Confused after Review Appointment

[KaylsNUFC]

Hi
I am a 27 year old who was diagnosed with Diabetes in July this year.
I carried out a random blood sugar test during diabetes week and I had a fasting reading of 10. I work in a hospital so I was able to have access to blood sugar testing. I then carried out further testing throughout the space of a week and had readings of 12 and 14 post lunch which resulted in me deciding I best get this checked out.
On diagnosis the doctors were quite confused about which type I was as I did not have any history of Type 1 Diabetes in my family and I am a young active female with a normal BMI. My HB1AC was 58mmol/l. The Dr I saw was lovely and carried out a range of blood tests to try and help l discover what type I was, I was placed on Metformin to try and help lower my blood sugar levels and a follow up appointment was arranged for a few months later.

I recieved the results in the post everything was relatively normal except I had a high amount of GAD. Today I went for my follow up appointment and my reading was 44mmol/l. I was really pleased with this however the doctor then began discussing that I was now in the prediabetes rang and that I was very unlikely to progress to diabetes, she said that they would potentially keep an eye on me for the next 10 years or maybe the rest of my life she wasn't sure. I was advised that I should carry on with using the Metformin and regularly checking for ketones if I have a high reading which at the time I thought this is great. Now I have had time to think about it I feel more confused than ever surely the reason I am lower is because of the metformin and if I came off that the readings would spike again??...surely this is diabetes??. I feel like maybe the doctor has dismissed me having Type 1 but not considered that I may have another type because I don't fit the usual criteria for Type 2 criteria. She did say she would speak to the professor and discuss me and see when he would like to follow me up, ideally I would like to try and talk to him next time to get a better understanding of what is happening. Now I have had time to think I feel a little lost and confused as to what is going on as I thought diabetes was irreversible and surely my lower reading today is just a sign that I am responding to Metformin? Has anyone else had anything similar happen to them?

Thanks

 

[Squire Fulwood]

I have only one comment. Metformin is not terribly effective and I am disinclined to believe that it is the sole reason your Hba1c dropped from 58 to 44. Many of us have found that dietary changes are more effective. Have you made any changes to your diet since you got your heads up in July?

 

[KaylsNUFC]

Yea I have also changed my diet and I have completed cut out full fat fizzy drinks.

 

[Squire Fulwood]

Yea I have also changed my diet and I have completed cut out full fat fizzy drinks.

This leads me onto another issue. Most people's diagnoses come as a surprise to them and they go away and do something about it. There are others who suspect they might have diabetes, do something about their diet and when they have the blood sugars under control, only then do they go to see a doctor. Not surprisingly the doctor finds them well and says so, or in your case pre-diabetic. No HCP that I am aware of has ever taken the effect of diet into consideration and so it is not seen as a factor.

I suspect that your good readings owe much to your new diet and as a result you now present as a pre-diabetic. If you had not taken pre-emtive action you would have been diagnosed as diabetic. I don't know which type though.

 

[wiserkurtious]

Hi
I am a 27 year old who was diagnosed with Diabetes in July this year.
I carried out a random blood sugar test during diabetes week and I had a fasting reading of 10. I work in a hospital so I was able to have access to blood sugar testing. I then carried out further testing throughout the space of a week and had readings of 12 and 14 post lunch which resulted in me deciding I best get this checked out.
On diagnosis the doctors were quite confused about which type I was as I did not have any history of Type 1 Diabetes in my family and I am a young active female with a normal BMI. My HB1AC was 58mmol/l. The Dr I saw was lovely and carried out a range of blood tests to try and help l discover what type I was, I was placed on Metformin to try and help lower my blood sugar levels and a follow up appointment was arranged for a few months later.

I recieved the results in the post everything was relatively normal except I had a high amount of GAD. Today I went for my follow up appointment and my reading was 44mmol/l. I was really pleased with this however the doctor then began discussing that I was now in the prediabetes rang and that I was very unlikely to progress to diabetes, she said that they would potentially keep an eye on me for the next 10 years or maybe the rest of my life she wasn't sure. I was advised that I should carry on with using the Metformin and regularly checking for ketones if I have a high reading which at the time I thought this is great. Now I have had time to think about it I feel more confused than ever surely the reason I am lower is because of the metformin and if I came off that the readings would spike again??...surely this is diabetes??. I feel like maybe the doctor has dismissed me having Type 1 but not considered that I may have another type because I don't fit the usual criteria for Type 2 criteria. She did say she would speak to the professor and discuss me and see when he would like to follow me up, ideally I would like to try and talk to him next time to get a better understanding of what is happening. Now I have had time to think I feel a little lost and confused as to what is going on as I thought diabetes was irreversible and surely my lower reading today is just a sign that I am responding to Metformin? Has anyone else had anything similar happen to them?

