Awaiting Diagnosis Have Questions

Hello, I am new here and have a number of questions.

I am currently being tested for LADA. I have been monitoring my BG and I spike after meals. I am seeing a Naturopath that is great but info about LADA seems to be limited and many recommendations still seem to be to treat it like Type 2. I was on Alpha Lipoic Acid for a very short time. I stopped taking it after reading about it triggering Insulin Autoimmune Syndrome in some people. The neuropathy in my feet did go away while on it and has not returned. I have since read that Sulphonylureas are counter-indicated in LADA. Alpha Lipoic Acid is a sulphur containing antioxidant. Does anyone know if Alpha Lipoic Acid will cause more rapid beta cell burnout?

I have read Dr. Bernstein's book, Diabetes Solution. Based on his book I think I may need per meal insulin. My Dr sent me some presentation nntes that would indicate treatement with long acting insulin. I think I know the answer to this but can anyone tell me what I should be looking for in treatment if my fasting BG is normal, spikes after meals but returns to normal within a couple of hours. I peak about an hour after eating.

Since discovering my BG's were spiking I have been trying to eat low carb but 3 grams of carb will raise my BG 15mg/dL. There isn't much a person can eat with only 3 grams of carb. I have been eating mostly salad, meat and dairy. I like what Dr. Bernstein has to say about low carb/high protein for normalizing BG. I have also read some other diets for diabetics. There is a person who is advocating a highly alkalizing diet and another person promoting a nutrient dense diet. I like aspects of both of these as well. Does anyone have info on bring these together? I have multiple food sensitivities so I am concerned about overeating in the egg and dairy department.

Finally any advice on how to find an endo that is up on LADA? I saw an endo. He said he would order the GAD65 for me but I would have to pay for it myself because he said he couldn't give me a diagnosis for insurance purposes until my BG was over 200. I told him I didn't want to let it get to that point. My Naturopath ordered the GAD65 and a bunch of other tests. If it comes back I have LADA as I suspect I don't want to go back to this endo. I live in Minnesota but am close to North Dakota.


Hi LF: First, good that you are being so proactive. Remember that LADA is simply slower onset Type 1 autoimmune diabetes, and thus treatment as if Type 2 is not appropriate. Here is a link to a blog I wrote on my top ten tips for the newly diagnosed adult-onset Type 1. In terms of food, if you have LADA/Type 1 diabetes, no amount of stringent low carb will truly work, you need exogenous insulin. Many TuD members here, all with adult-onset Type 1 diabetes, have used only very low doses of rapid-acting insulin in the beginning. Take a look at some of the LADA discussions to read about this, and I hope some of the people who are using just the low meal-time doses will chime in. Shawnmarie is one of them.

Finally, be sure to look at your test results. You will want to see if you were tested for the full suite of autoantibodies (GAD, ICA, IA-2, zinc transporter), not just GAD, because some adult-onset Type 1s are only ICA or zinc transporter positive. A c-peptide test shows how much insulin your own body is producing. Finally, it is more typical to use a fasting blood glucose for diagnosis of diabetes, and if your fasting BG is greater than or equal to 126 mg/dl, it's diabetes.

Again, I am glad you are being so proactive. Keep at it until you have the answers you need.

Hi and welcome. Melitta gave you great advice. I wouldn't pay for your antibody testing if your insurance will cover it. Your endo is painfully wrong. As Melitta said, diabetes is diagnosed with fasting over 126 and A1C over 6.5. You do need the full panel and c-peptide and don't let any doctor put you on type 2 meds. LADA, if it turns out that is what you have IS Type 1, it just comes on more slowly. Lots of good information on this board.

I would wait until the LADA diagnosis is definitely confirmed before making any hard-and-fast decisions. LADA and T2 are indeed very different things and call for different approaches. You need to know what you are really dealing with before you can respond in the most correct way.

For what it may be worth, I will share a little bit of my own experience, since it has some strong parallels with yours.

I have been T2 -- definitely T2, no doubt about it -- for some time. For the past year I have been following Bernstein in most (not all) respects, with extremely satisfying results.

The main reason I say make certain of the diagnosis is that the BG pattern you describe exactly matches mine: good control in the fasting state, and problems only when food enters the picture. The hallmark characteristic of LADA, especially in the early stages, is wild unpredictability. If your fasting numbers are always good, then you might indeed be T2. You need to know one way or the other. The diagnostic tests should tell the story.

Back to what I've done -- I follow a low carb/high protein diet pretty much along the Bernstein pattern, and I use rapid acting insulin to bolus for meals (no basal insulin). The results have been extremely positive -- my lipids dropped like a rock and have stayed down, my A1c is down in the 5's for the first time in years and continues to improve.

So, bottom line: get a definitive diagnosis and then choose the course that's most appropriate. The only other comment I would make is, don't be intimidated by insulin. It has given me a degree of control I was never able to achieve with diet, exercise and pills. I wish I had done this years ago.

My Naturopath ordered all the tests you mention except the zinc transporter. I don't know what that is but will google it. When I first started seeing her I was severely Vitamin D deficient. I had some trouble with the Vitamin D supplements at first but once I added in some of the co-factors, in my case magnesium, zinc (20mg/day) and Vitamin K, I am able to tolerate 10,000IU Vitamin D/day. My Dr is monitoring my Vit. D level but I am still insufficient so continuing at the higher dose. The plan is to retest my zinc (and other things in 3 months). My diabetes test results will hopefully be back in time for my appointment on Friday (that's the plan anyway). Thanks for the link I will definitely check it out.

