How Long Before Requiring Insulin?

[Badlands]

I touched on this in my introductory message, but figured I'd ask a more specific question here.

What is the longest a person with LADA has gone without needing to go on insulin? I realize that's hard to answer for some people, as they are sometimes put on insulin soon after diagnosis if they have LADA.

I've been classified as a Type 2 and have been on metformin alone for almost 9 years, but have never fit the T2 profile at all. Instead, I fit the 1.5 profile a lot closer (35 at diagnosis, 5"10, 135 lbs, in good shape, no family history). My blood sugar and A1Cs have mostly been in the non-diabetic range (A1Cs between the high 4s to the mid 5s), but have suddenly been a lot harder to control. I'm going to see the doctor next week.

I just wonder if I may still have LADA, but I haven't heard of anyone going nearly this long under control without needing insulin. As I've never had a C-Peptide or antibody test, I will probably request them (although I hate to spend the money if there's very little chance I'm LADA).

[angelsbridges]

I've only read other stories, but I've seen people state that they've been able to go 10 years without insulin if they're LADA as long as they maintain the right diet and exercise.

[Badlands]

I've only read other stories, but I've seen people state that they've been able to go 10 years without insulin if they're LADA as long as they maintain the right diet and exercise.

Thanks for the reply. I'd be interested to hear from people who have maintained good numbers without insulin for several years. I did quite a bit of searching here and elsewhere online, and couldn't find anyone with LADA who went over 5 years before requiring insulin.

[mortis505]

Most LADAs have been put on insulin pretty quickly after confirmation since the ongoing autoimmune attack on the beta cells. However look up the word "Honeymoon" as this is what the period between diagnosis and full term insulin usage is referred to as.

Since 1.5 mimics T2 at onset many have gone the route of oral meds to try and control, but the meds fail to control after a fashion. 9 years is pretty good IMHO, however if you are going for tests, Im not sure if the GAD65 will still be present, but I could be wrong. I'd go for the C-peptide at the least.

[lorilei]

yes...i agree with mortis..i had a great diet and good exercise habits plus am on my feet all day treating patients...so the line about good diet and exercise is not at all accurate (and many type 2's will tell you the same)...

reminder it is less the "profile" and more the reason for the high BG..type 2's are resistant...insulin is produced in quantities but it is in effective..1.5's are losing production...therefore less overall insulin produced...i am definately not resistant as i probably mentioned already! :)

sorry you keep getting the same people answering your questions..but i think many more people may repsond on the type 1 forum, because 1.5 is a matter of semantics (despite my denial!! i do get it)

[Ategeler]

It is important to start insulin therapy immediately after diagnosis of LADA. Studies show that it may reduce further destruction of the beta cells in the pancreas. I have been on 4 units of Long Acting Insulin for about 3 months and it does seem to make my numbers better overall. It isn't much but good to know there is some type of proactive things out there.
Hope this helps.

[Ategeler]

Sometimes the antibodies show up and sometimes they don't,even when they are present. A C Peptide might help but check with the insurance company first as it is an expensive test. Not all insurance companies cover it.

[MODY-RN]

There are other types of diabetes out there known as MODY- Maturity Onset Diabetes of Young, really inflicts all ages, not just the young. This type of diabetes is mongenic... different gene disorders prevent different types of MODY diabetes. Acts like type 2 but you don't fit the type 2 "profile"... some need oral medications, some need insulin, others just need diet and exercise... My family has some type of MODY but insurance won't pay for gene testing, so we don't know what type. We all currently take oral medications (ranging from Amaryl, Glypizide, Metphormin); some have good control, others not as good.

[jillrapp]

Why would you not want to use insulin? It helps to prevent beta cell burnout, can lower the risk of cardiac disease, peripheral vascular disease, and stroke, also facilitates the dilation of cornary and other arteries that may be constricted in many diabetics and even in nondiabetics. It also has been found to improve the absorption of oxygen by blood flowing through the lungs. (From Dr. Bernstein's book Diabetes Solution)

If something can work so well, why would you try so hard to avoid it? :)

[Badlands]

Why would you not want to use insulin? It helps to prevent beta cell burnout, can lower the risk of cardiac disease, peripheral vascular disease, and stroke, also facilitates the dilation of cornary and other arteries that may be constricted in many diabetics and even in nondiabetics. It also has been found to improve the absorption of oxygen by blood flowing through the lungs. (From Dr. Bernstein's book Diabetes Solution)

If something can work so well, why would you try so hard to avoid it? :)

Because in the previous 8 years (I erroneously said 9 previously) I had non-diabetic numbers without insulin. Had I been on insulin for those 8 years, not only would I have had all those years of the inconvenience of injecting insulin, a risk of hypoglycemia (compared to almost zero risk on metformin), but it would have cost me many thousands of dollars.

For a person who is insulin resistant, using insulin alone can *increase* insulin resistance. Sulfonyureas are probably a culprit of beta cell burnout, but metformin is a lot less likely to do so.

If I need to go on insulin to maintain my numbers, I don't have any problem with that, but it didn't make any sense to jump into insulin use when, as my doctor said, my numbers were probably better than his, and he's not diabetic.

While there are some good things about Dr. Bernstein's approach, I like to back up his claims with other sources, because he says some things without research that contradict actual studies and common sense.

Thanks for the reply!

[Ategeler]

My endo said she had a patient who had 3 children while being diagnosed with LADA and was able to go 8 years before needing insulin.

[fgummett]

While there are some good things about Dr. Bernstein's approach, I like to back up his claims with other sources, because he says some things without research that contradict actual studies and common sense.I'd be interested to see an example or two of this..?

[foxl]

Interesting thread, Badlands.

I have been panicky, worrying that I MUST start insulin to save my beta cells ... well, perhaps not? Maybe my IM doc is right and we need to wait and see ... ten years without insulin and increasing IR would be a good thing, for many reasons.

[Badlands]

I'd be interested to see an example or two of this..?

He recommends A1cs in the mid 4's, which is ridiculous. At those levels, people are at serious risk of hypos. I had a 4.6 once (when I was on glyburide), and was miserable (I feel waaay better in the 5s). The majority of non-diabetics have A1cs between 4.7 and 5.7.

He recommends the Aviva meter, which is known to run high, and uses a different A1c conversion chart than the standard one.

He thinks eating fiber is unnecessary, cardio isn't helpful for diabetics, and doesn't like insulin pumps.

He does have some good advice, but you can't take everything he says as being accurate.