Opinions Please - What Kind of Pre-Diabetes?

[Lesleywo]

I joined this forum 3 years ago when I found I had elevated fasting insulin levels. Having other autoimmune diseases that cluster with Type 1 Diabetes, I already knew I was GAD positive. HbA1C was, and remains, 5.8% I managed to get my insulin down during the next year but it still remained a bit over the top of the range. Over the last 18 months my insulin has come right down to 5 (range is 0-20). My HbA1C still sits at 5.8%. I low carb on and off (more on than off) but over the last few months I've been doing quite well most, but not all, of the time.

Today I went to the GP for blood test results - I was terrified what LCHF would do to my cholesterol but was pleasantly surprised. It had actually come down a bit and my good chol had remained good so not real problems there. However, the GP did say something about 'HbAlC and 5.6%" (TBH I wasn't really listening as I assumed nothing had changed). It wasn't until I got home that I saw on my copy of the results that the HbA1C range is now 4-5.6 and my result was marked as High. It seems the range has been changed to the American range which would have put me in the pre-diabetic range for the last few years, even with quite a bit of low carbing.

I have family history of Type 2 and quite probably Type 1, both on my mother's side - my question is, if I am pre-diabetic, does it mean I am pre type 2 or early Lada in honeymoon period? And, given my insulin is no longer high but HbA1C is still same, would that mean that an attack of the beta cells is slowly happening? I've had 2 c-peptides in the past 4 or 5 years and they have been in normal range (but not high) but not had one done recently.

Sorry for rambling

 

[urbanracer]

I joined this forum 3 years ago when I found I had elevated fasting insulin levels. Having other autoimmune diseases that cluster with Type 1 Diabetes, I already knew I was GAD positive. HbA1C was, and remains, 5.8% I managed to get my insulin down during the next year but it still remained a bit over the top of the range. Over the last 18 months my insulin has come right down to 5 (range is 0-20). My HbA1C still sits at 5.8%. I low carb on and off (more on than off) but over the last few months I've been doing quite well most, but not all, of the time.

Today I went to the GP for blood test results - I was terrified what LCHF would do to my cholesterol but was pleasantly surprised. It had actually come down a bit and my good chol had remained good so not real problems there. However, the GP did say something about 'HbAlC and 5.6%" (TBH I wasn't really listening as I assumed nothing had changed). It wasn't until I got home that I saw on my copy of the results that the HbA1C range is now 4-5.6 and my result was marked as High. It seems the range has been changed to the American range which would have put me in the pre-diabetic range for the last few years, even with quite a bit of low carbing.

I have family history of Type 2 and quite probably Type 1, both on my mother's side - my question is, if I am pre-diabetic, does it mean I am pre type 2 or early Lada in honeymoon period? And, given my insulin is no longer high but HbA1C is still same, would that mean that an attack of the beta cells is slowly happening? I've had 2 c-peptides in the past 4 or 5 years and they have been in normal range (but not high) but not had one done recently.

Sorry for rambling

Hi @Lesleywo ,
If as your message states - you're GAD positive, then you're a T1.

 

[ME_Valentijn]

Fascinating question. GAD autoantibodies can directly cause diseases other than Diabetes, and they don't always cause Type 1 when present. Though with both GAD autoantibodies and hyperglycemia at some point, the presumption would naturally be Type 1. With a family history of both Type 1 and Type 2, either or both could be having an impact.

But if it was pre-diabetes versus LADA, insulin wouldn't be necessary, and might not even be effective, as the underlying problem would be some degree of insulin-resistance. So a nice long LADA honeymoon seems most likely.

There are tests to assess insulin resistance, which could indicate Type 2 influences, but it sounds like that's pretty complicated. And, of course, a bit of both pre-diabetes and LADA would be a possibility, though it would probably be very unusual, especially while your situation is looking pretty well controlled.

 

[Sid Bonkers]

Taken from the http://patient.info web site used by GP's to advise their patients.


"HbA1c results in the UK have usually been aligned to the assay used in the Diabetes Control and Complications Trial (DCCT), expressed as a percentage (DCCT-HbA1c) - non-diabetic 'normal' range being 4-6%."

If your HbA1c is under 6% you are considered not to be diabetic although you are at the higher end of the scale at 5.8% so you may possibly be pre diabetic I suppose, im not entirely sure at what numbers Gp's diagnose pre diabetes as I never was, I just went straight from feeling fine to being a full blown diabetic .

 

[Alison Campbell]

That's two forum posts today that suggests the old values for prediabetes have changed/lowered.

 

[Alison Campbell]

I have only heard the term prediabetic used to mean pre type 2. I think you should ask your doctor for clarification.

 

[Lesleywo]

Hi @Lesleywo ,
If as your message states - you're GAD positive, then you're a T1.

Thanks I think so too. Sadly not a skinny one though

 

[Lesleywo]

Fascinating question. GAD autoantibodies can directly cause diseases other than Diabetes, and they don't always cause Type 1 when present. Though with both GAD autoantibodies and hyperglycemia at some point, the presumption would naturally be Type 1. With a family history of both Type 1 and Type 2, either or both could be having an impact.

But if it was pre-diabetes versus LADA, insulin wouldn't be necessary, and might not even be effective, as the underlying problem would be some degree of insulin-resistance. So a nice long LADA honeymoon seems most likely.

There are tests to assess insulin resistance, which could indicate Type 2 influences, but it sounds like that's pretty complicated. And, of course, a bit of both pre-diabetes and LADA would be a possibility, though it would probably be very unusual, especially while your situation is looking pretty well controlled.

Thanks for your input. I went to an Addisons Disease seminar last year and met a lady, same as me, with Addisons Disease, Hashimoto's and GAD positive. She was enjoying a long honeymoon period with no meds, just controlling with diet for the time being. I'm guessing I'm the same as her.

 

[Lesleywo]

That's two forum posts today that suggests the old values for prediabetes have changed/lowered.

Well I got a shock to be honest. Here in Oz the range used to be 4.0-6.0, suddenly dropped to 4.0-5.6. In which case you could say I've been pre-diabetic/LADA for years - years I could have been doing everything possible to look after myself better. I am seeing my endo in a few weeks. I do get frustrated as I've had several of them over the years and only ever had one that was very thorough and looked outside the square - he was the one that tested for GAD and did my C-peptides. In the meantime I am organising a private C-peptide to see if much has changed over the last couple of years. I didn't realise you could get private blood tests in Australia. And it's only $49 (about 20 pounds). This last year or so I've really learnt we have to be pro active with our own health - knowledge is definitely power. It annoys me that doctors don't want to know about diabetes until your fasting bs goes out of whack, which is the last thing to be affected. When it's almost too late.

 

[Lesleywo]

I have only heard the term prediabetic used to mean pre type 2. I think you should ask your doctor for clarification.

When I see my endo in a few weeks I will grill him. Can you please tell me where you saw another post with regard to change in range? I know if the States it's always been lower than here in Oz and in UK. Thank you

 

[Alison Campbell]

Can you please tell me where you saw another post with regard to change in range?

http://www.diabetes.co.uk/forum/threads/pre-diabetic-with-a-reading-of-5-6mmol.116879/
It was this post but it is not clear if it was a HBA1C

 

[Lesleywo]

Update: I am now thinking that the Australian guidelines haven't changed after all. I see on the copy of the tests there's a note saying they changed the way of testing which results in a lower range ... of which I am outside and could have been for the last two years.