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WendyL10

Follow Up

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WendyL10

So, I did go see another Endo on Friday, waited 3 weeks to see her. Here's what she told me, which, of course, counters the other Endo I was seeing. There's really Type 1 and Type 2, she said LADA's are really just older Type 1's, not that it matters. Also, she said, "NO, type 2's don't test positive for the GAD antibodies." My other endo told me they do or can.

 

Also, I am type 1..but, not to take anything yet because I'm stable, for whatever reason. She thinks because I was first put on insulin it kicked in my pancreas, my low carbing and resumed exercise has dropped my A1C from 12% to 6.4% (no meds for 3 months).

 

Also, she said for many LADA's ORALS are OK, one does not have to be put on insulin right away. Especially because many Type 1's are very insulin sensitive, as am I. She said Metformin is not the correct oral for LADA's...Januiva would work well because it improves insulin secretion and glucagon secretion.

 

So, that's what I know. Many LADAs can stay on orals without ANY damage to their beta cells for years.

 

Question, does the heat - summer affect BG levels? I been a bit high today, not sure why?

 

thanks!

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Tribbles
Also, she said, "NO, type 2's don't test positive for the GAD antibodies." My other endo told me they do or can.

She is simplifying. Beyond a certain age (65 from memory is the point usually given but I think it's just a convenient divide) anyone may test positive for GAD65, you don't even need to have diabetes. The catch is that these people will have just a few antibodies whereas a Type 1 will have lots.

 

Also, she said for many LADA's ORALS are OK, one does not have to be put on insulin right away. Especially because many Type 1's are very insulin sensitive, as am I. She said Metformin is not the correct oral for LADA's...Januiva would work well because it improves insulin secretion and glucagon secretion.

 

So, that's what I know. Many LADAs can stay on orals without ANY damage to their beta cells for years.

 

It is not uncommon for LADAs to be treated with oral drugs until their beta cells start packing up. This commonly happens when Types are confused.

 

I would have thought the change of an LADA lasting years without beta cell damage, while possible, is extremely unlikely. You can avoid doing extra damage to them with glucotoxicity, but the antibodies are chewing their way through your beta cells regardless and that part you cannot influence.

 

Question, does the heat - summer affect BG levels? I been a bit high today, not sure why?

 

Diabetics usually have impaired heat tolerance and one of the signs is increase insulin resistance and hence higher levels.

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WendyL10

Tribbles - It is not uncommon for LADAs to be treated with oral drugs until their beta cells start packing up. This commonly happens when Types are confused.

 

I would have thought the change of an LADA lasting years without beta cell damage, while possible, is extremely unlikely. You can avoid doing extra damage to them with glucotoxicity, but the antibodies are chewing their way through your beta cells regardless and that part you cannot influence.

 

Ah, are you a doctor. Just sayin'. I have to believe what my Endo tells me and trust that she has my health and best interest at heart. I have talked to MANY1.5's or LADA's, last one has been on meds (not insulin) for over 10+ years. It's difficult for some of us to go straight to insulin, like myself. Because even low doses, as our pancreas' are still kickin' in, causes lows.

 

Also, NO, I'm not going to read Blood Sugars 101 website. It bashes all medication and I have a huge drug phobia anyway, to read someone's opinion, which is all negative. no thanks. It just contributes and encourages FEAR.

 

Think I'm done with this website and wil follow the advice of my doctor.

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WendyL10

I would have thought the change of an LADA lasting years without beta cell damage, while possible, is extremely unlikely. You can avoid doing extra damage to them with glucotoxicity, but the antibodies are chewing their way through your beta cells regardless and that part you cannot influence.

 

This is also NOT true. One's who test positive for GAD antibodies, and get their sugars under control (regardless of how), their follow GAD 65 test can and often does show a much lower level and often times reveresed. Also, Type 1's often don't test positive for GAD 65 antibodies.

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ShottleBop
. . . Also, NO, I'm not going to read Blood Sugars 101 website. It bashes all medication and I have a huge drug phobia anyway, to read someone's opinion, which is all negative. no thanks. It just contributes and encourages FEAR. . .

