LADA Confirmed

[Lesleywo]

Hello all,

So today it was finally confirmed at my endo appointment that I am in the very early stages of LADA. Advice was to keep testing and that my pre-meal readings should be less than 5. When I start getting post meal readings in the 10's is when things are getting more serious.

I low carb most of the time and will certainly tighten up my act from hereinon but pre-meal readings are usually 5 or a bit above. I think part of my problem is I find it hard not to snack between meals. I've always been a grazer and feel better eating every few hours. I guess this is why I don't go too much below 5 too often as my sugars don't get the chance to get that low as I'm always 'topping up' so to speak. Having Addison's disease I find when my cortisol gets a bit low I feel better with a small snack with my meds.

Just wondering if anyone else has been told pre-meal figures should be below 5? And any tips appreciated.

Thank you

 

[azure]

I'm a Type 1 but I've never been told pre-meal sugars should be below 5 - not even when pregnant when control has to be really tight.

Perhaps it's a way to see if you need insulin? That is, you've been set strict targets so any BS rise can be spotted early and insulin introduced. As I think I've mentioned before on another thread, early introduction of insulin can help preserve your remaining beta cells for longer.

I'm glad you finally have confirmation

 

[Kristin251]

I too like very small meals and to graze which is more difficult while on insulin. As far as topping off, try not to eat carbs OR protein as they both require insulin. A few nuts or olives or some raw veggies in a mayo based dip. Bite or two of avocado. Jus something fatty and you won't keep spiking insulin.

 

[SimonCrox]

Interesting; I personally think that aiming for under 5 risks hypos; I trust that your Addison's is well controlled else greater risk of hypos.
I would aim 4 to 7 mmol/L before food.
I have just had a look at Diabetes UK website, which says that one should aim for glucose levels near normal, 3.5 to 5.5 mmol/L; they are quoting the normal non-diabetic range but it could easily be misread as the target in diabetic folk.
Are you on insulin at present?
Best wishes

 

[Lesleywo]

Interesting; I personally think that aiming for under 5 risks hypos; I trust that your Addison's is well controlled else greater risk of hypos.
I would aim 4 to 7 mmol/L before food.
I have just had a look at Diabetes UK website, which says that one should aim for glucose levels near normal, 3.5 to 5.5 mmol/L; they are quoting the normal non-diabetic range but it could easily be misread as the target in diabetic folk.
Are you on insulin at present?
Best wishes

Hi Simon,

No insulin as my HbAlc has only just crept into the pre-diabetic range but has risen by 3 points since last test 2 years ago. As my endo said, I am unique in that I already knew I was anti-Gad positive 4 years ago as I have other related autoimmune conditions. Most folk would present with symptoms of diabetes and find out afterwards that they were LADA. As he said, antibodies can present up to 10 years before blood sugars start to rise. I think it's one of those things that could happen suddenly or take years. It was a good appointment; the only thing we 'disagreed' on was when I said I would continue to low carb and he said that is only effective for Type 2 diabetics. I realise that I can't stop LADA happening, but I can delay having to take insulin and when I do, the amounts will be smaller. At least that's what I've read and understood from others on this forum. He also said there was a study done in Australia re. starting people on insulin earlier to preserve beta cells but there was no conclusive evidence. Some studies say it does. Who knows? Seems to be a bit of a grey area to me

 

[SimonCrox]

Thanks. I guess with your other auto-immune diagnoses, LADA / T1DM was always a risk. I had one patient who was GAD +ve, who stayed on metformin and tolbutamide for years and last I knew, had still not developed T1DM. I am sure that they are quoting you the normal non-diabetic glucose range. Yes, the use of insulin to delay T!DM immunologically or to rest the beta cells is unclear. There is data from Plymouth that T1DM occurs earleir if significantly overweight; sort of to be expected - if the beta cells are failing, then they wont cope with a bigger person more quickly. Yes - I guess that since folk were looking for autoimmune disease specifically in you, might well have found it earlier than in most people. Best wishes.

 

[Lesleywo]

I hope I will be like your patient and have a nice long honeymoon! Interesting about your point on obesity. I am interested to find out how Addisons affects Diabetes. My fasting bs is around 4.4 (lab test) but he said as cortisol is low in the morning it could be keeping bs low. Not looking forward to managing both conditions down the track. Also have Hashimotos but that's the least of my worries. . Got the trifecta, lucky old me

 

[SimonCrox]

Yes - fingers crossed.
As you say, low cortisols make glucose levels go low.
Sounds like you are under some very pro-active endocrinologists, so I would suspect that they have fine tuned your cortisol levels to be as good as possible.
The problem would be intercurrent illnesses increasing your cortisol requirements, but I guess you have been given some sick day rules, and everyone knows that you have Addisons. If you were on insulin, this could be where it could get tricky; the illness would increase your blood glucose, but being ill, folk eat less at times, dropping their blood glucose, and if your cortisol requirements rose, and you did not increase your cortisone, then your glucose levels would drop. So it would be frequent glucose testing, keeping up fluid intake, keeping up food intake on top of increased cortisone.
Excess steroids tend to make the glucose levels go up over the afternoon, and drop over night; this would not happen if your cortisol dose is pretty good, and if it occurs, is easy to fix if folk are on basal bolus.
Best wishes