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How do you know if you are LADA ( T1.5)?

Discussion in 'Type 1.5/LADA Diabetes' started by Elenas, Mar 28, 2021.

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  1. Elenas

    Elenas Prediabetes · Well-Known Member

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    What test did you ask to your GP to know if it's LADA and not a typical type 2?
    Is it you who initiated the conversation about it ? Or your doctor talk about it to you because you were matching the symptoms?
    Can you please share with me your story and how you discover your condition?

    I have the feeling this condition isn't well known even by medical field, I'm suspecting Lada for me but I don't know what shall I asked for diagnosis this condition. What makes me feel I could be type 1.5 is my low weight .
     
  2. KK123

    KK123 Type 1 · Well-Known Member

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    Hi there. I was also diagnosed as pre diabetic aged 52 and 3 years later ended up in hospital and was diagnosed as type 1 (LADA is type 1 of course, just a slower onset). The Consultants & Drs discussed the fact that I did not fit the so called type 2 profile other than by age, also of course by that time I had presented as on the verge of DKA with off the level glucose and ketones.

    They did a C Peptide test (to measure your own production of insulin) and a variety of antibody tests, one of which, the 'GAD' test came back positive. Those I believe are the main two tests to ask for, BE involved in the conversation and do your research is my advice or they will talk over you. INSIST that they explain why they are calling you whatever type, for me they were happy to do the tests based on appearance and my 'lifestyle' but it was by no means straightforward to get the tests, ie, very slim/very fit/non smoker/non drinker, ran every day and so on, so emphasise to them why you think it could be lada. x
     
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    #2 KK123, Mar 28, 2021 at 8:26 PM
    Last edited: Mar 28, 2021
  3. Elenas

    Elenas Prediabetes · Well-Known Member

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    Thank you for the feedback, that's informative for me. So you mean because you were not fitting the T2 profile they were okay to investigate more ?
    I actually do not match with the type 2 profile as well: Im 30 years old, used to be a fitness blogger, I was at normal BMI when diagnosed, even rather with thin waist. No metabolic issues, I don't smoke, drink and I've never ate unhealthy, processed food ( but yes used to eat lot of carbs such as wheat, lentil, potatoes, beans, bread... ).

    One day after a routine check up my they told me my fasting BS came high, so I've been send to see an endocrinologist .
    The endo test my hba1c, my fasting glucose, did a Glucose tolerance test, and fasting insulin.
    My fasting insulin came high so it mean indeed type 2 and not LADA? but paradoxically insulin is low after eating combine a reactive hypoglycemia. ( yet nothing was explained to me why )

    So because my fasting insulin was high + High fasting glucose high she said I have insulin resistance which is the first step of T2. And that was it.
    Today I became very thin, underweight even, my insulin isn't high anymore, but I'm still follow for pre T2.
    My doctor doesn't check something else when I see her. Just monitor my BS, hba1c and fasting insulin.
    Should I ask fo a C peptide test ?
     
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  4. EllieM

    EllieM Type 1 · Moderator
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    You've said the magic words reactive hypoglcemia so I'm tagging @Brunneria and @Lamont D who are the experts on this. I seem to remember that RH can be combined with T2?
     
  5. Brunneria

    Brunneria Other · Guru
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    Hi @Elenas

    did your doc specifically diagnose you with reactive hypoglycaemia?

    and what is your current way of eating? You mentioned a high carb diet in the past, but it looks like you may have changed that now?

    One of the characteristics of T2 is the loss of the first phase insulin response, while the second phase may stay strong. I wonder if this is happening to you.
     
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  6. KK123

    KK123 Type 1 · Well-Known Member

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    Hi Elenas, my insulin production was the 'low end of normal' (from the C Peptide) as they put it so you are different in that respect. x
     
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  7. Elenas

    Elenas Prediabetes · Well-Known Member

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    Well after my GTT my BS crash at 55 mg/dl after the 2 hours - ( fasting was 100.9/ 1h was 85 / and when I reach home and home- test with my kit so about 3h after I was at 41mg/dl) so yes it has been confirmed, LamontD already checked my results in my presentation page 1 month ago.
    But despite these results I don't feel I have RH in my day to day life , it's only when I do GTT test that I crash hard. What an idea to drink that much sugar

    My current way of eating is with less carbs than before. Although I keep eating a lot of starchy vegetables such as lentil, beans, peas, butternut ,pumpkin.... it's my main source of food. Yet ,no more rice, pasta, and white bread and I ban industrial sugar.

    One of the characteristics of T2 is the loss of the first phase insulin response, while the second phase may stay strong. Can you please let me know what do you mean by insulin phase ?
    I have problem mostly with my fasting result , actually it seems like I have a good insulin response after eating and actually my BS is always lower after I eat than before.
    So definitely T2 I guess ? So at least I know where I am.
     
    #7 Elenas, Mar 29, 2021 at 11:14 AM
    Last edited: Mar 29, 2021
  8. Elenas

    Elenas Prediabetes · Well-Known Member

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    Yes so I guess I m definitely a type 2 but with atypical profile ( young , low weight, unlucky )
    Thank you for the feedback
     
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  9. Lamont D

    Lamont D Reactive hypoglycemia · Master

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    Hi @Elenas.

    Insulin phase is the timing of insulin response to the food you have ate. If it is a carb laden meal, the higher the spike and of course with an OGTT, the crash is more severe.
    I have a low insulin response on my first phase, that triggers the secondary insulin response, (second phase) which is too much for the glucose remaining, so I go
    hypo.

