Help please - freaked out - is GAD indicitive of Type 1?

[elaine77]

The cake would have no doubt had carbs in which do take longer to be brought back down. Sugar spikes you really really high but comes down quite quickly compared to carbs so I don't think it will be as bad as the cake was. I can understand your reluctance but its so much worse to have the doctors not diagnosing you properly because your tightly controlling your condition at the moment. Unless they think you're condition is serious diabetes ur unlikely to get access to all of the tests/checks etc.. that everyone else gets.

A few hours of a high would be nothing compared to long-term issues due to an incomplete diagnosis. Also, when your control starts to slip and you need to move onto medication or insulin they will make you do it then anyway when you have even less cells left so I defo think the sooner the better for your cells in the long run. Nothing happens in the short term with this disease other than hypos....it's a progressive disease that over time has consequences not just the odd day or even be odd week...


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 23 currently controlled by only Metformin, 500mg twice a day.

 

[Sunshine_Kisses]

Thank you for the reassurances, I really do appreciate it... I had an ah ha moment this morning and suddenly remembered my uncle is a doctor (derrrrrr!!) - he lives in Germany so I don't see him that often, which is why, in amongst being emotional about my GAD results I sorta forgot. Anyway, I've just emailed him all my blood test results to look over and asked for his thoughts - so be interesting to see what he comes back with....

 

[Sid Bonkers]

Hi , running high bg levels for a few days is unlikely to do any lasting harm it is high levels over a long period that does the damage. Your low carbing prior to a proper diagnosis is probably actually hindering your diagnosis by covering up the very symptoms your doctor and endo are looking for and if you have a glucose tolerance test you will have to eat carbs prior to it as phoenix states.

So try to relax, short term high levels will not harm you, I was running at 29 mmol/L prior to my diagnoses and was almost unaware that I had any problem, it is very easy to slip into being obsessed about carbs, so just try to relax a bit then after your diagnosis is sorted out you can start to think about your new lifestyle and what you can and cant eat.

 

[elaine77]

Wen I had my OGTT test for my GD I didn't have to eat carbs... I'm not sure whether eating carbs would make much difference? Surely any diabetic who drinks that glucose solution is going to shoot right up straight after it regardless of their diet? Maybe ask your doctor if you do need to be eating normal carbs prior to this test....I'm sure he would have told you to if u needed to....


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 23 currently controlled by only Metformin, 500mg twice a day.

 

[phoenix]

I believe these are the normal instructions though obviously ask your doctor

Conducting the oral glucose tolerance test[18]
•Test preceded by ≥3 days of normal, unrestricted diet (>150 g carbohydrate daily) with normal physical activity.
•Carbohydrate-rich meal (30-50 g) on night before test.
•Overnight fast of 8-14 hours; drink only water.

http://www.patient.co.uk/doctor/Glucose ... -Tests.htm

The reason is because on a low carb diet you may actually have a reduced carb tolerance .
So if you are on a low carb diet your levels following the glucose challenge may be higher than they would be. Eating more 'normally' for a few days will give a better indication of your true tolerance.

This quote from a letter in the Lancet describes 2 different views as to why they think this happens (the full paper is behind a paywall)

Takashi Kaneko and colleagues (July 25, p 289)1 discuss the importance of carbohydrate intake before an oral glucose-tolerance tests (OGTT). They conclude that the impaired glucose tolerance after a low-carbohydrate meal is due to the proportionally less insulin release in response to glycaemic stimulus, and that the decrease in insulin secretion is associated with the Randle effect.2 The insulinogenic index was significantly decreased after the low-carbohydrate intake, but no significant difference in the insulin concentrations before and 30 min after OGTT was found between patients on the low-carbohydrate intake and high-carbohydrate intake. Therefore, we think that the impaired glucose tolerance after the low-carbohydrate intake reflects insulin resistance rather than decreased insulin secretion, since free fatty acids inhibit use of insulin-stimulated glucose in muscle via the Randle effect

http://www.thelancet.com/journals/lance ... 40-6736(05)60563-6/fulltext

.

 

[Sunshine_Kisses]

Thank you Phoenix - really helpful... I do remember reading something somewhere else that said you need to carb load before the test or else you're guaranteed to do badly on it...

 

[smidge]

Hi Sunshine!

