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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. ert

    ert Type 1 · Well-Known Member

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    Type 2 diabetics can have a progressive destruction of beta cells if they have uncontrolled blood sugars above the normal range. Clinically type 1 is deterioration onto insulin within the first 3 years, LADA is insulin requirement in the first 6 years. A lot of type 2's will require insulin after 10 years.
     
  2. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    It might help if you defined your terms.
    Could be anything over an HbA1c of 5.5% or anything with an HbA1c above 7.5%, for example.
    Uncontrolled is a very woolly term.
     
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  3. searley

    searley Type 1 · Moderator
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    If you produce extremely low/no insulin you will be diagnosed t1
     
  4. ert

    ert Type 1 · Well-Known Member

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    Only on diagnosis. Not 10 years later. Specifically, a c-peptide level of less than 0.2 nmol/l is associated with a diagnosis of type 1 diabetes mellitus (T1DM) when you are first diagnosed with diabetes. This how I was diagnosed in the first week. Otherwise, with LADA (which is type 1) it is GAD antibodies or rapid deterioration onto insulin in the first 6 years.

    Type 2's who have lost their beta cell function over time don't become type 1's. Some are eventually treated with insulin as their c-peptide drops off due to high sugars killing off their beta cells. Type 1 is an autoimmune condition.
     
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    #24 ert, May 3, 2021 at 6:02 PM
    Last edited: May 3, 2021
  5. ert

    ert Type 1 · Well-Known Member

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    NICE recommends a HbA1c below 6.5% to avoid complications.
     
  6. searley

    searley Type 1 · Moderator
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    Ok so I spent 9 years classed t2

    Year 8 had cpeptide test showed low.. but just over the minimum to be classed t1

    Year 9 cpeptide of extremely low.. no gad anti bodies… diagnosis T1
     
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  7. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    So assuming that a T2 has been keeping HbA1c below 6.5% you would consider that well controlled?
    Doesn't quite tie in with your statement of poor control killing off Beta cells.
     
  8. ert

    ert Type 1 · Well-Known Member

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    It's a general statement. My consultant and Dr Bernstein suggest the levels of tolerance are different for everyone. Some people run their blood sugars higher than NICE recommends and don't get complications. Bernstein supports 5.3% which is what I aim for to try to keep trace beta-cell function. NICE states 6.5% to avoid complications.
     
    #28 ert, May 3, 2021 at 8:13 PM
    Last edited: May 3, 2021
  9. ert

    ert Type 1 · Well-Known Member

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    As stated before and above, you had to use insulin months after diagnosis which classifies you as type 1. Unfortunately, you didn't get a referral to a specialist, which you should have been given you needed insulin so soon after your diagnosis, to give you the tests for type 1 and properly diagnose you. Ask your specialist next time you have your check-up.
     
    #29 ert, May 3, 2021 at 8:19 PM
    Last edited: May 3, 2021
  10. Fenn

    Fenn Type 2 · Well-Known Member

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    Does it matter because type two is considered self inflicted, where as type one is not the fault of the sufferer?
     
  11. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    Just checking.
    @searley
    I can't see any information which says they started on insulin within months of first diagnosis.
    Is this correct?
     
  12. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    That is a very old wives' tale.
     
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  13. HSSS

    HSSS Type 2 · Expert

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    Does what matter?

    Are you suggesting type only matters to some people due to the blame attached to type 2?

    If so what about the fact the earlier type 2 that still produce plenty of insulin have different options (that may even offer remission) to type 1/LADA or later type 2 that simply have no options other than exogenous insulin due to their own inability to produce normal amounts. Misdiagnosing a type 2 as type 1 removes their choice. Misdiagnosing a person without insulin as type 2 could be risking their life in some circumstances. It is important to accurately know type not guess.
     
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  14. Fenn

    Fenn Type 2 · Well-Known Member

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    I hesitate to reply because I neither want to fall out or cause offense. But feel rude not replying.

    I personally believe a type one would be desperate to avoid being lumped into a group with type twos, due to the stigma attached, and a type two would be desperate for a type 1 or 1.5 etc. diagnosis to get out of the above group. At the end of the day, I’m not convinced where my type is but I don’t think it matters as the treatment and consequences are the same, no?

