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Should all diabetics have a GADA test at first diagnosis

barrym said:
A binary diagnosis is not really possible with a honeymoon periods I assume, and the treatment may seem correct at the initial stage. So I do have some sympathy with the conundrum.
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Yeah, LADA doesn't have to present as LADA right away. Still, any time I hear of a skinny Type 2 my ears perk up.
 
I am the skinny “type 2”. Even eating a carnivore diet I still struggle with glucose higher than I think it should be (last A1C was 6.0%). It’s incredibly frustrating. I also walk at least 10,000 steps daily, weight lift and do yoga. I would LOVe to get the GADA test but in Canada it’s not easy. I believe there are only two labs in the country who do the test….it makes me crazy! I’m digging deep to see if I can get this test and I’d be happy to pay for it.
I had a total pity party yesterday, the smell of chocolate made me cry. I’m still plugging along with the diet until august and then I’m going to add a very few carbs. If the numbers go crazy I’ll go into begging mode….I just need to know. My c peptide is normal (right in the middle of the scale) and fasting insulin is low. I’m not insulin resistant.
 
Are these the two labs you're speaking of? https://www.bcdiabetes.ca/wp-content/uploads/bcdpdfs/Type-1-diabetes-auto-antibody-testing.pdf

I would see if you can get your blood drawn at a different lab and then shipped to one of the above. I also paid for my own oral glucose tolerance test, not sure if that's a possibility in Canada. I wanted to see how my insulin responded in relation to the blood glucose. Another option would be to eat a lot of carbs at home and then get a c-peptide or insulin test just to see if you're making adequate insulin in a fed state. Both my c-peptide and insulin are at the bottom of the fasting range, and insulin was on the low side for the OGTT as well, but antibodies came back under the threshold, so bloodwork isn't always the answer.

Edit: I wanted to add, if you've been carnivore for any decent amount of time, then you really need to go back on carbohydrates for several days before getting the above labs (not sure it matters for antibodies, but your response to a high carbohydrate meal could be misleading if you're fat adapted). Also, I've been enjoying cocoa powder mixed in hot water and some cream/milk. It gives me my chocolate hit without all the sugar.
 
Thanks Matt…that’s exactly what I was looking at. I did have a requisition for the GADa test with lifelabs but they told me they had no idea what it was. I’m now armed with the required info for “next time”.
my pancreas is damaged from a previous serious attack of pancreatitis so that could be an issue too…so fun.
I’m going to reintroduce carbs in a month (for a total of three months carnivore)…doing a little n=1 experiment on myself. Just trying to figure this out. With a Mexican holiday coming up this winter I’d sure love to eat some of the food (it was a disaster last winter…could, only eat one little tortilla before a huge spike)
my doc thinks I just don’t make enough insulin.
you are right, there are lots of variables. I totally appreciate your comments!
 
I was 44 when I was diagnosed nearly 2 years ago and I was tested for the antibodies
 
Bcgirl said:
my pancreas is damaged from a previous serious attack of pancreatitis so that could be an issue too…so fun.
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Huh, well that does add a wrinkle to things. Are you aware that they're now saying beta cells are capable of regeneration? Of course pharmaceutical companies are looking for answers, but simply keeping blood glucose low and steady with little insulin requirement seems to give the beta cells the rest they need. It seems to have benefitted some people who showed increased glucose tolerance over time. Keto (or carnivore) should work. Your doctor never brought up insulin? It's asking a lot for someone to go carnivore just to keep glucose somewhat normal. It's possible you wouldn't need much medication to return to a normal diet.
 
Matt…first I’ll try to regenerate those pesky beta cells! Resting my pancreas was a factor for sure. Carnivore was my choice, although doc does know I eat very low carb…she just doesn’t know the extreme. I’d rather not do insulin until I have to although the thought of eating somewhat normally is enticing. I’m so very new to this (diagnosed just last October) so I feel I have time. My numbers are in range now so that’s good. My initial diagnosis was an a1c of 6.5…so just diabetic. I thought it was triggered by tamoxifen (breast cancer drug) and it may have been, hence the life changes before drugs. I did stop taking the tamoxifen. Looking forward to my July results. Hoping for a 5.5…..
 
A subject dear to my heart because I was misdiagnosed for over 8 years. I even asked if I could be a type 1 to my pcp and my endo at the time and was told no and never tested. All sorts of drugs were tried on me to no avail. After 5 years I was put on a basal insulin only and kept getting worse. I finally switched doctors who added a bolus insulin and was sent to a new endo when she was hired, who tested me without me even asking and I found out I was positive for the antibodies and zero insulin production. Knowing the proper diagnosis changed my whole care. I already swam 75 laps a day, ate a really healthy vegan diet, but I thought my body could cope with skipping insulin sometimes as a type 2and I was nonchalant about doses used. I had been told to increase my insulin half the time because of highs part of the day, but never taught carb counting or proper dosing or even about hypos as a type 2. The type 1 diagnosis made me understand that I needed insulin for everything I ate and that it needed to be adjusted when I ate and for what I ate.

Part of the problem of misdiagnosis is drugs and lifestyle changes can work at first because you still make some insulin for a while, until you reach the tipping point. Being properly diagnosed means a clearer understanding of needing insulin and absolutely having to have it at some point. What you eat is important to everyone, not just diabetics. Healthy food versus unhealthy food. But as a type one it's about learning to dose for whatever food you do eat. And what exercise causes in lessening insulin needs, what stress causes in BG levels, that to carry hypo treatments everywhere because our body decides to change it up because it's a little hotter outside, etc. Being diagnosed as a type 1 in the US, means being able to get insulins, insulin pumps and CGM's of your choice. Although they are now starting to also okay CGM's for type 2's.

While most type 1's have a positive antibody test. The GAD test is the most commonly used, but it is not the only antibody test that can be done. Some Type 1's don't test positive but don't make insulin and they don't know why yet. That is where a C-Peptide is also useful. Low or low normal is a sign of being a type 1, high or high normal is a sign of being a type 2 because as a type 2 you try to make more insulin to compensate for being insulin resistant.

The figures are all over the place. But a couple a years ago they announced that over 38% of type 1's were still being misdiagnosed still as type 2's at first. "A study found misdiagnosis of type 1 common, with half of those misdiagnosed still being treated as though they had type 2 diabetes 13 years later. In May 2019 The results showed that twenty-one per cent of participants with insulin-treated diabetes who were diagnosed after age 30 met the study criteria for type 1 diabetes in England." " A study from the Diabetes Alliance for Research in England (DARE) found that 38% of type 1 diabetes patients diagnosed over age 30 were misdiagnosed with type 2 diabetes and did not receive the required insulin4. Testing for anti-GAD antibody and C-peptide is the first step to differentiate type 1 diabetes from type 2 diabetes. While up to 30% of patients with type 1 diabetes will be antibody negative8, a low C-peptide can help clarify the diagnosis9"

"In the U.S. as well, the National Institute for Health and Care Excellence (NICE) doesn’t recommend rigorous testing to differentiate between type 1 and type 2 diabetes. We know that providing type 2 treatment of tablets for those with type 1 diabetes is not effective, as they need insulin."

And still to this day Type 1 is often thought of as a childhood disease by the general population and the medical field. But 50% of people get it after the age of 30.

I know that my care and health changed for the better with the proper diagnosis of type 1. It became about learning to properly use insulin, that I had to have it to be healthy and stay alive.

(1) https://www.verywellhealth.com/diabetes-misdiagnosis-6745378
(2) https://www.diabetesincontrol.com/m...A6rm-woyL2x2QBIYDL2lv6ftQGOtGoJza1MeLASQIpogo
 
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