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Confused .. Lada Or Type 2?!

nyalam

Member
Messages
10
Hello all, first post here and doing so in the hope of receiving some advice / guidance I would appreciate if able to help.

Was diagnosed as having diabetes with an Hba1c of 10.7% last month there. Never experienced any outward symptoms as the amount of water I have always drank could explain the urination. Due to my age and the fact I was (and always have been) a normal BMI I was diagnosed as likely having LADA type 1.5. Obviously I was horrified at first but having researched (endlessly) I had slowly started to come round to accepting things and seeing it as relatively straightforward compared to some of the other illnesses and conditions people suffer from across the globe. However there still remains doubt about my diagnosis and I don’t feel satisfied that the medical staff I’ve been dealt with know exactly what they are doing. I don’t doubt I’ve developed some form of Diabates but the recent blood tests I have had carried out have done nothing it confuse me!

I am based in russia and my partner has to do all the translating and so on so I have been unable to ask the questions I really want to ask. This whole **** is putting a pretty heavy strain on things between ourselves but that’s another matter ...

My blood results showed the following results - which place a degree of doubt in my mind that I am type 1.5 / on the path to type 1. If anyone can shed some light or context to these I would massively appreciate it.

C-Peptide (fasting) - 1.63 ng/ml (539pmol)
Insulin (fasting) - 5.7 u/ml

Neither of those two results points either way to type 1 or 2 I guess. My antibodies which were done last week all came back as negative. I was tested for 3 different ones and I think - via google translate - they were as follows:

Insulin antibodies- 3.9 IU/ml (ref. 0-10ml)
Beta Cells Pancreatic - 0.26 (ref <0.95)
GAD antibodies - 0.6 IU/ml (ref <1)

Which would indicate I’m likely not LADA or type 1. All very confusing and I am losing my wits over being in russia and not being able to speak to someone in plain English about it! Going back to UK in a couple weeks so will hopefully get chance to understand things better then.

Thanks in advance

John
 
Hello and welcome to the forum. Tagging @daisy1 for the info pack offered to all newcomers.

It must be very confusing and stressful a time for you. Sorry I can't help with your numbers as I am T2 but members with 1.5 and T1 will be along shortly to offer advice. Meanwhile, have you been given any medication for your condition?

Have a wander around the forum and ask as many questions as you like.
 
Morning Guzzler.

Thanks for the prompt reply and kind words. Yep was immediately put on Lantus 6 units a day which I take in the am and 1 x 1000 Glucofage (Metformin I think) to be taken at evening meal.

Going by MySugar app my Hba1c should be somewhere around the 5.3/4% level tho I have been eating pretty low carb and ramping up the gym appearances since diagnosis. It’s a bind not being able to eat as one feels. Tried a piece of millionaires shortbread the other as I was coming off the back of a couple of days in the mid to late 4s just to see what it would do and 2 hours later my levels were 9.5. A crushing blow that one!

Obviously if I had the choice it would be neither but I’d guess I’d be happier with a type 2 diagnoses than Lada and eventual type 1. But important to always remember is neither condition is an end game and there is plenty of scope for improvement to health and quality of life in each. Even if pizza sadly has to be curtailed in both!
 
Cutting down on carbs is the right way to go. As for pizza try Fathead pizza made at home. Dietdoctor.com has great recipes for meals and snacks as does Ditchthecarbs.com. Great readings btw. This whole Diabetes lark is a learning curve at the beginning, We have to find a way to manage the condition as individuals.

Just to add to your confusion, up to 20% of those diagnosed with Type 2 Diabetes are of 'normal' weight. There is also a 'honeymoon' period for those with Type 1 so it can get messy at times trying to figure out the corrrect diagnosis but your insulin seems to be having the desired effects so keep up the good work.
 

Blimey @nyalam - It's never great to have a diagnosis in a place where communication isn't easy. What were the circumstances of your diagnosis? Had you been unwell, or were the bloods drawn as a general check-up?

