honeymoon period?

[Em16]

Hi all,

My current diagnosis is literally 'not known whether Type 2 or Type 1'. My consultant says my insulin is Type 2 but my metabolism is Type 1 and that he expects that I will run to Type 1 in time - that I'm essentially LADA and currently in the honeymoon period.

I've been controlling glucose successfully through low carb/high fats...but now I'm seeing my sugars going a bit higher than usual for no apparent reason. It's not a massive difference, for instance I normally wake to a 4.7 and it's been between 5.1 - 5.5 the last few mornings. I've just tested mid afternoon and sugars have risen to 6.1 at 3 hours after eating (following a 5.3 at 2 hours after lunch) and I had a low carb salmon salad.

Like I say, it's not much and I know those numbers are still ok....but having convinced myself that I am definitely Type 2 (as I'd got good control through diet) it is making me a bit anxious as I can't explain it.

Has anyone got experience of the honeymoon period beginning to tail off? Did it happen gradually or suddenly?

I should add that I also came back from a 2 week holiday abroad on 17th April where I wasn't able to keep to my home diet (although I still avoided carbs) and I've had Covid too in the past week - although that didn't make much of an impression on my blood sugars at the time. I'm still feeling a bit tired, but not ill. Could this explain it?

Thanks, Em

 

[Mrs HJG]

Have you been tested for C-Pep and GAD antibodies? This, according to the consultant I recently saw is the only way to tell if T1 or T2* - I am T1/LADA due to all 3 antibodies being present, but I'm currently controlling with low carb diet, exercise and Metformin, (like a T2), as 3 weeks of insulin at initial diagnosis in December, (T1, no T2, definitely T2, no T1!!), put my BG really low on only 10 units a day, so I stopped.
*yes there are T1s with no antibodies and non-diabetics with antibodies, but 'in general'...

T2 cannot turn into T1, you would be T1 all along; I believe my extra lockdown weight and/or Covid vaccines pushed me to insulin resistance. I lost 15kg before diagnosis (when eating everything like crazy), and a further 10kg in the last 4months on a good diet and extra exercise, so back to my pre-baby weight, (my kids are 17 and 15!!). I am now just below 8.5st and was 12st max. a year ago.

I am going to be starting Libre in June (after NHS induction, and 6 months from initial diagnosis), as it will be the best way to monitor if/when my blood sugars are slowly rising and insulin reducing. A correct diagnosis meant this has been possible, even with new NICE guidance I think T2s will need to argue for this on prescription.

I was told if my waking BG is >6 and post-prandial >8 at 2 hours regularly, then that will be the likely start of requiring insulin, but I want to stretch the honeymoon as long as possible by reducing stress on my pancreas with low carb, a Vitamin D supplement and no meds except Metformin. You may find once your holiday and covid are out of your system that your bloods settle back down again.

Hope something in my rambling is a little help. I'll be interested to know from others how quickly it all tends to go 'downhill' as the period when still producing insulin erratically and playing the balancing game with injections is the bit I am dreading

 

[ert]

Hi all,

My current diagnosis is literally 'not known whether Type 2 or Type 1'. My consultant says my insulin is Type 2 but my metabolism is Type 1 and that he expects that I will run to Type 1 in time - that I'm essentially LADA and currently in the honeymoon period.

I've been controlling glucose successfully through low carb/high fats...but now I'm seeing my sugars going a bit higher than usual for no apparent reason. It's not a massive difference, for instance I normally wake to a 4.7 and it's been between 5.1 - 5.5 the last few mornings. I've just tested mid afternoon and sugars have risen to 6.1 at 3 hours after eating (following a 5.3 at 2 hours after lunch) and I had a low carb salmon salad.

Like I say, it's not much and I know those numbers are still ok....but having convinced myself that I am definitely Type 2 (as I'd got good control through diet) it is making me a bit anxious as I can't explain it.

Has anyone got experience of the honeymoon period beginning to tail off? Did it happen gradually or suddenly?

