What am I: Type 1, 2 or 1.5 (LADA)?

[maxell]

I thought I was Type 2 but I'm not so sure anymore. Diagnosed 8 months ago as Type 2. Been on Metformin (1500mg). Controlling diabetes with a low carb diet, medication, and exercise. My FBG is now around 95-100 (5.27 - 5.55) (vs. 210 (11.66) upon diagnosis). My HbA1c is 6.4 (vs. 8.4 upon diagnosis).

I did not test positive for any GAD antibody. I have not taken Islet or Insulin antibody tests but my doc will order that for me, apparently. I understand that testing positive on these antibodies will identify me as T1 or T1.5 (LADA). I did, however, test positive on Antinuclear Antibody Direct.

My C-Peptide is near the low end, although not out of the normal range. My FBG when I took the C-Peptide was 105 (5.83). I've read that having a low to low-normal C-Peptide with a normal FBG (achieved through diet/exercise) may indicate T1 or T1.5/LADA.

How does establish my type status? Is it not clear upon confirmatino with more antibody tests? Is my C-Peptide low enough that my pancreas will burn out and not produce insulin, making me T1 when that happens? Shouldn't I just go on Insulin right now?

 

[phoenix]

Sorry but I don't think that there is a clear cut answer to these questions.
LADA itself is defined slightly differently in different studies (some include presence of antiGAD, others include other islet antibodies) but some longstanding type 1s also show no antibodies at the time of testing. Type 1.5 is also used for MODY (a genetic form of diabetes). http://www.phlaunt.com/diabetes/14047009.php
There is also a classification type 1b (which is type 1 that they haven't a clue what caused it!).
I think the best course of action must be to find a treatment that works but to be aware that if you are loosing pancreatic function then it might not work for ever. Some people claim that using insulin from the start might help keep some beta cell function, and people with LADA are put onto insulin immediately. This is not normally the case in the UK..but you might want to discuss it with your doctor.
http://www.locallada.swan.ac.uk/faq.html
There was a recent Cochrane review on the best intervention for LADA but they found that there was very little helpful evidence though they suggested that sulfs were not the best treatment .

http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD006165/frame.html

I went untreated/undiagnosed for up to 4 years. I also am pretty certain I had 2 distinct hases an intial one whith all the symptoms (weight loss, drinking gallons etc I was moving country at the time and managed to convince myself that I didn't need to see a doctor) followed by a period of stability, when I did a lot of hard physical exercise (restoring a house and huge garden + running) this came to an end quite abruptly.with another bout of weight loss and eventually DKA
My doctors feel that I may have lost most of my insulin production at the start but then did enough exercise plus a reasonalbly healthy diet in the next few years to keep my overall levels reasonably OK with the small amount of natural insulin I had left.

 

[maxell]

Thanks so much for the links. I'm finally learning about LADA, after having settled on T2 as my curse. Looks like I need some more to consider as I research my status. And the treatment options are open-ended even if I turn out to be T1.5

 

[frenchkittie]

Wow, great links, thanks for posting them Phoenix

I'd not heard of false hypos before, and had thought that perhaps I was being a bit weedy feeling hypo at 80 (4.44 mmol/l). Now I know why.

I finally got my GAD antibody test results back from the hospital yesterday, 121 u/ml. My diabétologue classes me as a type 1.

 

[cugila]

Wow, great links, thanks for posting them Phoenix

I'd not heard of false hypos before, and had thought that perhaps I was being a bit weedy feeling hypo at 80 (4.44 mmol/l). Now I know why.

I finally got my GAD antibody test results back from the hospital yesterday, 121 u/ml. My diabétologue classes me as a type 1.

Hi FK.
Feeling hypo at around 4.5 mmol/l isn't weedy, it is about the right level if you have hypo awareness. It is just your body telling you that you are getting too low and need to fill the tank.....eat ! My signs come in at about the same point, basically I start feeling cr*p ! Perhap's I'm a 'wimp ?'

A false hypo is just when your body has been running high Bg levels for a while, say 12 and you then drop down to a much lower level, say 6. Your body thinks that you are getting too low again, hence the hypo symptoms which actually AREN'T a hypo. That's the difference.

I have converted your BG number to UK numbers, but I have no idea what the conversion is for the number from the Hospital ? Are you able to help us out ?