Do none of the medics you are engaging with speak English? Perhaps you could ask for some sort of translator to be provided by the hospital/clinic next time you are there. I appreciate you aren't in the UK, but the NHS has some decent support schemes in place for those for whom English isn't their mother tongue.

I'm sure it does all sound bewildering for you at the moment, but it sounds like it could be useful for you to write some notes, listing your concerns and questions, for using at your next appointment. That way, it's harder to forget something, and it could make things a bit simpler for your partner, if she still needs to be translating, as she would at least have some forewarning of the questions you want to ask and the topics you need to cover.

Whatever your diagnosis, it takes a while for the dust to settle and some form of "new normal" to descend on things. For most folks going onto insulin, it takes a while for their regime to settle and for dosing to be properly understood.

In UK, you would be offered an education course, covering all sorts of "stuff", but it also affords you the opportunity to meet other people diagnosed with diabetes, which can be really useful.

When you say you're coming back to the UK in a couple of weeks, is that on holiday, or are youreturning for the foreseeable future? Either way, it makes sense to get a GP appointment in the calendar now, to avoid any delays when you get home.

If you have online access to your surgery, you could maybe make the appointment that way (although for mine, if I'm overseas, I need to use a VPN), or maybe you could put a call in, or ask a relative to make an appointment for you. The past thing you need is to get home, then find you can't get an appointment for 3 or 4 weeks.
 
Hi,

Nah it was just something I had always had in back of mind as I couldn’t remember last time I had checked blood sugars and whilst outwardly healthy and fit I did consume a bar of chocolate a day and maybe a couple pizza (takeaway) a month for watching football etc on tv. Also a big bread eater. No family history of diabetes - type 1 or 2 - but a coworker had her blood glucose kit in school and I had a check. After a glutinous weekend involving eating out in a Georgian restaurant Saturday, a Dominos Sunday and Monday a breakfast of Armenian cheese and herb bread, irn bru (yes can get it here too!) and a couple squares of chocolate after getting to work it was 16.something. Very high indeed - and as stated my Hba1c was 10.7 so I was running high for a while without any noticeable symptoms other than urination which I put down to the fact I only really drink water (and lots of it) with irn bru and cola when eating out / on weekends.

I reckon as I was never overweight on BMI or suffered health issues I may have been running high for years due to my questionable diet choices as they never showed to any great extent other than a bit of podge in belly - but in mid-30s again this isn’t uncommon.

The gf is Russian as I said so she’s been a great help in translating and helping me get treatment and meds etc ... but there’s only so much she can do and as I said earlier this is putting quite a serious strain on relationship as both of us are getting frustrated and tearing our hair out at the condition - and at times I’m struggling to take it all in. I do have questions etc to ask but other than recommendations on diet there’s not been much forthcoming.

I work here as a teacher so I’m home for 2/3 weeks only. Already have a docs appointment set up for the day after I’m back but know full well that it may take some time to referred to a diabetes nurse / specialist. May take the hit and go private - we’lll see.

Thankfully the insulin (Lantus) and glucofage is at such a low dosage just now it’s been pretty seamless and manageable by cutting out the sugars and going to gym a couple days week extra. But I had obviously steeled myself as being a Lada and eventual type 1 - now with the latest antibodies results that seems a lot less likely. I don’t seem particularly insulin resistant either given my perfectly normal fasting insulin levels and slightly low normal fasting c-pep levels.

Diabetes doesn’t seem to be well understood here in russia even tho it is in the top 10 countries of new cases being diagnosed each year. Private care here is expensive for normal Russians and many can’t afford. I reckon the amount of alcohol problems one sees here and lower than normal life expectancy coupled with people incapacitated with missing limbs could be a cause of the lack of diabetes knowledge and access to education and care.

Cheers for the advice

John
 

An antibody test can't prove you're not LADA. It can only show that 75% of LADAs are so. The remaining 25% of LADAs will 'fail' the antibody test. Insulin resistance is classically associated with Type 2, so my guess is that you ARE LADA. LADAs have a honeymoon period lasting from a few months to a few years before their pancreas seriously diminishes insulin production. I lasted just over 4 years before going onto insulin, probably thanks to adopting a low carb diet from the beginning.