Yes, it does look like your consultant is questioning your diagnosis because your fasting BG is in the impaired glucose rather than diabetic range. He should **** well know that this is typical of LADA on a low-carb diet. I had exactly the same issues. My fasting BGs used to be in the 4s and my HbA1c was only 5.3% when I first saw the consultant - he wrote to my GP more or less telling them to stop wasting his time and he offered to undiagnose me. The GTT showed quite clearly that I was diabetic, but they don't seem to understand what an impact low-carbing has on LADA. As much as you don't like it, you do need to increase your carb intake, record the bad PP spikes as evidence, have the OGTT done and fail it. Then you'll get an accurate diagnosis - otherwise you could be in this battle until you actually become ill with Type 1 sort of symptoms, which is what happened to me. Play their game and get your diagnosis would be my advice. As Elaine says, you could ask for a c-peptide test, but the easiest way really is to prove to them that you are diabetic by doing that OGTT.

Take care

Smidge

 

[SamJB]

I'm a bit late to this thread as I've been away with work for a few days, but I think you've had some great advice. I did think from other threads you've been on that you don't appear to be a typical Type 2 case. Best of luck, hope you have a constructive meeting with your consultant.

 

[Sunshine_Kisses]

Thanks Smidge & Sam... I spoke to my uncle (the doctor, who's based in Germany) today - he said that given my test results - and blood sugar readings pre carb reduction, I'm undoubtably type 1... I see my GP in the morning so it will be interesting to see what he has to say... Will keep you posted, but really appreciate all your replies - feeling v 'bouncy' at the mo...

 

[Syl 1]

Hi I too thought i was t2 for 2+ years. Consultants registrar now thinks im t1 but my diabetic nurse says im in a grey area and is finding what works for me. Cut out metformin and am continuing lantus in a morning and have a quick acting jab before each meal. Levels generally a little high at the minute but i dont have the big high after eating that i did have before. ( transition not too bad as yet as you said Angie thanks) Only just started new regime at weekend and i think it needs tweeking a bit but so far so good. Ps can anyone recommend how many carbs i should have at each meal please. I average about 30-35 at the minute made up of wholegrains and jacket/new potatoes. Thanks

 

[Sunshine_Kisses]

Hey Y'all - just a lil update to say I finally got to speak with my endocrinologist consultant today who diagnosed me as Type 1... which was pretty sucky - but I kinda knew it was coming so at least it wasn't a shock.

Anyway, I've got an longer apt with him in a few weeks to discuss things further (he wants to discuss low insulin - I want to discuss *lots more* !)

Anyways, just thought I'd let you know - and thanks for all your support whilst I bounced around in limbo for the last two weeks... you helped me heaps x

 

[SamJB]

At least you've got an answer, even if it probably isn't the best outcome. You sound pretty conscientious with your diabetes, so bar injections and testing you can live a perfectly normal life with T1. Best of luck!

 

[Sunshine_Kisses]

Thank you Sam! You seem pretty on it too - so be warned - I'll probably be asking you lots of questions over the coming months!! ;-)

 

[SamJB]

Sure, keep them coming. I just wish that I had this resource when I was diagnosed!

 

[Sunshine_Kisses]

Aw, I agree - it's a great resource...

 

[mrman]

Glad you've got a proper diagnosis, and hope it takes some of the worry away.

Sent from my GT-S5360 using DCUK Forum mobile app

 

[Sunshine_Kisses]

Glad you've got a proper diagnosis, and hope it takes some of the worry away.

Sent from my GT-S5360 using DCUK Forum mobile app

Thanks Brett Though obvs would rather they said something else, at least knowing what I'm dealing with defo helps...

 

[smidge]

Hi Sunshine!

Welcome to the LADA club! If they offer you low doses of intermediate or long acting insulin, give it a try. It's not so bad, I promise At least you know now.

Take care

Smidge

 

[Sunshine_Kisses]

Thank you Smidge
I see the consultant when he's back from his hols...

 

[worrywart]

hi sunshine, i just saw your post and i apologise for being late

I was diagnosed LADA in may 2012 with antibodies over 2000 (off the scale). Weird thing was my blood sugars were still in the normal range.

Today, 18 months later i dont have have diabetes, dont take medication and have HbA1C of 4.3%. GAD level is now 477

I guess what im trying to say is some people may just get GAD antibodies which dont do anything bad to you, whereas others have GAD and develop diabetes.

If you search on this forum you'll find the epilogue i wrote about when i found out, what i did and so on.
Send me a message if you want to discuss
Karl