[tealas]

I don't have LADA, so I can't speak from direct experience but I would think you have (at least) two aspects of beta cell damage to watch out for; continued autoimmune destruction, and beta-cell damage mediated by raised blood sugars.

There have been good posts about the second issue, and the recently published "Blood Sugar 101" book has a chapter on this. From research it sounds like fastings over 100mg/dl and post-meal spikes over 140mg/dl are certainly capable of triggering beta cell damage. I found it interesting that while pregnant I was supposed to keep my fastings below 90mg/dl and my post-prandials below 120mg/dl. So once I gave birth I was told I could relax those to 100 and 180! If it is good enough for my baby, I think it might be better for my pancreas most of the time

Elsewhere someone mentioned their doctor using a 6.5 HbA1c as a cutoff for starting insulin therapy. A 6.5 HbA1c corresponds to an average blood sugar of 154. So at that point your average would well over the minimum level that beta cell damage is occuring at, for about three months. Looking at it as best we know about beta cell damage, I would think you would always want an HbA1c of at least 6.0 (136 avg) or below - but of course with risks & tradeoffs of hypoglcemic events factored in.

I think the autoimmune component of the beta cell damage is probably much more important for LADA's, and unfortunately has no approved treatment as far as I know. My Endo pointed me to this research page last year: TrialNet - Information for Patients If you are within the first 100 days of diagnosis, you may be eligible to enter a trial for autoimmune drugs that could help delay the autoimmune damage to the pancreas.

So if you are past 100 days and you want to actively work on the autoimmune risk you would probably have to go into an alternative medical system or consider anectodal-type evidence.

For many people this is probably not how they would approach their situation. But for sake of sharing information, the two main areas I know about in this regard are Traditional Chinese Medicine (TCM), and using raw foods (some anecdotal stories of Type 1's preventing further damage and not requiring insulin on a raw food diet). But because I don't have LADA, I have no comprehensive TCM information to share. I did find this article, apparently they have identified a potential autoimmune drug for Type 1 diabetes from the chinese herb hydrangea: New Lead For Autoimmune Disease From Chinese Medicine

[foxl]

Tealas, apparently from the articles I am retreiving off PubMed, the high blood sugars are presumed to be a component of the autoimmune damage, as well.

[tealas]

Originally Posted by foxl

Tealas, apparently from the articles I am retreiving off PubMed, the high blood sugars are presumed to be a component of the autoimmune damage, as well.

You mean high blood sugars initiating the autoimmune damage to beta cells, or further fueling it once it starts?

[lilituc]

I had normal fasting, but super high postprandials. My endo knew me pretty well, so when I called and told him my postprandial bg was up to 300 and wouldn't come down (this was on all the T2 meds), he agreed that it was time to start insulin.

[foxl]

Originally Posted by tealas

You mean high blood sugars initiating the autoimmune damage to beta cells, or further fueling it once it starts?

My understanding is that the high sugars lead to increased insulin secretion, leading to more attack on beta cells by T cells ...

[foxl]

Originally Posted by lilituc

I had normal fasting, but super high postprandials. My endo knew me pretty well, so when I called and told him my postprandial bg was up to 300 and wouldn't come down (this was on all the T2 meds), he agreed that it was time to start insulin.

A good reason for documenting my response to a carby meal, once in a while ... ONCE. IN. A. WHILE.

[tealas]

Originally Posted by foxl

My understanding is that the high sugars lead to increased insulin secretion, leading to more attack on beta cells by T cells ...

But why does the blood sugar go high to begin with? Due to some initial autoimmune damage to the beta cells? Or are they saying there are other reasons that blood sugars starts to go up and that rise then initiates the autoimmune damage? I guess I'd heard the hypothesis that there was virus which triggered attack to a similar antigen on the beta cells (in some families, hence the genetic component to the disease).

[luckharm]

Hi all,

No offense taken by the replies to my prior post. We are all here to share information and learn from each other.