Здравствуйте
Geoff
 

I think it's noteworth that not all nailed on T1s have high antibodies, so that's worth bearing in mind. To be perfectly candid, as a T2, I can't recall the percentages I've seen posted for that situation, and I won't stab at a number, but I'll tag my colleague @Juicyj , whom I'm fairly certain has talked about this in the past.

Take it steady. Diabetes isn't the end of the world, but the beginning of a whole new phase of learning.

Good luck with it all.
 
Thanks for information Geoff, will keep an open mind on things until I get definitive clarification either way - however I also read that some diabetics can be stuck in a limbo region between type 1 and 2! There’s also the possibility I’ve developed MODY as well .... it’s a minefield.

Outwith the c-pep and the antibodies are there any other definitive measures to prove LADA either way - or is it a case of monitoring them over the course of the next year to see if they drop?
 
I'm not completely sure what type I have, but I think LADA is the most likely. (I didn't bother to ask for the tests, as by the time I knew about them I was already on insulin).
I think the most important is getting blood sugars as right as possible. When diet and tablets don't do enough, and insulin does, that's fine with me. If diet/tablets/exercise work, you still have to keep an eye on bg to see if that changes. Some people with LADA can go years without insulin, some need it right away. But then again, some type2's need insulin right away too.

I hope you'll find your answers, but in the meantime I would concentrate on getting better blood sugars. Good luck!
 
Hi @nyalam A GAD test isn't conclusive in diagnosing type, from trials with type 1 patients, 75% showed GAD antibodies at diagnosis. https://www.diabetes.co.uk/gad-antibody-test.html Your right about keeping an open mind, about diagnosis as the only real benefit to this is ensuring you are getting the right medication to suit your condition. Over time you will see what medication works to keep your blood glucose levels within range. It already sounds like you're doing a great job in keeping this in check, exercise is a really important tool in maintaining good control, as well as reducing your carbs which will help keep your insulin dose low, but also at this stage to avoid taking a quick acting insulin each time you eat carbs or need to reduce a high blood glucose level. Try to keep a diary of your results, it will help you identify patterns and see where adjustments can be made, Diasend is a good phone app and is free, or just keep a manual diary you can carry with you. When you see a specialist this will help them to see how you are managing. If your levels are climbing higher then it may be necessary to take a quick acting insulin to cover carbs eaten at meal times too. I have nothing but praise for the NHS over my diabetes care so would recommend this is the best access for you when you return to the UK, it's personal preference though whether you prefer private to NHS.

It's important to develop your knowledge and understanding of this, the more you know then the better equipped you are to manage this well and live a relatively 'normal' life. A good read which will be useful as you get your head round this is 'think like a pancreas' although written by a type 1 it's for anyone who has to manage diabetes with insulin.
 
nyalam said:
Outwith the c-pep and the antibodies are there any other definitive measures to prove LADA either way - or is it a case of monitoring them over the course of the next year to see if they drop?
Click to expand...

I'd say monitor your blood sugar levels. During my four years as an assumed Type 2, I was able to maintain good levels on diet alone, so much so that I gave up testing. When eventually I fell quite ill, I didn't suspect for a moment it was blood sugar related until a visit to my GP revealed levels in the 20s !!! You'll need to know when your pancreas has had enough, and given up.
Geoff
 
@nyalam

Hello and welcome to the Forum Here is the Basic Information we give to new members and I hope you will find it useful. Ask as many questions as you want and someone will be able to help.

BASIC INFORMATION FOR NEWLY DIAGNOSED DIABETICS

Diabetes is the general term to describe people who have blood that is sweeter than normal. A number of different types of diabetes exist.

A diagnosis of diabetes tends to be a big shock for most of us. It’s far from the end of the world though and on this forum you'll find well over 235,000 people who are demonstrating this.

