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Dulverton1958

Am I Early Lada?

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Dulverton1958

Hello,

Just wondering what your thoughts are - I am 57 and have Addisons Disease and Hashimoto's and have consequently been under an endo
for around 17 years. My endo
did a heap of bloods for other autoimmune disease and I tested positive to GAD 3 years ago, HbAlc was 5.8%. He didn't say much, only said I tested highly positive and asked if there was any Type 1 in my family. This I am not sure of; my mother developed type 2 (diet only) about 18 months before she died and and uncle and aunt of hers were both diabetic but not sure what type. Unfortunately they are no longer alive so no way of finding out.

About a year ago my GP
did a fasting insulin which was elevated but after losing about 9kg and lowering my carbs I am at the top of the insulin range. I recently had GAD and C-peptide tests. GAD positive at 88 (range less than 10) and c-peptide was 589 (range 280-1250). HbAlc still remains at 5.8% but would be higher if I didn't stick to a reduced carb diet (around 80g a day).

My question is, am I early LADA
? My endo
says 'you're not diabetic' as my blood sugars are reasonably good. I am fed up with not knowing if I am LADA or will be LADA in the future - if I knew for sure I would tighten up my glycaemic control in order to preserve as many beta cells as possible.

I would be interested to hear your opinons.

 

Many thanks.

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NoraWI

With the information you give, YES, you are LADA. Not all endos are well versed on diabetes. There are medical specialties within specialties. Your endo may be great when dealing with Addison's and Hashimoto's but seems to know little about diabetes. Although frequently so, a family history of T1 is not necessary. Besides, even a generation ago people hid their diabetes and there were no treatment options for the different types. Yes, tighten your control and expect to be using insulin in the near future.

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Aggie

If you are positive for the antibodies then you must be LADA.  As I understand it, LADA can take many years to develop, unlike type 1 in younger people which presents much more quickly.

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jwags

I think there is a strong possiblility you will develop LADA but right now you still have strong insulin production. I would do everything you can to keep that insulin production. As time progresses you may need insulin.

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fjordscape

Here's a concrete figure for treatment decision. Just one researcher's conclusion, not necessarily standard practice: http://www.ncbi.nlm.nih.gov/pubmed/17435855 

 

"Conclusion: We agree that patients with LADA should be differentiated on the basis of GADA titers and that patients with GADA titers > 20 U/ml benefit from early insulinization." 

 

What I would research is what percent of GAD positive patients have LADA. A priori, the answer is not necessarily 100%. That's what you need to look up: measures of the correlations between being GAD positive and being high BG and specifically being diagnosed with LADA. 

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fjordscape

The links I posted in this thread I started are very informative. http://www.diabetesforums.com/forum/topic/75887-lada-without-antibodies-some-doctors-say-so/ 

 

At one link it is reported that 30% of Type 1 patients do not have antibodies. Amazing, because Type 1 is supposedly characterized by autoimmune destruction of the beta cells. 

 

Also, it is possible to have high antibodies and not have diabetes. Perhaps this is an extremely rare situation. 

 

You wrote that before you fasting insulin was elevated, now that you've lost 9k now you're at the top of the insulin "range". I suppose you mean "reference range". I hope you're saying that insulin is down now that you've lost a goodly amount of weight. 

 

You should take the A1c with a grain of salt. Some people test too high, others too low. There are published lists of recognized confounders of the A1c test. Then again, if you consistently test invalidly low, I doubt it would be by a huge amount, although there isn't really evidence for how far off it could be. I just doubt you're above, say, 7.0%. It would be spectacular enough if you're really at 7.0% when you're testing at 5.8%. 

 

But the A1c is not crucial information. To be sure of what your BG is, I suggest getting test strips and testing a lot for a week. 

 

Doctors are not all in agreement on whether to start insulin right away if you have high GAD or symptoms of actual beta cell impairment. There was a short period when that was trendy advice, but now there are skeptics. Even if you get diagnosed with LADA, therefore, you may not get a prescription for insulin. Show me the big evidence that you can thwart LADA by tighter glycemic control. Yeah, 5.3 would be healthier than 5.8, but is the 5.8 specifically promoting the development of LADA? 

