The Beginning of the End.....

[elaine77]

Well it has been 14months since I was diagnosed with LADA and I have managed up until now with no medication increase, no insulin and just a lower GI carb diet... But the last week or so my morning fasting levels have risen from 7-8mmol to 9-10mmol and my post prandials have risen from 6-8mmol to 8-10mmol.... I fear more cells have now been killed and maybe it is time to have the "chat" with my consultant regarding insulin :-( they may suggest a larger dose of Metformin but I'm not sure how much of an effect it will have....


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

 

[Alanp35]

Hi Elaine
Please,don't worry, it is not the end merely another step in your journey.
I am LADA but only a beginner. I was fine as a diet and metformin controlled. My produced insulin dropped off the cliff with no warning and here I am on Humalog mix insulin and still taking care of my diet.
You'll be fine, just another day . . . . . .



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[ShellyC23]

I started off diet controlled for about 7 years then was shocked to be given Metformin and insulin 3 years ago. I started off on 0.5 units of Novarapid per 10g carbs after evening meal but this had gradually risen and now it's up to 2 units per 10g. I'm really upset about it as I feel like a failure if BG is on the high side 2 hours after injection. I find it really hard not to eat during this 2 hours especially if my partner is stuffing his face with chocolate :-(


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[Daibell]

Hi Elaine. The GP may prescribe Gliclazide and or Sitagliptin for a while as these can help increase available insulin. Metformin has some but little effect for those of us with a failing pancreas. Depending on the rate of progress of your LADA you may have to go onto insulin when the extra tablets don't work. Your GP may do the right thing and put you straight onto insulin but if yours is like mine you may have to go thru the tablets first.

Shelly, has your weight increased since being on insulin? If so this might explain the increased injected units. Low-carbing should help bring it back again. Ignore what I'm saying if your weight is normal!

 

[desidiabulum]

Well it has been 14months since I was diagnosed with LADA and I have managed up until now with no medication increase, no insulin and just a lower GI carb diet... But the last week or so my morning fasting levels have risen from 7-8mmol to 9-10mmol and my post prandials have risen from 6-8mmol to 8-10mmol.... I fear more cells have now been killed and maybe it is time to have the "chat" with my consultant regarding insulin :-( they may suggest a larger dose of Metformin but I'm not sure how much of an effect it will have....


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

Do keep your nerve, Elaine. It's not the beginning of the end -- perhaps nearing the end of the beginning. As Daibell says, sulfonylureas like gliclazide may be your next call, rather than straight onto insulin. Good luck!

 

[smidge]

Hi Elaine!

Sorry your condition seems to have progressed.

Sit down quietly and have a think about what you want to do. I know you're a bit apprehensive about insulin, but it's really not that bad - you get used to it and adjust really quickly. In your position, I would seriously consider trying a low dose of basal insulin rather than running through all the tablets one by one. You might get away with one or two injections for a few years if you're careful with your diet - some LADAs manage very well for a long time with just basal - it means injections are confined to morning and/or evening and the risk of hypos from just basal are quite low.
Obviously it does mean 3 year driving license which I found strangely upsetting even though it makes no practical difference to me.

Have a think and then speak to your doctor. I always find it best to have thought things through before talking to them!

Good luck

Smidge

 

[elaine77]

Thanks Smidge, it's true that I hate needles but to be honest the DVLA problems, the insurance problems etc etc is all bothering me more than the needles at the moment... I don't think it's fair to treat all diabetics the same because I am not insulin dependent I am insulin deficient at the moment... Insulin dependence suggests that if I didn't inject I would die...that's not the case for me right now and so I don't think it really applies to me as I still rarely go above 10mmol after eating carbs and I wouldn't die if I didn't inject I would probably just risk damage to myself due to running high levels... If you only inject say, once a day on a nighttime, it doesn't seem right that your driving license should be effected the same way as some one who has to inject 5 or 6 times a day throughout the day whilst driving.... :-(


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

 

[pavlosn]

Thanks Smidge, it's true that I hate needles but to be honest the DVLA problems, the insurance problems etc etc is all bothering me more than the needles at the moment... I don't think it's fair to treat all diabetics the same because I am not insulin dependent I am insulin deficient at the moment... Insulin dependence suggests that if I didn't inject I would die...that's not the case for me right now and so I don't think it really applies to me as I still rarely go above 10mmol after eating carbs and I wouldn't die if I didn't inject I would probably just risk damage to myself due to running high levels... If you only inject say, once a day on a nighttime, it doesn't seem right that your driving license should be effected the same way as some one who has to inject 5 or 6 times a day throughout the day whilst driving.... :-(


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

Dear Elaine

As I understand it, the main worry regarding diabetes and driving is the risk that a diabetic driver may cause injury to himself and others not because his levels are too high but because they are too low (hypo) - say anything below 4 mmol/l. A diabetic who is tto low is very similar to a person who is very very drunk and not fit to drive.

