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Arrgy

When T2 Diabetics become T1

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jwags

I don't think Type 2 diabetics become Type 1's. Most type 2's are never offered antibody testing, so many are mis diagnosed in the first place.

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Bountyman

Was wondering; that's 12 pages of stuff that I just can't grasp. I mean, those kind of articles are probably useful to someone with a Masters in biostatistics...but I'm just a lowly diabetic. So, maybe you could do a synopsis version for me...tell what you took away from it?

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Arrgy

You just have to read it. If I tell you what it says, five people gang up and tell you I'm wrong. Believe that! lol

 

Google Scholar

 

Is a great place to get you going. Look at my nightmare thread. The last time line I wrote might fit your life. Let me know, k? :)

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Subby
You just have to read it. If I tell you what it says, five people gang up and tell you I'm wrong. Believe that! lol

 

If you actually quote the section or provide the outline of whatever it is that says "legitimate type 2s morph into type 1" for you, we will be very happy to respond with thought. As a matter of point, I don't know of a reason a genuine type 2 (as much as we can say considering how vague it really is) might not get type 1 as well. If the type 2 was legitimate, it's not going to "change" into type 1, though, in the sense of the type 2 mechanisms and insulin resistance just drying up and buggering off.

 

What the study does talk about is misdiagnosis of LADAs as Type 2s, though it doesn't use the word misdiagnosis, presumably as a matter of prudence (so as not to overstate their research, and as from their position, someone clinically diagnosed type 2 who is in fact LADA, may be getting appropriate treatment so it may not matter). This is not the same as "type 2 becoming type 1s" in the sense of a shift from one to the other.

 

Incidentally, it also generally suggests that a diagnosis of LADA may not be all that important, as the treatment and indeed progression towards insulin, can often be similar. Same goals: maintain glycemic control with whatever means healthy and necessary, including insulin as required. I think this should be your current take-home message considering how urgent it might be for you to access insulin.

 

Autoantibody testing in adults with clinically diagnosed type 2 diabetes picks out a subset with features and clinical course approximating to those of typical type 1 diabetes, but translating this observation into measures that can usefully influence individual patient management is far from simple. An antibody-positive patient’s risk of progression to insulin requirement is modulated by age and clinical features as well as by the extent and intensity of islet autoimmunity detected. A middle-aged or elderly patient with type 2 diabetes who has one antibody is probably at no greater risk of early insulin requirement than a patient of the same age who lacks antibodies, whereas a young person with multiple autoantibodies is almost certain to need insulin soon. These factors need to be taken into consideration in counseling patients. A further major limitation is that the clinical benefits to an individual patient of a diagnosis of LADA—as opposed to careful monitoring and treatment of hyperglycemia—are unclear. There is some evidence that in antibody-positive patients, sulfonylureas might lead to more rapid reduction in β-cell function than insulin therapy, but larger and more complete studies, including assessment in antibody-negative patients, are needed before clinical practice is changed. In some situations, such as atypical diabetes, it is useful to know that a patient is antibody negative, but again the result must be taken in context.

 

I realise this may be a red rag to a bull, but I would rather try. Stress, such as can result from engaging in debate on forums about a diagnosis you are determined to gain, can have a massive effect on your blood sugars. Please consider if your seemingly passionate mission to prove you are LADA to a bunch of strangers who can do little about it anyway, is worth the possible health effects for you.

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Subby

Hostility? In bubbles? That's a really unfortunate reaction to what I think is a reasonable post and certainly one taking your source seriously. But you can't please everyone, hey?

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foxl

Well, this article does emphasize the controversial aspects of screening Type 2's for LADA. However, am ore recent one (Jan '11 I believe) updated article by Cochrane group emphasized that earlier use of insulin in LADAs preserves control of blood sugars and A1c.

 

As well, do look up Ketosis-Prone Diabetes, in Pubmed. There are several articles using this term, which provide a great view of the physiology of beta cell shutdown and recovery. I found their work to be VERY helpful, to me.

 

I am someone who went on low doses of insulin, one year after a DKA diagnosis. Getting insulin was a huge relief to me -- it has provided better control and more flexibility than the oral meds ever could have.

