Here I am too! Another LADA....

[SB_Krista]

Visited an endocrinologist today, and received my blood work from 2 weeks ago. C-peptide=0.8 ng/ml (the low end pt of normal range for the lab used) and GAD-65 antibody was 5.0 nmol/L.
So, after almost one year getting used to the idea that I'm a type 2 diabetic, the Dr now says I'm a type 1.5 or LADA! All a bit overwhelming! Plus, the endo has discontinued the metformin er immediately and I start on Januvia, 50 mg/day, beginning tomorrow. The endo actually gave me two options. One, the Januvia with the caveat that he might increase it to 100 mg/day, and it might not be covered by insurance (it was) or two, skip Januvia and take Lantus at bedtime. He preferred the first option, and so did I as I want to avoid injections for as long as possible. For any type 1.5's out there, any feedback on which option worked for them? Thanks!

[soso]

I started on bolus (mealtime, fast acting) insulin, for the simple reason that that is when I had the problem.. it might seem simpler to take one shot a day, but that is not what Lantus is designed for.. Controlling blood sugar spikes is an important factor in control.
No experience or knowledge of Januvia....

[mortis505]

Just an observation here, and I may be incorrect. Januvia stimulates insulin production. This in theory could shorten your honeymoon period and hasten the use of Insulin. Januvia is indicated for T2 diabetes.

I was diagnosed T1.5/LADA and was started on insulin immediately. By doing so I may have increased my honeymoon period for an as yet unknown amount of time (my TDD is less than 25u)

Your Endo may be trying to help you adjust, but Insulin will need to be started eventually. T1.5 is similiar to the autoimmune of T1(GAD-65) but just on a slower time table. I'd recommend a good basal/bolus regimen.

[Subby]

Krista, good luck with the transition. I hope it's all uphill from here - a correct diagnosis may well improve things dramatically for you in general.

Just another med comment - metformin helps with resistance or more specifically, overactivity of the liver. Some type 1s/1.5s can have that issue as well. I just wanted to mention that, in case things get worse without the met - it might have been helping somewhat, after all.

Can't comment on the Januvia. Basal insulin is absolutely nothing to fear, though. Really, a week or two, you'd laugh as your injection fears. If your doc is sympathising with a general fear of insulin/needles, I don't think they are doing their job to well... the decision should be based on things like the efficacy of the medication, not fear of needles in any way.

[dbc]

My "progression" worked like so
1. Initial misdiagnosis as T2, A1c of 7.4%
2. 6 months later correct T1.5/LADA diagnosis - no meds, no insulin as A1c was 6.4 due to drastic change in eating plan and increased regular exercise
3. ~ 6 months later the endo suggested to try metformin, as A1c had drifted up to 6.9. He'd been reading research papers that indicated metformin can be beneficial to T1.5 patients.
4. After ~6 months on metformin A1c was down at 6.5
5. Another 6 months or so (sorry, the exact timing of all this is a bit hazy now. . . .) the A1c had drifted up to 6.9 again, & he started me on Lantus. At the time, from reading on this forum, I figured that I should start on bolus insulin first. The endo's position was "get the morning fasting readings down first, check the effect on A1c, and go from there...." So that's what I did. But I kept on with Metformin
6. A1c went down again for a while, then crept up again as the beta cells gave up, so I started bolusing as well.

That's where I am now, about 5 years after initial diagnosis - Lantus, Apidra and 1500mg metformin XR. TDD around 16-18U/day, which probably means I still have some residual beta cell function left.

Personally, I would not favour any meds that stimulate the beta cells to proiduce more insulin, due to possible burnout. I'd rather keep whatever I've got and use exogenous insulin to supplement what's there

[foxl]

Just an observation here, and I may be incorrect. Januvia stimulates insulin production. This in theory could shorten your honeymoon period and hasten the use of Insulin. Januvia is indicated for T2 diabetes.

