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Getting diagnosed

Discussion in 'Type 1.5/LADA Diabetes' started by kellywelly, Jul 15, 2017.

  1. kellywelly

    kellywelly Type 2 · Member

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    Hi

    I was previously diagnosed as Type 2 Diabetic 3-4 years ago. I have until now been managing this with Metformin and my hba1c was pretty good. At the beginning of the year, this rose from the 40s/50s to the 90s. At the time the hospital thought that this was due to stress, as my parent had recently been diagnosed with Cancer and my sister had had a heart attack.

    They increased the dose of Metformin and said that it would improve. My diet hasn't changed, but even with the extra medication my latest hba1c has actually risen. Now my GP thinks that the reason may be that I am LADA.

    My hospital doesn't have any available appointments for the diabetes team until September, so they have now written to my GP with me in cc and confirmed that I could have LADA and asked for my GP to start me on insulin. It was such a shock that the first I knew that this would be happening was via a letter in the post.

    I thought I had a good understanding of Diabetes and now I am freaking out as much as I was with the first diagnosis. The only relief is that with daily ranges from 10-22 for the last 4 months, at least I might start feeling better.

    Is it normal for the Diabetes team to delegate starting insulin to your GP? I have a great one, I'm just concerned that I may get rushed through it because they are so busy.

    Also, is it likely that the hospital will test me officially for LADA, or should I push for it?

    How did other people find switching from Metformin to insulin?

    Any advice would be much appreciated.

    Kelly
     
  2. catapillar

    catapillar Type 1 · Well-Known Member

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    Have you had a cpeptide test to see what your insulin production is looking like? Have you had a GAD test to see is you have the antibodies associated with type 1? If not, it seems a bit of a leap to decide that an increase in hba1c is because you are LADA rather than just a progression of type 2. It also seems a bit of a leap to go from metformin straight to insulin when usually the treatment for type 2s would be to try sulphonyureas first, although these aren't recommended for LADA.

    Going on insulin won't hurt while the tests are awaited. Your GP will be perfectly capable of starting you on insulin. Your GP is also perfectly capable of ordering cpeptide and gad tests.
     
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  3. Daibell

    Daibell Type 1.5 · Expert

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    Hi. It is surprising that the hospital has made the leap from Metformin to insulin without going thru the sulfonyl ureas such as Gliclazide. I agree that someone should be doing the GAD and c-peptide tests. My surgery, in fact the DN, started me on insulin with no problems. There is nothing against going from Metformin to insulin but you may find you only need small shots to start with. BTW I'm assuming you are not overweight? If you have a lot of excess weight you will almost certainly be T2 not T1 and need to seriously reduce the carbs.
     
  4. Bluetit1802

    Bluetit1802 Type 2 · Oracle

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    I agree with the others that this seems a big leap and a big supposition. You need the GAD and the C-peptide tests to confirm all this. You need to push for these. If it happens you are still T2 but uncontrolled, it could be down to increasing insulin resistance. If that is the case there are other ways to combat this. (Diet being the key, along with exercise and other meds) If you are producing plenty of your own insulin, but your cells are rejecting it, the cells will also try to resist some of the injected insulin.
     
  5. ringi

    ringi Type 2 · Well-Known Member

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    Personally I think insulin is less bad for a Type2 (insulin resistance) then long term Sulfonylurea as Sulfonylurea can over work the pancreas and can make it fail sooner. I think I would be pushing for SGLT2 Inhibitors (Forxiga) if I needed more then metformin unless there was a good reason for me not to take them.

    But Forxiga are "off label" for Type1, so going directly onto insulin until the hospital can do a full investigation may be a very sensible option.
     
  6. librarising

    librarising LADA · Well-Known Member

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    It sounds like LADA to me. I spent 4 1/2 years as a T2, diet-controlled alone and not taking Metformin. My HbA1c went from 42 to 102 within months. I'd stopped testing because I'd learned how to control my blood sugars on lowcarb. I see no other reason yours has gone up so much. Sure, push your GP for tests, but I'm suspecting insulin will be what you're needing. I was never tested for c-peptide, and my GAD came back negative (25% of T1/LADAs do)
    I was initially under my local Diabetes Clinic, but they released me back to my GP's care.
    Feel free to ask me anything
    Geoff
     
    • Informative Informative x 1
  7. kellywelly

    kellywelly Type 2 · Member

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    My GP has tried to order the tests but he has not been able to, the Diabetic nurse has provided the name of another Dr at the hospital who has to authorise these. This is now happening.

    The original plan after the first raised hba1c was to try other medication before insulin, but the latest results have speeded this up.
     
  8. kellywelly

    kellywelly Type 2 · Member

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    From what I have read, I thought judging by weight alone was how LADA was easy to misdiagnose?

    In my case, I do have some weight to lose, but I have been losing it steadily over the past year using Slimming World and even though I'm losing weight, my levels continued to rise. The dietician couldn't figure out, as she was happy with my diet. I already have cut down on carbs.
     
