Thoughts On Whether I May Have Lada

[LucyAuch]

Hi there,

I'm 41, 83kg and 5 ft 7.

I was diagnosed as Type 2 about 15 months ago with an hb1ac of 103. Disappointingly, I had written a letter to my doctor some 18 months earlier with a list of random symptoms while investigating something else, all of which I now know are symptoms of diabetes. It was only when I had sudden weight loss which in no way was deserved, that I was tested.

Anyway, I was prescribed metformin and my next hb1ac three months later was 50.

However, as I read more, I have all the LADA symptoms listed on this site except tingling nerves.

I contacted my new doctor (who seems much more switched on but who may not have had all the history shared properly from my previous doctor) to ask if it was worth the test.

He said it's unlikely as my initial drop from 103 to 50 with Metformin was too quick for it to be LADA.

What do you think? Has anyone else had the same experience and been diagnosed with LADA after tests?

My doctor has said he'll look to organise a test if I really want but I don't want to be "I read it on the internet so it must be true" without hearing other people's thoughts.

Thanks in advance

 

[librarising]

Did you make any other changes ? A drop from 103 to 50 seems too much to attribute to Metformin alone.
Geoff

 

[LucyAuch]

Hi Geoff,

I cut out sugars (not carbs - this was before I'd had a diabetes course) and the biggest changes was a complete removal of Lucozade from my life.

Historically I'd had a bottle a day, often 2, for about 15 years.

Thanks,

Lucy

 

[Alexandra100]

I have all the LADA symptoms listed on this site except tingling nerves

Tingling nerves can just as well be due to nerve damage from sustained high blood glucose levels as a T2. I am absolutely no expert but I think I may be heading for LADA myself. My understanding is that T2s who cut carbs drastically and maybe also take a sufficiently high dose of Metformin should see their bg fall, as Jenny Ruhl puts it, "like a stone". If not, that suggests T1 / LADA.

How much Metformin are you taking? How many carbs are you eating?

 

[Alexandra100]

Hi Geoff,

I cut out sugars (not carbs - this was before I'd had a diabetes course) and the biggest changes was a complete removal of Lucozade from my life.

Historically I'd had a bottle a day, often 2, for about 15 years.

Thanks,

Lucy

My goodness, no wonder cutting out the Lucozade lowered your bg!!! I suggest you experiment with cutting carbs further and see what happens. Have you thought of acquiring a meter so you don't have to wait for your next A1c to see what is happening? You can order one free here:
http://spirit-healthcare.co.uk/product/tee2-plus-blood-glucose-meter/
but the 10 free strips that come with the meter won't last long, so realistically you will need to pay £7.75 for a tub of 50 strips. No need to buy lancets at first as the 10 that come free will last a long time if, like many of us, you re-use them. You can avoid paying VAT by typing "diabetes" in the appropriate box.

Here is some useful advice on how to test: http://www.phlaunt.com/diabetes/14045524.php

 

[Antje77]

I didn't think there are differences in symptoms between LADA and type2. Both give you high bg, and high bg gives the symptoms. Or am I missing something here?

 

[LucyAuch]

Thanks, everyone for your thoughts.

I'm on 2000mg of metformin a day (slow release) and generally eat 150-175 carbs a day. Occasionally it may be as high as 250 but not too often. That's normally when I'm at the "what's the point, I feel rubbish anyway" stage where I may have a packet of fruit pastilles or similar.

I have a testing kit and my 7 day average is 9.2. I tend to start quite high in the morning (even as high as 14.2), drop down to 6ish during the day and then go to bed around 8.5 a couple of hours after dinner.

This week I've changed on my doctor's advice to taking all my metformin at bed time to try to bring it down quicker for the morning but haven't seen real changes yet.

@Antje77 - you're right of course. One thing I didn't mention which may be relevant is I am significantly more susceptible to bugs now than I ever was - I tend to pick something up every couple of weeks, probably from my 3 year old who rarely seems to get sick. May be I'm reading too much into the auto-immune side of it!

 

[Alexandra100]

I didn't think there are differences in symptoms between LADA and type2. Both give you high bg, and high bg gives the symptoms. Or am I missing something here?

Yes. As a possible pre-LADA in the honeymoon stage, I am watching out for any unexplained deterioration in my bg readings. At that point, I will be hassling my GP for tests, with a view to possible basal insulin. I am aware that if the amount of insulin I am myself producing suddenly diminishes I could, worst case scenario, find myself in hospital, so I'll be testing regularly. As long as I can get fairly acceptable results by eating 20-30g carbs daily, I see no point in asking for tests.

I am hoping that by the time I really need meal-time insulin, my lower bgs will have allowed my gastroparesis to heal. It's too early to be at all sure, but at present I am actually seeing some post prandial readings where I am up at 1 hour and down again at 2 (instead of erratically down at 1 hour and then up at 2 / 3 / more hours after eating). This is a first for me, but I find diabetes is a fickle business so I'm not counting my chickens just yet.

IMO the best course, whether one is T2 or LADA, is to try to lower bg by low carb and maybe Metformin. If that works, one can go on like that until it doesn't. If low carb diet and Metformin no longer give acceptable bg levels, it will be time for tests, insulin and a new identity as fully fledged LADA / T1.

 

[thesilverpenny]

I didn't think there are differences in symptoms between LADA and type2. Both give you high bg, and high bg gives the symptoms. Or am I missing something here?

