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hungry

Is LADA treated the same way as Type 2?

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hungry

Recently my doc, a GP who is supposed to have developed into a Diabetes Whiz, said that to him he was not concerned whether I had Type 1.5 or Type 2, as he would treat them both in the same way.

 

I think he meant, he will keep me on Oral Meds (Now Metformin in my case) and keep trying to persuade me to ever increasing levels of suffering in diet and exercise until I absolutely must be on Insulin.

 

Is he right?

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k_dub

No, LADA is treated like T1.

 

There are reasons why a "honeymooning" LADA (person who is still producing some insulin) would want to start insulin early on. Using insulin will help maintain some of your pancreatic beta cell function longer...

 

I had an endo who wanted to keep me off insulin as long as possible, despite scientific evidence suggesting that early insulin therapy is helpful, and I wish I had fired him early on...

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k_dub

Also, I'm not a big fan of GP's treating autoimmune diabetes. Find yourself a good endocrinologist, if you can.

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hungry

I hear U. But with Medicare being as it is. A lot of docs are more into moving large herds to make enough cash to keep the doors open.

 

My doc now is now an Internist, not the GP. First time I went to see him. I have him a ten page typed letter about my health history, which I doubt he read (who could blame him, he wants to depend upon his own analysis and diagnosis over what might be errors by other doctors, or changed situations). First time I see him he asks what I want him to do, I said "lose weight." I am 5 feet nine inches and weighed 282 pounds, I also have arthritis, heart problems, sleep apnea, all of which work against each other and multiple the effect of the other.

 

So he gives me a one page diet, that is very close to the phase one South Beach diet, for a month. Also said that a normal person should have nearly always have a blood sugar that is below one hundred. Hmm. Miserable month. Lost seven pounds. Got a lecture from his assistant that diet bars, like the South Beach diet Bars, and Atkins diet bars are not on the page. To which I said but I do not have the money to eat lean meat all the time either. Remarkably, for the first month, my blood sugars were stable, mostly between 90 and 110. The lack of roller coaster-ing blood sugar makes me feel much better. While a Phase one South Beach is supposed to be mostly a water loss, I am clearly, as a consequence of being a heart patient, carrying too much water on me. So that water might not be so quick to come back as it would in a normal person.

 

After the first month I am allowed to experiment with perhaps having one slice of whole wheat bread or a little fruit. Doc also suggested Wine, which is a big no no for me because I am descended from a long line of serious alcoholics. He suggested one could take up to 8 grams of Omega 3 Fish Oil. By luck I found some fish oil that has a high concentration of DHA, whereas the fish oil from Wal Mart makes no DHA percentage claim in their label He also said that no one had ever been harmed by the Atkins Diet. Hint. I should keep working on the diet and exercise.

 

I am not sure it is possible to fix, but I have body temp that averages two degrees below normal. By my calculations, if I had a normal 98.6 body temp for the last year, then the amount I have eaten, I would be normal weight, like 170 pounds or less. The medical Community seems to think the road to improvement is based upon my hurting (exercise on Arthritic joints) suffer (pain is beautiful) and do without (diet on a starvation level).

 

How can I be more sure that I have LADA? Once a PA was going to write an order for an insulin level. Which might clarify things.

 

In the one month of the of diet, my A1C went from a start of 6.7 to 6.0. I have had like ten years on oral meds for diabetes. The back of my eyes do not show any Retinopathy. Anyway. I am not to see him for another three months. I am going to guess that he is not too anxious for me to start shooting insulin with an A1C of 6.0, which has two worse months on it. I can not guess how I could afford insulin, syringes. and such. The easier to use Insulin Pen is not going to be much covered by insurance. There was another med he wanted to write for hypertension, but it was also a patent drug. No on my budget.

 

I also know, if I get up the morning, and before anything else, I check my blood sugar, it is likely below 120. If I then get on the treadmill for a slow ten minute walk (no heavy breathing at all). Wait another five minutes, my blood sugar is likely above 140. That screams to me that I do not have insulin in my body. That sounds more like LADA to me. Or that might be normal? I then take my two 500 Mg tablets of Metformin. Blood sugars will be down a lot by 11 AM, and I can not delay eating at that time, unless I want to feel awful.

 

I feel that since Metformin tells the liver not to release sugar, in some ways, Metformin inhibits my ability to lose weight. That is, to lose weight, I need for the fat in my body to become sugar by way of the liver.

 

I also strongly believe that my diabetes has been made worse by the hypertension (now I take three different types) and cholesterol lowering (Simvistatin) drugs I have been taking for many years.

 

I am also- well, either I miss understand diabetes treatment or some of the medical sponsered websites about Diabetes are completely inaccurate. It is like the page(s) on diabetes were written by a professional writer who tried to sum up the different types of diabetes, treatments, and their effects. Reminds of being in the hospital and being told that they had written diabetic on my diet chart, so I could feel free to eat whatever was send up. Which once was noodles and another time potatoes, and always bread. At night a nurse brought in two packages of cheese crackers with peanut butter and thing of apple sauce. Not doubt great for a type one. but not a type two on oral meds. Which is like one of the problems a lot of medical people have with diabetics. They do not understand the differences between the different types of diabetes, and the consequences of some diet things versus others. At least not until someone points it out to them. Tell me where I am wrong?