  9. kellywelly

    kellywelly Type 2 · Member

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    Thanks Geoff. Much appreciated.

    Did you see a fairly immediate result with the switch to insulin? After having good control and feeling pretty well, I'm now really feeling how much the rise in levels is having all of the time. I feel awful. As much as I hate the idea of insulin, I really want to feel better.

    Diet/carbs is not having any impact at all now, where as previously it did. I'm seeing the most random levels.

    Did the insulin make you put on weight? I've worked hard to lose quite a lot of weight. I'm worried I'll start putting it back on.

    Thanks.
     
  10. librarising

    librarising LADA · Well-Known Member

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    I felt awful for several weeks before going on to insulin, with blood sugars in the 20s, nudging 30. I felt instant relief after starting the insulin. It took some weeks for blood sugars to get down to normal levels as my doses were gradually increased.
    In the weeks before insulin I lost a stone in weight. This went back on along with an additional 5-6 lbs, but this has long since stabilised at that slightly higher level.
    My regime is Levemir (started on bedtime but I switched to twice daily) and Novorapid to cover meals.
    Geoff
     
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  11. ExChocoholic

    ExChocoholic Type 2 · Well-Known Member

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    I had same issues - dx 2007 steady control until December 2015. Now nothing will get my BS and taking 2000mg SR metformin. I asked to see endochronologist specialist in diabetes. Saw him yesterday, he is considering that I may have LADA but starting low dose gliclazide also further blood test and being put under his clinic care rather than GP - had thorough examination and getting cardiogram and kidney scan. Strange your GP has ordered insulin without further investigations or trying gliclazide.
     
  12. ringi

    ringi Type 2 · Well-Known Member

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    Insulin is a good "holding action" until he can see a consultant, the consultant appointment is already booked. Gliclazide has risks if used by someone with diabetes that is not understood yet.
     
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  13. azure

    azure Type 1 · Expert

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    Gliclazide isn't recommended for Type 1 (LADA is a form of Type 1). Moreover, some studies have shown that early introduction of insulin can preserve remaining beta cell function for longer :)
     
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  14. ExChocoholic

    ExChocoholic Type 2 · Well-Known Member

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    I'm really worried - I saw an endochronolgist at a diabetes clinic - he wants to take gliclazide 40mg - and get more tests for suspected LADA. He mentioned possibility of insulin. Now I am hearing much negativity regarding gliclazide in relation to LADA. If I can't believe the professionals I am not sire what to do. Not been happy about gliclazide as I had seen negative comments long before I ever dreamt I would be anything but T2.

    Sent from my SM-G930F using Diabetes.co.uk Forum mobile app
     
  15. DaftThoughts

    DaftThoughts LADA · Well-Known Member

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    Diabetes is a condition where you learn to fend for yourself as you learn how to manage it. Medical professionals know the medical details and how things work in theory, but they're typically not very interested in anecdotes and self-management from patients and prefer to use a generalized approach in my experience. My DSN still thinks Metformin actively lowers bloodsugar when in reality that's not really what it does. They overly simplify things towards patients and then end up trusting the simplification too much themselves.

    Many who treat us don't actually have the condition themselves and while we're dealing with diabetes 24/7 without a break, they go home at the end of the day and forget about it. It's a job to them, so I can't expect them to have this same deep understanding of diabetes that I do.

    The reasoning behind gliclazide for LADA is that some doctors think that insulin dependency should be put off as long as possible. Unlike with T1 and T2, opinions on how to treat LADA are still very divided - some think insulin should be given immediately, others disagree. The idea is that the gliclazide puts off insulin for longer by forcing whatever cells are left to work overtime. This leads to an equivalent of burnout in the cells, but if a doctor prioritizes not being on insulin for even a few months longer they're usually fine with that.

    As a patient you have the right to choose your own treatment. You can opt not to take gliclazide and wait for the test results, and if they come back positive for LADA, you can request insulin. As LADA means you can't manage it with diet and exercise alone in any case whatsoever, you're entitled to insulin. Or you can take gliclazide and see how it works out for you.
     
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  16. ringi

    ringi Type 2 · Well-Known Member

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    The reasons I don't think gliclazide is right for LADA is that keeping even a very limited number of cells than can produce insulin in response to BG changes can result in someone only having to take high half life "insulin", rather then having to work out the correct dose of short half life insulin for each meal.

    But there is more to go wrong if someone is put on insulin unless they get very good training in how to manage their insulin.
     
  17. badcat

    badcat · Guest

    There are also forms of monogenic diabetes ( Specific gene mutations in Mody etc) that make the body v sensitive to sulphonylureas like glic and in turn enable long term low dose useage of this med in preference to others. It is laregly the fact that I have been on the same low dose of Glic for over 20 years, that is now making the medics question my T2 diagnosis
     
  18. ringi

    ringi Type 2 · Well-Known Member

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    That's one reasons I wish insulin resistance was tested for (fasting BG divided by fasting insulin levels) as it gets very confusing with Type2 being used to cover everyone that is not Type1.
     
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