On diagnosis, what medication were you given?

[tim2000s]

Looking through the forum, we see a lot of LADA/T1.5 diabetics that have been given type 2 drugs on diagnosis. research into auto immune diabetes suggests that it is the process of creating insulin that drives the autoimmune attack, so prescribing a drug that increases insulin secretion potentially speeds up the loss of beta cells. In discussion with a couple of diabetologists, they suggest that LADAs shoul dbe put straight on insulin where drugs are required, rather than using these other drugs.

As a result, this is a quick poll to try and see how many are on what type of medication following diagnosis of LADA/T1.5.

 

[allan2010]

Looking through the forum, we see a lot of LADA/T1.5 diabetics that have been given type 2 drugs on diagnosis. research into auto immune diabetes suggests that it is the process of creating insulin that drives the autoimmune attack, so prescribing a drug that increases insulin secretion potentially speeds up the loss of beta cells. In discussion with a couple of diabetologists, they suggest that LADAs shoul dbe put straight on insulin where drugs are required, rather than using these other drugs.

As a result, this is a quick poll to try and see how many are on what type of medication following diagnosis of LADA/T1.5.

Levomir basal (8 units twice a day.)
Novorapid bolus (4/5 units before meals)

 

[Brihaze]

Looking through the forum, we see a lot of LADA/T1.5 diabetics that have been given type 2 drugs on diagnosis. research into auto immune diabetes suggests that it is the process of creating insulin that drives the autoimmune attack, so prescribing a drug that increases insulin secretion potentially speeds up the loss of beta cells. In discussion with a couple of diabetologists, they suggest that LADAs shoul dbe put straight on insulin where drugs are required, rather than using these other drugs.

As a result, this is a quick poll to try and see how many are on what type of medication following diagnosis of LADA/T1.5.

LADA shows up in your c peptide results as type 2 not until later down the line does it show as LADA as the c peptide diminishes

 

[tim2000s]

LADA shows up in your c peptide results as type 2 not until later down the line does it show as LADA as the c peptide diminishes

That's not strictly true either. LADA is an autoimmune attack, so typically shows up beta cell attacking antibodies. A C-peptide test shows mostly normal levels. A type 2 c-peptide typically shows elevated levels. Which is why, if there is even a suspicion of LADA, and there are plenty of indicators that it might be that most GPs are unaware of, both of these tests should be undertaken.

 

[Brihaze]

think I have put my reply in the wrong place so will make another attempt LADA shows up in your c peptide results as type 2 until later down the line as the c peptide diminishes is when it can be classified as LADA so you will be using tablets until this is established

 

[tim2000s]

think I have put my reply in the wrong place so will make another attempt LADA shows up in your c peptide results as type 2 until later down the line as the c peptide diminishes is when it can be classified as LADA so you will be using tablets until this is established

That's the point though. In many cases the wrong tests are being done. It is estimated that 10% of those over 35 and 25% of those below 35 diagnosed with T2 are in fact LADA.

The graph below shows T1 as grey, T2 without ICAs as white and T2s with ICAs (LADA) as Black. It shows that at diagnosis, typically LADAs have a lower level of c-peptide production, but in response to glucose it is indeterminate, however in response to glucagon, it is almost exactly the same as a T1. This would suggest that a cheap test for LADA would involve the use of Glucagon prior to taking blood for c-peptides.

More importantly, they show Islet Cell Autoantibodies, which are a clear sign of LADA (and T1).

The issue is that by prescribing insulin secretors of any type, you increase the production of pro-insulin, which is a key marker for auto immune attack, so the treatment is making the condition worse. Hence why I'd like to understand how many people that have been diagnosed as LADA were put on these treatments at diagnosis of LADA.

