will do nothing for you. Until you can get the results, exercise and eating low carb for the moment may be the way to go.

[sprzepiora]

When I had those tests done, it took two weeks to get a result, I am not sure if the c-peptide or GAD65 test was the reason, but one of them needed to be sent to Boston as not every lab does it

[UpNorth]

Welcome to the forums


It does at least sound like you've gotten yourself a decent endo, but it does seem odd you didn't get a rapid acting insulin too, instead of metformin. i'd think it would be better to have something that WILL work, than something that might work, while you wait for the test results. But does indeed seem like you are a T1.5.

[Scratch]

Definitely sounds more probable that it's LADA/1.5 over type 2. And if there's one thing I've seen all too often on these boards now, it's too many people being pegged as type 2 only because of the age. We've had a fair number here at DF who show up with similar profiles to yours and they've had some unnecessary hardship getting a proper diagnosis because so many GPs are seemingly unaware of LADA.

But with your job position and being friends with jen_slc, that's definitely helped point you in the right direction of finding an endo. Now I don't think the GAD antibodies will take until July for the results, I think you would be well advised to pester the endo's office, within reason, about hearing what those results are, especially seeing how the endo hasn't put you on a rapid acting insulin and you've obviously monitored how your post-prandials are too high. That's what rapid acting bolus insulins are used for, to let type 1s eat more like normal human beings.

I'd like to think that your appointment would be moved up sooner if GAD comes back positive, because metformin is probably of little use if you aren't insulin resistant.

[Brian23]

Sounds like my story. About a year ago (I was 27 yrs old, 5'11 151lbs) I began having excess thirst, excess urination and blurred vision; Googled the symptoms and sure enough, diabetes. Three days later had blood work and fasting # was 328 mg/dl and A1c was 8.5%. Dr. said well you dont have juvenile diabetes so here is some Avandia(bad drug). After reading on Avandia and edjucating myself(mostly on this site) about diabtes, I switched Dr.'s and asked if I could control it with diet and exercise and not take the Avandia. I was able to control it with diet and exercise for about 6 months(got my a1c down to 6.4%), but began to be more difficult to control. On Christmas i caught the flu and was running in the 2-300's for 3 days. Dr ordered GAD, c-peptide and Oral glucose tollerance test. I failed the OGTT (1hr:228, 2hr: 329), tested normal on c-peptide(.09, normal, but very low end of normal) and GAD came back negative and A1c rose to 6.9%. Dr consulted with Endo and put me on 10 u of lantus a day until I could see the Endo. By this time I had lost weight and was weighing 130 lbs. When I met with endo this march, he Dx'd me as very slow developing, late onset type 1. I told him I would like to gain my weight back and eat normal. Since March 17th, I have been on multiple daily injections of Lantus and humalog and could not be any happier(unless I did not have diabetes). I have gained 17lbs back and eat whatever I want. I am now 28 yrs old, 5'11, 148lbs and have a new little girl. I am atheletic and healthy. I am still trying to gain more weight and minimize the complications of diabetes. I am going to get my blood work done in a week and expect an A1c in the 5's. My 30 day average on my meter is 109 and I test 8 times a day. Read the forum, it has helped me greatly.

[BrianSCohen]

Kelly,

Welcome. What a rough introduction to diabetes. Most type 2 diabetics have their condition emerge over time. I am sure this has hit you totally out of the blue. There are many knowledgable people here who can help you. Often diabetes manifests itself in a range of ways. Even with millions of diabetics, there is still not a clear taxonomy of the disease. In either case, to a first order it does not matter. You mission is to control your blood sugar. You are already on insulin and that with some diet considerations and continued exercise and you should be fine. At this time, whether you are type 1, type 2 or type 1.5 does not really matter.

As an epidemiologist you are obviously educated, and you should find great information on this site. I recommend that you examine diet, I follow a low carb diet and find that it can dramatically improve my blood sugar control. You will likely find that restricting carbs can really bring your swings into the 200s down.

Remember to keep a good attitude through this. This is a very hard time for you, and although you seem to have a great outlook, it can be quite depressing to go through learning you have diabetes and will have to make significant changes for the rest of your life. Keep in mind that with proper diet, exercise and medication you can reasonably expect to life a long and normal life with few complications.

There are many knowledgable and friendly people here to talk with as you go through this time. Best of luck.

[kgm0612]

Welcome to the forum, Kelly. Nice people and a wealth of valuable information to be found here.

Karen

[sugardumplin]

Morning Kelly! So glad to read your thread. I have the exact same symptoms as you. I have had a GAD65 and a C-Peptide test run. I got my results back on the C-Peptide and nothing on the GAD yet. C-Peptide showed normal. Metformin wasnt really working for me. I am on 24 units of insulin everynight. I am athletic. I exercise heavily a minimum of 5 days a week. I do lots of cross training. My symptoms came on Fast and Hard. I am 29 years old. I just did a three day test wearing some sort of thing with a sensor in it, so it could check my blood sugar 24 hours a day. I am getting those results Wednesday. I was told by the guy who put the sensor on me, that he believes I am not your normal case of Type 2. (just his personal opinion.) That I would more than likely be a LADA. If you find out anything...please post. I don't really want to be LADA, I just want to be diagnosed properly so that I am medically treated properly.

[k_dub]

Update: My GAD Ab test was positive. I have an appointment with endo on July 15th (would be sooner, but I'm going on vacation).
Will be interesting to see what he changes my meds to. Currently on Metformin and Lantus.

[mcgriff]

That is a weird combo. The endo must be covering his bases. I am newly diagnosed type 1 and in my 30s so your story sounds similar. You will probably drop the met and go to Novolog injections before meals. It sounds like you could benefit from the pump given your described lifestyle. I just started pumping today and it feels nice not to be a slave to the pen.

It may be messy getting your Lantus dose correct after being on met, but you will nail it down. One thing I've learned is that you have to be in charge of your diabetes. You are on the right track. And for the record, I think managing type 1 (or 1.5) is simpler than managing type 2. Since my pancreas decided to go part time, I have total control. It's ok to be afraid. Fear kept me going and got me motivated during the first few weeks.

Before you go on vaca I really would insist on getting some Novolog pens. I think you said you are experiencing post meal highs so MDIs may be the way to go. MDI (common is lantus + mealtime novolog) is super easy to learn and you don't want to be on vaca and have to hit the ER with ketoacidosis. If that's not an option try to keep your carb intake pretty low. 1 gram of carb basically raises my sugars by 4. That may be different for you, but I bet it's not too far off. Good luck and enjoy the vaca!

[Scratch]

I'd second McGriff's recommendation about trying to see the endo before going on vacation, to start getting some coverage of the carbs you're eating. The Lantus and metformin can act as good-enough kind of remedy until the 15th if need be, but it's not the optimal solution.