 

That's not entirely accurate. Jenny quite likes metformin. Check out her most recent post in her blog, "Diabetes Update."

 

ETA: no longer her most recent post. See June 9 for her paean to metformin.

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Granny Shanny
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Think I'm done with this website and wil follow the advice of my doctor.

 

As you wish, Wendy.

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WendyL10
That's not entirely accurate. Jenny quite likes metformin. Check out her most recent post in her blog, "Diabetes Update."

 

ETA: no longer her most recent post. See June 9 for her paean to metformin.

 

and some of us can't take met...and some very much like januvia or other meds too. hey, they're drugs, no doubt about it, they all have side effects, even too much tylenol can be bad. so...one has to go with what works and what their doctor tells them to do.

 

if we sit here and read all the 'bad stuff', we (myself) would be too scared to do anything!

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soso

no need to fear anything wendy...been lada 6 yrs and doing ok.. 2 yrs on low carb and insulin ever since..it is what it is, how you cope is your concern. Blood sugar 101 is an interesting site.. imo it lays out all the choices and then we use what works for us. I am not expecting to expire any time soon.

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Tribbles
Tribbles - It is not uncommon for LADAs to be treated with oral drugs until their beta cells start packing up. This commonly happens when Types are confused.

 

I would have thought the change of an LADA lasting years without beta cell damage, while possible, is extremely unlikely. You can avoid doing extra damage to them with glucotoxicity, but the antibodies are chewing their way through your beta cells regardless and that part you cannot influence.

 

Ah, are you a doctor. Just sayin'. I have to believe what my Endo tells me and trust that she has my health and best interest at heart. I have talked to MANY1.5's or LADA's, last one has been on meds (not insulin) for over 10+ years. It's difficult for some of us to go straight to insulin, like myself. Because even low doses, as our pancreas' are still kickin' in, causes lows.

No, I am definitely not a doctor, I read a lot of scientific papers and am living proof that a little knowledge can be a dangerous thing :D

 

Having got the disclaimer out of the way; people think diabetes is black and white but it really isn't, and LADA could be the poster child for this confusion. There are (at least) two distinct classes within LADA - a more classic T1 version which arguably is an extension of T1a, and a version that is much nearer to T2. The chief difference is the quantity of GAD65 antibodies - large numbers of antibodies suggests the T1 variant, lower numbers suggest the T2 variant, trace antibodies suggest plain Type 2. Arguably the T1 variant is just a continuation of T1 rather than a distinct type in it's own right. Time to insulin dependence is based on the level of GAD65 antibodies because those are what are sending the T-cells after your beta cells.

 

Anyway, here is a paper worth reading that discusses this whole thing, Beta Cell Protection and Therapy for Latent Autoimmune Diabetes in Adults - Diabetes Care. Interestingly it comes down fairly heavily against sulfonylureas for beta cell preservation. As you say though while you are only mildly impaired insulin can be tricky although a basal regime can work well.

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foxl

I am hedging my bets and taking low-dose insulin. I simply feel I cannot afford to not do everything possible to preserve my beta cells.

 

Insulin is terrific and makes me feel like I have some control, where oral meds did not.

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Tribbles

That paper I cited basically says that is the best approach;

 

It would probably seem somehow paradoxical to initiate early insulin treatment in LADA, since this disease is defined by lack of insulin requirement at onset and the therapeutic aim is alteration of the risk of progression toward insulin dependency. The rationale for early insulin intervention though would be improving glycemic control while protecting β-cell function. The exact mechanisms for the apparent beneficial effects of insulin treatment reported in several studies are not yet fully understood, but it is thought that administration of exogenous insulin would allow β-cell rest, at least in part by downregulating the β-cell metabolism and/or by releasing them from the hyperglycemic stress

 

The conclusions for insulin were;

 

Overall, these results are encouraging because they imply that the insulin-treated patients maintain better β-cell function. The optimal insulin regimen is not clear. Given that the loss of rapid insulin release occurs early in LADA, replacement with fast-acting insulin might be beneficial. However, from a practical point of view, it might be difficult to initiate multiple insulin injection therapy in LADA patients, especially if their blood glucose levels are moderately increased.
Thus, a long-acting insulin injection might be a good alternative.

