Prediabetes and LADA

[frombc]

Hello,

I was just recently diagnosed as having pre-diabetes...totally blindsided me. I've been doing alot of research on the internet and came across diabetes 1.5 aka LADA. What I would like to know is, is glucose intolerance (prediabetes) a precursor to only type 2 or can LADA follow the prediabetic stage. Is it important to find out now whether I fit into this category rather than type 2. Can I be tested at this stage? The reason I'm curious is that I'm not overweight have good blood pressure and cholestorol. I did have a baby that weighed 9 lbs. 13 oz. Thank you if anyone can help.

[Harold]

What I would like to know is, is glucose intolerance (prediabetes) a precursor to only type 2 YES can LADA follow the prediabetic stageThe distinction between Type 1 and Type 1.5 lies only with the age of onset. The early stages of Type 1 and Type 1.5 have been best termed as "The Honymoon Period." Pre-Diabetes refers to Insulin Resistance and is a matter of degree. Up to a certain level of resistance it has been shown to be reversable with diet, exercise, and/or medication. So Pre-Diabetes might be reversable for some, but no one reverses the Honeymoon. It is possible to develope either type of diabetes and have both at the same time.Is it important to find out now whether I fit into this category rather than type 2.Well if you have been misdiagnosed and you are checking your bg's with a meter as you should be doing, it will become apparent before you are in danger. Can I be tested at this stage?Sure a C-Peptide test will determine if your producing normal levels of insulin. After that with a low c-peptide result you would have to have a positive result for a beta cell anti-body test. Type 1 (1.5) is an autoimmune desease and to be classified as one you have to have very little insulin production AND the right antibodies. You can have no insulin production, but without the antibodies your not Type 1. You still have diabetes, but not type 1(1.5) or 2. Typically it's referred to as Secondary Diabetes. Now to confuse things insulin resistance may also be secondary, and secondary refers to having another desease first that causes diabetes. Your probably asking what desease can do this and at the moment three come to mind pancreatic cancer, thyroid, and hepatitis c, and there are others.The reason I'm curious is that I'm not overweight have good blood pressure and cholestorol.Your in good company. A lot of us Type 2's have been saying this. Although doctors have been slow to catch on they are now diagnosing prediabetes earlier and catching it before the weight gain that so many of us went through in the 2 or 3 years before dx. I did have a baby that weighed 9 lbs. 13 oz.Having a large baby shows a predisposition to insulin resistance. Just remember the best way to beat this desease or live with it is to manage it yourself no matter which type you have. Good Luck!

[frombc]

Hi Harold, Thanks so much for your thoughtful reply. There is so much information to sort through...too much information can be a dangerous thing LOL!

Anyway, let me try and get this straight. With LADA you're numbers are either normal or in the diabetic range...no in between? What does the honeymoon period refer to. I guess what I'm asking is, does anyone that has LADA start off as pre-diabetic?

I also found something else confusing on 'ask the diabetes team' website. This woman had pre-diabetic numbers with fasting glucose (5.6) but when she had an oral glucose test she had 212 after 2 hours. This scared me, thinking maybe I should have an oral glucose test done as well as the fasting. Is it possible to get different results (diagnosis) from the two tests. I was under the impression the fasting glucose was the test of choice. Sorry for all the dumb questions and thanks.

[liz32]

Not to sound ignorant but what is LADA? I've never heard this term before and am curious as to what you're talking about? Thanks
Liz

[Harold]

With LADA you're numbers are either normal or in the diabetic range...no in between?You have to be carefull when using the term NORMAL. Since you might mean normal as with no diabetes or normal for diabetes. With LADA your numbers could be all over the place, but usually high without insulin.
What does the honeymoon period refer to.Very simply put, the time period it takes for your beta cells to poop out and die.
I guess what I'm asking is, does anyone that has LADA start off as pre-diabetic? In the context your using it NO.
There is so much information to sort through...too much information can be a dangerous thing LOL!With this desease not enough information will be painfully deadly. Keep at it though it takes time to asorb it.

[Harold]

Not to sound ignorant but what is LADA? I've never heard this term before and am curious as to what you're talking about? Thanks
Liz
Latent Autoimmune Diabetes in Adults (LADA) is a form of type 1 diabetes aka Type 1.5

[dbc]

Hello,

I was just recently diagnosed as having pre-diabetes...totally blindsided me. I've been doing alot of research on the internet and came across diabetes 1.5 aka LADA. What I would like to know is, is glucose intolerance (prediabetes) a precursor to only type 2 or can LADA follow the prediabetic stage. Is it important to find out now whether I fit into this category rather than type 2. Can I be tested at this stage? The reason I'm curious is that I'm not overweight have good blood pressure and cholestorol. I did have a baby that weighed 9 lbs. 13 oz. Thank you if anyone can help.

