Is this LADA?

[RN25]

Hi,
I am recently diagnosed type 2 but it has come on from normal Hba1c to diabetic within a year (and I think would have been within 6 months if I hadn't adopted carb free diet when I was diagnosed prediabetic). So I asked GP to test for type 1. They took bloods for c-peptide and antibodies but the lab rejected them. I have an appointment with the specialist diabetes team early April so was hoping they would do the tests then. However I've just gone on my nhs record and while the c-peptide test is still declined the antibodies result is now showing.
The result say
Anti-GAD antibodies >2000
Zinc transport protein 8 antibodies 1240
IA2 antibodies 53.2
Does this align with LADA? I'm not on insulin, just metformin and gliclazide.
Thanks

 

[Melgar]

Hi there @RN25 we are not allowed to diagnose on the forum, it is against forum rules. In general, diabetes, very low C-Peptides and the presence of autoantibodies is the diagnostic criteria for Lada. C-Peptides are used to see how much insulin your pancreas is producing, as they correlate with insulin production. C-Peptides are used instead of insulin as they remain stable outside the body whereas Insulin deteriorates within hours.

What was your HbA1c ? Here in Canada if your HbA1c results are under 9% they will not do a C-Peptide test. Different antibodies can be produced for a variety of autoimmune issues, not all of them relating to diabetes. C-Peptides are the first step, usually because if they are very low, when blood sugars are high, then the next step would be to test for autoantibodies. Low C-peptides are the first step to differentiate T1 from T2 because people with Type 2 usually produce an abundance of insulin and therefore their C-Peptides would be high normal to high. Contrast that to very low insulin /C-Peptides in T1.

 

[RN25]

Ok thanks. I guess I need to request the c-peptide test again then. My hba1c was 80, that was still being quite careful with my diet but not full on low carb.

 

[RN25]

Sorry 80 is equivalent to 9.5% I think

 

[Antje77]

A combination of having positive antibodies and a high hba1c is usually diagnostic for T1/LADA.

 

[Melgar]

Push for that C-Peptide test @RN25 . You shouldn't have to, but with your lab rejecting your blood sample, you may have to really push. As you have an appointment with a specialist diabetes team in early April you may get some movement. GPs are generalists not specialists, but they should know the basics. Keep testing your blood levels. My brother was diagnosed as Lada and lost so much weight just prior to his diagnosis, his blood sugars were sky high. The Dr put him straight onto insulin. He was getting DKA symptoms when he went to his GP. He was diagnosed with Lada within a week. It does take about a week to get C-Peptide results back, I was told that it is not a run of the mill test, but neither are antibody tests.

Yes you are right a HbA1c of 80 mmol/mol is 9.5%.

 

[Honeyblossom]

It's good that you managed to get the antibody test and with all three positive would be an strong indicator towards type 1 / lada. I had one positive autoantibody which makes a diagnosis less conclusive and my specialist advised it wasn't worth doing doing a c-peptide for at least 3 years post diabetes diagnosis as there is usually still some insulin still being produced.

 

[RN25]

Thanks all. Will ring the GP today. I also read in a research type report that gliclazide is not recommended for type 1 as it can hasten the damage to beta cells? So will ask about that too. I have paid for a cgm and being v careful with food and exercise to keep blood sugar levels low(ish). They were sky high until the last couple of weeks. With low carb food, exercise, metformin and gliclazide I am averaging 10-11 mmol throughout the day, higher on a morning. It will come down to 5ish after exercise but creeps back up and rises with food.

 

[RN25]

It's good that you managed to get the antibody test and with all three positive would be an strong indicator towards type 1 / lada. I had one positive autoantibody which makes a diagnosis less conclusive and my specialist advised it wasn't worth doing doing a c-peptide for at least 3 years post diabetes diagnosis as there is usually still some insulin still being produced.

I am wondering if its the specialist team that have resubmitted the antibodies test ahead of my appointment with them. I was very surprised to see the results on my record last night.

 

[RN25]

So I saw the diabetes specialist Dr today and he has confirmed I'm type 1 and will be starting insulin tomorrow after I see the nurse.

 

[MrsA2]

Sorry, a "winner" emoji felt both right and wrong. Well done on pushing for answers, and for getting a clear diagnosis

 

[RN25]

Sorry, a "winner" emoji felt both right and wrong. Well done on pushing for answers, and for getting a clear diagnosis

Thank you. I said to the specialist that I was quite pushy with the Dr as it didn't seem like T2 to me, and he replied, well you were right. It's good to feel validated even if it's not the best result. And to be fair to the GP they did listen and refer me for pancreas scan and take the blood tests for T1. I don't think I'd have got anywhere for months without paying for the CGM though as the first course of action was "take metformin, get Hba1c retested in 2- 3 months". I dread to think what that result would have been if I'd blindly followed that. When my blood glucose was still super high they agreed to test for Type 1 (and luckily I'd had enough previous blood tests to show it all came on within a year, from normal to diabetic).
Onwards and upwards, I hope...