Hello...New LADA and need Med's advice.

[bravopapa]

Dear All,

New Member and as my profile suggests I have been a lazy Type II since diagnosis in 2000. Strong family history of Diabetes which led to awareness to catch high BG fairly early. However Diet + Exercise + weight loss (lately probably due to high BG) led me to "forget" and despite doctors kicking me for HB1aC on every visit.
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So December 15th 2014 I collapse unconscious on a train after an apparent vertigo episode. No BG meter anymore (was far too addicted in 2000 and went opposite way) and buy one from Amazon. When new one arrives a spot test shows 29.7 and off to A&E.

Nearly 2 months of low carb and Gliclazide (80mg AM and 40mg PM) I have been diagnosed Type 1.5 with positive GAD Antibodies and and an HB1aC that apparently was an average of 16-17mmol.

As of today I am seeing post meal bloods of around 7 and mid afternoons of mid 5's. I have a higher fasted of mid 8's and have just been put on Metformin SR to reduce the fasted levels.

My concern is that I read everywhere that Glic is BAD for beta cell demise and early insulin is the best way to go. Protecting what you have left may help with metabolic control over a longer period.

My consultant says this has no evidence and Glic is working so keep on. He said no trials have confirmed any support of beta cell protection in early insulin adoption and I should just keep on tablet as long as possible until "burnout" and then look at insulin therapy.

I seem happy with Metformin SR and can see harm as possible have IR and see it suppresses liver glucose release and should benefit morning BG levels.

However should I push harder to go on insulin early if on a basal to begin with? My wife and Doc happy that I don't yet have all the concerns of Insulin whilst I come to terms with diet and monitoring. However I want the best long term outcome. Really looking for advice please.

 

[phoenix]

The evidence isn't very good (small numbers, different definitions of LADA etc) but the Cochrane review suggested that insulin led to better control of LADA than sulfonylureas http://www.ncbi.nlm.nih.gov/pubmed/21901702
This more recent summary from DIapedia basically says that there is no conclusive evidence about best treatment
http://www.diapedia.org/type-1-diabetes-mellitus/lada-latent-autoimmune-diabetes-of-the-adult
I don't live in the UK and was sent to hospital with similar levels to yours. I was put straight onto insulin and don't regret it. However, by the time I was diagnosed my C peptide was very low.
Now you have started using metformin it would be as well to wait and see what the results of that are. During the day they don't sound too bad. I wouldn't be happy at having a fasting reading in the 8s though and if the met doesn't help then perhaps would be a good time to ask about the use of a basal.

 

[Daibell]

I agree with Phoenix. If the Glic is working, stay with it for while longer. I was on full dose 320gm/day and it had no effect and then went onto insulin when I couldn't reduce the carbs any further and my c-peptide was very low. When you start to struggle on full dose Glic and low-carbs then the time for insulin has come. Going onto just Basal early won't do any harm so it is an option and would mean just one injection per day possibly at night so not intrusive.

 

[Ian DP]

Hi bravopapa
I was diagnosed LADA 13months ago, with similarish BG levels that you currently have. My diabetes consultant advised me to stop taking the Gliclazide as he said it can do more damage than good (squeezes the insulin making beta cells till there is nothing left, I think we're his words). He said I could continue with the metformin if I wanted, as it would do no harm, but that in his opinion it would not help either..... So I stopped both.

With my high levels of GAD he said I would be on insulin within weeks, maybe a month..... That was 13 months ago. My BG levels are much lower now than then....... But this is down to my diet, and eating to my meter.

Lots of folk on this forum have found the low carb high fat diet to be very effective at keeping blood sugars low. I did not set out to go LCHF, but started to eat to my meter, and found within a couple of months I was LCHF, and I have been that way ever since.

Dr Bernstein's diabetic solution is a good read. I have been following his 'solution now for 6 months. It works for me. He believes (as many other also believe, but many don't) that insulin making beta cells destruct when BG levels rise above around 7.5mmol. His solution is to keep fasting BG levels at 4.6 and 5.6 2hr after meals. I have not been able to get to his 4.6 levels, averaging around 5.0 over the last 6 months and I have not see any deterioration in my insulin making abilities during this time. Dr B says that if you can keep to his 'normalized' BG levels the honeymoon period that we are both in can last many years......so far it is working for me.... Maybe worth looking into to see if it might work for you, but if you are going to give it a go, you need to do it pretty quick, as possibly your beta cells are gradually destructing now, and once gone, they are gone.

You can download his book on kindle for around £5.00. Dr B is a T1 diabetic, with his own diabetes practice in USA with hundreds, maybe thousands of patients. Diagnosed at 12, now 80, with no diabeetes complications.... He also does not recommend Gliclazide, but does Metformin.

 

[smidge]

Hiya. I started with a basal insulin as soon as diagnosed LADA - although I lived a year on diet and exercise as a mis-diagnosed Type 2. I'm glad I went onto insulin early. It has had very few downsides for me and I believe has extended my production of my own insulin. I still have some insulin production more than 5 years on. I low-carb to try to keep my BG as low as safely possible.

Smidge

 

[Ian DP]

......I have a higher fasted of mid 8's......However should I push harder to go on insulin early

Should have added......If you can't get lower than these levels, then in my opinion, yes, you should go on insulin. You have said you are already low carbing, not sure how low. If you are around 36g carbs already then there probably isn't a lot more you can do. If you are above 36g per day, then try lower Carbing, and a little exercise (walking) helps as well. I am ready to go on insulin when my fasting BG reaches 7.0. I have an insulin pen ready for this.

 

[LucySW]

I'd go for 6.0, Ian.

 

[Ian DP]

I'd go for 6.0, Ian.

The problem with 6.0 (pre breakfast) is that I would normally be 0.5 lower at bedtime, thus 5.5.... And taking insulin at 5.5 before bed is scarey, especially as I have on the odd occasion checked my BG in the middle of the night and it has always been lower still..... I don't think a few 6.00s fasting will do too much harm, especially if not going above 7:00 2 hours after eating.

 

[LucySW]

I dont really see the point of trying other drugs, except for Metformin, which is very beneficial. Why wait with insulin? Why not start now on a low basal, and then add bolus when you need it? If you're going to be in it ultimately anyway.

Insulin in practice isn't horrid and isn't frightening. Especially at low doses. I would always advise a low-carb lifestyle too, but the two together work really well.