I was (mis)diagnosed by my family doctor as T2 almost 2 years ago on the basis of fasting bs levels and a glucose tolerance test. I freaked out royally! - which most people on this forum will attest too, so you're not alone there.

Later I transferred to a specialist who diagnosed T1 LADA on the basis of antibody tests (I think the C-peptide test is more expensive??). I also am not overweight and have not had a cholesterol problem (didn't have a baby though, left that to my wife!)

I'm still in the honeymoon phase - my insulin production can more-or-less cope as long as I stick to a low carb diet. Don't know how much longer this will last - and the doctor can't say either, so I try and take things as they come.

Although the management of the diseases (T1/T2) aren't that dissimilar, for me it was important to know what I was dealing with, to "get my mind right". So I'd say yes, get the tests done, the better your knowledge the better you're equipped to deal with this.

[Simon]

LADA is supposed to be much rarer than the other forms though for some reason half the people on this forum seem to have it. This may be because it strikes people in their 30's and 30somethings are more likely to use the internet. Anyway LADA has a very long slow onset compared with type 1 which can make it more like type 2 in that respect (hence type 1.5). There is some research that suggests the antibodies can be destroyed by drugs and stop the diabetes before insulin is needed but this is very experimental at the moment.

[foxl]

fromBC, I am bumping up your first post ... was curious how long you had been dealing with pre-D ... wow -- 3.5 YRS!

I can see you are not obese, as would be typical in T2 ... maybe you SHOULD get GAD and other antibody tests! So you can plan on using insulin, if necessary, instead of worrying about it ...

[mazea]

I was undiagnosed prediabetic/diabetic for 2 years before diagnosed as Type 2 for 4 days and then became LADA and went straight on insulin. because my blood sugar was 19mmol and I wasn't responding to type 2 medication. I had no antibodies on diagnosis. My C peptide was low on diagnosis and I had slight kidney damage due to the having high blood sugars without knowing I had diabetes for so long.
When I was undiagnosed, my blood sugar fasting tests continually were borderline, and the fasting tests that were borderline were probably not showing up my high post meal blood sugar levels when I had good fasting natural insulin and poor mealtime natural insulin. So that it why it went undiagnosed for such a long time. I had problems 5 years before being diagnosed so who knows how long it went on for.

For me, prediabetic LADA had some symptoms. For about 5 years before I was diagnosed, I had trouble holding on going to the bathroom after meals, and had some urinary incontinence which magically disappeared when my blood sugar levels came under control. It and breathing fast which was misdiagnosed as panic attacks were the only 2 symptoms I had as a prediabetic. I'm 31.

An oral glucose test would have picked LADA up I think.

[frombc]

fromBC, I am bumping up your first post ... was curious how long you had been dealing with pre-D ... wow -- 3.5 YRS!

I can see you are not obese, as would be typical in T2 ... maybe you SHOULD get GAD and other antibody tests! So you can plan on using insulin, if necessary, instead of worrying about it ...

Hi again, Wow, this is an old post. Yes, I posted on here 3.5 years ago when I first had a fasting test done. I hadn't had the OGTT yet, but when I did 3 months later my fasting came back as 103 and 2 hour OGTT was 118. Which in Canada, makes me perfectly normal.

My numbers have basically stayed the same over the the last 3.5 years (my fasting actually went down to 85 for over a year) until just recently. That's why I was asking the questions about LADA.

Would LADA have stayed the same over these last few years and then just suddenly changed? I thought there would probably be more of a gradual degradation in the numbers rather than a sudden jump.

I'm trying to arm myself with information before I see my Dr. this Friday, so I can give him a logical reason to get the GAD.

As mentioned before, he doess't even consider me to be PD, let alone D. I don't really blame him, because when you look at my numbers, they do look 'normal'.

[foxl]

LADA could behave like that, yes.

Your beta cell mass would fluctuate but your blood glucose could remain in the normal range.

I had hypoglycemia for a period about 14 years ago when I was hypothyroid. I suspect it was a low point in my beta cell mass.

I had no other abnormalities in blood sugars, until symptoms began in Dec 2008!

[frombc]

Hi Linda, Would the numbers not go up and down though because of the change in beta cell mass? My numbers have basically not moved much at all in the last 3.5 years. Even the increase recently is nothing major...just enough to freak me out though :)

I guess most people with LADA don't catch it in the stage that I'm at (if that's where I'm headed), so there really isn't anyone to compare the progression to.

Most seem to be dx'd when they have full blown D.

I've also heard from a few sources that having a large baby, as I did is more indicative of insulin resistance thus type II. I wish my Dr. had done a GD test on me back then.

I guess if I get an A1c later this week, it will perhaps give me a clearer picture of what my numbers are doing when I'm not monitoring them. Thanks for talking to me. It's very helpful.

