My husbands story and a few questions...

[Christinety]

Hi,
My name is Christine. My husband was diagnosed with type 2 diabetes in January. He went to sleep one day and woke up the next not being able to see anything further than three feet away from him. His FBG was 366, his A1c was 9.2, his triglycerides were 1146 (normal would be less than 200), his cholesterol was high at 245. But were told definately that he was type two, because of the high lipids. The funny thing abou these number was during his yearly physical in October they were all well within normal ranges.
He was put on 10 units of lantus a day and 45 mg of tricor. As well as 500 mg of glucophage. We saw a dietician within a few days, and he started a diet of 60 carbs per meal. We also saw a nurse educator that told us about LADA, and thought that my husband was typical LADA, although the doctor hadn't done an antibody test.
Next time we were at the doctors I requested they do a c-peptide and a GAD level, as well as a recheck on his lipids. This was 10 days after dx, his lipids were all wonderful. His Triglycerides were 126 and total cholesterol was 140. When we got the labs back for the Anti-bodies, his GAD65 was 0.25, the normal range for the labs are less than 0.025. Under those results a note from the lab said "patient shows high pre disposition to Type 1 diabetes and other thyrogastric autoimmune diseases". They did not do a c-peptide. But did measure the amount of insulin in his blood which was 7 the normal range was 1-14.
Yet again the doctor says type 2 because he's still making insulin.
He is now taking 500mg of metformin 3 times a day and the tricor. He was having issues with low blood sugars for a while. Stopped taking the lantus, to see what would happen. He hasn't had a low, and his 2 hour post prandials are usually less than 140. His sugars have been excellant.
Just a side note, my husband has no family history of type 2 diabetes, is not overweight, (he's in good shape, he's in the military) and did not have a real bad diet before dx. He does have a family history of autoimmune disease.
So my questions are: From your knowledge and the info I have given do you think this is LADA? If he does have LADA do you think the treatment would change? Could he be in his honeymoon period? Do type 2 diabetics have honeymoons?
I am sorry this is so long. I know you all are probably not doctors, and I am not asking for a diagnosis. I just wonder what you think from what I have told you. It's very frustrating because while I really like our doctor, I can't get straight answers from the doctor about my husbands condition. Other than he's type 2 because he makes insulin.
Thank you so much for any input you can give.

[BlueSky]

Sounds like early T1 or T1.5 to me, especially since the anti-body test came back positive. It sounds like the insulin level was tested after insulin injections had been started. In which case it would not be surprising that the insulin level was in the normal range. If he was T2, the insulin level would have been very high. T2s make a lot of insulin to overcome insulin resistance, which your husband clearly doesn't have a problem with. So the doctor's comments don't seem right. I would get him to an endocrinologist for a second opinion.

During the honeymoon, symptoms often weaken so much that it looks like the diabetes has gone away. This may have happened with your husband. But it is a temporary effect. And if he is T1/T1.5 the sooner you get him back on insulin the better.

[lilituc]

Was that first cholesterol test a strict fasting test (i.e. 12-14 hours with only water)?

They did an insulin test *instead* of c-peptide? I'm amazed because I've heard of people trying to get an insulin test and not being able to, only c-peptide. In any case, c-peptide will show how much endogenous insulin is being made, but once you start taking insulin, natural insulin production will go down. I think, though, that even with that you'd still expect to see elevated c-peptide in a Type 2 (as Bluesky said). An elevated c-peptide is an indicator of insulin resistance, the hallmark of Type 2.

Still, the antibody test sounds pretty conclusive to me: regular Type 1 or LADA. I would recommend finding a good endocrinologist ASAP (because usually it takes months to get in with one). It doesn't surprise me that a nonspecialist might not be conclusive about this - many doctors don't even know LADA exists. I had a really good GP and he still thought I was Type 2.

I think early insulin treatment is best for LADA because it rests the beta cells, preserving function for as long as possible. You want to do this because with some natural insulin production, you have a better chance of avoiding DKA and severe lows. Metformin is probably not going to do much for him and unless he has a rare side effect, probably won't be harmful. Anything that increases insulin production (sulfonylureas, glipizides, Starlix) is not recommended for LADA and could possibly be harmful. My last endo started people with LADA on a long-acting insulin first (Lantus or Levemir), then added mealtime insulin as needed (Novolog, Humalog or Apidra).

Personally, I would go with dropping the Lantus dose instead of stopping it (to preserve beta cells), unless *any* dose was causing lows, but that's something an endo can help you with.

Here's more about LADA:
IOH latent autoimmune diabetes (lada) diagnosis chart (http://www.isletsofhope.com/diabetes/symptoms/lada_chart_1.html)
It's different from regular Type 1 because the onset is gradual and occurs over a period of years, which is just another way of saying that the honeymoon is really long, and as you may know, "honeymoon" means "still producing insulin."

Note: recently the media has been calling double diabetes (and not LADA) "Type 1.5," so you're probably better off just saying "Type 1" and "LADA" when talking about LADA with doctors. :(

I forgot to add: good job keeping up with his blood sugars. With LADA, insulin production can be erratic, so sometimes bg will vary for seemingly no reason. It's a good idea to keep an eye on it, even if things are going well. You also probably want to have ketone testing strips, just in case.

[Christinety]

I thought it was strange they didn't do a c-peptide also. Because they acted like the main purpose was to do a c-peptide, and get and GAD test while they were at it. When we got the lab results back there was no c-peptide.
Thank you for answering my questions, I am really glad there are some people that don't think I am crazy!

[David_S]

I was dx in Oct. 2006.. I am tall, slim and no hx of diabetes.. a cousin on my mom's side... but no close family.
My c-peptide showed I wasn't making insulin.. very low number.
Based on that I was given type 1. I have no type 2 issues to speak of.. never overweight..
I was given a diet of 300 plus carbs a day.. I only eat 200 on avg. and I walk daily for work.. about 3 -4 hours.
My initial A1C was 14.. now I am 6.3. I focus on carbs per meal.. and I have to snack to avoid lows inbtw. due to high level of exercise at work.

I would say type 1.5 ... why no c-pep test?? Is this an endo?

[Christinety]

I don't know why they didn't do a c-peptide. It is not an endo she is a family practioner. My husband really wants to see an endo, however he is not sure the insurance would cover it, because we are on medicaid. He is starting a new job next month we are hoping the new insurance will definately cover it for him.
He is going for a new A1c test in may, as well as other labs.