Lada since 2009

Hi. It's unusual to be LADA and not need any medication? Metformin won't have much effect if you are slim and hence probably not insulin resistant. If you do have a failing pancreas which is normal with LADA then Gliclazide would probably be a better drug to start with as it stimulates the pancreas. LADA normally develops to the extent that you do need insulin when tablets no longer work. Metformin shouldn't cause weight loss by itself as it merely reduces the amount of glucose that is absorbed as well as reducing insulin resistance. Increasing protein and fats when reducing the carbs will help avoid weight loss

Hi, I too am LADA without insulin or medication, but have been for only 6 months.
When I was diagnosed my dr took me off of Metformin and Gliclazide (I was previously diagnosed 3 months before as a T2).
I am managing to keep my blood sugar levels under control with a low carb diet.
I too was loosing weight, but have managed to put on 6kg over the last 2 months, by eating more - much more - fat and protein (meat, cheese, cream, nuts, eggs etc.). My dr originally said I would be on insulin within weeks, and I am sure it is only because of the low carb diet that I am not on insulin yet.

My BS readings are currently around 6.0 before breakfast, dr said when they are over 10.0 I should go on insulin, but I will be requesting to go on insulin before they get that high, as I believe the few beta cells i have left will last longer at lower blood sugar levels.

If you are not on low carb already, then try it, as I am sure you will see your blood sugar levels drop.
If you are already low carbing then maybe the time has come to take some insulin, I guess it will be small amounts first, as you are obviously still producing some insulin yourself.


Diagnosed T2 in sept 2013, BS levels 20+. BMI 22, age 58. Requested a GAD test in November, came back very high 2,000+, doc said I would be T1 very soon, but presently LADA, and managing to keep 99% of my BS readings one hour after meals under 7.8 without insulin or any medication.
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I don't eat any bread, no pasta, no potatoes, no rice. But by eating more protein and fat foods ( meat, fish, butter, double cream, nuts, mayonnaise etc. ). I have put on some weight.


Diagnosed T2 in sept 2013, BS levels 20+. BMI 22, age 58. Requested a GAD test in November, came back very high 2,000+, doc said I would be T1 very soon, but presently LADA, and managing to keep 99% of my BS readings one hour after meals under 7.8 without insulin or any medication.
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Hi,
As far as I can see there isn't any accepted treatment path for LADA. Doctors in some countries intiate insulin early, others just follow a T2 type treatment path.
There isn't very much good research but what there is seems to suggest that Sulfs like Gliclazide are not a good idea. People have worse control on them compared with insulin and the drugs themselves may actually cause a quicker loss of insulin function.

Prof Pozzilli, of the European research group 'Action LADA'' wrote in a paper on LADA treatment

'Even though it is difficult to generalize these data because the studies had different selection criteria and ethnicity as well as different outcome parameters and follow-up durations, taken together, they do suggest that sulfonylureas accelerate (or at least do not protect against) progressive β-cell failure and are similar to (or worse than) insulin in obtaining good metabolic control'

His review of treatments is here but is a few years old .
There has still been no evaluation of the use of Metformin, the use of Rosiglitazone which he suggested might be useful is no longer possible (withdrawn in Europe) . I don't think that there have been any reported trials of the incretins in LADA . (Byetta ,Victoza or Bydureon). though he seemed to think that they might be useful
There have been trials of the newer drugs that he mentions but they are nowhere near being available (if indeed they work).

In the paper I get the impression that he tends to support the use of insulin saying

"Given that the loss of rapid insulin release occurs early in LADA, replacement with fast-acting insulin might be beneficial. However, from a practical point of view, it might be difficult to initiate multiple insulin injection therapy in LADA patients, especially if their blood glucose levels are moderately increased. Thus, a long-acting insulin injection might be a good alternative"
A Cochrane review in 2010 didn't add much to this but also seems to suggest that the use of sulfs may not be the best strategy:
http://summaries.cochrane.org/CD006165/interventions-for-latent-autoimmune-diabetes-lada-in-adults

Ironically the Danish Diabetes Academy is holding a conference on LADA in Odense next week. One of the speakers is Prof Pozzilli and his subject is the treatment of LADA
Maybe your doctor may hear something from this conference.(or they may release some more info/abstracts)

Dr Bernstein agrees with Prof Pozilli that pancreas stimulating drugs should be avoided in T1 and LADA, and possibly in T2, due to accelerating beta cell loss.

I would suggest either low carbing, or injecting insulin early, to preserve your beta cell function as long as possible.

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Excellent! Eating no carbs at all is pretty radical, and in practical terms eating zero carbs is nearly impossible. You should see good results though if you keep total daily carbs from all sources down below about 100g - 130g per day. Some people find they need to go lower to get the best results. I would suggest you use mostly fat not protein to make up the shortfall in calories. This is called "LCHF".

Miraculously sent via Diabetes Forum App. Probably on the 4th or 5th try :-/

jangodog said:

Hi Spike i will follow your advice with fat and maybe i should compensate with
a little protein because i'm pretty skinny

Thank's again and i'll get back later with some results


jangodog

Click to expand...

If you have around twice as many grams of fat than grams of protein that should be fine.

Miraculously sent via Diabetes Forum App. Probably on the 4th or 5th try :-/

Hi. Metformin won't do any harm but won't help much either. I'm only still on it to keep my DN happy as she says it has overall protective properties which appears to be correct. I went thru three tablets over the years (Metformin, Gliclazide and Sitaglipin) whilst starving myself to keep blood sugar down. I asked my GP for insulin but she refused saying it was a 'last resort' which was pretty stupid. A year later when my HBa1C shot up she said I needed to start insulin which was the best thing I could have done. So, my advice is start insulin early if Gliclazide fails and/or you want to avoid the downside of Gliclazide as Phoenix has pointed out. If Gliclazide works you may gain weight as it stimulates the pancreas if you have working islet cells. Insulin can also cause weight gain if you have too many carbs but I've not gained measurable weight with it in over a year and certainly not lost any more weight either