[foxl]

Hi Linda, Would the numbers not go up and down though because of the change in beta cell mass? My numbers have basically not moved much at all in the last 3.5 years. Even the increase recently is nothing major...just enough to freak me out though :)

I guess most people with LADA don't catch it in the stage that I'm at (if that's where I'm headed), so there really isn't anyone to compare the progression to.

Most seem to be dx'd when they have full blown D.

I've also heard from a few sources that having a large baby, as I did is more indicative of insulin resistance thus type II. I wish my Dr. had done a GD test on me back then.

I guess if I get an A1c later this week, it will perhaps give me a clearer picture of what my numbers are doing when I'm not monitoring them. Thanks for talking to me. It's very helpful.

Hmmm no, maybe if you are above normal BGs for non-D, then it would indicate an already sub-effective level of beta cell mass, so that would indicate it is NOT LADA.

[frombc]

Hi Linda, Sorry, your last statement went right over my insane head ;)

[foxl]

Well, if you are running high, regularly, due to LADA, it would mean your beta cell mass is already depleted, right? So if you had only marginal blood sugar control, I would expect the fluctuation in cell mass to show up as fluctuation in your blood sugar.

But if you had higher beta cell mass, even fluctuating, you could go for years without the flcutuation in blood sugar.

Does that help?

(I WISH I COULD FIND THAT GRAPH AGAIN! DARN it).

[frombc]

Well, if you are running high, regularly, due to LADA, it would mean your beta cell mass is already depleted, right? So if you had only marginal blood sugar control, I would expect the fluctuation in cell mass to show up as fluctuation in your blood sugar.

But if you had higher beta cell mass, even fluctuating, you could go for years without the flcutuation in blood sugar.

Does that help?

(I WISH I COULD FIND THAT GRAPH AGAIN! DARN it).

Ok, I think I see what you're saying. If my BG is high because of beta cell damage due to LADA any fluctuations in the beta cell mass would show up in my BG numbers if I wasn't being careful.

On the other hand if I still had good beta cell mass and they fluctuated a bit, it probably wouldn't show up in my BGs. Have I got that right?

Hmmm no, maybe if you are above normal BGs for non-D, then it would indicate an already sub-effective level of beta cell mass, so that would indicate it is NOT LADA.

This is where I get lost :confused: How does this statement relate to my situation where I do have slightly high fasting for 3 1/2 yrs (that I know of) and my recent fluctuation. Does my situation indicate LADA or type 2?

Thanks for being so patient with me Linda.

[frombc]

I tried to edit, but I had gone past the 10 minutes.

I know I'm probably over thinking this, but I do find this type of sleuthing interesting.

So, if as you say, my slightly high fasting numbers were due to LADA, I would see a fluctuation in my BGs because of fluctuations in my beta cell mass, correct.

Does the fact that my numbers have stayed so steady for the the last 3 1/2 not point more towards type type 2. Would the beta cell mass not have fluctuated during these last few years, and therefore shown up in my BG?

[mazea]

There are also 2 types of pancreatic insulin cells. One produces fast insulin and the other insulin cell produces slow basal insulin. It is possible to have a deficiency in one of the type of cells and not so much of a deficiency in the other type of cell at the one time.

In my experience of LADA, I have had different times where I have had insulin deficiency and remission for my basal insulin and different deficiency and remission of fast insulin. Sometimes my Levemir will be high and novorapid low, sometimes my novorapid will be high and my Levemir low. The different insulins don't change at the same time for me.

[foxl]

There are also 2 types of pancreatic insulin cells. One produces fast insulin and the other insulin cell produces slow basal insulin. It is possible to have a deficiency in one of the type of cells and not so much of a deficiency in the other type of cell at the one time.

In my experience of LADA, I have had different times where I have had insulin deficiency and remission for my basal insulin and different deficiency and remission of fast insulin. Sometimes my Levemir will be high and novorapid low, sometimes my novorapid will be high and my Levemir low. The different insulins don't change at the same time for me.

WOW I have totally missed THIS -- Now I need to go read up on it! Cool ...

But frombc, picture a roller coaster profile, swooping high and low, and the peaks getting gradually lower, and lower toward the end ... now draw a level, horizontal line acorss the bottom, oh, say,. quarter of the height.

Now, imagine that roller coaster is your beta cell mass ... and the line is the norm -- a blood glucose of 100 -- and picture the effect on your blood glucose.

Does it help any?

[frombc]

No, LOL, that doesn't help. That might as well have been said in another language :)

I know you can't Dx me online. I'm just looking for an educated opinion. Does my situation, as described look more like type 1 or 2?

[foxl]

Got no clue -- but odds are you are a T2.

[frombc]

Got no clue -- but odds are you are a T2.

Thanks Linda. Are you saying that because in general the odds are that I'm a type 2, or are you basing that on what you've read about me?