Do They Always Test For Lada?

[ringi]

What's Lada?

Very slow speed type1, a child with type1 often will go from normal BG to producing no inslin within weeks, adults with type1 often take months, people with LADA take many years.

Hence unlike full spead type1, LADA can often be controlled just with diet for many years.

 

[KK123]

With levels like that they should have started you on inslin while waiting for the test results. Stockport has a "phone a consultant" service GPs can use to get advice to try to prevent this type of error. I was told by a consultant that a GP is unlikey to see more then 1 or 2 adult type1 new cases in their life.

ringi, I would suggest that is because most GPs would not be able to recognise one!

 

[Deleted Account]

I was told by a consultant that a GP is unlikey to see more then 1 or 2 adult type1 new cases in their life.

That's very surprising considering 57% of people with type 1 are diagnosed over the age of 20: https://blogs.diabetes.org.uk/?p=5184

 

[ringi]

That's very surprising considering 57% of people with type 1 are diagnosed over the age of 20: https://blogs.diabetes.org.uk/?p=5184

But often not by GPs, also think about how few people have type1.

 

[Deleted Account]

But often not by GPs, also think about how few people have type 1.

If you are suggesting someone else apart from a GP does the type 1 diagnosis, this is not my experience: I was diagnosed by my GP. As I said earlier in this thread, when diagnosed as an adult, the onset is usually slower and less likely to result in emergency hospital admission.

As for fewer people having type 1: one tenth of the people with diabetes, have type 1.
If the other 90% have type 2, this suggests the average GP will only diagnose 36 people with type 2 in their life.
[I have taken the upper limit of 2 adult type 1 diagnosis, assumed this is half the total diagnosis (rounded down 57%) and then multiplied by 9.]

Sorry, I am not trying to be provocative or argumentative; I am trying to share my experience and research ... and I am sure you are doing the same - it's interesting to read the different takes.

 

[ringi]

Also people are often sent to consultant or DN when metformin does not work.

 

[Kailee56]

Lot of people with LADA are inslin resistance, there is nothing stopping someone having type2 and LADA at the same time. Hence if the NHS was to do more tests as standard, I think the most useful would be fasting inslin, so that someone's inslin restiance can be tracked.

I thought the fasting insulin level would be OK, as long as you weren’t on insulin. Then I read, in the labs’ description of the two tests, that having insulin antibodies can distort the results. That’s why I would recommend the C-Peptide if you are trying to rule out LADA.

I know I’ve read T2’s may eventually need insulin. I thing Dr Fung called it something like T2 + 1. I also know that LADA is often misdiagnosed as T2. I did not know that it was possible to be insulin resistant when you body cannot make insulin due to a autoimmune attack. Thank you for the information. Will have to do some more research.

 

[Bluetit1802]

I did not know that it was possible to be insulin resistant when you body cannot make insulin due to a autoimmune attack.

Yes, perfectly possible.

 

[Kailee56]

Yes, perfectly possible.

Could you stear me toward any studies. I would really like to learn more.
Thanks.

Just found one. Thanks so much. Can never stop learning.

 

[handicapable]

No, it's not standard to test for T1 (LADA) upon diagnosis with diabetes, unless you land in hospital with ketoacidosis.

Which is exactly what LADA looks like if caught early.

I found myself in a hospital bed with ketoacidosis 3 weeks ago and was diagnosed as being T1 but I'm fairly certain I have T1 (LADA) as I'm 30 years old, was experiencing symptoms for many months and I've found with some drastic lifestyle changes I'm barely having to take any of the prescribed insulin.

I made a forum post titled 'Does This Sound Like Type 1 Diabetes?' in the 'Newly Diagnosed' section last night that goes into greater detail that's worth checking out and based on what I've read about the various forms of diabetes I'm not taking it for granted that I was screened for T1 (LADA) whilst in hospital and I'm going to bring up the subject when I see my DN on Friday.