On the forum we have found that with the number of new people being diagnosed with diabetes each day, sometimes the NHS is not being able to give all the advice it would perhaps like to deliver - particularly with regards to people with type 2 diabetes.

The role of carbohydrate

Carbohydrates are a factor in diabetes because they ultimately break down into sugar (glucose) within our blood. We then need enough insulin to either convert the blood sugar into energy for our body, or to store the blood sugar as body fat.

If the amount of carbohydrate we take in is more than our body’s own (or injected) insulin can cope with, then our blood sugar will rise.

The bad news

Research indicates that raised blood sugar levels over a period of years can lead to organ damage, commonly referred to as diabetic complications.

The good news

People on the forum here have shown that there is plenty of opportunity to keep blood sugar levels from going too high. It’s a daily task but it’s within our reach and it’s well worth the effort.

Controlling your carbs

The info below is primarily aimed at people with type 2 diabetes, however, it may also be of benefit for other types of diabetes as well.

There are two approaches to controlling your carbs:
  • Reduce your carbohydrate intake
  • Choose ‘better’ carbohydrates
Reduce your carbohydrates

A large number of people on this forum have chosen to reduce the amount of carbohydrates they eat as they have found this to be an effective way of improving (lowering) their blood sugar levels.

The carbohydrates which tend to have the most pronounced effect on blood sugar levels tend to be starchy carbohydrates such as rice, pasta, bread, potatoes and similar root vegetables, flour based products (pastry, cakes, biscuits, battered food etc) and certain fruits.

Choosing better carbohydrates

The low glycaemic index diet is often favoured by healthcare professionals but some people with diabetes find that low GI does not help their blood sugar enough and may wish to cut out these foods altogether.

Read more on carbohydrates and diabetes.

Over 145,000 people have taken part in the Low Carb Program - a 10 week structured education course that is helping people lose weight and reduce medication dependency by explaining the science behind carbs, insulin and GI.

Eating what works for you

Different people respond differently to different types of food. What works for one person may not work so well for another. The best way to see which foods are working for you is to test your blood sugar with a glucose meter.

To be able to see what effect a particular type of food or meal has on your blood sugar is to do a test before the meal and then test after the meal. A test 2 hours after the meal gives a good idea of how your body has reacted to the meal.

The blood sugar ranges recommended by NICE are as follows:

Blood glucose ranges for type 2 diabetes
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 8.5 mmol/l
Blood glucose ranges for type 1 diabetes (adults)
  • Before meals: 4 to 7 mmol/l
  • 2 hours after meals: under 9 mmol/l
Blood glucose ranges for type 1 diabetes (children)
  • Before meals: 4 to 8 mmol/l
  • 2 hours after meals: under 10 mmol/l
However, those that are able to, may wish to keep blood sugar levels below the NICE after meal targets.

Access to blood glucose test strips

The NICE guidelines suggest that people newly diagnosed with type 2 diabetes should be offered:
  • structured education to every person and/or their carer at and around the time of diagnosis, with annual reinforcement and review
  • self-monitoring of plasma glucose to a person newly diagnosed with type 2 diabetes only as an integral part of his or her self-management education

Therefore both structured education and self-monitoring of blood glucose should be offered to people with type 2 diabetes. Read more on getting access to blood glucose testing supplies.

You may also be interested to read questions to ask at a diabetic clinic.

Note: This post has been edited from Sue/Ken's post to include up to date information.
Take part in Diabetes.co.uk digital education programs and improve your understanding. Most of these are free.

  • Low Carb Program - it's made front-page news of the New Scientist and The Times. Developed with 20,000 people with type 2 diabetes; 96% of people who take part recommend it... find out why

  • Hypo Program - improve your understanding of hypos. There's a version for people with diabetes, parents/guardians of children with type 1, children with type 1 diabetes, teachers and HCPs.
 