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Subby

I agree that the assertions of the study provided regarding a kind of loose attitude to the importance of screening of LADA, don't seem that convincing. I'd have thought there were more compelling reasons to do so than it suggests. It may be a case of older or more lax control expectations overall.

 

I'm all for Arggy to get checked out for LADA more thoroughly, despite current indications such as a likely normal c-peptide than may suggest otherwise. However I don't think there should be any perpetuation of a conception that type 2 morphs into type 1/LADA which seems to be the point of contention to all of their recent posts. Unless someone can come up with something concrete for us to look at.

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Tribbles
I agree that the assertions of the study provided regarding a kind of loose attitude to the importance of screening of LADA, don't seem that convincing. I'd have thought there were more compelling reasons to do so than it suggests. It may be a case of older or more lax control expectations overall.

 

I'm all for Arggy to get checked out for LADA more thoroughly, despite current indications such as a likely normal c-peptide than may suggest otherwise. However I don't think there should be any perpetuation of a conception that type 2 morphs into type 1/LADA which seems to be the point of contention to all of their recent posts. Unless someone can come up with something concrete for us to look at.

 

There is some evidence for this but not in the type of cases Arggy is talking about. Both Wilkins and Chawla have found mechanisms where Type 2 triggers Type 1 (the Accelerator Hypothesis) in young people. There are quite a few papers on this link.

 

In Arggy's case it sounds like straight forward Type 2. After the time period in that case to have that c-peptide level remaining doesn't sound like LADA at all. Certainly with that c-peptide level antibodies would still be active in some numbers. I think I would look elsewhere for the cause of the pain problems - the danger is fixating on a possible cause and discovering later that there is a different actual cause.

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Arrgy

The problem with some is, they closed a book that is unfinished. LADA is still in the first chapter. Look at what is new since starting this...

 

Subject: LADA?

To: r.d.g.leslie@qmul.....

 

Hi. I have a dilemma. I was type 2 but then all the oral and

injectable meds stopped working. I was deemed type 1 and was able to

get a 24 hour insulin with humalog. I had to change doctors and got re

diagnosed back to type 2. My new doctor was sure glyburide would work.

I ate soup for 4 days and had glucose readings of 250 to 350 until I

quit. I suspected LADA for the longest time as everything I read

mirrored my situation. My GAD of <5, C-peptide 1.7 causes them to

reject LADA. Is this definitive? I checked all five of these

indicators...

A team of Australian physicians recently developed a screening

system that may help doctors suspect LADA. They found that, compared

with people with type 2 diabetes, LADA patients were more likely to

have at least two of the following traits:

 

Younger than age 50 at diabetes diagnosis

Normal weight (a body mass index less than 25)

Acute symptoms (such as extreme thirst, frequent urination, or

unintentional weight loss) when diagnosed with diabetes

A personal history of another autoimmune disease, such as autoimmune

thyroid disease, rheumatoid arthritis, or celiac disease

A family history of type 1 diabetes or other autoimmune diseases.

Johns Hopkins: Diabetes on type 2 diabetes|LADA: Special Reports

 

Dear Mr Reed,

 

I am writing on behalf of Professor David Leslie in regards to your below email.

 

Unfortunately, Professor Leslie cannot comment as it is unprofessional to comment on individual cases.

 

However, he did say that data suggests that >some patients can have IA-2 or ZnT8 autoantibodies (unpublished) and potentially T cell changes without GADA so the lack of GADA may not be definitive.<

 

All the best,

 

 

Stephanie

 

Stephanie Cunningham

Administrative Assistant

 

actionlada.org

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Arrgy

Also. My new Endo, who seems to have closed the book too, put me on 600mg Alpha Lipoic Acid for a new burning area on my torso/l.side. I think it is just starting to show it works. The SPS has been quiet but I had 3 episodes in one day a few ago. They are 100% debilitating.

 

I've requested the IA-2 or ZnT8 autoantibodies tests...waiting.

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maryblushes

You might find these interesting...

