Type 2 or LADA. To test or not to test?

[Antje77]

I was diagnosed whith diabetes (type 2) last november. Looking back, I know I've had it for at least two years before diagnosis (returning itches you-know-where started around that time). Within three months I went from tablets to more tablets to tablets plus long-acting insulin to basal/bolus without tablets.
I'm in the Netherlands, get all the test-strips I want and there are no other issues insurance- or otherwise if I suddenly became listed as a type one. The only difference I can see is that I would probably be referred to hospital for my treatment and check-ups, as type two's are usually treated by their GP and DN who is part of the GP-practice, and type ones are under hospital care.
So if I ask for a GAD/C-peptide test, and I test positive, I might lose my truly great DN.

My question: What reasons are there to want to know which type I am?

My answers so far:
- Statistics.
- The more people get diagnosed with LADA, the more will HCP's expect LADA and the sooner might people get recognised and get the right treatment.
- Easier to explain ('I have type 1 diabetes' is a lot easier than 'I have type 2 but get treated like most type ones', which results in trying to explain two different diseases to my bewildered audience, and then trying to explain why no-one knows which one I have, and explaining why it doesn't make any difference in my case. And that still leaves out explaining the difference between (what they might know about) type one and LADA)
- Essentially the same goes for posting on fora, such as this one, but whithout all the explaining.
- I would really like to know, for no clear reason.

None of those answers are enough to risk losing my DN I think. But I still don't like not knowing.

 

[tim2000s]

The best reason for a diagnosis of some form of T1 is to get the appropriate treatment. T2s are generally treated with drugs that force the beta cells to deliver more insulin. If you are a T1/LADA, this is a bad thing as it encourages the autoimmune attack on the beta cells and as a result, destroys more of them. Given that most future treatments generally look like they are looking at regenerating beta cells, you might not consider this medication approach a good thing. At least exogenous insulin relieves the pancreas of having to produce insulin and therefore reduces the autoimmune attack.

Knowing you are LADA would also mean you had a better decision tree available to you to understand how you wanted to approach the condition.

 

[Antje77]

Tim2000s,
Thank you for your answer. I fully agree with you, except that I am already on basal/bolus whithout tablets, so knowing I am LADA wouldn't make a difference in treatment in my case. Basal/bolus works fine (hba1c from 78 in december to 48 in march, and expect the next one in a few weeks to be 38-40) for me, thanks to my wonderful DN. She has given me a lot of freedom figuring out how much and when to take my insulin, as long as I promised not to shoot myself in a deep hypo. This was the best approach for me, I think, as I'm a stubborn know-it-all, and I don't want to lose her.
If I do have LADA, I probably would lose her because I then would have to be under hospital care (Netherlands). I would still have the same treatment, I guess, because it's clearly working and as far as I know hba1c's don't get much better than mine without low-carbing, wich I do not.
So what do I gain by knowing my type? (except 'just wanting to know')

 

[AndBreathe]

Tim2000s,
Thank you for your answer. I fully agree with you, except that I am already on basal/bolus whithout tablets, so knowing I am LADA wouldn't make a difference in treatment in my case. Basal/bolus works fine (hba1c from 78 in december to 48 in march, and expect the next one in a few weeks to be 38-40) for me, thanks to my wonderful DN. She has given me a lot of freedom figuring out how much and when to take my insulin, as long as I promised not to shoot myself in a deep hypo. This was the best approach for me, I think, as I'm a stubborn know-it-all, and I don't want to lose her.
If I do have LADA, I probably would lose her because I then would have to be under hospital care (Netherlands). I would still have the same treatment, I guess, because it's clearly working and as far as I know hba1c's don't get much better than mine without low-carbing, wich I do not.
So what do I gain by knowing my type? (except 'just wanting to know')

What do your medical records classify you as? Do you wear any medical alert tags, carry a card, or the like?

My thoughts, were I on insulin, would be that I would want clarity over my condition, so that should I be unfortunate enough to land in hospital, without being able to speak up for myself (unconscious or whatever), I would not be in danger of receiving poor care.

Personally, I'd just want to know. I wouldn't be wholly wedded to any given individual (although whilst she is there, my preference is to deal with one GP in the practice I use). They can leave in the drop of a hat, and your care would have to be overseen by someone else anyway.

I would have thought that having got a handle on things, and achieved a very good HbA1c, I can't see too many health care professionals wanting to meddle in that too much, unless yo are having too many lows, or vastly swinging numbers, for comfort.