 

[NewTD2]

It's like what I said everyone's journey to their diagnosis is different. My bloods at first we're in the high 20's and low 30's. 2 months in my average is about 6. I don't know much about type 2 in terms of control and meds. But different types have different things you can take as positives. That's one of the key things that has helped me. Yes I'm a type1(LADA) and multiple daily injections look grim... But I can eat more or less what I want. And after sinking a pack of 3 krispy kreme donuts the future isn't looking too bleak with a little bit of understanding.

I love Krispy Kreme Donuts...delicious!!!

Unfortunately I can’t have them anymore, not allowed!

 

[Jollymon]

Could you stear me toward any studies. I would really like to learn more.
Thanks.

Just found one. Thanks so much. Can never stop learning.

The term for it is called “double diabetes”. Just look that up.

 

[handicapable]

Type 1 diabetes in adults: diagnosis and management
NICE guideline [NG17] Published date: August 2015 Last updated: July 2016

1.1.3 Do not measure C‑peptide and/or diabetes‑specific autoantibody titres routinely to confirm type 1 diabetes in adults. [new 2015]

*This was copied from NICE.org.uk so if you have recently been diagnosed do not assume they would have tested for LADA*

 

[kitedoc]

What bugs me is the attitude of diagnosis of T2D by BSL/HBA1C and age, and only if the bsls go way up (which you may have no meter to test for and ketones appear (which you have no way of testing) at some indeterminate time in the future ( days to years), by which time you can be in DKA (a medical emergency), does the penny (or whatever the modern day currency equivalent) drop.
Health rationing is compromising health. And I really wonder why pathology testing is not cheaper at times ( not that I am advocating wage and staff cuts). Could local chemist provide, at nominal cost, opportunities for patients without glucose monitors the chance to check their BSLS, community nurses also.
Most GPs would have monitoring facilities, including freebies given them my company reps etc. Why cannot someone with T2D denied a meter and unable to afford one, at least call in to their GP's surgery to see nurse and get a BSLs done and if high a ketone reading ? Commonsense and a better 'index of suspicion' need to prevail.

 

[Seacrow]

What bugs me is the attitude of diagnosis of T2D by BSL/HBA1C and age, and only if the bsls go way up (which you may have no meter to test for and ketones appear (which you have no way of testing) at some indeterminate time in the future ( days to years), by which time you can be in DKA (a medical emergency), does the penny (or whatever the modern day currency equivalent) drop.
Health rationing is compromising health. And I really wonder why pathology testing is not cheaper at times ( not that I am advocating wage and staff cuts). Could local chemist provide, at nominal cost, opportunities for patients without glucose monitors the chance to check their BSLS, community nurses also.
Most GPs would have monitoring facilities, including freebies given them my company reps etc. Why cannot someone with T2D denied a meter and unable to afford one, at least call in to their GP's surgery to see nurse and get a BSLs done and if high a ketone reading ? Commonsense and a better 'index of suspicion' need to prevail.

Oh boy. Clearly the medical service where you are is structured differently to where I am.

OK, diagnosing t2 by blood sugar levels is insufficient, we agree there. But adding in the ketone level and the length of time symptoms have been apparent gives a reasonable indication for most people.

Testing for ketones - ketoDiastix. I was given a pot of 20 and told I could buy more from the chemist over the counter, or get them prescribed if the GP believed I wasn't wasting them.

Testing bg - my local pharmacy lets the pharmacist test your bg if you go in feeling ill and say you are an unmonitored t2 diabetic. Also, at my GP you CAN make an appointment to see a 'diabetes nurse' and have your bg measured. If you can show that you're using the results, they'll give out a glucose tester. Still limited test strips though. Heck, there's a stall once a month outside the supermarket that offers a free bg test if you take their food advice leaflets.

I'm a bit of a special case, my diabetes is complicated, but I have strolled into my diabetes clinic (no appointment with doctor or nurse) and requested a blood test, including thyroid and lipid panel. They dig out a doc, he listened to my reasons, and said yep go ahead with it. Got the results the next day (speed due to my kidney disease). I have found that generally, if you have a clear logical argument, you can get what you need as an individual. Pity it doesn't work on politicians.

 

[kitedoc]

When a person has one autoimmune disease, developing another is more likely than the norm. Consider the number of diabetics (all types) with Hashimoto's Thyroiditis.

