The honeymoon is over. Now what?

[HuckFinniganagain]

Hi all - long time lurker, first time poster. I am hoping to hear from other LADAs who became insulin dependent. I know there are several threads on weight gain, and that is certainly a concern. At this point I'm mostly wondering if I should be fighting to keep some of my Type-2 drugs along with the insulin.

Long story short, I was lucky enough to find out I was LADA early on, but my doctor opted to treat me as Type-2 until it was no longer working. (That course of treatment isn't the point of my post, though I understand its merits are debatable.) For better or worse, I was able to prolong my honeymoon phase for a few years with diet, exercise, Metformin, and Trulicity.

Now I'm insulin dependent. My new endo wants me to go off the Type-2 drugs and be treated fully as Type-1. Is there any LADA-specific reason I would want to keep Metformin or Trulicity? If I do go off those drugs, will it mean I need a lot more insulin than otherwise? Anything else to consider?

I've had to be vigilant in understanding the differences between LADA and Type 2 for so long (since my Dr. didn't), that I now wonder if I have to be vigilant in understanding any differences between LADA and Type-1.

 

[EllieM]

Welcome to the forums @HuckFinniganagain .

I don't know about trulicity, but I think metformin is one of those drugs that can help T1s with insulin resistance, so it's not surprising that some LADA use it, as they often have insulin resistance to go along with their T1.

As for the trulicity, my (limited) understanding is that it increases insulin production from your beta cells, so don't see how it would work once your cells are dead. (Disclaimer, I am not a doctor).

So I can understand why your endo wants you to stop the trulicity, I think you could make a case for the metformin if you wanted it, but as a T1 who happens to be insulin resistant.

 

[Daibell]

Hi. Normally when you move to insulin you stop most if not all other 'T2' drugs. The main exception might be Metformin as it has some other protective benefits and I still take it. You shouldn't need to take Trulicity with insulin. If you still need Trulicity due to insulin resistance and excess weight then you might question being LADA and also insulin doesn't work well with insulin resistance. When your beta cells are failing and insulin is needed to replace the insulin then there is rarely a need for diabetes 'T2' drugs.

 

[AnnJohnston]

I was diagnosed Lada 5 years ago and they kept me on my metformin as they said it helps with insulin absorption.

 

[Shari68]

Hi, I was diagnosed with LADA in February 2020, after being misdiagnosed as T1 since 2013. As soon as I got my LADA diagnosis I was put on insulin, Tresiba and Fiasp. I was to stop metformin altogether. After going onto insulin my weight didn't as much creep up, but go on in rapid speed. I went from 8 stone (112 pounds) to 13 stone 10lbs (over 183 pounds) in a matter of around 10 months!. I am also disabled, and can't walk for any more than 5-10 mins, so that was another factor of me putting on weight. Anyway 2 and a half years later I was put on Trulicity, 4 weeks on 1.5mg and I'm now on my 1st dose of 3mg. After I finish 4 of them I've to go onto 4.5mg for the foreseeable future. On the 1.5mg dose I lost a pound each week. I'm now on day 5 of 3mg and I've lost 4lbs since last week! On the info page on this website it states that Trulicity is not diagnosed in T1s, I think that needs to be updated. Since being on Trulicity my insulin intake has decreased. I was on 48 units of Tresiba a day and I was having to take almost 3 units to 10g of carbs on Fiasp. I am now down to 30 units of Tresiba and 1 unit to 10g of Fiasp. I have Libre2 Freestyle sensor and my average on target has went from around 60% over a week to 95% on target. The only downside is the side effects, nausea, which lasts 1-3 days after injection, diarrhoea or constipation, and fatigue, but I'm willing to put up with these as the positive effects outweigh the side effects.

 

[In Response]

Maybe we have a different definition of "honeymoon" but just because you are now on insulin does not mean the "honeymoon period" is over.
This is the period during which your body produces some insulin before the insulin producing cells all die off. I have heard that taking insulin can protect some of these cells and prolong their lives so I am surprised when doctors hold back on starting insulin.
I was diagnosed with Type 1 in my mid 30s. According to some definitions, this was LADA. I was given insulin from the start and found that my injected insulin dose rose slowly over 8 years as more of those cells died off. After 8 years, my insulin needs remain the same.

I cannot comment on using type 2 drugs as I never had any. However, with regard to weight gain, this is something that I have not experienced in nearly 20 years of injecting insulin. This is no surprise as my understanding is that it is excess insulin which causes weight gain and not experiencing any insulin resistance means I have no excess insulin.

I realise some people do experience weight gain and insulin resistance. I guess this is another case of "we are all different". But Metfomin and Trulicity are not required by many of us with Type 1 diabetes even if we were diagnosed as adults.

