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Type 2 for 12 years (Diet Controlled) - Recent jump to 82.4 HbA1c. LADA suspect?

mangoman

mangoman

Member
Messages
6
Hi everyone,

I've been a member here for a while and have always found the advice invaluable. I’ve been "Type 2" for 12 years, and for most of that, I’ve had great success with a strict low-carb diet (no bread, pasta, potatoes, sweets, etc.). My HbA1c used to sit comfortably between 38 and 46.

However, over the 18 months, my numbers have shot up to the 60s, and my latest HbA1c has hit 82.4 mmol/mol, despite no changes to my diet. I was 38 at diagnosis, normal weight, and very active (lots of walking). My diabetic nurse keeps brushing me off and telling me to take more Metformin, but it makes zero difference.

I suspected LADA (Type 1.5), so I went private for some baseline tests. Here are my fasting results:

  • HbA1c: 82.4 mmol/mol
  • C-peptide: 2.02 ng/mL (approx. 668 pmol/L)
  • Insulin: 38.3 pmol/L
  • Glucose: (Cancelled by lab, but clearly high based on the A1c)
To me, a "normal" C-peptide of 2.02 when my blood sugar is high enough to cause an 82.4 A1c seems inappropriate. In a T2, wouldn't you expect that number to be sky-high to compensate for the resistance? I maybe getting the wrong end of the stick.

Has anyone else had "normal" C-peptide results but high A1c and ended up being re-diagnosed as LADA? How did you get your GP/Nurse to listen? I’m planning to ask for a GAD antibody test next, but I’d love to hear from anyone who has been in this "middle ground" where the meds stop working despite the diet being on point.

Thanks in advance!
 
Hi there @mangoman reading your fasting C-Peptide results in relation to your high blood sugars I would tend to agree with you. Not wishing to diagnose, of course, but one would think a T2 would have C-Peptides over 1200 + pmol/L for blood in that range. Of course, HCPs will see a figure of 668 pmol/L for your C-Peptides and think ‘normal range’. The depletion of beta cells may happen for other reasons too and may not be associated with an autoimmune condition.

If your Heath team are unwilling to request autoantibody tests fir you, are you able to get these tests done privately ? There are 4 types associated with the development of T1DM / LADA, islet cell autoantibodies (ICA), antibodies to insulin (IAA), glutamic acid decarboxylase (GAA or GAD) and protein tyrosine phosphatase (IA2 or ICA512) . If you are producing 2 or more types of antibodies then you would likely be diagnosed with LADA. I produce just 1 type but negative for the other 3 types.

https://www.trialnet.org/events-new...taging-classification-opens-door-intervention
 
Thanks, that’s really helpful and reassuring.
Click to expand...
That’s exactly what concerned me — the C-peptide looks “normal” in isolation, but feels low in the context of an HbA1c of 82 and a lean and active. I agree that autoimmune causes aren’t the only explanation, but I do feel antibody testing would at least help clarify the picture. I’ve been declined this in the past by my NHS team, but I’m now considering private testing for GAD, It’s also helpful to hear that single-antibody positivity (or even none) doesn’t exclude beta-cell–limited diabetes. Really appreciate your insight — it’s helped me frame this more clearly for my next discussion with my care team.
Click to expand...
 
Are you losing weight and what is your ketone production like @mangoman? If (and this is still an if) your insulin production is declining, for whatever reason, you need to watch out for DKA

www.nhs.uk

Diabetic ketoacidosis

Find out about diabetic ketoacidosis (DKA), including what the symptoms are, when to get medical help and how to prevent it.
www.nhs.uk www.nhs.uk
 
mangoman said:
Hi everyone,

I've been a member here for a while and have always found the advice invaluable. I’ve been "Type 2" for 12 years, and for most of that, I’ve had great success with a strict low-carb diet (no bread, pasta, potatoes, sweets, etc.). My HbA1c used to sit comfortably between 38 and 46.

However, over the 18 months, my numbers have shot up to the 60s, and my latest HbA1c has hit 82.4 mmol/mol, despite no changes to my diet. I was 38 at diagnosis, normal weight, and very active (lots of walking). My diabetic nurse keeps brushing me off and telling me to take more Metformin, but it makes zero difference.

I suspected LADA (Type 1.5), so I went private for some baseline tests. Here are my fasting results:

  • HbA1c: 82.4 mmol/mol
  • C-peptide: 2.02 ng/mL (approx. 668 pmol/L)
  • Insulin: 38.3 pmol/L
  • Glucose: (Cancelled by lab, but clearly high based on the A1c)
To me, a "normal" C-peptide of 2.02 when my blood sugar is high enough to cause an 82.4 A1c seems inappropriate. In a T2, wouldn't you expect that number to be sky-high to compensate for the resistance? I maybe getting the wrong end of the stick.

Has anyone else had "normal" C-peptide results but high A1c and ended up being re-diagnosed as LADA? How did you get your GP/Nurse to listen? I’m planning to ask for a GAD antibody test next, but I’d love to hear from anyone who has been in this "middle ground" where the meds stop working despite the diet being on point.

Thanks in advance!
Click to expand...

Can I ask you how you are feeling ?
 
mangoman said:
Has anyone else had "normal" C-peptide results but high A1c and ended up being re-diagnosed as LADA?
Click to expand...
Probably missed the boat here.

Your HbA1C is not a good indication of your BG at the time of the test. C-peptide is an at that instant test, like BG.

I had one positive test to GAD early in my journey, Which I remember as being at the very bottom end of detection. We have lots of little labs here that get gobbled up by bigger labs. And new labs that splinter off of the bigger ones. So the results of that early test have been lost in the shuffle. This was ignored and I was still diagnosed as type 2, though the drugs didn't work very well.

Did OK with (very) low carb but had a sudden very high HbA1C. (from 5% to 10%)
Subsequent tests showed my C-peptide was low-normal to sub-normal and didn't show any relationship to BG. I was given LADA after a series of these tests.
 
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