 

I think my real questions to you guys is, How can I distinguish between my having LADA versus simple Type 2. If it is LADA, how can I sell it to my doctor without telling him I looked it up on the internet, which will infuriate him no end?

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Jan B

I think my real questions to you guys is, How can I distinguish between my having LADA versus simple Type 2. If it is LADA, how can I sell it to my doctor without telling him I looked it up on the internet, which will infuriate him no end?

 

All you need to do is tell your doctor you are trying to educate yourself more in order to do a better job taking control. If this doctor is truly infuriated because you are trying to learn and understand more . . . that's a doctor to run from. Any decent doctor would be happy their patient is trying to take an active part in his/her care.

 

Also, I'd think treating LADA in the way Type 2s are treated just wouldn't work!! If T2 treatment isn't working, that's a big clue you may be LADA.

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Kenton

The BS rise in the AM is one I often had back when I was trying to treat with pills and diet but that is not a symptom of LADA, its more of YALD ( yet another liver dump ) . I still get it but it's more common when I'm lifting weights. If you were to keep a slow steady pace of walking you might find the BS is dropping. What will tell you if it's LADA or not is a GADA test which may or may not show evidence and the C-Peptide test showing low.

What Jan B said is how I finally was diagnosed correctly. The pills and diet were not working, I was losing weight rapidly and at a maximum dosage of the pills and the A1C was very high. They agreed to test further as they suggested I go on insulin and soon after I'm told I'm not T2 so I can give up the fantasy of it going away :(

I do not think there is a way you will be able to tell without testing, lots of T2's also end up on insulin and early stages of LADA mimics the symptoms of T2 diabetes.

I imagine there of lots of folks out there who were diagnosed as T2 and after a few years ended up on insulin who in reality were T1.5.

My feeling is, it does not matter if it's T1 , T1.5 or T2 , you do your best to manage it so you do not get complications, that's my goal now.

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Tribbles

I think my real questions to you guys is, How can I distinguish between my having LADA versus simple Type 2. If it is LADA, how can I sell it to my doctor without telling him I looked it up on the internet, which will infuriate him no end?

 

If you have LADA you will have will probably have GAD65 antibodies (not sure if LADA is only GAD65 or if it can be any of the antibodies) and a low c-peptide. They will treat LADA as Type 2 up to the point where you stop responding to drugs. If you have levels around the 100 mark then they are very unlikely to change the treatment because you are well controlled.

 

The diet comment is interesting. My endo is extremely skeptical about diets and doesn't like Atkins however he is ok with South Beach. Personally I like the paleo diet because it is a basic healthy diet (ignore the marketing hype) although I would add back dairy but I have used South Beach in the past and it has worked. In the normal run of things I gain 5lb a year so every couple of years I diet for a month or so to get back to my baseline.

 

A line you could take with your doctor is to say that you are worried about progression and ask for a c-peptide test - if that is in the normal range then you don't have to worry. They will often order a c-peptide test where they would be reluctant to order a panel of antibody tests. If the c-peptide test is low then ask for the antibody test and they will order it because there is clear cause.

 

 

My feeling is, it does not matter if it's T1 , T1.5 or T2 , you do your best to manage it so you do not get complications, that's my goal now.

This is hands down the best approach. Don't worry before you have to.

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k_dub

Tests that help diagnose LADA vs T2

- C-peptide (proxy test for insulin production) (Typically, people with autoimmune diabetes will be low)

- GAD65 antibody (Most LADAs will be positive)

- anti-islet cell antibody (May be positive for negative).

 

I was GAD65 antibody positive and anti-islet cell negative. I don't remember my initial c-peptide value, but it was super low.

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GretchO

I am technically LADA, but was always treated/labeled as a Type 1. The theory is that early and judicious use of insulin preserves your beta cells. Going easy on the carbs and using insulin puts less stress on your pancreas.

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Arrgy

Gretcho, IA-2 & ZnT8 ABs can also attack beta cells. A letter from actionlada...

"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,"

 

The new billing codes are nightmares to doctors.

Online ICD9/ICD9CM codes

LADA looks to be code 250:V58.67

It took about 30-40 minutes to cross check to be sure.

 

My new doctor changed me from T1 to T2 and swore I wasn't T1. He put me on Glyburide, which I swore to him they don't work anymore. He said, you'll see. I ate soup for 4 days and lost 8lbs. and had levels of 250 to 350. I finally talked him into getting me back on insulin. The stress caused stiff man syndrome. What a nightmare!

My endo covered for his mistake.

My 3rd doctor treated me as if I were T2 and only concern was why I tested 3 to 4 times a day.

None of these doctors have any personality. They are like sad sheep. Slaves to codes that harm proper care.

 

Read this..How many markers did you check of the 5?

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

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Chelle D

My Doc (new to me.. 9 months ago... previous doc retired)... Says that they are trying to educate the newer docs coming into fields to start insulin much much earlier. To maybe try one oral med, and when that stops working, to start an insulin.

 

I also believe the thought was to prolong the beta cell insulin production. He really doesn't want me on glipizde, but... My quick meal insulin requirement is MUCH less than if I do not take glipizide.

 

he said at one point, my pancrease will probably stop working... (thats the LADA right?) and that insulin dosing will just continue to go up. But that I don't really need test for it yet, because we know I still have functioning beta cells since the glipizide makes a difference.

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