 

 

Is type II diabetes mellitus a disease of the innate immune system? Is type II diabetes mellitus a disease of the i... [Diabetologia. 1998] - PubMed - NCBI

 

Type-2 diabetes linked to autoimmune reaction in studyType-2 diabetes linked to autoimmune reaction in Stanford study - Office of Communications & Public Affairs - Stanford University School of Medicine

 

"... The findings blur the lines between type-2 diabetes (which has been thought to be primarily a metabolic disease) and type-1 (or juvenile) diabetes..."

 

Do Immune System Ills Help Drive Type 2 Diabetes?

Do Immune System Ills Help Drive Type 2 Diabetes? - US News and World Report

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Tribbles

However, he did say that data suggests that >some patients can have IA-2 or ZnT8 autoantibodies (unpublished) and potentially T cell changes without GADA so the lack of GADA may not be definitive.<

 

He is perfectly correct. It is usually referred to as idiopathic Type 1 or Type 1B and is usually due to collateral damage from a pre-existing condition, mechanical damage, or drug damage. There are also unexplained cases that are thought to be due to unknown antibodies or inflammation. On the flip side what he didn't say is that the presence of antibodies alone isn't definitive either as 40% of people with low levels of antibodies will not develop diabetes (a little known fact - this comes from research in identifying people at risk of T1).

 

The problem you will have in getting to an LADA diagnosis is that your c-peptide results are far to high after the duration of your diabetes. If you think you have SPS it would be far more useful to get an EMG as this would be both easy and definitive.

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Arrgy
You probably have pancreatitis. Have you been checked for that?

 

No pain. None of them. Maybe I have LADA! lolA

 

Symptoms

By Mayo Clinic staff

 

 

Signs and symptoms of pancreatitis may vary, depending on which type you experience.

 

Acute pancreatitis signs and symptoms include:

 

* Upper abdominal pain

* Abdominal pain that radiates to your back

* Abdominal pain that feels worse after eating

* Nausea

* Vomiting

* Tenderness when touching the abdomen

 

Chronic pancreatitis signs and symptoms include:

 

* Upper abdominal pain

* Indigestion

* Losing weight without trying

* Oily, smelly stools (steatorrhea)

 

When to see a doctor

Make an appointment with your doctor if you have persistent abdominal pain. Seek immediate medical help if your abdominal pain is so severe that you can't sit still or find a position that makes you more comfortable.

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StringCheese

Thank you so much for posting this! It was just what I was looking for. I'm a research scientist (not in the field of diabetic research) and this is giving me a great starting point to help me figure out whats going on with me. I was diagnosed as diabetic a month and a half ago but I don't seem to fit any group as of yet I'm now on insulin and will be seeing an endocrinologist in a month. My Dr.'s words were that I'm a "medical mystery". I'm 30, overweight, have been running abt 5 miles several times a week and lifting weights for a long time, have been eating abt 1600 cal/day for years (I've met with dieticians and trainers and I'm doing what I should be doing), but I'm still 270 (6 ft, not pear shaped). I've had high fasting blood sugars for 7 years (possibly before I don't know) up until this year my A1c was 5-6, but this year it was 10.2 even though nothing in my diet or exercise changed. My dad was diagnosed when he was ~28 as type 1, he was at a normal weight and was on insulin his whole life though the last 5 yrs of his life he became a bit insulin resistant and had to increase his dose a bit, both of his siblings have been recently diagnosed with type 2 they are in their 60s. My brother is also showing signs of diabetes and hopefully I will be able to convince him to go to the Dr and he like me is also over weight but he literally lived at the gym for the last year. The metform drugs had no effect at all on my sugars even though I lost 10 lbs on them the first week. I am responding well to the insulin, which besides my weight suggests LADA/1.5, I also have low cholesterol and normal bp, but I'm GAD negative. My thought may be one of the MODY mutations because my dad's father died of a heart attack when he was abt 50, and then his father's mother died before 50 also a heart attack and she had 13 miscarriages between her 2 children and she had a brother who died when he was 33 of a heart attack. Which suggests genetic involvement, but it seems most of the MODY mutations do not often require insulin. So I'm just as confused as my Dr.