 

How can beta cell destruction be slowed or reversed? One possibility was demonstrated by the Counterpoint study in Britain, ca. 2011, led by Roy Taylor. Leach excess fat from the pancreas using a 600 calorie/day diet consisting mostly of protein. How else? By increasing cellular insulin sensitivity, reducing blood insulin. That boils down to diet, exercise, and maybe meds, maybe insulin. 

 

I don't get your conviction that you have high BG in contradiction to all the numbers -- which have improved, to boot. The 5.8%, if accurate, should be cause for celebration. By the numbers, you obviously have much bigger problems already. Also, there are several significant numbers missing. How old was your mother when she became diabetic? What are your BP and triglycerides? Your BG is barely elevated. If BP is in the safe range (below 120), then you would have even less grounds for concern. 

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fjordscape

Oh, gee, one possible symptom of Addison's disease is hypoglycemia. I didn't previously know about this disease. As a diagnosed person, have you done your research on it? 

 

And your C-peptide is normal. A normal level, says WebMD, does not rule out Type 2, but it does rule out Type 1. Fasting insulin is reported to be improved, reduced into the reference range. 

 

The ref range for C-peptide you report does not come close to the range suggested by diabetes.co.uk, in units of either ng/mL or nmol/L. 

 

The high level of GAD is reasonable cause for concern. You did not say whether you specifically asked your doctor to explain it. Nevertheless, aside from GAD, not only are you not close to diabetes, but you have a permanent metabolic disease which may be protecting you from hyperglycemia. 

 

I don't think you should hold off on tighter glycemic control for lack of proof of LADA. 

 

Have you discussed how beta cell destruction is proved? Yes, GAD antibodies might be suspected of destroying the beta cells. But there seems to be absolutely no clinical evidence there is any beta cell destruction, any impairment in insulin production. Until recently, you tested out as overproducing insulin. I don't see the logic in asking to be prescribed insulin. 

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Jannah

Having just read about LADA and some of the stuff here about it I kind of wonder if that's where I fit in. I am not overweight nor do I gain or lose weight, no matter what I eat. Seems odd, considering undiagnosed Type 1's are supposed to lose a lot of weight while many Type 2's are overweight at time of diagnosis. I don't know, maybe I'm just looking too deeply into things right now. I should stop before I worry myself.

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jwags

I am a very thin type 2. I am at 112 pounds now. I have difficulty gaining weight even with tons of calories. My doctor finally did the GAD test and it was in the normal range. My c-peptide was 1.1 which is. low normal. So I don't have any antibodies to my knowledge attacking my pancreas.

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GretchO

Doctors are not all in agreement on whether to start insulin right away if you have high GAD or symptoms of actual beta cell impairment. There was a short period when that was trendy advice, but now there are skeptics. Even if you get diagnosed with LADA, therefore, you may not get a prescription for insulin. Show me the big evidence that you can thwart LADA by tighter glycemic control. Yeah, 5.3 would be healthier than 5.8, but is the 5.8 specifically promoting the development of LADA? . 

 

Once I was correctly diagnosed I was put on insulin from that moment on. My A1Cs were under 6 for the first 5-6 years. I was positive for GAD and had lost a significant amount of weight during the previous 3 months prior to diagnosis and didn't respond very well to diet changes (VLC + exercise + T2 meds like sulfonylureas did jack). I had a pretty slow but steady decline in insulin production so the endogenous insulin assisted and in the beginning I didn't need very much at all to maintain good BSs. Tighter glycemic control doesn't "thwart" LADA but I felt a thousand times better once my BS was under better control. I know some LADA's pancreases are touch and go and it can make taking insulin difficult.

