Doctor using LADA/1.5 term vs. Type 1

[Ategeler]

I should probably have done a poll on this but haven't quite figured it out yet :) .

For those of you who consider yourself LADA/Type 1.5, how many of your doctors openly uses the term LADA/1.5 as a diagnosis? And did you have to push for the actual diagnosis or did you initially get diagnosed that way?

I am curious about this since my doctor refuses to actually use those terms but just says Slow Onset Type 1, which is the same thing. I find it strange that they shy away from using such terminology.

[lorilei]

I'm fairly sure that my primary used the specific term "autoimmune diabetes" when she was suspicious that the gd was...don't necessarily recall the latent partvs the slow onset part initally, but we had several discussions through my denial stage...

2/2 endos just said type 1...which quite honestly freaked me out (still does a bit here and there)..and that is what is in my chart at the endo's..think i first heard 1.5 at my primary's after a melt down about becoming a type 1 ensued after endo # 1 put me in panic mode with the mention of going back on insulin immediately. kind of funny now though.

[Ategeler]

I know what you mean about the "type 1 label". When I was in the Endo's office this past Monday I asked her what my actual diagnosis was. She said slow onset type 1. I knew this but just to hear the words "type 1" gave me a bit of a twinge in my stomach. Ugh.

[mazea]

I suspect strongly I have type 1.5 as my C peptide is lowish, I have low insulin requirements, no antibodies, a genetic history of type 1/ 1.5 and a high onset blood sugar level of 20 without ketones.I'm glad I read about it on these forums.

My endocrinologists have never used to term type 1.5 and refer to me as having Type 1 with honeymoon. You think it would have made a huge difference to my treatment if I'd been diagnosed with 1.5 rather than 1 it as I would have been better prepared for the insulin depletion and remission cycles, which I've had 30 of since last year. Some of these cycles have caused very bad hypos which have nearly landed me in hospital. I consider insulin depletion remission cycles to be important enough consequences for my health that the doctors should identify type 1.5.

[Ohana]

When my Endo said slow onset type 1, I said "you mean LADA?"

He said I could call it "whatever makes me feel better"

I think I grate his nerves as much as he grates mine. - Is it bad that this makes me feel better? :D:D:D

[lorilei]

i know that the course of treatment is insulin at dx to preserve beta cell function, but it took me 18 mos to come to terms with this as i had such wacky times on insulin first go around when pregnant (probably b/c they assumed resistance vs lack of insulin)...i think if i went on insulin sooner though i would have had a heck of a time with the rollercoaster pancreas...i always said that on some level i just thought burning out would be easier albeit more risky if caught without a high bg and without a solution...

I have recently bee given info about cardiac stuff from likely the same virus, but i was crazy with guilt that my prolonging insulin was the cause of this...

i am grateful that I have never had an a1c higher than 8.2 or an occasional bg higher than 400 to my knowledge...that being said, something is more comforting in the 1.5 terminology than 1..despite my near done c peptide and ab results...guess we just need a rope to hang onto...

and it is blessing to have this when I am no longer in my teens...life experiences (ie having kids) helps to some degree in keeping things in perspective..diabetes seems to make ppl grow up so stinkin fast..

[HelenM]

After being in hospital for 3 days on an insulin pump,
the consultant told me, that I'd have to take insulin for life.
I was flabbergasted and muttered something about wasn't it type 2?
He replied that they thought I had type 1, or perhaps we could call it 1.5. Every 'official' document has type 1 on it.
Never been told that I have LADA.

[lilituc]

I don't like "1.5" because too many things have been described by it. I usually say Type 1 with any medical person I don't know. If they press for details, I will confirm LADA. So far, this has only happened here in Seattle, which has the highest rate of Type 1 in the country. So, more doctors here know what LADA is.

I almost cried when I first saw my current primary care doctor, and he looked over the history I'd filled out and said, "so do you have MODY or LADA?"