While on a diet only or diet and metformin treatment regime, the risk of going this low are limited. The risk is considerably higher with some other medication particularly with insulin.

But do not jump the gun. See what your doctor has to say first.

Even if you do have to go on insulin, what is more important to you, your driving license or your health?

Pavlos


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[smidge]

Hi Elaine!

I know exactly where you're coming from on this - none of the laws around driving and insulin make any bit of sense or stand up to close scrutiny. I ranted and raved about it when I went onto basal - how it was discriminatory, unfair etc etc. I still believe it is. After all, those on glic can go low but DVLA aren't interested, non-diabetics can go down into the mid to high 2s but can legally drive like it, I am at greater risk of hypos mid morning than late afternoon and yet I have to push my BG to 5.5 at all times before I can legally drive - it's not fair. Unfortunately life's like that!

I cried a lot when I applied for the 3 year license and a lot more when it arrived. I guess somehow the stuff with the license once on insulin made this life-long serious condition seem real to me - insulin marked the change in my perception from diabetes as an inconvenient condition to a serious illness that I had to incorporate into my life forever. It was dealing with this mind set that I found challenging rather than the insulin itself.

If insulin is the best treatment for you now to manage your diabetes long-term, try to sort your head out and welcome it. Once you do that you'll feel more in control instead of waiting for diabetes to make the decisions.

Smidge

 

[elaine77]

Well my driving license is my livelihood so...tough question!

And yes I know it is the risk of going low not high but like I said, taking one injection on a nighttime before bed...not sure how that would cause hypos whilst driving through the day? Like Smidge said, you can have hypos with sulfonylureas so why do people taking those not have to renew their license every 3 years??? It is discrimination absolutely it is!


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

 

[michellepixeldot]

Hi Elaine, I'm new here but have been looking at the ap for quite a while. My story is the same as yours.
I was diagnosed with GD when pregnant with my twin boys, fasting 7.1 no need to continue with the test, I was given a meter and metformin. GD went away after the birth of my boys after a hba1c of 5.3.
Anyway after around 7 months I started feeling really thirsty a knew there was something wrong so after being refused test strips I bought some off eBay and after waiting 3 days for them to arrive I rang the doctor with bs of 24, I was immediately admitted to hospital and put on a sliding scale with +4 ketones.
I spent 3 heartbreaking days in hospital away from my 5 children. After being told I have to stay in until the diabetic clinic opened on Monday and my bs being down to 13 and ketones gone I discharged myself.
I made an appointment with my gp who diagnosed me with type 2 although I didn't fit the bill (in her words), was put on metformin and gliclazide which worked wonders aside a minimum carb diet, bloods never went above 7.
My recent hba1c in December was 5%
And I was told to stop all meds which was music to my ears.
Since stopping the meds my bs has rarely been below 11 and was 15.3 fasting this morning. I went back to the docs last week and was put back on maximum dose of metformin and gliclazide which haven't made a slight difference to my numbers. My gp told me I will need to go on insulin at some point.
My concern is that my bs is running high whilst I wait for my doc to put me on insulin and I have got into my head that it could be pancreatic cancer as there is no explanation other than my children had hand foot and mouth while I was pregnant which is also known as the coxsackie virus which has been found to cause diabetes.i suppose I'm just looking for answers.
Sorry about the rambling, just needed to get it off my chest.



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[elaine77]

Hi Michelle,

I think you are most likely LADA like me and probably have slow onset type 1. This can be diagnosed with an antibody and c-peptide blood test, if you haven't already had them done it may be worth asking your GP to do it so that you can get a correct diagnosis because gliclazide can often speed up beta cell destruction in people with LADA and so is usually not prescribed.

The medical professionals just seem to know nothing about LADA or why it happens or what causes it but my theory is that something in pregnancy can trigger the autoimmune response that kills the beta cells but for some reason does it very slowly and gradually rather than an all out blitz.