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Jannah

I am a very thin type 2. I am at 112 pounds now. I have difficulty gaining weight even with tons of calories. My doctor finally did the GAD test and it was in the normal range. My c-peptide was 1.1 which is. low normal. So I don't have any antibodies to my knowledge attacking my pancreas.

 

Are you physically active though? I feel that could make a difference. I'm not very active. In fact, pretty much everything about my lifestyle would ordinarily be found in somebody overwight. Either I have a really good metabolism(which is unlikely with diabetes I think) or there's something abnormal going on in my body. Perhaps it's something else to mention to the doctor on Monday when I go in for diagnosis.

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jwags

I am not as active as I was . I used to walk 5 miles a day but lately I have had a lot of health issues so I haven't done much exercise. Exercise always increases my bgs anyway. No matter what I do my HbA1 c is in the high 6's

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Jannah

I am not as active as I was . I used to walk 5 miles a day but lately I have had a lot of health issues so I haven't done much exercise. Exercise always increases my bgs anyway. No matter what I do my HbA1 c is in the high 6's

 

Exercise is hard for me because of the chronic fatigue that comes from the diabetes. With that said, I doubt my particular case of diabetes is caused by lack of exercise. It's kind of why I'm questioning whether I'm type 2 or not. I just assume as such since it's the most common for somebody at my age. I suppose the only way to find out is to see how treatment for Type 2 works out for me. Most likely if I'm diagnosed(which there's no doubt I will be) I'll be put on oral meds anyway. I think most are.

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jwags

Not exercising has nothing to do with getting diabetes. diabetes happens when we are insulin deficient or we can't use the insulin we do make. Being GAD positive means you have antibodies that could attack your beta cells at some point.Chronic Fatigue Syndrome is a separate autoimmune disease. It is not caused by Type 2 diabetes. Type 1 is also an autoimmune disease.

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jwags

LADA is something a lot of doctors are not familiar with. A lot of diabetics are initially dx'd as type 2's because they are adults. They get the wrong treatment for years because their doctors won't do antibody tests on them. Autoimmune diseases often happen in clusters . So if you have one, there is a chance you may get several. Right now your HbA1c is at the per diabetic level, but that doesn't mean pre

type .2. LADA can be very slow developping over many years. As your bgs increase your c-peptide will probably lower. Now I am a type 2 because I tested negative for antibodies and have no other autoimmune diseases. But my progression is very similar to a LADA. So there is a lot of of gray area between type 1 and type 2. Many doctors treat early LADA with type 2 meds until they need insulin.

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Kenton

It took six years from initial " your test are reading a little high" to being on insulin. I started with just watching what I ate which worked for awhile to more activities then metformin was added which did not do much so glimepiride was added which did help for awhile. Then the slow climb in BS started again and I started loosing weight. Finally I changed to an endo and was telling him I took my meds in the morning and had to skip breakfast to keep my readings near 200. So Lantus was added to the mix and with some reluctance the doc had me tested as I kept asking him to do so.. Shortly after I was told to drop the meds and apidra was added. Funny thing is his nurse commented they should have looked for that right way since I've had graves disease and am covered with vitaligo.

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AMANDAinKC

After a night at the hospital with stomach flu, the doc informed me my fasting glucose was 165. I assumed it was type 2 since I was "fat and forty" and had no other symptoms. I decided I would try to lose weight and manage it myself with diet and keep an eye on my numbers. Things escalated quickly - my highs went from the 150's to over 400 within months. I went to the endo and my GAD came back at 1,595 when I was diagnosed as LADA and put on Lantus/Novolog immediately. 

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RobinP

I finally had my latest round of labs done this week and had my follow up with my Endo today. Gad positive and also positive for Hashimotos. I'm not surprised as I've thought since my first year of diagnosis, that I was more type 1 than 2. It's just good to finally see actual proof. I was one of those diagnosed by pcp as type 2, put on different oral drugs with no results. My pcp never considered me being anything but type 2, so I found an endo to work with. 

 

Kenton, my son, who's a type 1, also has vitaligo. He got that at 12, then about 6 months later was diagnosed with type 1. 

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