T2 is a metabolic disease and cutting carbs, losing weight and exercising can go a long way to correcting the problem. Fatty liver (NAFLD) and fatty pancreas are usually implicated in T2 (and can be in LADA if central obesity is an issue). Insulin resistance, due to hyperinsulinemia (chronic high insulin) is another aspect of T2 diabetes, which is not present with LADA (just the opposite). LADA, on the other hand, is an autoimmune disorder where the insulin producing beta cells in your pancreas are being destroyed by your own immune system. It is a slow developing type of diabetes (they call it Type 1.5), and can sometimes be misdiagnosed as T2, especially in the beginning. But essentially what is happening is that eventually the pancreas can no longer make enough insulin (or stops making it altogether) and the person will become insulin dependent (meaning you turn into a T1 diabetic). If you have one autoimmune disease, it would be wise to rule out LADA by having your doctor perform a GAD65 antibody test.

 

[Antje77]

T2 is a metabolic disease and cutting carbs, losing weight and exercising can go a long way to correcting the problem. Fatty liver (NAFLD) and fatty pancreas are usually implicated in T2 (and can be in LADA if central obesity is an issue). Insulin resistance, due to hyperinsulinemia (chronic high insulin) is another aspect of T2 diabetes, which is not present with LADA (just the opposite). LADA, on the other hand, is an autoimmune disorder where the insulin producing beta cells in your pancreas are being destroyed by your own immune system. It is a slow developing type of diabetes (they call it Type 1.5), and can sometimes be misdiagnosed as T2, especially in the beginning. But essentially what is happening is that eventually the pancreas can no longer make enough insulin (or stops making it altogether) and the person will become insulin dependent (meaning you turn into a T1 diabetic). If you have one autoimmune disease, it would be wise to rule out LADA by having your doctor perform a GAD65 antibody test.

You're completely right of course on the differences between type2 and LADA. None of those differences give you different symptoms though.

 

[Daibell]

T2 is a metabolic disease and cutting carbs, losing weight and exercising can go a long way to correcting the problem. Fatty liver (NAFLD) and fatty pancreas are usually implicated in T2 (and can be in LADA if central obesity is an issue). Insulin resistance, due to hyperinsulinemia (chronic high insulin) is another aspect of T2 diabetes, which is not present with LADA (just the opposite). LADA, on the other hand, is an autoimmune disorder where the insulin producing beta cells in your pancreas are being destroyed by your own immune system. It is a slow developing type of diabetes (they call it Type 1.5), and can sometimes be misdiagnosed as T2, especially in the beginning. But essentially what is happening is that eventually the pancreas can no longer make enough insulin (or stops making it altogether) and the person will become insulin dependent (meaning you turn into a T1 diabetic). If you have one autoimmune disease, it would be wise to rule out LADA by having your doctor perform a GAD65 antibody test.

Hi. Although LADA is strictly speaking an auto-immune condition, there are several different antibodies and viruses that can cause the same beta cell destruction and show the same end result so all are in effect LADA. The c-peptide test can be more useful than GAD as it shows your actual insulin level and not the cause of the beta cell destruction and is the best guide to treatment i.e. insulin.. The OPs weight of 83Kg sounds bit on the high side and knowing the BMI would help. I'm 5' 6" and 62Kg. Being slim is a strong pointer as the body will be trying to burn fat.

 

[librarising]

it would be wise to rule out LADA by having your doctor perform a GAD65 antibody test.

Sadly a GAD test can't rule out LADA, as only 75% who take this test prove positive for it. So testees have a 1 in 4 chance of being left in diagnosis limbo. A LADA's best bet just as with T2s, is to test their blood sugar regularly to check for any fall-off in in insulin production and subsequent rise in blood sugar.
Geoff

edited for clarity

 

[LucyAuch]

Thanks, everybody

 

[Alexandra100]

The c-peptide test can be more useful than GAD as it shows your actual insulin level

In his latest Tele Seminar Dr Bernstein says that the c-peptide test is useless unless you test your bg at the same time, because insulin rises and falls in response to bg.

 

[Alexandra100]

You're completely right of course on the differences between type2 and LADA. None of those differences give you different symptoms though.

Except in the sense that eating very low carb and taking Metformin are likely to give much better results in lowering bg for a T2 than for a LADA.

 

[Daibell]

In his latest Tele Seminar Dr Bernstein says that the c-peptide test is useless unless you test your bg at the same time, because insulin rises and falls in response to bg.

Hi and thanks. First time I ever heard of that. This would imply that the majority of c-peptide tests carried out are useless? The test is supposed to be a fasting one as mine was and I guess therefore the BG will be low-ish unless BS control is poor i.e. no medication? I've also read that the actual value of the reading doesn't tell you much other than if it's very low it implies T1 and if very high it implies T2

 

[Alexandra100]

Hi and thanks. First time I ever heard of that. This would imply that the majority of c-peptide tests carried out are useless? The test is supposed to be a fasting one as mine was and I guess therefore the BG will be low-ish unless BS control is poor i.e. no medication? I've also read that the actual value of the reading doesn't tell you much other than if it's very low it implies T1 and if very high it implies T2

Perhaps doing the test fasting levels out the playing field? It seems to me that the best indicator is whether bg levels start to be higher with the same level of carb intake.

 

[cz_dave]

He said it's unlikely as my initial drop from 103 to 50 with Metformin was too quick for it to be LADA.

What do youthink?

That still doesn't rule out LADA. You should get proper tests.