[TommyC1]

I think I was Dxed before 1.5 LADA or MODY were invented. Pretty sure my beta cells were smoked years before I'd ever heard the term.
So I consider myself type 1.
The fact that I went almost a year with symptoms at 35 years old (can you say denial?), lost 60 lbs, clocked in at 700 mgdl on Dx and never suffered DKA or anything like makes me wonder if in fact I got here via some form of 1.5. Actually I'm pretty well convinced.
But at this point, for me, I don't think there is any difference in how I would deal with it so I still consider myself a type 1 insulin dependent diabetic.
I am glad I got to live my first 35 years without this ball and chain though.:cool:

Tommy

[NoraWI]

Oh, yes! Diagnosed with BGs of around 500 and an A1c of 13% at age 62, I was assumed to be T2. Was treated with metformin for a year at which time control went out the window. The nurse practitioner and her supervising M.D. insisted I take Avandia while I vehemently refused and asked for insulin, which they resisted. They also refused to do a GAD65 antibody test. I fired the lot and traveled 2 hours to the BIG city to an endo who immediately prescribed an MDI regimen of insulin and ordered the GAD which came back T1. Curiously, he was reluctant to officially change the diagnosis because he thought I would have trouble buying insurance! Indeed! At age 62, did I NEED insurance, other than health insurance? I argued that if I were taken to hospital with DKA, I didn't want them treating me inappropriately. He then agreed. I don't understand what the problem is with the medical profession and correct diabetes identification. There was never any mention of T1.5 or LADA, just an outright T1 with maybe a mention or two of "late onset" and/or "slow-progressing."

[fgummett]

Canadian Diabetes Association Clinical Practice Guidelines 2008... (http://www.diabetes.ca/files/cpg2008/cpg-2008.pdf)DEFINITION OF DIABETES AND DYSGLYCEMIA
Diabetes mellitus is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both. The chronic hyperglycemia of diabetes is associated with significant long-term sequelae, particularly damage, dysfunction and failure of various organs – especially the kidneys, eyes, nerves, heart and blood vessels.
Dysglycemia is a qualitative term used to describe blood glucose (BG) that is abnormal without defining a threshold. The adoption of this term reflects uncertainty about optimal BG ranges and the current understanding that cardiovascular (CV) risk and mortality risk exist in people with even slightly elevated BG levels.
Classification of diabetes
• Type 1 diabetes* encompasses diabetes that is primarily a result of pancreatic beta cell destruction and is prone to ketoacidosis.This form includes cases due to an autoimmune process and those for which the etiology of beta cell destruction is unknown.
• Type 2 diabetes may range from predominant insulin resistance with relative insulin deficiency to a predominant secretory defect with insulin resistance.
• Gestational diabetes mellitus refers to glucose intolerance with onset or first recognition during pregnancy.

*Includes latent autoimmune diabetes in adults (LADA), the term used to describe the small number of people with apparent type 2 diabetes who appear to have immune-mediated loss of pancreatic beta cells

[lorilei]

True Frank and I think we get where we fall in classification (ie under type 1) but wish more docs expected and explained the course...it can be baffling especially if misdiagnosed to begin with..think that's why we look for another label and why type 3 is not appropriate...

[fgummett]

True Frank and I think we get where we fall in classification (ie under type 1) but wish more docs expected and explained the course...it can be baffling especially if misdiagnosed to begin with..think that's why we look for another label and why type 3 is not appropriate...I agree that education and raised awareness of the many and varied courses of Diabetes is needed. But in terms of labels where do you draw the line..? How many here, ostensibly with Type 1, still have some Pancreatic Beta cell function, or at the very least went through an extended period of "honeymoon" when first diagnosed? What about a Type 1 who eats freely, covers carbs with insulin, gains weight and then has the added benefit of IR? What about a Type 2 whose beta cells burn out from overuse and so becomes insulin dependent?

Which is more important... the label or the approach to treatment?

I'm all for simplifying the label but increasing overall awareness of the condition in all its complexities -- Diabetes mellitus is a metabolic disorder characterized by the presence of hyperglycemia due to defective insulin secretion, defective insulin action or both.

[DCaplinger]

I think I grate his nerves as much as he grates mine. - Is it bad that this makes me feel better? :D:D:D

Ohana:

If you seriously are grating with your Endo... then find a different one. My Endo and I have a great relationship. He's very supportive, and has given me complete freedom with my care. I set my insulin levels, and he just calls it into the pharmacy as my needs change.

As to this thread... my doctor recognizes LADA, but does not use the Type 1.5. He sees us as Type 1's that are slow onset.

Regards,

D