I should add that I also came back from a 2 week holiday abroad on 17th April where I wasn't able to keep to my home diet (although I still avoided carbs) and I've had Covid too in the past week - although that didn't make much of an impression on my blood sugars at the time. I'm still feeling a bit tired, but not ill. Could this explain it?

Thanks, Em

Metabolism isn't used to diagnose type 1 or 2 diabetes. You need a c-peptide and GAD, IA2 antibody tests as type 1 is an autoimmune condition.

 

[Em16]

Thank you both for your replies.....yes I've had C peptide and Gad but they were inconclusive. I was initially diagnosed as Lada, but as time has gone on and I've managed to control with LC/HF I've queried that diagnosis - hence the not known if type 1 or type 2. I'm under the hospital and have bloods checked regularly as they're unsure - so that is good as I feel well supported and cared for. I had a DKA incident which I think muddies the water. I was definitely told that my metabolism was like a Type 1 though: I burn off calories very quickly eg. falling into anorexic BMI despite eating really well on the low carb/high fat diet (I need high fat snacks between every meal, which would not be what a type 2 would need or want to do). This is apparently typical of Type 1 - although I don't think they were using this as diagnostic for the diabetes...just that it posed a query really. I've never, ever been anything other than very slim, have always been active and ate healthily, so not a type 2 phenotype. It's a bit of a mystery....! However, as you suggested Mrs HJG, I think the bumps may well have been Covid and the holiday....it all seems back to normal today and I'm feeling so much less anxious as a result. Thank you again for you replies

 

[ert]

Thank you both for your replies.....yes I've had C peptide and Gad but they were inconclusive. I was initially diagnosed as Lada, but as time has gone on and I've managed to control with LC/HF I've queried that diagnosis - hence the not known if type 1 or type 2. I'm under the hospital and have bloods checked regularly as they're unsure - so that is good as I feel well supported and cared for. I had a DKA incident which I think muddies the water. I was definitely told that my metabolism was like a Type 1 though: I burn off calories very quickly eg. falling into anorexic BMI despite eating really well on the low carb/high fat diet (I need high fat snacks between every meal, which would not be what a type 2 would need or want to do). This is apparently typical of Type 1 - although I don't think they were using this as diagnostic for the diabetes...just that it posed a query really. I've never, ever been anything other than very slim, have always been active and ate healthily, so not a type 2 phenotype. It's a bit of a mystery....! However, as you suggested Mrs HJG, I think the bumps may well have been Covid and the holiday....it all seems back to normal today and I'm feeling so much less anxious as a result. Thank you again for you replies

15% of type 2's are thin so your metabolism suggestion does not stand. Type 1's can be obese as the condition is due to an autoimmune attack. Diagnosis comes down to how little insulin you are producing supported by a c-peptide test due to your immune system killing off most of your islet cells. Type 1 and type 2 diabetics and non-diabetics can go into DKA.

 

[Em16]

15% of type 2's are thin so your metabolism suggestion does not stand. Type 1's can be obese as the condition is due to an autoimmune attack. Diagnosis comes down to how little insulin you are producing supported by a c-peptide test due to your immune system killing off most of your islet cells. Type 1 and type 2 diabetics and non-diabetics can go into DKA.

Thanks ert, I had a c-peptide test which was inconclusive - I might ask for a repeat of this if my sugars don't stay where I would like them to when low-carbing

 

[ert]

Thanks ert, I had a c-peptide test which was inconclusive - I might ask for a repeat of this if my sugars don't stay where I would like them to when low-carbing

That's a sensible idea.

 

[Em16]

That's a sensible idea.

It was all such a shock and a blur at the outset that I never even clarified what was meant by inconclusive at the time. I am so thankful for this website, where I think the real experts are and the best advice available and given! Thanks again, Em

 

[HuckFinniganagain]

Hi all,

My current diagnosis is literally 'not known whether Type 2 or Type 1'. My consultant says my insulin is Type 2 but my metabolism is Type 1 and that he expects that I will run to Type 1 in time - that I'm essentially LADA and currently in the honeymoon period.