 

But thanks for posting this, it's given me a lot of good sources to track down. And if anyone has any thoughts on my situation I'd welcome any input. Thanks!

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Lizzie G

Pancreatitis is associated largely with alcoholism; I would doubt that Arrgy has it on this basis, unless he's omitting vital details ;-)

 

Find these types of threads entertaining - always turns into a p*ssing contest with the same people spouting medical jargon verbatim. sometimes (but not always) real life can be so much more rewarding than spending entire evenings being opinionated on the internet!

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Hoping4Cure

The easiest way to find out if you're type II or type I (a or B), is to lose a lot of weight and find out if you still need insulin. Seriously, dude, I was 230 lbs and type 1, and I'm 6 feet tall, now I'm 211 and I feel a million times better.

 

Up to you. Whatever you're doing with your life and diet is not working out. Maybe it's time to change? Best/easiest way is to low carb it. This forum can help. But you have to be willing to listen. Otherwise you're just chasing at windmills pretending to solve things that you (nor I), aren't really qualified to solve. For example, I just found out after 20 years that I'm not type 1, but type 1b. Maybe you are Type 1 or 2 (no GADs likely suggest type 1b or type 2 or maybe 1.5). I'm also doing this, my goal is to get around 180 lbs and see what happens. Maybe I was misdiagnosed. Who knows. I grew up thin, but only in the past five years did I get overweight in any major way. I also worked out and lifted weights a lot. Lifting weights, at least for me, makes me hungry all the time which makes it that much harder to focus on staying thin and keeping my sugars in check. The only question you need to ask is if your lifestyle is more important to you than your health.

 

If you're working out a lot and on only 1600 calories a day and weigh 270 lbs, I don't know what to say...that doesn't add up to me. I'd do cardio and go low-carb gradually. Oh wait...I already am. I lost nearly 20 pounds since july. As an experiment, I went back to doing more weights and consequently less cardio (there's only so much I can do in one workout before shaking badly), I eat more and gained back 4 pounds. Lesson learned : weights are not a good way to lose weight. I end up putting on not only muscle but fat too. The more insulin you take, the harder it is to stay thin. Actually it's pretty much the definition. The amount of insulin you take or produce is directly proportional to your weight. It's a sliding scale. It varies with how lean / fit you are. But the more muscle I pack on, the more flab I invariably get. Best way to avoid that is to focus on more cardio than weights. Sure weights are fun and easier after a long day at the office. But you burn more fat when you do cardio, that's a fact. Weightlifting as a diabetic is a recipe for ever-increasing weight as your metabolism slows as you age.

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Tribbles

I guess you know this but the main reason your weight increases with weight training is that you add muscle mass which is far more dense than fat which it is replacing. You need to monitor body fat to see the real effect. Cardio produces more dramatic effects because there is little muscle mass gain.

 

Interestingly insulin abuse is a problem amongst body builders because increases muscle mass (from memory on a 2:1 ration to fat - the exercise burns off the fat).

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StringCheese

Unfortunately, I've always been heavy (100 lbs in kindergarten, 180 in 5th grade etc even though I was playing 7 sports year round). My whole family is large and tall on both sides (ranging from the smallest at 5'8'' 145 and 6'0'' 150 (who live every moment by diets) to the largest at 6'7'' 520ish and 6'4'' 440ish (who don't really care about their weight which they should I'm probably the average in my family). So, I think that there are probably some significant genetic factors involved in my size. The baby sitter I had growing up from 1-6/7ish she fed us the same as her kids and while my siblings and I were all chubby her kids were all thin, and she made all of our meals and snacks. Once my mom took over as far as preparing meals for us she didn't really do the best job while we were growing up, pizza and fast food were far to commonly our dinner (she was a great mom in a number of respects this just was her greatest shortcoming). But I think looking at my families weights while the babysitter took care of all the meals its pretty evident that there are at least some genetic contributions, even if the diet I grew up on is still the major cause of my families obesity. Anyway, so 7 yrs ago I was told my blood sugar was high but A1c normal and that's when I started exercising and reduced/improved what I ate and within the first year I lost over 40-50 lbs (felt much better!) but the next test I took still said my fasting was high but A1c normal. But I continued eating abt 1600 cal and exercising. Then I moved and my dad passed away within 2 weeks and to be honest I didn't get any exercise or eat well during that time and put the weight back on that year, but the fasting was still high and A1c normal the next time I took the test a yr or so later. But I snapped out of it and started going to the gym again had a trainer for a bit and paid attention to my diet again (although I wasn't counting carbs which now I know I should be) and I lost the weight again. But I've been about the same as far as diet and exercise for about 2.5-3 years now and my weight has stayed the same at abt 270 (smaller than I was in high school). Only this year my A1c spiked to 10.2 for no apparent reason.