Hi. I've been down the same route. My GAD was negative but my c-peptide was right near the bottom of the normal range and I believe that I was still coming out of the honeymoon period after many years. I suspect that a c-peptide test now would show me below the minimum 'normal' range. My blood sugar control with my insulin has become more critical with increased Bolus ratios. So, as others have said (and so does NICE), that the GAD test can be inconclusive with the c-peptide being more useful as knowing your insulin level is more important than knowing the cause of it being low. This then helps the right treatment i.e. insulin which I was initially refused as I was classed by default as T2. So if you are reasonably slim and having difficulty controlling your blood sugar with various tablets such as Gliclazide and having a LC diet then you are most probably LADA and needing insulin.
 
Since LADA is an autoimmune type of diabetes, meaning your own immune system is destroying your insulin producing beta cells, I think the presence of antibodies is necessary for the correct diagnosis of LADA. There are several antibody tests, besides GAD, that your GP can perform. That withstanding, beta cell burnout can happen in T2 diabetics, and a fatty pancreas can cause dysfunction, which may cause a T2 diabetic to require insulin. I went for 20 years misdiagnosed as a T2, when actually I was a slow developing LADA. It was so frustrating because I was doing everything right dietwise. I started out low carb, then when that didn’t work for long, I went lower carb, eventually on a very strict ketogenic diet with fasting. I lost over 65 pounds and have kept it off for almost 5 years...but, as soon as I thought I put T2 diabetes into remission, my blood glucose would start creeping up again. It didn’t make sense!! My fasting insulin was normal, my C-peptide was low-normal (if I was a T2, these numbers would most likely be elevated). It wasn’t until I asked my GP for the antibody tests to rule out LADA that I discovered my GAD antibodies were sky high!! I was bummed at first, having to start insulin, but now that my BG is beautiful and running in the normal range, I’m actually relieved to discover the missing puzzle piece that finally makes everything in my long struggle make sense.
 
Again thanks for sharing your experiences on the journey you’ve had ... it’s another example of how hard diabates can be to nail down!

I understand from the advice given earlier in the thread that GAD negative - like me - doesn’t always mean it’s the all-clear from Type 1 Lada. However I was also tested for the two other main antibodies related to diagnosis of type 1 and again was negative in both cases.

Similar to yourself the fasting insulin and C-Peptide figures .... I wonder what the c-peptide of a non diabetic person would be for reference?

If it is to be type 1 I’m on the path to I’ll look forward to the day I am in more control of it with bolus insulin!
 
Yep Daibell this sounds like it could be a mirror of what I’m going through just now - not only GAD but the other two main antibodies used to test for type 1 were also negative yet if I wasn’t using 6 units of basal per day I think my blood glucose would be much less easier to control and spike more after eating - something which I guess type 2s usually have more control over than Lada going into type 1s.

I’ve been trying to watch carefully what I eat, but as a mentioned earlier in thread a piece of millionaires shortbread had me up around 10 2 hours after! I know the 6 units basal I currently take aren’t meant to level out post meal spikes but still it showed that my blood sugars are too out of control for me not have insulin.

My C-peptide being 1.63 ng/ml whilst fasting wouldn’t appear to be really low normal either - but you reckon that’s it on the way to being so? Out of interest would you have any idea what the fasting c-pep of a non-diabetic person would be?

Cheers

John
 
Hi. I think all you can do at present is to see how your HBA1C goes over the coming months/years and if it increases then have another c-peptide test done? At least you are now on insulin which is a good treatment even if T2 and not LADA and a Bolus can always be added to provide optimal control. I suspect a non-diabetic would be somewhere mid-range with a c-peptide test as the body should be producing 'normal' insulin levels and not high (T2) or low (T1/LADA)
 
Was at doctor today and that’s basically what we discussed - through interpretation - that as there’s no antibodies present and the C-Pep and Insulin are ‘normal’ the only course of action is to do the 3 month Hba1c in August as well as check C-Pep levels to back up the likely belief that it’s Type 1 Lada. If not any discernible difference in C-Pep & insulin then genetic testing for MODY - another hit in the pocket’
 
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