LADA Update

[Swillbos]

I had my first consultant appointment today following referral for possible LADA and move onto insulin in July. Turns out I am LADA after seven years thinking I was type 2: islet cells positive for antibodies, GAD>2,000, HBA1c of 107, down to 85 within a couple of weeks of starting insulin, but pretty confident it will have come down much further since then.

Consultant enthusiastic and positive with my progress, which is always nice on a human level! But she does seem to be of the view that I will need to move on to bolus and basal regime within a year or so (currently on basal only - 9 units Humulin 3). I had been hoping to avoid this as long as possible. I know Dr Berenstein is a great advocate for low carb and little and often insulin, so this is probably the way to go just not sure it will ever feel normal injecting.....In the mean time a few tweaks to my current regime:

• Split dose of Humulin to 6 units at night 4 in the morning (or vice-versa). This was based on the fact that my bed-time readings tend towards high (range 7.2-13.2 since start Sept), with a significant overnight reduction (range 3.8-8.6 over the same time period)
• Stop taking Glimeperide
• We had a discussion re continuing metformin, Dr mostly mentioned benefits as an aid to prevent possible weight gain on insulin. I seem to think I have read there are benefits over and above that for type 1/1.5s (?) But as I have had some very good results with metformin and no adverse effects I am happy to continue
• Start taking statins....apparently my tri-glycerides are very good (0.78) but total cholesterol high (6.5). Must admit I am still sitting on the fence here....

I hope my experience adds in some small way to the wealth of knowledge on this site, but must admit my brain hurts with all of this! Going for a walk in today's lovely autumn sunshine to recover

 

[KK123]

I agree with helensaramay, if you have both at hand you have the option of using the bolus should you decide to eat something other than very low carb. I am on both (10 units of Lantus) and then 1 or 2 units of bolus every so often if I eat a meal higher than 15 carbs. If I don't, then no bolus required. Most days I don't use bolus but it's nice to know it's there when I need it. I was diagnosed 2 years ago so think I am still in the honeymoon period but who knows! I'm not a fan of eating exactly what you like if it means taking massive doses of insulin to cover it as I'm afraid that will lead to big swings and chaos (for me on an MDI regime), but I also don't feel I need to stick to a virtual keto diet either. Balance is the key plus lots of testing! x

 

[Brunneria]

I am very very glad that you now have the correct diagnosis and are moving onto the correct treatment regime.
Also glad you came to share it here - you are right, the more individual experiences we have here on the forum, the more likely it is that someone else will see themselves in your experience. Thank you.

 

[LittleGreyCat]

Start taking statins....apparently my tri-glycerides are very good (0.78) but total cholesterol high (6.5). Must admit I am still sitting on the fence here....

Personal opinion, but I would jump off the fence quick and hard onto the NO side.

At 6.5 your total cholesterol isn't that high.
If the markers such as triglycerides and HDL ratio are good then you may not need to take another drug.

Take some time to surf around the forum.
There is a lot of information on why statins may not be a good thing, and why higher cholesterol may in fact be a good thing.
As usual, everyone is different.
However medical opinion is slowly but surely moving against the automatic prescription of statins.

 

[Japes]

18 months after my LADA diagnosis and into a basal/bolus regime from the moment I set foot in the DSN's office at the referral appointment, I can say injecting now is second nature for me.

I've found being on insulin far less stressful than the constant battle with meds/diet/exercise especially once that stopped working effectively.

 

[Swillbos]

Many thanks for the words of encouragement, and especially helpful to think of bolus as potentially optional, rather than necessarily needed with each meal in the honeymoon phase at least.

I think some of what I have been grappling with today is the change in expectations of my diabetes management: what was said to be "good" management of T2 diabetes by a community team (which was more "good enough" rather than properly good for 6 out of 7 years- I now know!!!) falls below the ambitions of my new hospital consultant-led approach to T1.5. Don't get me wrong, this is a good thing, and I know I'm being childish stamping my foot and shouting "but I don't like needles!" But we all need a bit of reassurance at times. xx

 

[Circuspony]

I'd wait until you've got your hba1c down and then re-look at your cholesterol figures. When I was first diagnosed with hba1c of 147 they kept going on about statins. All I could think was that I was very unwell and there was no way any one could make decisions until the insulin has done its job.

Two years down the line and hba1c < 50 and no one ever mentions statins.

 

[ert]

I had my first consultant appointment today following referral for possible LADA and move onto insulin in July. Turns out I am LADA after seven years thinking I was type 2: islet cells positive for antibodies, GAD>2,000, HBA1c of 107, down to 85 within a couple of weeks of starting insulin, but pretty confident it will have come down much further since then.

Consultant enthusiastic and positive with my progress, which is always nice on a human level! But she does seem to be of the view that I will need to move on to bolus and basal regime within a year or so (currently on basal only - 9 units Humulin 3). I had been hoping to avoid this as long as possible. I know Dr Berenstein is a great advocate for low carb and little and often insulin, so this is probably the way to go just not sure it will ever feel normal injecting.....In the mean time a few tweaks to my current regime:

• Split dose of Humulin to 6 units at night 4 in the morning (or vice-versa). This was based on the fact that my bed-time readings tend towards high (range 7.2-13.2 since start Sept), with a significant overnight reduction (range 3.8-8.6 over the same time period)
• Stop taking Glimeperide
• We had a discussion re continuing metformin, Dr mostly mentioned benefits as an aid to prevent possible weight gain on insulin. I seem to think I have read there are benefits over and above that for type 1/1.5s (?) But as I have had some very good results with metformin and no adverse effects I am happy to continue
• Start taking statins....apparently my tri-glycerides are very good (0.78) but total cholesterol high (6.5). Must admit I am still sitting on the fence here....

I hope my experience adds in some small way to the wealth of knowledge on this site, but must admit my brain hurts with all of this! Going for a walk in today's lovely autumn sunshine to recover

I'm sorry you've had such a long journey towards diagnosis. My understanding of a GAD measurement greater than 2000 U/ml is that it's associated with rheumatoid arthritis and thyroid disease.

 

[Daibell]

Hi. Good you've had the correct diagnosis now. I would go for Basal/Bolus as it's so flexible and gives you complete control and you can eat freely. Note that you don't have to split the Basal if you don't want to and save an injection. Just adjust the last Bolus ratio before the next Basal to suit the fading Basal.