Perhaps coeliac disease is another to add to that list !!

 

[kitedoc]

Oh boy. Clearly the medical service where you are is structured differently to where I am.

OK, diagnosing t2 by blood sugar levels is insufficient, we agree there. But adding in the ketone level and the length of time symptoms have been apparent gives a reasonable indication for most people.

Testing for ketones - ketoDiastix. I was given a pot of 20 and told I could buy more from the chemist over the counter, or get them prescribed if the GP believed I wasn't wasting them.

Testing bg - my local pharmacy lets the pharmacist test your bg if you go in feeling ill and say you are an unmonitored t2 diabetic. Also, at my GP you CAN make an appointment to see a 'diabetes nurse' and have your bg measured. If you can show that you're using the results, they'll give out a glucose tester. Still limited test strips though. Heck, there's a stall once a month outside the supermarket that offers a free bg test if you take their food advice leaflets.

I'm a bit of a special case, my diabetes is complicated, but I have strolled into my diabetes clinic (no appointment with doctor or nurse) and requested a blood test, including thyroid and lipid panel. They dig out a doc, he listened to my reasons, and said yep go ahead with it. Got the results the next day (speed due to my kidney disease). I have found that generally, if you have a clear logical argument, you can get what you need as an individual. Pity it doesn't work on politicians.

Thank you. I was actually using examples of what other posters have described in UK. In Australia my impression is that LADA is not well known by GPs. They tend to defer such decisions about antibody tests to the endocrinologists although with appropriate wording on requests for C-peptide etc they are not penalised (as far as i know) by Medicare.
Like you describe in your area, nurses at GP clinics here can do BSLSs pretty much on demand and ketostix are really available also.
More education for GPs on LADA, T2, T1 as far as diagnosis is concerned and some guilleines on follow up of persons with ambiguous diagnosis finding seems like a good idea.

 

[Julie27318]

I love Krispy Kreme Donuts...delicious!!!

Unfortunately I can’t have them anymore, not allowed!

I used like the little jam cram ones from Morrisons 4 in a bag!!!ohh i do miss um, it's heartbreaking!!!

 

[Marie 2]

I caught my blood sugar at home when it was 120 when I would first get up. I went to the Doctor and he said it was just a fluctuation. Next year same thing, A1C higher. By 3 years later I was waking up around 200. By this time I moved and went to a different Doctor. I had told them I had an uncle who had been type 1, could I be? I had been a vegan for 20 years had been slowly losing weight but was very active, But because I was overweight I believe she just kept telling me, no you're not type 1, you're type 2. The medications wouldn't work at all if you were type 1. (so wrong) Even the specialist they sent me to said no you're not type 1 let's try some of the medications again, even though they had made me sick with hardly any improvement. I refused to go back to him.

I got a new Doctor, an internist that put me on both kinds of insulin and she was happy I was having an A1C of 7.2-7.4, but the group got a new endo she sent me to that tested me for type 1 (LADA) without me saying anything or knowing she was even doing it. I had given up on thinking I was a type 1 because of the first specialist and Doctor being so sure I wasn't. And I didn't know any better to still question it.

To this day I am so thankful to the new endo and the internist that had just went ahead and put me on insulin. I don't have any side effects from being a type 1/LADA, so many do by the time they are properly diagnosed. It explained so many things.

So no, they don't always test you and seem to want to just label you. The endo that diagnosed me is a type 1 herself and probably recognized that I had an uncle that was type 1, and maybe that I was thriving on insulin, and that something else might be going on. Maybe the healthy diet and active job helped too. But I'm thankful.

 

[Alexandra100]

I used like the little jam cram ones from Morrisons 4 in a bag!!!ohh i do miss um, it's heartbreaking!!!

Yes, it's hard! You know, double cream is still on the menu. I love it with Hartley's 10cal jelly pots. Strawberry flavour are only 0.2g carbs per pot. They are extra nice chilled in the fridge. The full price of £0.75 is rather steep, but if you shop around you can find them cheaper.
http://www.hartleysfruit.co.uk/our-range/hartleys-jelly/hartleys-10-cal-jelly-pots/