 

[Circuspony]

I was diagnosed at 43 and needed insulin pretty much straight away. I've never had any more problem with weight gain than I had before diagnosis. I would say it's worth getting your insulin requirements sorted first and then seeing if you also have T2 type issues which would need Metformin on top

 

[Helen R]

I was diagnosed LADA about 6 years ago, though that doesn't include the T2 misdiagnosis for a further 2 years trying many different drug combinations. So I'm well past my honeymoon period. I was also taking metformin. Six months ago I decided to stop the metformin to see if it made a difference. It definitely did! Bgl up and down all over the place! I went from an average of 70% in range to 30%. I lasted 2 weeks and went back on the tablets. Again, an immediate difference. Blg steadied and quickly went back to normal. I do have insulin resistance issues, but much better with the metformin.

 

[Helen R]

Must change my profile details! Lol

 

[JPritch84]

I was diagnosed in 2017 with type 2 which was diagnosed as LADA, I am now on insulin, metaformin and Forixga. Seems like I am on more
Meds that most, is anyone else on similar?

 

[johnsands64]

I was diagnosed in 2017 with type 2 which was diagnosed as LADA, I am now on insulin, metaformin and Forixga. Seems like I am on more
Meds that most, is anyone else on similar?

I am on exactly the same as well as statins. I was taken off Trulicity as my weight plummeted to below 13 stone and I am 6ft tall. Could do with that weight loss now as I have gained a lot and back up to 16 stone. I do need to have a checkin as because of Covid I just haven't had access

 

[agwagw]

Hi all - long time lurker, first time poster. I am hoping to hear from other LADAs who became insulin dependent. I know there are several threads on weight gain, and that is certainly a concern. At this point I'm mostly wondering if I should be fighting to keep some of my Type-2 drugs along with the insulin.

Long story short, I was lucky enough to find out I was LADA early on, but my doctor opted to treat me as Type-2 until it was no longer working. (That course of treatment isn't the point of my post, though I understand its merits are debatable.) For better or worse, I was able to prolong my honeymoon phase for a few years with diet, exercise, Metformin, and Trulicity.

Now I'm insulin dependent. My new endo wants me to go off the Type-2 drugs and be treated fully as Type-1. Is there any LADA-specific reason I would want to keep Metformin or Trulicity? If I do go off those drugs, will it mean I need a lot more insulin than otherwise? Anything else to consider?

I've had to be vigilant in understanding the differences between LADA and Type 2 for so long (since my Dr. didn't), that I now wonder if I have to be vigilant in understanding any differences between LADA and Type-1.

Hi,

I became diabetic in 1994 - misdiagnosed as type 2 for some years, then LADA. I was also on type 2 drugs for about 10 years after starting on insulin. They became ineffective after a while - to be honest I am not convinced they ever helped at all. My pancreas would have been still producing some insulin. I am now on Tresiba (very good) and NovoRapid (actually rather slow). I think I still have some insulin production. My advice would be a low carb diet and exercise - even a brisk walk every day helps greatly. Be aware that exercise can suddenly cause blood glucose to drop much faster than injecting insulin, so always have glucose tabs handy.

 

[northmen24]

Hi all - long time lurker, first time poster. I am hoping to hear from other LADAs who became insulin dependent. I know there are several threads on weight gain, and that is certainly a concern. At this point I'm mostly wondering if I should be fighting to keep some of my Type-2 drugs along with the insulin.

Long story short, I was lucky enough to find out I was LADA early on, but my doctor opted to treat me as Type-2 until it was no longer working. (That course of treatment isn't the point of my post, though I understand its merits are debatable.) For better or worse, I was able to prolong my honeymoon phase for a few years with diet, exercise, Metformin, and Trulicity.

Now I'm insulin dependent. My new endo wants me to go off the Type-2 drugs and be treated fully as Type-1. Is there any LADA-specific reason I would want to keep Metformin or Trulicity? If I do go off those drugs, will it mean I need a lot more insulin than otherwise? Anything else to consider?

I've had to be vigilant in understanding the differences between LADA and Type 2 for so long (since my Dr. didn't), that I now wonder if I have to be vigilant in understanding any differences between LADA and Type-1.

I was diagnosed with LADA and stayed on oral meds for a few years until I asked my endocrinologist if I could go on insulin to have more control over my BG levels. I began taking insulin injections before meals and completely abandoned my oral medications which were Metformin and Glyburide. I continued with injections for a few more years before transitioning to a pump. Since I am still producing some amount of insulin, my daily insulin requirements are quite low. Like you, I exercise regularly and closely monitor my intake of carbs.

 

[Antje77]

I am now on Tresiba (very good) and NovoRapid (actually rather slow).

Have you considered asking for Fiasp or Lyumjev instead of the NovoRapid?
Both work better for me.

 

[agwagw]

Have you considered asking for Fiasp or Lyumjev instead of the NovoRapid?
Both work better for me.

Many thanks for the suggestion (not been on recently so missed your reply ) I'll discuss with my Nurse practioner.