 

Talking about sulfonylureas;

 

Even though it is difficult to generalize these data because the studies had different selection criteria and ethnicity as well as different outcome parameters and follow-up durations, taken together, they do suggest that sulfonylureas accelerate (or at least do not protect against) progressive β-cell failure and are similar to (or worse than) insulin in obtaining good metabolic control. Therefore, sulfonylureas should not be used as first-line therapy in patients with LADA.

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Tribbles
I would have thought the change of an LADA lasting years without beta cell damage, while possible, is extremely unlikely. You can avoid doing extra damage to them with glucotoxicity, but the antibodies are chewing their way through your beta cells regardless and that part you cannot influence.

 

This is also NOT true. One's who test positive for GAD antibodies, and get their sugars under control (regardless of how), their follow GAD 65 test can and often does show a much lower level and often times reversed. Also, Type 1's often don't test positive for GAD 65 antibodies.

 

Type 1 test positive for GAD65 in about 75% of cases to the extent that often it is the only antibody test done because it is so common, if you find GAD65 then you don't need to bother with the others. Of the remaining; 20% of cases are made up of the other two antibodies, and 5% that have no known antibodies.

 

Once an antibody exists it continues to exist for years afterward (think of vaccines). That being the case I can see no reason why the antibodies would stop sending T-Cells out to kill your beta calls, or why antibodies would disappear, just because you BG dropped. I am quite happy to be proved wrong and would be interested in any material you have showing this.

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foxl

Tribbles, I have seen articles alluding to (presumably) decreased autoimmune disease, with lower A1c. Also of GAD disappearance, with improved control.

 

I do not know, for sure, immunology is insanely complicated, but it is the basis of low-dose insulin.

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WendyL10
Tribbles, I have seen articles alluding to (presumably) decreased autoimmune disease, with lower A1c. Also of GAD disappearance, with improved control.

 

I do not know, for sure, immunology is insanely complicated, but it is the basis of low-dose insulin.

 

This is true. And, yes my Endo is fully aware of all forms of LADA, as am I. I too have read everything.

 

My antibodies levels were high GAD 65 - 60, yet...here I am 3 months NO medication, nothing...controlling with diet and exercise. And, I bet next time I have my GAD 65 test redone it will be very low.

 

So, no one is the same. And if you discuss LADA's with a number of ENDOS they may all tell you something different. I have read that Metformin is not good for LADA's...but, that's just what I've been told. If it works, it works.

 

Insulin is not the best step for many of us right now. I have no wishes to go on it right now as I will be hypo all over the place.

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WendyL10

Anyway, here is a paper worth reading that discusses this whole thing, Beta Cell Protection and Therapy for Latent Autoimmune Diabetes in Adults - Diabetes Care. Interestingly it comes down fairly heavily against sulfonylureas for beta cell preservation. As you say though while you are only mildly impaired insulin can be tricky although a basal regime can work well.

 

And, in reading what you posted, it states this, within that article:

 

There are no current guidelines for treatment of LADA, since this condition still has no clear definition. While waiting for the results of current and future studies, a couple of points should be taken into consideration emerging from the few studies that have evaluated interventions for LADA (reviewed here), even though their results are difficult to generalize. Sulfonylureas seemed to provide either similar or poorer glycemic control than insulin alone and caused earlier insulin dependence. Therefore, until proven contrary, sulfonylureas should not be used as first-line therapy. Small doses of insulin given early after diagnosis might be beneficial in maintaining stimulated C-peptide values and thus, supposedly, β-cell function.

 

I was on insulin initially, which, apparently, kicked in my pancreas, and now I'm OK with no meds. So, go figure...this is exactly what my Endo told me, what was stated above. So, I'll believe her and follow her advice. When it comes time, my numbers increase, then...I'll try Januvia first. I hated insulin!

 

Also, this is coming from someone who was told she was 100% insulin dependent, my disease would progress very, very rapidly. Well...the fact is...quite the opposite. I've dropped my A1c down 6 points no meds!

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