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  1. today I got an appointment with an endocrinologist, my first ever. It'll be a 10 week wait to discuss getting tested for LADA and MODY.

    The big picture is that I want to get some clues as to whether I will progress beyond prediabetes and how soon.

    I first became aware of my dysglycaemia two years ago. Almost certainly, at a molecular biological level, the problem is blockage first phase postprandial secretion. The beta cells can still produce plenty of insulin, although conceivably there has been an impingement in this. When did my signs begin? Maybe when they were discovered, or maybe 10 years ago.

    The dysglycaemia is IGT, mild IGT. When I eat or drink a lot of sugar, the glucose rises to 10 mmol/l. While this peak is terribly high, the duration of such an event is OK: I get back to fasting level in two hours. 2 hours is not so good, but it is in fact normal for people with normal glucose metabolism, at least under the usual Western diets, which are moderate carb to high carb. I've never taken a standard glucose challenge test, but I've improvised challenge tests. With this mild intensity, there's no need for medications. I have reduced the average glucose by taking up walking. I could enhance it by eating less sugar.

    T1 and T2 are ruled out. That reduces the likely immediate cause to just a secretory defect. I reason that there may also be an as yet mild insulin production deficit or mysterious "other category" cause. The secretory defect could be due to MODY 3. Therefore, testing for LADA and maybe after that MODY are in order. I think LADA would be the ailment that offers the worst prognosis.

    I have an excellent rapport with my GP. It was taking months for me to get the chance to consult an endocrinologist. In the meantime. I asked the GP to order the GADA test. It was negative, but I knew there were other autoantibodies.

    I imagine, I hope, if the specialist approves the panel of antibodies, test result could be available in a month, including getting the insurance company's approval (the American system). If i get tested for MODY 3, that's a genetic test with a 5 week turnaround time; again, once the insurance company approves it.
  2. If you want to know what's what with multiple autoantibody testing for prediabetes and diabetes, check out the Venn diagrams and tables for three studies that compared the Ab profiles of patients with T2, T1, or LADA.
    In Argentina, Trabucchi et al. 2012 tested for GADA, ZnT8A, IA-2A, and PAA. Published in Autoimmunity.
    In Norway, the HUNT3 study, Sørgjerd et al. 2012 tested for GADA, ZnT8a, and IA-2A. Published in Diabetologia.
    In Italy, Tiberti et al. 2011 tested for GADA, ZnT8A, IA-2A, and IAA. Published in Clinical and Experimental Immunology.

    diapedia.org has tutorials on LADA.

    Please let me know of similar studies.
  3. Two years after having been detected to have dysglycaemia, I still don't know what kind it is; LADA or MODY. I am seeking more tests. I already got three tests: fasting insulin, fasting C-peptide, and hs-CRP. Dysglycaemia is often self limiting. I wonder whether mine will get worse, how much worse, in how many years. So far, the dysglycaemia has improved, thanks to exercising.

    At the immediate level of description, my dysglycaemia seems to consist solely of short term defective insulin response to eating. There is no IFG and perhaps no official IGT. Of course defective insulin response to eating reduces glucose tolerance, but if I took an official glucose tolerance test (GTT), I think I would fall either a little short of the threshold or a little over. I am totally negative for any indicator of insulin resistance (IR). Two years ago, it took my system 3 hours to return blood glucose to fasting level after a huge amount of juice. After a year of cardio with no change in diet, it takes only 2 hours. However, the glucose rise is unchanged, it rises to 10.0, 10.2 mmol/l, which is much too high.

    It's possible I've had this dysglycaemia for years and years. The only evidence this may have been the case is that I often get drowsy after eating, and I now know this could be reactive hypoglycaemia. For many years there have been FPG measurements, always around 4.7 mmol/l, but the mealtime rises in glucose were not measured before.

    I haven't taken a standard GTT. Instead, I've gone to health fairs where fingerstick testing is offered. In my own improvisation of a glucose challenge, I drink half a gallon of juice, then get my finger jabbed twice within two hours. In this scattershot way, I have determined my mealtime insulin response.

    Going by tests that actually measure glucose at a particular time, prediabetes is subclassified into IFG alone, IGT alone, or both. By the A1c, in fact, I am usually prediabetic. However, I am confident I test too high on the A1c. It's impossible to know by how much. My recent result is 5.9% (40 to 41). I think the "true" value is 38, 37, or 36. But 37 is officially deemed prediabetic.

    I am obviously not Type 1, since I don't have its acute, life threatening symptoms. I'm also not T2, because its dominant driver is IR, but I'm negative for every IR manifestation that is associated with T2 (blood pressure, HDL, TG, interior belly fat), and I'm even negative by the direct measure of IR, fasting insulin. That leaves two other normal possibilities for the type of dysglycaemia: LADA and MODY.

    In order to rule out LADA, getting tested only for the antibody (Ab) GADA is insufficient because some people don't have it, but they have other autoantibodies. Even knowing this, I decided to start with requesting a GADA test only, because it is low hanging fruit for the following reasons.

    * GADA is by far the most prevalent of them,
    * the majority of Ab positive people have it,
    * probably few doctors have heard about the 2nd ranking Ab.

    I was afraid of being denied testing for a panel of Ab. I figured that if I were to test positive for GADA, this would be a coup, and I could easily get approval further testing. I am negative for GADA, so it's time to request a panel.

    There are five autoantibodies to the islet cells, and there is an autoantibody to insulin itself (IAA). A person can have one or more of them. At a minimum, the panel should consist of GADA and ZnT8A, because maybe over 90% of persons positive for just one Ab, it will be one of them. Since it's convenient to find out how many Ab's you have by a single test, It's better to add in IA-2A and IAA. The remaining two Ab's are even more obscure. I have seen PAA mentioned in only one study. Years ago, most clinical research into LADA mentioned ICA, "islet cell autoantibodies", but they mention it less and less now.
  4. I'd like to use my blog to go on in detail about physiology, calculations.
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