Obviously pregnancy is not the only thing that can trigger it as many people who are men and who don't have children have LADA but pregnancy does seem to be the trigger for quite a few people...I certainly think it was for me as I was never ill or anything prior to diagnosis... My consultant put it down to the stress I was under the year I was diagnosed but I'm not convinced because I had it during my pregnancy which was BEFORE that stressful year.... Perhaps we will never know but it is a mistake to tell pregnant women that GD can lead to type 2 diabetes in letter life when it actually is looking more likely that it leads to LADA


Diagnosed with GD in 2010, Completely disappeared postpartum. Re-diagnosed December 2012 with type 1.5 diabetes, age 26, BMI 22 currently controlled by only Metformin, 500mg twice a day.

 

[mo1905]

As far as DVLA and driving goes, I understand the risk of hypo. However, I work for emergency services and have never dealt with hypo related vehicle accident ( not saying they don't happen though ). I have attended many vehicle accidents relating to heart attack at the wheel. Strange that those with heart disease or heart meds do not require annual medical.


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[Crimsonclient]

As far as DVLA and driving goes, I understand the risk of hypo. However, I work for emergency services and have never dealt with hypo related vehicle accident ( not saying they don't happen though ). I have attended many vehicle accidents relating to heart attack at the wheel. Strange that those with heart disease or heart meds do not require annual medical.


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I understand what you are saying BUT as I was a lgv1 driver with ADR licence the thoughts of having a hypo at the wheel is too scary to even think of. Sat on the hard shoulder of a motorway for 45 mins with highly toxic or petrochemical on board and someone hitting the back of the truck. In most cases prevention is better than cure


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[mo1905]

I understand what you are saying BUT as I was a lgv1 driver with ADR licence the thoughts of having a hypo at the wheel is too scary to even think of. Sat on the hard shoulder of a motorway for 45 mins with highly toxic or petrochemical on board and someone hitting the back of the truck. In most cases prevention is better than cure


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Totally agree, just saying in my experience, heart attack at wheel is more prevelent yet no annual medicals ? I'm not saying risk of hypo should be ignored.


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[Crimsonclient]

On that note I totally agree with you any medication should be reported to DVLA


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[catherinecherub]

Totally agree, just saying in my experience, heart attack at wheel is more prevelent yet no annual medicals ? I'm not saying risk of hypo should be ignored.


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Anyone can have a heart attack at any time.

There are guidelines for people with existing heart related problems.

This is the document that Drs are aware of from the DVLA

https://www.gov.uk/current-medical-...professionals-cardiovascular-chapter-appendix

This one goes into more detail.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/275982/aagv1.pdf

I have had a heart attack and was not allowed to drive for 6 months and had to do stress tests at regular intervals.

The same document for professionals has a section on diabetes
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/275982/aagv1.pdf

The whole document lists other conditions that may cause a ban.

 

[mo1905]

Anyone can have a heart attack at any time.

There are guidelines for people with existing heart related problems.

This is the document that Drs are aware of from the DVLA

https://www.gov.uk/current-medical-...professionals-cardiovascular-chapter-appendix

This one goes into more detail.

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/275982/aagv1.pdf

I have had a heart attack and was not allowed to drive for 6 months and had to do stress tests at regular intervals.

The same document for professionals has a section on diabetes
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/275982/aagv1.pdf

The whole document lists other conditions that may cause a ban.

My
Brother-in-law recently had heart attack but no restriction on driving at all. DVLA contacted but they were not interested. No annual medicals required or anything.


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[catherinecherub]

My
Brother-in-law recently had heart attack but no restriction on driving at all. DVLA contacted but they were not interested. No annual medicals required or anything.


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I think a lot depends on the severity of the heart attack and the Dr's assessment. The more the heart muscle is damaged, then the more severe the attack.

http://www.scai.org/SecondsCount/Resources/Detail.aspx?cid=d7afebbf-d04c-4345-a9cd-50e562e58e9b

I hope your BIL is feeling better, it is a life changing event which makes you aware that you are not invincible.

 

[mo1905]

Thanks Catherine, he seems fine now. Hardly seems fair though as severity of diabetes not taken into account regarding DVLA. I have very good control but still have to jump through all required hoops. I consider myself very low risk. My brother-in-law, although recent emergency resolved, is certainly at higher risk of cardiac arrest at wheel than I am of having hypo although he has no on-going medical or DVLA assessments whilst I have to endure the 12 monthly scenario. I'm not suggesting there shouldn't be tight medical controls, just saying should be fair for all.