I've been controlling glucose successfully through low carb/high fats...but now I'm seeing my sugars going a bit higher than usual for no apparent reason. It's not a massive difference, for instance I normally wake to a 4.7 and it's been between 5.1 - 5.5 the last few mornings. I've just tested mid afternoon and sugars have risen to 6.1 at 3 hours after eating (following a 5.3 at 2 hours after lunch) and I had a low carb salmon salad.

Like I say, it's not much and I know those numbers are still ok....but having convinced myself that I am definitely Type 2 (as I'd got good control through diet) it is making me a bit anxious as I can't explain it.

Has anyone got experience of the honeymoon period beginning to tail off? Did it happen gradually or suddenly?

I should add that I also came back from a 2 week holiday abroad on 17th April where I wasn't able to keep to my home diet (although I still avoided carbs) and I've had Covid too in the past week - although that didn't make much of an impression on my blood sugars at the time. I'm still feeling a bit tired, but not ill. Could this explain it?

Thanks, Em

As far as the honeymoon tailng off, my experience was that it tailed off gradually as each treatment I tried lost its effectiveness. There is no telling how it will be for you. If you are LADA, you will need insulin eventually. Nobody can tell you how quickly that will be. It could be weeks, or it could be years.

I managed to extend the honeymoon and stay off insulin for over three years from diagnosis. (Opinions vary on if staying off insulin after LADA diagnosis is good or bad.) For the first year I got away with just diet and exercise, but my bg was all over the place. I would go very high, then do cardio until I got back to a decent number. This resulted in a big swings that took a lot out of me.

After a year I couldn't keep my numbers down with diet and exercise, so I started metformin. That made my bg more steady, but excercise became less effective for dealing with highs. Eventually metformin stopped working, so I started Trulicity. When that first dose stopped working, they doubled the dose. Then it had to be doubled again several months later. A few months later fasting bg couldn't be tamed and I was headed for DKA. I started on long acting insulin then, and added fast acting insulin a couple months later.

Many doctors don't understand LADA. Many of us LADA folks start out misdiagnosed as type 2 and don't know we are LADA until type 2 treatment fails (and possibly dka requires a hospital stay). Either way, just know you may suddenly need insulin. What your specific diagnosis is right now may not matter as much as knowing that.

 

[Em16]

As far as the honeymoon tailng off, my experience was that it tailed off gradually as each treatment I tried lost its effectiveness. There is no telling how it will be for you. If you are LADA, you will need insulin eventually. Nobody can tell you how quickly that will be. It could be weeks, or it could be years.

I managed to extend the honeymoon and stay off insulin for over three years from diagnosis. (Opinions vary on if staying off insulin after LADA diagnosis is good or bad.) For the first year I got away with just diet and exercise, but my bg was all over the place. I would go very high, then do cardio until I got back to a decent number. This resulted in a big swings that took a lot out of me.

After a year I couldn't keep my numbers down with diet and exercise, so I started metformin. That made my bg more steady, but excercise became less effective for dealing with highs. Eventually metformin stopped working, so I started Trulicity. When that first dose stopped working, they doubled the dose. Then it had to be doubled again several months later. A few months later fasting bg couldn't be tamed and I was headed for DKA. I started on long acting insulin then, and added fast acting insulin a couple months later.

Many doctors don't understand LADA. Many of us LADA folks start out misdiagnosed as type 2 and don't know we are LADA until type 2 treatment fails (and possibly dka requires a hospital stay). Either way, just know you may suddenly need insulin. What your specific diagnosis is right now may not matter as much as knowing that.

Thank you HuckFinniganagain, yes, I think that I need to keep a close eye on things, and I am fortunate that I've good support who think the same. It is helpful to have the insight of how the honeymoon period tailed off for you, even if, as you say, it could vary for different people. I am hoping I can always keep it controlled with diet/exercise - but I do feel that its changed and less predictable at the moment. Many thanks, Em