 

The obvious answer is to up the amount of exercise I'm getting because it seems I plateaued with it's effects on my weight loss and double check my diet for anything which isn't working for me (I haven't fully adjusted everything to a low carb diet, still working on that). And I really need to work on being consistent about everything. I tend to go for 3 weeks doing everything right and then I slip up, I think the girls reading this can probably relate a bit more but I tend not go go to the gym for that 4th week and then the cycle repeats and about every other month there's usually a stress full week or so at work which derails my schedule to get to the gym, I do really need to get that aspect of my life under control before I can really be absolutely certain about any of my theories as to what is accounting for what. But since starting all of this I've had no energy to get to the gym first the metformin wiped me out! then with the insulin I feel great sometimes but headachy and tired other times. I've only really started getting back to the gym the last week or 2. And it's been a disaster, before any of this I could exercise for 2-3 hrs without a problem even if I over did it, but now I last only 30 mins and need to take a nap! It is truly absurd! (even though my blood sugar hasn't gone down). Also I noticed that my muscles are sore the next day when my entire life no matter how hard the work out it takes my muscles 2 days to become sore. I feel like whatever mechanism my body was using to collect and use energy is no longer working the same way. Which is obviously problematic seeing as I need to loose weight whatever type of diabetes I have. I'm hoping this lack of sustained energy is a result of my body getting used to lower blood sugars and that I will accommodate to it quickly.

 

I do find that I put on muscle mass very easily compared with loosing fat, my arms in particular have always been fatty and any time I've tried to focus on loosing that weight all that happens is that the muscle gets larger but the fat doesn't seem to go anywhere. I think take your advice and I'll stick to the cardio for now. I've still been ridiculously tired even when I've just done cardio but at least it will help not put on more weight. On the metformin I lost 10 lbs the first week and having been on the insulin for about a month I've gained that back. Hopefully, that trend will tapper once I get back to the gym more often.

 

Thanks

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Arrgy

I was positive for IA-2...

 

The role of C-peptide levels in screening for latent autoimmune diabetes in adults.

Bell DS, Ovalle F.

Source

 

The University of Alabama School of Medicine, Faculty Office Tower, Room 702, 510 South 20th Street, Birmingham, AL 35294-3407, USA. dbell@endo.dom.uab.edu

Abstract

 

Early detection of latent autoimmune diabetes in adults (LADA) is important in that the earlier insulin therapy is initiated, the greater the preservation of pancreatic beta cells. This study assessed whether a random C-peptide level is an effective screening test for LADA. Random C-peptide levels were measured in 39 subjects with LADA and 39 subjects with type 2 diabetes who were matched for age, race, gender, and duration of diabetes. LADA was definitively diagnosed by the presence of antiglutamic acid decarboxylase antibodies. The mean C-peptide level in the LADA group was 1.0 +/- 0.2 ng/mL and 5.1 +/- 0.4 ng/mL in the group with type 2 diabetes. Only 1 LADA subject had a C-peptide level above the normal range, and all subjects with type 2 diabetes had a C-peptide level within or above the normal range. LADA can be ruled out in adult-onset diabetes by the presence of elevated C-peptide. The more expensive testing for anti-GAD antibodies to definitively diagnose LADA should be reserved for patients who on screening have a low or normal random C-peptide level.

 

PMID:

15266224

[PubMed - indexed for MEDLINE]

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