Type2 or LADA?

[GregCanada]

2014/Oct/22, having got suspicious on the increased water consumption and recent weight loss, I got confirmation that the blood sugar and A1c levels were way off.

Age is 40, BMI at 21, hike and snow shoe and weight train and canoe.
92kg, and have to do 3000+ cal/d for weight maintenance.

I'm now on medication to get the sugar levels (A1c of 13) back under control.

Should they test for LADA rather than type 2, how would they do it, and is there a significant different in treatment? I have vitiligo (auto immune response to pigment), and a history of autoimmune in the family (mother died of rheumatoid arthritis, and going through prior generations there seems to have been some lupus).

For snacks during the day in the office, I was looking at peanut butter (no sugar) with wholewheat bread. Now looks as though it should be peanut butter with red or green peppers. Any other suggestions for something that is not too perishable (prefer to avoid the office coffee area fridge).

 

[Emmotha]

Hello.
They will test for the antibodies present in type 1. They would have taken a blood test. Do you know if they did?

 

[GregCanada]

I'll need to check back with the doctor as it was all on a computer screen, with no hardcopy for me to refer to later. The blood test would have been a generic annual check up combined with a test for rheumatoid arthritis.

 

[Emmotha]

Oh ok, it might be worth asking

 

[colsan]

Hi...If the docs haven't already tested for LADA, please insist that they do with a GAD antibodies test. I was incorrectly diagnosed with type2/MODY 7 year ago at age 38. My diagnosis has recently been changed to Type1/LADA after going into DKA. Also had sudden weight loss just prior to this - sounds very much like LADA to me.

 

[Emmotha]

Yup. I also almost got misdiagnosed as type 2 so deffo ask for test.
LADA is type 1, so will be different treatment to type 2, so you need to know for sure

 

[GregCanada]

Slightly more relaxed this week:

last week had the A1c at 13, and fasting at 11, and most measurments over the weekend were 12-15.

Yesterday was a high protein high fibre bread with no sugar peanut butter for breakfast, a low carb caesar salad with chicken skewers for lunch, and stir fried beef, broccoli, peas, mushrooms, with a side of bocconcini cheese for dinner. I also had enough energy left to do a small cardo workout.

pre dinner was 9.5, post dinner at 10.5.

 

[GregCanada]

Dinner of salad: spinach, mushrooms fried in olive oil, two slices of bacon, tomatoes, and then two chicken thighs roasted in the oven, and dessert of an apple.
pre dinner was 8.5, post dinner got to 9.8.

A resource that may be of interest for blood sugar testing patterns is:
http://guidelines.diabetes.ca/CDACPG_resources/SMBGPwDPattern_FGH_2.pdf

 

[colsan]

That's great - sounds delicious too

 

[GregCanada]

only quirk is reading about olive oil and frying, a friend of mine is recommending more coconut oil as the medium chain fats are more stable to heat.
Now back to weight training 2-3x a week and 30minutes of cardio a day.

 

[GregCanada]

Definitely no bread in the diet from now on -
sprouted grain high fibre bread over the weekend, and my blood sugar is sustaining 10 rather than the 7 that I got to last week with no bread.

 

[Daibell]

Hi. Yes, the sudden weight loss is indicative of LADA. Many GPs don't understand or even accept that LADA exists. Do ask for the two tests i.e. GAD for the anti-bodies and c-peptide for insulin level. I was negative for GAD but had very low insulin. There can be many causes for islet cell failure so nothing is simple. The probability is that you will gradually need to go thru up to three tablet types and then insulin over the coming months or years. Don't panic though as insulin is not a big problem and does offer complete control. Reducing the carbs will delay the need for full meds.

 

[GregCanada]

Had a chat with the doctor today, he is waiting for the 3 month checkup on Hba1c to also specify the c-peptide and GAD tests.

He is surprised by the speed of the drop back to 7. It's the diet.

 

[GregCanada]

Interesting how much stress hits the blood sugar levels.
Now consistently down in the blood sugar, most days of the week it is 5.5 pre meal and 6.5-7.6 post meal.
Yesterday was no different for food or exercise other than the emotions of remembrance day, which has been a bit different this year for Canada, and the blood sugar has been up at 7 - 7.5 most of the daytime
After dinner (slow roasted leg of lamb, lots of spinach and mushroom and olives salad, half an apple) with friends and their cats, the blood reading is back down to 5.5 post dinner.
So I'll be cat sitting for some other friends in December as a trial run of whether a cat and I can survive each other.

 

[Daibell]

Hi. Yes, your blood sugar is keeping surprisingly low. I dad quite good blood control once I reduced the carbs for the first few years with some meds but by about year 6 after diagnosis it started moving up and eventually insulin become essential. I remained slim throughout. You can't beat a cat for reducing the stress levels and keeping you company!

 

[Diamattic]

Hey Greg, I am in Canada as well.. When i was diagnosed i was told that our system doesn't recognize LADA yet and we only have T1 and T2. With that being said, within a few years LADA just becomes T1, so IMO you'd be better off just starting insulin now, you'd likely have a better transition period and better sugar levels then if you went the T2 route... Also you'd likely have to change your eating and life less with the insulin supplements rather then trying really hard to eat low carb all the time.

I have no medical basis for this, but if was given that choice i would go full T1 out of the gates...

 

[GregCanada]

I've already started pushing the doctor for the c-peptide and the GAD test, that will be available for my one month check in, more so I can plan around the swtich to insulin. I'm already discussing the auto immune vitiligo response, and how a tablet that promotes more pancreas activity may just be presenting more of a target.

my diet has switched completely:
breakfast and 10am snack - peanut butter, spinach and mushroom and black olives and cheese.
lunch - greek salad, chicken or calamari, a sandwich every other day
afternoon snack - peanut butter
dinner - broccoli and cauliflower with cheese, carrots with some butter, wild rice 2x per week, more spinach salad, and some meat, and a slice or two of apple
bloods are 5.5-6.5 pre and post dinner, and occasionally lower after dinner than before.
The only thing I am noticing is I have to be careful if I do an hour of weight training and then a 45minute walk home, then I feel low.
However when I got home low was 5.5, so low is merely lower than I have been in the months leading up to the diagnosis.

Fortunately for me I have two friends that are highly intolerant of gluten and sugar, so the switch over has been relatively smooth, and had the oversight of my trainer who is also a nutritiionist. A plate of 2/3rds vegetables and 1/3rd meat/cheese/protein is what the father of a friend of mine with T1.5 did, and he got to 81yrs with the only complication being strokes in the last 2 yrs.

Next week is a discussion with a different nutritionist, to make certain I'm not missing anything more subtle.

 

[Diamattic]

Well, sounds like you have this all figured out then Greg!
I like to have a snack before my gym times, and get my sugars up around 9 or 10 so that i can work them safely down to 5 throughout the 2 hours at the gym, maybe carry small candies in your gym bag (i like the small tootsie rolls each one is 20cal, and 5.5g of carbs)

When i was first diagnosed i was getting symptoms of a low when my sugars were around 7.5mm/l lol They were so high for months my body was freaking out whenever they dropped into the 'normal' range, now i hardly feel anything unless i get down around 3.5mmol/L which is much much better.