Links: http://diabetes.diabetesjournals.org/content/54/suppl_2/S68.full#F3

 

[Brihaze]

I was diagnosed as type 2, for 2 years was on tablets I then stopped medication as I was hypo or dumping most of the time went to my Endo tests found everything was normal continued checking BGs everything OK until about 1year later was suffering extreme thirst back to my Endo more tests revealed high c peptide and BGs so back to tablets for another 1 year but finally couldnt hold levels down so onto slow acting insulin then progressed to fast acting for meals then pumping for 18 years I have diabetes now going on 40 years but had no problems with it so far c peptide tests now low as is my insulin usage about 36 units a day using pen with levimer & humalog as I can no longer use pump due to site breakdowns after about 36 hours was classed as LADA I am now 83

 

[Daibell]

Hi Tim2000. You are quite right in what you say, but with so much ignorance amongst even diabetes specialist GPs many of us fight an uphill struggle. My second diabetes GP didn't even know that LADA existed and she had just come off the Warwick training course. My fist db GP didn't have a clue and I had to ask for Gliclazide. I should have gone onto insulin 2years before I did but with very slow onset LADA as mine has been, it can fool GPs unless they do the tests which are expensive or preferably open their eyes and see that you may be slim. My first GP saw that I had lost weight at a follow-up review and said 'great - keep it' up and there I was stick-thin not thinking it might be because I didn't have enough insulin to use the carbs.

 

[tim2000s]

It's slightly scary, as the research suggests that LADA makes up more of the diabetes population than Type 1 does. It feels like the classic case of storing up problems for future generations to deal with...

 

[LucySW]

[QUOTE="tim2000s, post: 1067984, member:]The issue is that by prescribing insulin secretors of any type, you increase the production of pro-insulin, which is a key marker for auto immune attack, so the treatment is making the condition worse.[/QUOTE]

This is the key, and new T1.5s/LADAs should learn these words off by heart and say them to their doctors.

Yes, yes, yes.

 

[LucySW]

Your Q.

Initially diagnosed as T 2 and given Metformin. They did the GAD antibodies test (and C-peptide too).

Two weeks later when the results were in, reclassified as T 1 and given basal insulin. It was me who used the term 1.5/LADA. After three months saw consultant, who also used the term.

On my request six months later, given Novorapid for bolus.

 

[tim2000s]

@LucySW Think my latest blog entry will be of interest to you!

 

[LucySW]

Yes, just read it. Well done.

The link. http://www.crick-tech-munch.blogspot.dk/2016/02/latent-autoimmune-diabetes-in-adults.html?m=1

 

[Daibell]

Yes, just read it. Well done.

The link. http://www.crick-tech-munch.blogspot.dk/2016/02/latent-autoimmune-diabetes-in-adults.html?m=1

Excellent link. The one point I would make is that some Late onset T1 is not due to GAD but due to other problems such as pancreatitis, viruses etc. My GAD, although taken after 8 years so not reliable, was negative but everything else including c-peptide and always being slim pointed to Late onset T1.

 

[fairylights]

My GP didn't try and treat me, sent my results straight to the hospital where I was seen the next day. Even though they didn't know what type of diabetes I had I was injecting insulin within 15 minutes of being in hospital (due to BGL of 33 and ketones) and they took bloods and tested for GAD and c-peptide, It was two weeks later they got the results and said definitely type 1 probably LADA. My honeymoon only lasted 3 months so I think I am closer to type 1 or maybe that's because my GAD result was extremely high (not sure the exact number but caused the endo to raise his eyebrows almost off the top of his head).

 

[LRD]

That's the point though. In many cases the wrong tests are being done. It is estimated that 10% of those over 35 and 25% of those below 35 diagnosed with T2 are in fact LADA.

The graph below shows T1 as grey, T2 without ICAs as white and T2s with ICAs (LADA) as Black. It shows that at diagnosis, typically LADAs have a lower level of c-peptide production, but in response to glucose it is indeterminate, however in response to glucagon, it is almost exactly the same as a T1. This would suggest that a cheap test for LADA would involve the use of Glucagon prior to taking blood for c-peptides.

More importantly, they show Islet Cell Autoantibodies, which are a clear sign of LADA (and T1).

The issue is that by prescribing insulin secretors of any type, you increase the production of pro-insulin, which is a key marker for auto immune attack, so the treatment is making the condition worse. Hence why I'd like to understand how many people that have been diagnosed as LADA were put on these treatments at diagnosis of LADA.

Links: http://diabetes.diabetesjournals.org/content/54/suppl_2/S68.full#F3

 

[LRD]

I was diagnosed as a 2 and then as a 1. Because I am not on insulin, but was told autoimmune disease, I gather that I am LADA. What test does UK give for Lada? Some say to be on insulin, but I am not. What do the doctors say in the UK? Also, Bernstein does not address LADA in his old book I read.