1.5/LADA what should I be asking the GP?

[RichBromiley]

Morning everyone-

I was 'diagnosed' last week as a possible type 1.5 (tall, thin body shape, reasonably fit, aged 37). Doctor has given me metformin 500x2 after first HBA1C of 91.

Unfortunately I didn't really know of the 1.5/LADA condition until after I'd been to the GP so didn't know what to ask about it. When I first went in I assumed something type 2 so was more prepared for that- diet and exercise. Now I've done a lot more reading I think I know more, but could do with some help with getting the right questions to ask the GP in order to get all the answers I need about my condition.

Elaine 77 kindly suggested a couple of things- GAD65 and c-peptide test in order to give me a proper diagnosis. What else should I be asking- are there any other tests that I need doing in order to get a complete picture of what is happening? I'm not yet sure which test determines my insulin production level yet so if someone could enlighten me I'd be really grateful.

Other questions that I think I need to ask the GP are:
- Do I need to do a glucose tolerance test? I've not yet done one.
- Should I be referred to a consultant/specialist?
- Is Metformin a sensible route for the moment or will insulin (low dose hopefully) be more effective long-term in retaining any beta cell function?
- Are there any courses that I should be aiming to go on if I'm definitely a type 1.5?
- Do I need to worry about ketones? ( I had one urine test and was clear)

I don't expect answers to these questions from the forum - it's more to build up a list of what I need to so if you have any other questions that I need to be asking I'd really appreciate it!

Rich

 

[hale710]

I'm not type 1.5 so I do t feel confident in answering most of those questions. But you're in the right place and it's good you're being proactive about things!

With the ketones, if you're clear for now then you're good in the short term. Do you have a form of testing for ketones available to you? Personally my BG meter does it but I know most people still use urine sticks. If not you need to request them. When you BG is exceptionally high, or you have a fever or just generally unwell you should check for ketones

 

[RichBromiley]

Thanks Hale- I realised that my post was a bit ambiguous so have amended it.
I'll definitely stick the question about ketone sticks on the list.

 

[phoenix]

Hi,
Testing for the level of GAD antibodies is a good way of seeing if there is an autoimmune attack. They are the most common antibodies found in adults presenting with T1 or LADA. They aren't infallible, there are other antibodies which are sometimes tested for (they actually discovered a new one only a few years ago.) There are also some people who have no evidence of antibodies yet still have a form of T1 (Type 1b)
C peptide is a marker of the amount of insulin produced. Generally people with T1 will have low levels, people with T2 normal or high levels but someone with LADA who had an early diagnosis can have low normal levels and someone who has had T2 for a long time could also have low levels .
(ie it isn't definitive all the other aspects have to be taken into account)
From what I read some GPs have little knowledge of the 2 tests.

An HbA1c of 91 means you may have had average glucose levels of 14.1 mmol/l during the time before your test. This is far higher than the levels required to diagnose diabetes on an OGTT so to me there wouldn't be any point in having one. Unfortunately you definitely have diabetic levels.

Unless your GP proves to know a lot about diabetes then I think that pushing for a specialist appointment is probably the best thing you can do.
If the doctor hasn't given you a meter and strips I think that would be really important to discuss.
(if you haven't got a meter and he won't prescribe strips then I would get one myself and test as frequently as I could afford, watching for a rise to high levels, checking for ketones if glucose rise above 14mmol/l )

Treatment depends on correct diagnosis which is why it's good that you are questioning which type you have. There are other, albeit rarer, alternatives to LADA ( a form of T1) and T2 . That's why you need a specialist and appropriate tests.

 

[RichBromiley]

Thanks Phoenix- that's really useful and helped clarify a couple of things for me.
I have a meter and I'm monitoring much more closely, allied to diet and exercise, so things are ( for the moment at least) looking much more controlled. I've bought my own meter and strips for the first set but GP stated that the strips will be prescribed.

Many thanks!
Rich

 

[elaine77]

Hi Rich,

I agree with the above in that a diabetic consultant is so much more informative than the GPs usually are, my GP surgery are not the best but my consultant is great!

I'm controlling only with Metformin at the moment, it's a really good drug and it basically helps your body to use the insulin you ARE producing whilst your still producing it! I have debated in my head time and time again whether I should go onto insulin to preserve my beta cells but one of the main things stopping me (other than my fear of injecting) is the lack of evidence that it actually preserves your beta cells...there is suggestions in the medical journals that it helps for the first 18 months but after that all LADAs basically end up the same so I really think its just a personal choice with LADAs about WHEN they go onto insulin as there is no IF....

With regard to the OGTT, I had a fasting BG of over 7 mmol on two separate occasions, by Hba1c was 82 and I tested positive for GAD65 antibodies so there was no need...the only time I think the doctors think its relevant to have one of these is when youre pregnant and when you have only slightly diabetic fasting BG levels which is quite common in LADAs (apart from me as my fasting are the worst of the lot!).

All in all I think you now have a very good idea of what to ask the doctor and good luck


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 23 currently controlled by only Metformin, 500mg twice a day.

 

[sal18sam16]

I am 47 and had diabetes one and a half year back.Initially Type 2. But a quick check this April o C levels and GAD 65 showed that this has become Type 1.5 Or LADA. I am on Insulin Humalog25 and very fast in September the doses almost doubled after the so called honeymoon period. Now even with these doses, the sugar levels remain high about 8-13.