1 year after LADA diagnosis

If this is inappropriate, please forgive me. Last January, my bloodwork showed beta cell dysfunction and high anti-GAD numbers, along with insulin resistance, I went on a ketogenic diet. I have lost 60 pounds, 25 to go. Yesterday I had my physical. I am still showing insulin resistance and beta cell dysfunction. My glycemic control is normal. Hemoglobin a1c is 5.4. My doctor said I do not need any further tests, and I do not need to be on exogenous insulin or any diabetes treatment. He said he could tell that I have enough insulin production and we will just call this a red flag for LADA, which he was sure I had last year. He is so proud of my labs, and called me a rock star. I am worried that I am in the honeymoon stage of LADA and wonder if I need to insist on a referral to an endo. He said I didn’t need one. He’s a great, thorough young doctor but I want to be sure we don’t miss something. What do you guys think? I am 63 years old.

I can’t tell you what to do, but I’m in more or less the same position: 41, GAD positive, eating near ketogenic (I’m not quite that low carb), and my numbers are now much better (4.8 a1c). Here’s the thing: once diabetic, it doesn’t go away, at least to my understanding. I had a doctor that wanted me to stop treatment and more or less declared me “cured.” I got a new doctor.

My new doctors, including a specialist, are encouraging me to maintain my treatment routine, continue testing, and stay aware of any changes in my fasting or postprandials. Why? Because with auto-antibodies, it’s almost certain I’ll have progressive beta cell dysfunction. Best to stay on top of it, at least in their opinion (and mine). Not all doctors understand diabetes, and certainly not LADA.

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I was able to manage my diabetes with diet, coming down from an A1C of 10.7 to 5.0. My doctors declared me “cured” and left me to my own devices. A few years later and my insulin production has been halved and I’m on an insulin pump.

I was able to avoid dealing with my diabetes through progressively more restrictive eating, eventually developing an eating disorder… I still have messed up ways of thinking about how to take care of myself. If I could do it over again, I would have set some limits on what is reasonable, when to say “I need help” and stayed in regular contact with an endocrinologist.

I hope you don’t progress but wanted to share my experience with how it went down for me…

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Pursue treatment based on what your body does. I remember being in a Type 1 support group and there was a young woman who hadn’t gone on mealtime insulin yet and was convinced she maintain control just by eating low carb. I really wanted to say to her,

“You’re mistaking your honeymoon for your marriage. You will probably end up needing mealtime insulin eventually. It’s not failure if it happens. That’s what happens in Type 1.”

It’s better to expect it than to think it won’t happen and be crushed.

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Hi -According my Dr and the Mao ‘Values > or =0.03 nmol/L are consistent with susceptibility to autoimmune (type 1)’ that is if you have positive high GAD you are at risk for LADA.

That said, you are ‘at risk’. This is an auto-immune disease where you attack your insulin. Insulin is needed by the body to ferry sugars into the cells so that they can be used for fuel. No insulin, no way for the body to get sugar to use as fuel so they build up in the blood…the more they build up… did you have a c-peptide done? This test measures how much insulin you are making…

My take if I found out I had GAD antibodies as high as yours, I would get with an Endo and be sure to keep an eye out…you may never need insulin or you may need it one day best to get an expert opionion. FYI -not to scare you (I’m only talking about myself) I presented in full DKA, 5.2 A1C eight months before then 13 on presentation…but everyone is different.

Ahh, unless your doc is psychic the “knowing your insulin production” comment should be supported by diagnostic lab work. I’m a LADA who originally was told she should loose weight and exercise to lower high BG numbers - the assumption was I was type 2. As I was actually T1 the result was DKA and intensive care. You should stand firm on the endo referral. By the way, you are a rock star!

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Phenomenal!!

My son is T1, so little expertise, but I would still recommend you get an endo. Too many of my T2 friends lose it in a few years.

I expect it to happen. Everything I have read says it will happen. What I am confused by is all I am reading that says I should be on exogenous insulin early on so as to help the struggling pancreas out while it is trying to manufacture insulin. My doctor says it is not time to do that. When I asked if I should be seeing an endo, he said that when I no longer have confidence in him, I definitely should. I told him it had nothing to do with confidence in him, but he said that’s all he could tell me. He feels I don’t need one,

Ha…definitely NOT a rock star. I think I am going to ask for a second opinion with an endo. Lord, give me strength and assertiveness, please.

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C-peptide (ng/mL) was in the normal range at 2.5.
In the normal range were:
GLucose
HBa1c
EStimated average glucose (mg/dl)
Fructosamine
Glycation Gap
Adiponectin
HOMA-IR
Insulin
In the Intermediate risk:
Leptin
Free fatty acid
Ferritin
Oleic acid
Proinsulin
High risk:
Postprandial GLucose Index
Leptin:BMI ratio
A-hydroxybutyrate
Linoleoyl-GPC
Proinsulin:C-peptide Ratio
ANti-GAD (>120)

Thank you so much for that! Hope you are doing well.

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See Lab info posted. He said the labs showed my pancreas is still making sufficient insulin. I hope so.

@LHromika – Any chance that you can post actual lab numbers? Was the c-peptide fasting or provoked? For comparison/monitoring of progression, do you have labs from last January? Have you been tested for other autoantibodies? Latent autoimmune diabetes of the adult: current knowledge and uncertainty

Are you testing postmeal? Postprandial Hyperglycemia: Clinical Significance, Pathogenesis and Treatment

Since your physician has suggested that you have insulin resistance, has he mentioned metformin?

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I would post my labs but I don’t know how to attach a picture. Any hints?

First, put the picture file on your computer where you can find it. I often use the desktop for this, but you can use the download folder or the document folder. When you press “Reply,” a composition field opens up with this row of editing icons on top:

Click on this one:

Then click on the choose file from this computer. Find the picture of your labs, select it, then upload it.

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I’d go to an endo. There is some evidence now early insulin therapy can either stop or slow down the autoimmune attack.

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I totally agree with Meee and you should watch your sugars with regular testing so that you don’t end up in an emergency situation … meters and strips are available everywhere if your Dr. didn’t give them to you…I even used the ones from walmart when my dr. didn’t order enough testing supplies

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Those are really comprehensive laboratory results! It definitely appears, from my layman’s-informed-by-experience perspective, that you could be early in the LADA progression. It’s also possible you could be early Type 2 (some apparently have anti-GAD and never progress to a Type 1 presentation, according to Trial Net).

The tests definitely indicate insulin resistance, which can be characteristic of early 1.5 or Type 2. Regardless of actual diagnosis, it might be wise to treat through diet, exercise, and weight loss since there is evidence of insulin resistance. I’m not giving advice, but that is what I would do given those results, given what I know now about diabetes from doing online research. And I’d also be aware that things might very well progress towards a Type 1 presentation of DM.

If you’re trying to lose more weight and experiencing insulin resistance, is there a reason not to try a small dose of extended release metformin? I don’t know why that’s not more aggressively prescribed to anyone with even a hint of insulin resistance, especially given all the recent research suggesting it may have a range of systemic benefits (anti-cancer, anti-aging, etc). I have T1 (juvenile onset), and I’m now on it thanks to my current excellent endo—wish I’d done it even sooner. I bet within a few years, more and more T1s and people of whatever type currently being told to try exercise/diet first will be on it.

You still might need insulin eventually too, but if you’ve got insulin resistance, exogenous insulin works a lot better in my experience in combo with something that helps treat that too.

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