    I know I’m generalizing and making huge assumptions based on my opinion, feel free to ignore me.
     
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  15. HSSS

    HSSS Type 2 · Expert

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    No offence taken at all. I think I already outlined why it matters (beyond stigma) as treatment options and maybe consequences are not the same.

    Many if not most genuine type 2 have a shot at avoiding insulin altogether, especially if they can utilise successful non drug management early enough.

    Insulin, whilst life saving to type 1, comes with complications and considerations to life that I assume most would rather not have. Type 2 on insulin seem to have more issues associated with IR and weight gain than type 1 from what I’ve read on here and maybe more other complications as their underlying issue (IR) is being circumvented rather than addressed. I could be wrong.
     
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  16. LittleGreyCat

    LittleGreyCat Type 2 · Well-Known Member

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    As a T2 I have no desperate desire to be recategorised as T1 to avoid the shame of being T2.

    I would very much prefer to remain T2 on diet and exercise, thank you very much!

    The whole area (as shown by the tread title) is still very ill defined.

    Is T1 defined by the inability to produce insulin?
    If so, T2 can logically transition to T1.

    Is T1 defined by a positive test for antibodies?
    If so, where does that leave the T1s who don't show antibodies?

    Is T2 defined by insulin resistance?
    If so, where does that leave T1s who also have insulin resistance?

    There appears to be no clear answer, but it is probably best not to get too hung up on which club you seem to be in, and instead to focus on the treatment required from now on.
     
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  17. oldgreymare

    oldgreymare Type 1 · Well-Known Member

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    If I extrapolate from my own experience I initially presented at age 51 with ongoing weight loss over 10 months, constant thirst, peeing, increasing infections, "positive" OGTT result but no signs of DKA. My endocrinologist in Singapore put me on insulin immediately to see if my beta cells could recover. Three months later and HbAC1 down to 7% he ordered c-peptide and GAD antibody tests. C-peptide was about half the low normal threshold, GADAb levels were elevated. He was somewhat shocked that I wasn't a T2 but said I was definitively T1 and I've been an insulin user ever since. But in hindsight possibly LADA for a couple more years.

    That said, I suspect I fall also into some T2 territory as I feel very prone to insulin resistance even with few carbs. @LittleGreyCat is correct focus on the best approach for each individual is what matters,.
     
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  18. Bubbleblower

    Bubbleblower · Member

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    QFT, glad somebody else said it.
    From the ADA:

    "the rationale for the strict criteria that are most often used to define LADA, including age >30 years at diagnosis and insulin independence for at least 6 months after diagnosis, have been questioned repeatedly. There is substantial heterogeneity in LADA, with some cases closely resembling T1D (e.g., low BMI, association with other autoimmune diseases), and others that share many features with T2D. Many authors and clinicians question the evidence base for defining LADA as a distinct entity and propose instead that LADA and childhood-onset T1D are opposing ends of the same continuum of autoimmune diabetes."
     
    • Informative Informative x 1
  19. Circuspony

    Circuspony Type 1 · Well-Known Member

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    I had probably had diabetes for a year before I got sick enough that a GP thought to test my blood sugar (I'd been in for other symptoms that all quickly disappeared once I was treated).

    BG just showed as Hi on his meter, ketones about 5 and first hba1c was 147. But I was 43 so they still insisted I was T2 (I'd lost a stone in 3 weeks)

    2 weeks later I was in A&E and thankfully they got me sorted. 4 months later I was asked to do a c-peptide test and oral glucose
    challenge. My pancreas was still producing some insulin but was very 'sluggish'. The test was repeated a year later where it was even more sluggish.

    I did have antibodies on diagnosis.

    I am apparently a text book LADA case. In fact the various consultants were surprised the GP even considered type 2 I ticked so many boxes for T1 / LADA
     
    • Informative Informative x 1
  20. Saman1

    Saman1 · Member

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    Keep up the good work. Lentils, beans, peas, pumpkins are NOT STARCHY . They are also my main source of food. Yes, I am also ,no more rice, pasta, and white bread and all forms of sugar. - After suffering 35 years, I am getting close HbA1c- 5.9 -
     
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