    If your fasting levels are in normal levels, (100.9) depending what causes the insulin overshoot,, I don't know, but it does show that RH is a possibility. There are many types of Hypoglycaemia.
    You go hypo at least an hour before I do. So it is slightly different from my diagnosis.
    It is similar to what bariatric patients have, but I'm only guessing. If you spike within an hour and go hypo before two hours, I have read that this is a form of glucose dumping. That is your initial insulin phase response, is too much for the glucose derived. Glucose dumping is the opposite of a liver dump. Which helps you when you need glucose during exercise etc.
    And if you have insulin resistance on top of that, the insulin keeps on being produced.

    It is complicated, type two covers a lot of endocrine problems with glucose tolerance.
    The way that doctors diagnose is Hba1c and your fasting levels. If you are in normal levels for both , then you are not T2.

    I'm afraid more tests are required.
    During your tolerance test did they fit a cannula to send bloods to a laboratory?
    If so, a c-peptide test should have been included.
     
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  10. searley

    searley Type 1 · Moderator
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    I’m LADA… officially categorised T1

    Diagnosed 10 years ago as T2. Always questioned the diagnosis

    Had a few cpeptide tests that showed producing a reasonable amount of insulin

    Eventually a cpeptide test last year showed me producing almost no insulin hence the now T1 badge
     
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  11. Daibell

    Daibell LADA · Master

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    My GPs hadn't a clue when it came to LADA 15 years ago when I was diagnosed. I do have a very good DN however. My first private C-peptide showed I was at the lower end of normal. A further private one 5 years later showed I was just above the upper end of T1. I had private tests as my GPs were clueless. My nice DN has organised an NHS C-Peptide at my request. The first one got lost by the test lab. The second one organised by my Diabetes Clinic consultant has also gone into a black hole since 6 weeks ago. I see another private test on the horizon....So LADA can come on very slowly for some like me so perhaps have another one done? I agree low weight is one big pointer. I suddenly started losing weight for no reason and became stick thin. My BS kept going up despite lowering my carbs.
     
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  12. chrisy62

    chrisy62 LADA · Member

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    I had a c-peptide test five years ago said I was producing so little insulin I now must be bordering T1.5 nothing became of it just kept treating me as T2, still on the same meds, insulin, and nova rapid + victors, now my diabetes has gone completely hay wire, not sure what’s triggered it, it could be some new meds I’m on for another condition have spiked it been told let’s see what happens before we start changing your diabetes meds. It seems so complicated this complaint I feel sometimes I can’t keep up. Being disabled I can’t do the exercises I used to do and what with the pools being shut Im stuck behind a rock and a hard place it would seem. My weight has stayed the same so they said it’s nothing to do with that and I’m on a Mediterranean Diet, been told not to do the keto one! Hopefully when we can get back to seeing face to face consultants something might be done I live in hope!
     
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  13. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    One thing confusing me in this thread; talk of an insulin test but not a C-peptide test.
    Followed by talk of a C-peptide test showing insulin levels.
    Are there tests for insulin levels which are not C-peptide?

    As a slim T2 (13 years in) I am watching LADA discussions because I suspect that my insulin production is reducing over time.
    However I'm reasonably sure that I wasn't misdiagnosed 13 years ago.
     
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  14. searley

    searley Type 1 · Moderator
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    Cpeptide is the test, cpeptide is a molecule that comes out of the pancreas attached to the insulin.. so it 1for1 in volume. So the cpeptide gives the insulin level.. cpeptide lasts longer than insulin in the blood so is more reliable to test for.

    Also if you are on insulin there no point in testing for insulin.. you want to know what you are producing so cpeptide is what you test for
     
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  15. HSSS

    HSSS Type 2 · Expert

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    You can test directly for insulin as well as for c peptide. Privately it’s usually cheaper too. But it does have the limitations @searley mentions.

    I’ve been reading today about insulin testing and LADA. The Kraft protocol suggests a single fasting insulin reading isn’t really sufficient (a bit like a single bgl) and it is better done with a OGTT and carbed up to get a better picture of not just fasting but first and second stage insulin.

    I’m another one wondering if I’m stuck and unsure if it’s with IR and need to double down on working on that or if it’s low insulin. Private testing for this is not cheap.
     
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  16. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    Yes, I had a private HOMA-IR test a couple or so years back.
    Inconclusive (for me) as it showed insulin in the lower part of the normal range but fasting BG elevated a bit, so some IR.
    I wonder at what point the surgery kicks into a second round of diagnosis when you are comfortably pigeon holed as a well controlled T2?
     
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  17. searley

    searley Type 1 · Moderator
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    If you are well controlled nothing will change as far as diagnosis it only when not controlled they will bother to look
     
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  18. HSSS

    HSSS Type 2 · Expert

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    My head is spinning with this issue. I keep thinking I’ve got my head round it and then I think I haven’t and then back again. Does these results only mean IR? What would the result be if the lowish insulin was the reason for failing to maintain normal bgl rather than IR?

    and then there’s the effect (or not) or being low carb/carbed up, and whether fasting or in response to food is more relevant. Argggggg
     
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  19. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    I was pensive about my results as I was eating LCHF/keto at the time and so probably under producing insulin anyway.
     
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  20. ert

    ert Type 1 · Well-Known Member

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    A lot of type 2's will show a low c-peptide 10 years after diagnosis and need insulin. That doesn't make them type 1's. It just means their beta cells have been exhausted due to out of range blood sugars. What supports your type 1 disgnosis is you needed to be treated with insulin a few months after diagnosis.
     
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