Thanks

See my situations not too dissimilar to yours,I was diagnosed in july after been taken into hospital with very high keytones and blood sugars off the scale. I had to stay in for 3 days on a drip where they diagnosed me type 1. after coming out of hospital i kept having hypos on very little insulin,no fast acting just basel. diabetic nurse told me to come off insulin,which I've now been off for 3 months now to see how things would go. on diagnosis my hba1c was 58mmol my last 1 which was last week was, 38mmol all down to the exercise and change of diet,my diet wasn't all that bad before pre diagnosis tbf. my mams got type 2 diabetes but I'm a liitle unsure which type I have tbh,had gad results done and they came back negative I was speaking to the diabetic nurse about this and she said this would mean your not type 1,which left me a little confused so I googled about GADs so I can learn for myself . I feel that maybe I should ask about metformin don t feel right not treating my diabetes,yes its going very well but still

 

[tim2000s]

I recieved the results in the post everything was relatively normal except I had a high amount of GAD.

If you have a very high GAD number then it is highly unlikely that you are type 2. That is generally seen in Type 1 or Type 1.5 and you need to get a C-Peptide test undertaken straight away. Insist on it. This will confirm the amount of insulin you are producing.

Given that, with diet and metformin, your Hba1C has come down, it is likely that you are LADA (Type 1.5) rather than Type 1 in the honeymoon.

But please get the C-Peptide test done, or you are at significant risk of long term issues.

 

[Squire Fulwood]

If you have a very high GAD number then it is highly unlikely that you are type 2. That is generally seen in Type 1 or Type 1.5 and you need to get a C-Peptide test undertaken straight away. Insist on it. This will confirm the amount of insulin you are producing.

Given that, with diet and metformin, your Hba1C has come down, it is likely that you are LADA (Type 1.5) rather than Type 1 in the honeymoon.

But please get the C-Peptide test done, or you are at significant risk of long term issues.

I concur.

 

[KaylsNUFC]

If you have a very high GAD number then it is highly unlikely that you are type 2. That is generally seen in Type 1 or Type 1.5 and you need to get a C-Peptide test undertaken straight away. Insist on it. This will confirm the amount of insulin you are producing.

Given that, with diet and metformin, your Hba1C has come down, it is likely that you are LADA (Type 1.5) rather than Type 1 in the honeymoon.

But please get the C-Peptide test done, or you are at significant risk of long term issues.

Thanks everyone. I have had a C-Peptide, the first doctor I saw in July was brilliant and tested everything as she was unsure of what type I could be as other that high blood sugar levels I had no other symptoms. The results showed my insulin production was still quite good. I think next time I go I am going to ask to see the Professor who runs the clinic as it is literally just by chance of the order you are called in as to whether you see a registrar or the professor. The doctor I saw yesterday I feel didn't really understand what was going on and I kinda felt she thought I was there in error as I got the feeling she didn't really know what to say to me, I also think maybe she has been a bit rash telling me I am now only prediabetic and unlikely to develop into anything more. On the plus side at least my levels are lower so something is working! I have opted to receive the letter they send to my GP, I actually work in a hospital that isn't the hospital that I am under so I am thinking of trying to discuss it with the diabetic nurses there once I have my letter. Thanks everyone I have only just found this forum and I think it is great, it's really helped me yesterday and today.

 

[Indy51]

I seem to recall that high GAD antibodies can be connected to other autoimmune conditions beyond Type 1/1.5. Some kind of food intolerance might also be involved?

 

[tim2000s]

I linked this topic in a tweet to some diabetes specialists. They were of the opinion that you appear to be early diagnosis LADA!

 

[tim2000s]

This might be interesting too:

http://www.tudiabetes.org/forum/t/m...person-with-adult-onset-type-1-diabetes/41884

 

[KaylsNUFC]

This might be interesting too:

http://www.tudiabetes.org/forum/t/m...person-with-adult-onset-type-1-diabetes/41884

Thanks I will give this a read.

 

[Daibell]

Hi. My thoughts are similar to the other posters that LADA is a likely diagnosis. The high GAD indicates that you do have antibodies that may gradually knockout the islet cells and may already have done some damage. LADA or Late onset T1 (aka 1.5) is effectively T1 appearing later in life and is due to the death of islet cells same as T1. This can progress very slowly, over several years in my case. The causes vary but GAD is the most common cause. The fact that your BMI is normal is another indicator of T1 rather than T2. It sounds like you are very early stage T1. The Metformin only has small effect on blood sugar so your diet change has probably helped the most. If you are losing islet cells, albeit slowly, then you will probably need to go thru tablets such as Gliclazide, Sitagliptin or similar and end up with insulin but this might take years. Just keep monitoring your blood sugar; in particular the HBa1C if the GP will do it and take it from there. The 'good' c-peptide indicates you do have a lot of your own insulin available.

 

[KaylsNUFC]

I have discovered that you can actually send a message through the Newcastle Hospitals Website to the Professor's. I have sent a message to the Professor who's care I am under expressing my confusion and concerns. Thanks for the messages. I will update if he responds.

 

[tim2000s]

@Daibell There is a concern with this approach. The drugs you mention increase insulin output whilst inhibiting other hormones. Given that there is a lot of evidence that the automimmune attacks on beta-cells are triggered based on pro-insulin production, increasing insulin output is not necessarily a great idea. It may be better in the LADA case to maintain lower insulin production levels to retain beta cell function for longer.