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Should I push for a LADA diagnosis?

Discussion in 'Type 1.5/LADA Diabetes' started by Pinkerbell, May 17, 2014.

  1. Daibell

    Daibell LADA · Master

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    Be aware that both your morning fasting levels and your 2 hour after meal readings need to be taken account of when considering insulin (or just more tablets). My fasting was typically below 10 but my post meal readings were going into the 20s despite low-carbing and three level tablets. Hence the need for me to go onto insulin with an HBa1C that shot up to 8.3%. The NICE Diabetes Pathways doc gives excellent guidance on this (Google it). If your HBa1C goes over 7.5% then your medication does need to be increased. BTW do think about whether you want the statins or not. They have nothing to do with diabetes and the recommendation is that they should be given to those with a high risk of cardio problems.
     
  2. Pinkerbell

    Pinkerbell Type 1 · Well-Known Member

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    I've been researching statins and I do have concerns, I am on fluconozole fortnightly, which I read in the simvastatin literature, has been known to cause a problem in combination, although only rarely. My other concern is whether it will lower my blood pressure, which is already low enough to cause regular fainting problems, especially on standing, when hot and after eating. I couldn't find anything in the medication details about this, but then again, it is not likely to be considered a negative problem for the majority of people put on it. I also switched from smoking to eciggies last Wednesday and on balance, think I would be happier waiting a few months and retesting before considering any new meds.

    Does anyone have any experience of the effects of statins on blood pressure?
     
  3. Spiker

    Spiker Type 1 · Well-Known Member

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    Interesting about Swansea.

    In the long term I agree it makes no difference to treatment. Twenty odd years after diagnosis I am a T1 and LADA or not is ancient history. However I do think treatment potentially could be different for LADA at diagnosis and for the first few years. In hindsight I wish I had had that opportunity. I would most of all liked to have therapy which made the top priority the preservation of beta cell function for as long as possible, probably through early insulin therapy, insulin sensitivity approaches, and carb reduction. By accident the "misdiagnosis" of classic T1 rather than LADA does provide early insulin therapy so I am grateful for that.

    OP if I were you I would reject any pancreas stimulating drugs for fear they accelerate final beta cell failure. And for the same reason I would go on insulin right away, take metformin and do strength exercises for improved insulin sensitivity, and go low carb. And only take statins if those changes don't improve your lipid ratios - ignoring total cholesterol which is a meaningless measure.

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  4. Pinkerbell

    Pinkerbell Type 1 · Well-Known Member

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    I am worried about the drugs I'm on speeding the process, however I can't take metformin, I know it's not meant to happen, but my body reacted to it with multiple daily hypos (as low as 1.8 and regularly 2.5) and although it settled as soon as I was taken off it, they re extremely reluctant to start me on insulin while I'm sometimes seeing levels of 3.5 before meals and my A1c is 6.5% DSN told me insulin is too likely to cause hypos at this stage and I don't feel I understand the situation well enough yet to be able to question that.

    I think it's my reaction to metformin and low BP which makes them keep testing for Addison's, although all tests negative so far. They seem pretty convinced that something else is going on that no one's worked out yet... It's all a bit scary :(
     
  5. Spiker

    Spiker Type 1 · Well-Known Member

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    When you had the hypos were you also on the pancreas stimulating drug? That, alone or in combination with metformin, is a more likely cause of the hypos. Have you ever been on metformin alone and had those hypos?

    Sent from the Diabetes Forum App
     
  6. Pinkerbell

    Pinkerbell Type 1 · Well-Known Member

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    No, metformin 500mg twice daily, nothing else. They then tried without medication for a few months and decided on repaglinide when the numbers started going up. We were all completely baffled as aware that metformin is the one drug that just shouldn't do that! They theorised that maybe my body is prone to lows and metformin just helped it achieve that more quickly ... Hence the suspicions of Addison's and the horrible tests!
     
  7. oldgreymare

    oldgreymare Type 1 · Well-Known Member

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    Hi Pinkerbell,

    Following this thread with great interest - I think you touch on many important aspects of how to get to optimal treatment for interim diabetics most efficiently. Sadly NHS is struggling on this front.

    I'm in same camp as Phoenix and Spiker - at diagnosis (age 51) I was classified Type 1 (based on almost 0 c peptide and +++ GAD antibodies), so straight to insulin treatment. But with hindsight probably a few years of LADA. That said, both endocrinologist in Asia and diabetic nurse specialist in UK said to me that they believe immediate aggressive insulin therapy is key to extending any diminishing beta cell function. Obviously only works with comprehensive bg monitoring...so you must have access to as many test strips as necessary....catch 22 under NHS if not already classified type 1?

    BTW do note it is known (at least in USA) that some diabetics can show very positive GAD antibodies, but still have insulin production - full blown autoimmune Type 1 should show almost zero c peptide (insulin marker) as well.
     
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  8. Pinkerbell

    Pinkerbell Type 1 · Well-Known Member

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    I am very lucky in some respects, I have access to as many test strips as my bruised pinkies can handle, but they are still reluctant to start on insulin because of a reasonably good A1c and occasional minor lows through the day. I do worry what effect the pancreas stimulating drugs are having on my beta cells and also whether the morning and evening highs are causing damage. I feel stuck in a position where I'm almost wishing for it to progress so I can start on insulin and get it under proper control, but another part of me is terrified of this prospect. I have tried eating to the meter, but unfortunately my bg levels seem to be wildly unpredictable (A meal that results in a postprandial level of 7 on one day can trigger an 18.9 on a different day) I just want to be able to understand a little better what is going on, or at the very least, that my health care providers give me the confidence that they have some idea!
     
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  9. RoxanneBT

    RoxanneBT Type 2 · Newbie

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    Question?

    Is type2 taking insulin, possibly LADA?
     
  10. Pinkerbell

    Pinkerbell Type 1 · Well-Known Member

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    It's possible, particularly if you don't match the typical profile of a type 2. If you have concerns, then it might be worth requesting GAD and CPeptide tests which will determine the presence of the auto antibodies responsible and whether you are producing insulin.
     
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