Any sure signs of LADA ?

[eddie1968]

I've been T2 for nearly 5 years now. Was on max doses of Metformin, Gliclazide and Sitagliptin for a long time and was transferred to Humulin M3 a year ago. I inject 88 units daily (52 am, 36 pm). My BGs were a wee bit above normal for a long time but they are rising. A new thing is morning nausea when sugars are high and bought a bottle of Ketostix for a fiver. They are not normal, lowest is 'traces' and the usual is a dark pink. Usually lots of water and peeing tends to ease the nausea/vomiting but sure takes hours. Thanks and appreciate all replies
EDDIE

 

[Daibell]

Hi. I went down the same route with max dose of Met, Glic and Sitagliptin with sugars still rising despite low-carbing. I was also slim which was a strong pointer to LADA. Your injection units seem quite high which implies a high BMI? If so I would try to get any excess weight down by low-carbing and see what that does to your BS. Weightloss at diagnosis and possibly after is one of the symptoms of LADA. So, if you are around normal weight then LADA is stongly indicated but otherwise it's less easy to guess. There are two tests for LADA, but as you have exhausted all the tablet options, insulin becomes the next best solution anyway and really works but is at it's best when weight level is around 'normal'.

 

[jack412]

I've seen it said here, you should have a fast acting for corrections with M3, if your bg is over 13 and you have ketones over 1.5 ..I would go to A&E to get your BG fixed
it sounds like you have ketoacidosis and you need urgent treatment

 

[eddie1968]

Thanks both, BMI is 27, medication induced diabetes, quickly taken off it. Do have high insulin resistance and had dark velvety patches in armpits for 5 years before diagnosis and was told it is Acanthosis Nigricans which is insulin spilling into your skin. Hope this helps, again ta

EDDIE

 

[jack412]

with the vomiting anf high ketones, you really need to get to A&E, ...ketoacidosis is serious

 

[phoenix]

From what you say this is happening every morning.
It sounds as if you have insufficient insulin at that time of day. See your doctor about this.
If you have ketones and high glucose levels and are vomiting now then , as Jack says,you need to get medical help. Water is useful but a mixed insulin is a very blunt instrument and won't start working for a while .

Doesn't really sound like LADA which is autoimmune rather than medication induced.
Sort out the immediate problem now. You can read the rest if you remember later.

For reference here is one set of criteria which was found to work in an Australian study. It was very effective at ruling out people (ie those who would be negative for antibodies) It was quite good at selecting those that would.

1. manifestation of diabetes below age 50 years;
2. Acute symptoms at diagnosis;
3. Body mass index <25kg/m2;
4. Positive personal history of autoimmune disease;
5. Positive family history for autoimmune diseases.

If two of these criteria were satisfied, specificity for diagnosis of LADA was 71%; The negative predictive value for LADA was 99% when none of these criteria were met. However, these criteria have not yet been validated with populations outside Australia
I had 3 of the criteria at diagnosis, since then I've developed another autoimmune condition so it works for me and actually my first manifestation, rather than actual diagnosis was at 49 so I fulfil all of them.
http://www.ncbi.nlm.nih.gov/pubmed/16644622

 

[jack412]

it could be a bad batch of insulin too??

 

[phoenix]

Yes agree that is also a possibility.

 

[Daibell]

Hi. I went down the same route with max dose of Met, Glic and Sitagliptin with sugars still rising despite low-carbing. I was also slim which was a strong pointer to LADA. Your injection units seem quite high which implies a high BMI? If so I would try to get any excess weight down by low-carbing and see what that does to your BS. Weightloss at diagnosis and possibly after is one of the symptoms of LADA. So, if you are around normal weight then LADA is stongly indicated but otherwise it's less easy to guess. There are two tests for LADA, but as you have exhausted all the tablet options, insulin becomes the next best solution anyway and really works but is at it's best when weight level is around 'normal'.

Sorry, I missed the fact that you are already on insulin. As others have said be prepared to go to A&E if your sugars are in the 20s or above and you have measurable ketones. As and when that selttles you may want to ask to be swapped to the Basal/Bolus insulin regime. It gives much better overall BS control. Once you are on insulin it becomes irrelevant whether you are T2 or LADA as the treatment process and diet needs are similar

 

[eddie1968]

Thanks everyone for great advice (as usual, the forum lives up to it's reputation). Family history a bit useless, my dad died at 35 with Addison's disease and mum at 45 with stomach cancer. I was 13 and moved into my big sister's. Long time ago, have moved on.