I was diagnosed T1.5/LADA and was started on insulin immediately. By doing so I may have increased my honeymoon period for an as yet unknown amount of time (my TDD is less than 25u)

Your Endo may be trying to help you adjust, but Insulin will need to be started eventually. T1.5 is similiar to the autoimmune of T1(GAD-65) but just on a slower time table. I'd recommend a good basal/bolus regimen.

Yah, Mortis, my thought too was I would not want Januvia ... I want insulin to keep my betas as long as possible.

[foxl]

Krista, good luck with the transition. I hope it's all uphill from here - a correct diagnosis may well improve things dramatically for you in general.

Just another med comment - metformin helps with resistance or more specifically, overactivity of the liver. Some type 1s/1.5s can have that issue as well. I just wanted to mention that, in case things get worse without the met - it might have been helping somewhat, after all.

Can't comment on the Januvia. Basal insulin is absolutely nothing to fear, though. Really, a week or two, you'd laugh as your injection fears. If your doc is sympathising with a general fear of insulin/needles, I don't think they are doing their job to well... the decision should be based on things like the efficacy of the medication, not fear of needles in any way.

Subby just described my thoughts on what has happened to me (I just posted it on my thread, in fact). I injected when hospitalized and it is really no big deal. I sought a LADA diagnosis, not just because I was sure it was more accurate for me, but because I WANT to be on insulin. It helps save your own insulin, which makes life far easier in the long run.

I have read, in fact even the Cochrane Symposium states, that SUs are not recommended for LADA as stimulating insulin hastens beta cell deaths.

[zoelula]

Welcome, Krista and congratulations on having a smart doctor. Many of us had to figure out our LADA diagnosis on our own and then convince a doctor of it! I was on oral meds for a bit over a year when my numbers started climbing. Long story short I am now on a basal/bolus regimen and doing well!

[SB_Krista]

Thanks all for your thoughts. I too was concerned about taking Januvia and causing my limited pancreas function to 'burn out' quicker and ask the Endo about this. BTW, my C-peptide was 0.8 so I apparently have limited pancreatic function for now. Anyhow, the Dr. said some very new studies have shown Januvia to have protective abilities on b-cells. He went on to say if my pancreas can produce more insulin, then the increased insulin will signal my liver to stop dumping glucose, so a two fold benefit.

[tiffanyfaith86]

unless im reading everything wrong.. Your doctor wants you on Januvia with Insulin? My doctor minute he got me on insulin wanted me to stop Januvia

[foxl]

Yes I think there is some recent evidence that Gliptins preserve Betas ... I do remember reading it ... somewhere!

But here is some other info on Januvia. Jenny seems pretty critical of all oral meds, however.

Diabetes Update: New Study Links Januvia to Pancreatitis and Pancreatic Cancer (http://diabetesupdate.blogspot.com/2009/05/new-study-links-januvia-to-pancreatitis.html)

[foxl]

Yes I think there is some recent evidence that Gliptins preserve Betas ... I do remember reading it ... somewhere!

But here is some other info on Januvia. Jenny seems pretty critical of all oral meds, however.

Diabetes Update: New Study Links Januvia to Pancreatitis and Pancreatic Cancer (http://diabetesupdate.blogspot.com/2009/05/new-study-links-januvia-to-pancreatitis.html)

This looks like a good article on beta cell rest/regeneration with oral meds: {beta}-Cell Failure in Diabetes and Preservation by Clinical Treatment -- Wajchenberg 28 (2): 187 -- Endocrine Reviews (http://edrv.endojournals.org/cgi/content/abstract/28/2/187)

[SB_Krista]

TiffanyFaith86: I am not on insulin (yet!); just Januvia now.

Foxl: Thanks for the links to the articles! I've read Jenny's take on Januvia and am aware of how she feels about it. Since my original post, I've spoken to my Endo again about Januvia, and he does not share the same concerns about this medication as I do. For now, we're taking a wait-n-see approach...it very well could be that the drug doesn't work well for me and this all is a mute point. It has only been one week so far...
BTW: I'm not afraid to take insulin or give myself a shot. I was insulin dependent during both of my bouts of GD and know first hand that injecting insulin is not a big deal and in fact is less painful than finger pricks!