My Endo was trying different medications before making the insulin decision. I have been on 10 units of Lantus now for about 1 month and my BS numbers are still a little high, averaging about 160 in the morning. I called my DR. yesterday and she has now upped my dosage to 15 units per day. We'll see how that goes.

This disease is like trying to hit a moving target. Just when you think you have it under control , it gets away from you. I had a honeymoon period of about 8 months when I had BS numbers of about 110 just with Metformin and I was eating a sensible diet with about 2 servings of carbs per meal. Then, slowly, my numbers started to climb even though I was not changing my diet or exercise. My Dr. said that my pancreas is now producing less and less insulin, thus the need to go on Lantus.

I get really frustrated sometimes and just want to get this under control!

I am 5' 4" and weigh 120 lbs. Is 15 units of Lantus OK? Maybe I even need more? I am now limiting myself to 1 serving of carbs per meal just to get my numbers down.

[Ti-Jae]

Not sure whether to pipe in or not since I'm type 2, but when I was diagnosed at the emergency room in January and admitted to the hospital that night, my BG was over 400 mg/dL and my A1C was 13.54%. The endocrinologist on call, who is still my endo today, immediately started me on a couple insulins. When I last saw him for a checkup in August, my A1C was down to 4.9% so he said I could discontinue the insulin; we'll see how I do without it. I'm very grateful he put me on insulin. Between the insulin, having a supportive endo on my side and lurking in these informative forums, I felt I had much more control than I would have otherwise during a nearly overwhelming time filled with many lifestyle changes.

[foxl]

Margie, are you still on metformin with the Lantus? You of course are THIN (I need a green face for envy ), so it might not be any insulin resistance affecting your insulin needs ... or it STILL could be ... but that is not a huge dose of Lantus, either.

Ti Jae, I do appreciate you chiming in here, since you were DKA, you too have KPD -- ketosis prone diabetes, and it is possible you, like I have got beta-cell insufficiency as well as IR ... some diagnosticians by the way categorize T2 = non-insulin dependence; T1 = insulin dependence or NO insulin secretion. It it a very loose definition.

Please keep us posted on how you do without insulin! It does take about 6 months for beta cells to rebound after a DKA episode, according to one study Mike (Rekarb) posted somewhere in the T1.5 forums ... it sounds to me like your endo followed the protocol I wished MY Endo had followed ... better for your betas. I now see his partner and suspect she would have discharged me on insulin.

have you had antibody testing at all?

[luckharm]

Linda,

No, I stopped the Metformin when I started the insulin, so right now I am only taking 15 units of insulin. This morning my BS was 94 so I was thrilled! Maybe I have finally found the right dosage. I'll keep my fingers crossed.

[foxl]

Originally Posted by luckharm

Linda,

No, I stopped the Metformin when I started the insulin, so right now I am only taking 15 units of insulin. This morning my BS was 94 so I was thrilled! Maybe I have finally found the right dosage. I'll keep my fingers crossed.

Excellent!

.................................................. .................................

[Ti-Jae]

Originally Posted by foxl

have you had antibody testing at all?

Yes, testing for antibodies was among the first battery of many tests he performed right away while I was in the hospital. The results were negative.

[foxl]

Well we still are dealing with the same issues --possible insulin resistance, and possible insulin insufficiency in unknown quanitities, right Ti-Jae?

[Rekarb]

Originally Posted by tealas

But why does the blood sugar go high to begin with? Due to some initial autoimmune damage to the beta cells? Or are they saying there are other reasons that blood sugars starts to go up and that rise then initiates the autoimmune damage? I guess I'd heard the hypothesis that there was virus which triggered attack to a similar antigen on the beta cells (in some families, hence the genetic component to the disease).

From what I'm slowly gathering, at least for ADMs, is that the first phase starts going slightly off the track at about adulthood. It then lies low as a mild but persistent hyperglycemia that slowly erodes this first phase as glucose toxicity increases. Of course ADMs typically don't have antibodies, now that I think about it.

Mike