 

[EveryCloud]

I sometimes have similar symptoms. My doc says going onto insulin is inevitable and will happen soon, but whenever I see my nurse she is clueless, I think she thinks I am still type 2. I have just ordered some Ketone sticks too, if anything to put my mind at rest as getting appointments for my favourite doctor are few and far between. I always feel guilty going to A&E.

I know - I am an idiot...

 

[eddie1968]

I sometimes have similar symptoms. My doc says going onto insulin is inevitable and will happen soon, but whenever I see my nurse she is clueless, I think she thinks I am still type 2. I have just ordered some Ketone sticks too, if anything to put my mind at rest as getting appointments for my favourite doctor are few and far between. I always feel guilty going to A&E.

I know - I am an idiot...

Doesn't seem idiotic at all going to A&E

 

[Totto]

For reference here is one set of criteria which was found to work in an Australian study. It was very effective at ruling out people (ie those who would be negative for antibodies) It was quite good at selecting those that would.

1. manifestation of diabetes below age 50 years;
2. Acute symptoms at diagnosis;
3. Body mass index <25kg/m2;
4. Positive personal history of autoimmune disease;
5. Positive family history for autoimmune diseases.

If two of these criteria were satisfied, specificity for diagnosis of LADA was 71%; The negative predictive value for LADA was 99% when none of these criteria were met. However, these criteria have not yet been validated with populations outside Australia
I had 3 of the criteria at diagnosis, since then I've developed another autoimmune condition so it works for me and actually my first manifestation, rather than actual diagnosis was at 49 so I fulfil all of them.
http://www.ncbi.nlm.nih.gov/pubmed/16644622

I have four out of five but am type 2. I think.

 

[phoenix]

I think it's really an indication of people who might prove to have LADA so might be worth testing. It was much better at excluding than including (ie l28% false positives) .It is a 'test' that needs to be replicated in other countries and with other larger populations.
Anecdotally, from people on forums I'd say that the best indicator seems to be fast unexplained weight loss.... but that can also happen in people who have untreated T2 .
People who are diagnosed with T2 most often have a reasonable insulin production but are also insulin resistant so requiring more than they produce. There are certainly also people with no antibodies but produce only a little insulin. Maybe they are more like people with MODY(MODY though is inherited) . We're back to trying to fit a multifaceted condition into too few boxes.

 

[LucySW]

Don't hang in there on your own Eddie, go and get help now. Read it up later.

Later, basal/bolus gives much more flexibility and control. Also, your insulin doses are massive. If it was me (and of course I know absolutely nothing about your circs), I would go very low-carb immediately, which would a) cut your insulin resistance, b) necessitate smaller insulin doses to match reduced carb intake, and c) in itself lower your BS. All these things are interlinked. The weight would probably melt away.

Big carb + big insulin = not recipe for happiness, as I understand it.

Good luck, get in there.

 

[eddie1968]

Cheers Lucy, thanks for the help. Read my dad's death cert and it only lists cause of death as 'Addison's Disease'. Googled this and it is an autoimmune disorder. On my diet I am mainly eating LCHF partly for my bowel, had half my colon removed due to surgery the year before my diabetic diagnosis and wow I had shed some weight then. Ta very much
Eddie

 

[Lesleywo]

Cheers Lucy, thanks for the help. Read my dad's death cert and it only lists cause of death as 'Addison's Disease'. Googled this and it is an autoimmune disorder. On my diet I am mainly eating LCHF partly for my bowel, had half my colon removed due to surgery the year before my diabetic diagnosis and wow I had shed some weight then. Ta very much
Eddie

Hi Eddie, just browsing the forum and I have just read your post. I would be interested to see if you have LADA. If your father had Addisons Disease then it's quite possible you have GAD antibodies (as I have), which are found in autoimmune diabetes. Do you have any other endocrine/;autoimmune conditions? They usually come in clusters (as if only having one isn't enough!), hence a lot Addisonians also have Type 1 or LADA, along with other autoimmune conditions.

Keep us posted

 

[eddie1968]

Cheers Lesley. Had some ketones in my urine at the weekend and GP referred me to DSN. I spoke to her yesterday and they have issued me with a Glucomen LX Plus meter with B-Ketone strips. She also said I might be a late slow Type 1. I have to go for more tests.

 

[phoenix]

Good that they are looking into it.
The info you have given now is much more like that of LADA
family history of autoimmune condition plus weight loss plus being under 50. (so three at least of the criteria I found that suggest testing is worthwhile

 

[Lesleywo]

Hey Eddie, have you had your tests yet?