Confused at diagnosis

L.A.D.A. is a slow-onset form of type 1 diabetes. To quantify the word "Slow," some people are able to live more than 10+ years before they become insulin-dependent.

If the nurse told you to read up on LADA/Type 1.5 then there SHOULD have been a reason to say that. It's a much more rare disease than type 2 and medical professionals don't just throw that term around.

The possibility of you having LADA isn't as worrying as the (seemingly) much higher possibility that your doctor is an a**. If a doctor didn't know what lada/type 1.5 was, I wouldn't even let them touch me (much less diagnose me).

This is NOT something you put off. You need to figure out why the nurse told you read up on LADA and consider finding a new doctor. Even a first year med student should know what type 1.5 is.

Galja said:

There is a special test for lada

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Do you know what the special test for LADA is? I just assumed it would be a GAD test & observation as to how slow the onset is.

Hi. Your HBa1C is quite low so your diabetes on that scoring is marginal - perhaps only pre-diabetes? As others have said LADA (Late onset T1) occurs when the pancreas is failing to produce enough insulin and tends to show-up in those who are slim and may be younger. T2 is when there is too much insulin but the body can't use it due to insulin resistance. T2s are often overweight. There are two tests for LADA i.e. c-peptide and GAD. If you haven't had these tests and you're not slim then LADA is less likely. I'm generalising but I'm afraid the GPs do that as well!

Thanks @Galja I read the articles & I confess I'm confused. I still think it's a GAD test and observation of the speed of the onset.

@Daibell sorry to bother you, but do you know if there is any further antibody tests for LADA? Or is diagnosis just a case of someone actually taking notice of what you are saying, diminishing c-peptide & positive GAD? Because, if there is a special test for LADA I'm sure it would help OP to be able to ask for it be name from her less than informed doctor, but if there isn't, asking for a special test for LADA probably isn't going to get her very far.

Galja said:

It is somewhat of a complex process depending on peoples' antibodies or some such, but here is an article

http://care.diabetesjournals.org/content/29/5/970.long

http://care.diabetesjournals.org/content/29/5/970.full.pdf+html

The bottom line is that there are certain drugs, like Byeta, sitagliptin and others which are not supposed to be given to LADA folks. Also, the amount of time the process takes for onset is also of concern

general

http://diabetes.diabetesjournals.org/content/54/suppl_2/S68.full.pdf+html

A testing opinion is here by

Bruce Bode, MD

Atlanta Diabetes Associates

JDRF Research Team/ CGMS

"LADA is just a subset of Type 1 diabetes occurring later in life. IT IS TYPE 1 DM!! NOTHING MORE OR LESS. We see Type 1 presenting all the time in adulthood but most primary care physicians and even endos and CDEs miss it, thinking it is burned out Type 2 diabetes.

"All patients presenting the hyperglycemia that is not classic Type 2 diabetes (obese, direct relative with Type 2 DM, no weight loss) should be screened for auto-antibodies to the Islet cell or insulin (ICA, GAD, IA2, IAA, and Zn T - autoimmunity marker tests). If positive, treat as a Type 1 with multiple daily injections or insulin pump therapy. If negative, still treat with insulin if symptomatic then revert to metformin plus incretins, with or without a TZD drug.

This should be standard of care but it is not."

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Wow. How nice to see a medic saying what many of us know from our own experience and that the NHS could do well to note. Even NICE is now beginning to accept LADA.

catapillar said:

Thanks @Galja I read the articles & I confess I'm confused. I still think it's a GAD test and observation of the speed of the onset.

@Daibell sorry to bother you, but do you know if there is any further antibody tests for LADA? Or is diagnosis just a case of someone actually taking notice of what you are saying, diminishing c-peptide & positive GAD? Because, if there is a special test for LADA I'm sure it would help OP to be able to ask for it be name from her less than informed doctor, but if there isn't, asking for a special test for LADA probably isn't going to get her very far.

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Good questions. My two diabetes GPs weren't aware of LADA and I had an argument with my current one who said you aren't a T1 therefore you are T2 (I was diagnosed with a urine stick in the doctors office!). I was stick thin all the time. I gave up with them and paid for my own two tests (c-peptide and GAD) done privately. The GAD was negative and the c-peptide showed quite low insulin. I've since learned from the 2015 NICE Diabetes T1 Guidelines that the GAD test becomes less reliable as time passes after diagnosis but the c-peptide becomes more reliable. The Guidelines also say the GP should take note of anyone who is slim. My test was 7 years after diagnosis. There are a good few known antibodies beyond GAD and IA-2 but they are rarer. Some labs that do GAD also do IA-2 as well. There are other causes of islet cell failure including viruses and pancreatitis. In my case for various reasons I believe I had some form of inflammation of the pancreas. GPs are reluctant to do the two tests anyway partly due to ignorance of their existence or the cost to the NHS. The acronym LADA implies antibody destruction but it isn't just antibodies which is why my siggie says T1.5 and not LADA. The bottom line is that a low c-peptide means you need insulin - whatever the cause. If the GP refuses to accept the point then you need to ask for a referral to the clinic or pay for the two tests yourself (approx £300). I'm still listed as T2 but I know I'm T1 hence the NHS diabetes stats are messed-up and this affects the focus of research.