Thanks for bringing me back to reality. You are absolutely right that I need to get a correct diagnosis first. I have a sister with Type 1 diabetes and have an autoimmune disease myself. My sister and I are both thin. So I suspect LADA.

Zinc transporter is a recent addition to the autoantibody testing scene. It is only a low percentage of adults who are only zinc transporter positive. I am glad your naturopath ordered GAD/ICA/IA-2. You are definitely on the right track.

I am LADA that was misdiagnosed as T2. I was on T2 oral meds (by PCP) for almost a year, even able to be off meds for several months before going to Endo and having GAD and antibodies done. Then got correct Dx of LADA and started Insulin. It is hard to find info on LADA (elsewhere) but you will learn so much from this website. Lab tests should help a lot, good luck and keep us posted!

Hi LF: I also wanted to mention that you posted on the LADA Group page, but you will actually get more responses from a variety of people if you post in "forums." And I do hope that you have looked at some of the past LADA discussions where people like Shawnmarie discuss using mealtime insulin only. Best of luck to you!

Hi Melitta and others,
I checked out the link to your blog for Newly Diagnosed Type 1’s. I was just what I needed. I cried when I got to the part about allowing yourself to grieve. The past 2 years have been overwhelming. I have just tried to deal with it but reading that I realized I just needed to take a moment to acknowledge how hard it has been. My story is like so many others, knowing something is wrong but doctor after doctor telling me I was fine. Two years ago I had viral encephalitis of unknown origin but thought to be related to tick or mosquito. I was in ICU for 8 days and out of work for 2.5 months. Initially I was getting better very slowly. Then I plateau’d and then began to decline. First it was discovered that I had a severe Vitamin D deficiency. The last April I found out I had celiac gene pairs but tested negative for the disease. Last August I was diagnosed with Hashimoto’s disease. I went gluten free at that point. I just got my LADA test results back. My insulin and C-peptide levels are low but my antibodies (GAD 65, Islet IA-2 and Insulin antibody) all came back at zero. I have been monitoring my blood Glucose and it spikes after I eat. My doctor is saying I don’t have LADA because I don’t have antibodies. She is calling it pancreatic insufficiency. When I googled pancreatic insufficiency it talked about pancreatic enzymes but did say that it could develop into diabetes. So, could I have LADA without antibodies? I read that antibody levels can go to zero when a person has had Type 1 diabetes for a long time. I am still able to bring my BG back to normal so I don’t see how I could even have had LADA for a long time. I feel it’s important to get the diagnosis right so the treatment will be correct.

I noticed that after chewing licorice gum (real licorice not anise flavor) my BG was lowering than my normal (but still in the normal range not hypo). I found that licorice has BG suppressing properties so I did an experiment and took a licorice root supplement and then ate some yogurt with cherries. My BG only went up to 122. I am wondering how licorice root works. Does it stimulate the pancreas? Will it cause more rapid burn out of my beta cells? My doctor, a naturopath, has me taking it with meals (low carb diet). I will continue to monitor BG. My goal is nothing over 120. I have a follow-up appt in 4 weeks. But I am wondering if the licorice root is like the Type 2 drugs that work for a while but will destroy all my beta cells. This is where I think the correct diagnosis is important. Could the Hashimoto’s (I am hypothyroid) be mimicking diabetes?

I guess in some states Naturopaths can write prescriptions but in my state they can’t. She said there aren’t any good endo’s in the state. I know the one I went to wouldn’t help me.

I also liked what you said about learning at a pace that doesn’t overwhelm you. I feel like am in a race to save my thyroid, pancreas and adrenal gland (I have high cortisol levels). I just can’t learn fast enough. The doctor I am seeing now is great. She listens and is willing to check things out. I am a Type A personality and recognize my tendency to perfectionism. Your reminder not to be too hard on myself was a good one. I think

Any additional information or direction regarding diagnosis would be much welcomed!

Hi there,

Your situation sounds really similar to mine. When I went to the doctor in November with blurry vision, I got tests done and had an A1c of 8.6 and blood sugar of 303. I was put on amaryl and within a week came off because of hypos. I was following a low carb diet and was not on any medication or insulin and had a AIC in february of 4.5. Here is the problem, i lost what little weight I had. I was (naturally) thin to begin with at 108 lbs and went down to 96 lbs. My insulin levels were low and initially all of my antibody tests came back negative. I got the GAD test redone and it came back at 3.4, or "mildly" positive. It would seem I have LADA, but I am interested to learn about the pancreas insufficiency thing you speak of. I was also diagnosed with hashimotos at the same time, but the thyroid antibodies were not so bad that the doc decided to hold off on treating the thyroid. Since my diagnosis and low carb diet, I have also had some digestive issues. I have eating 60% fat, which is probably hard for anyone to digest, but I do think I have had some mild gastroparesis, because I get a full feeling and irregular BMs. Occasionally my blood sugars will take a while to peak, when usually it is at the 1 hr.

I am the same as you. Type A, feeling like I am in a race to do what I can to improve my situation, but I haven't been happy with the treatment I have been getting. Not sure what to do next.

I did start taking a few units of levemir every morning for the past month to see if that can help me eat more carbs. I am trying to max the amount of carbs I can eat in an attempt to gain weight, but the weight is not going on!

You mentioned that your sister has Type 1. My brother has Type 1 too and was diagnosed years ago.

I'd be interested to learn about the licorice root. Let me know what you find out!

When I was first diagnosed I was told I am a type 2. They re-did all of the test and it came back as inconclusive. Once I saw an endo, he had the test done twice and I learned about LADA before going to his office again. He diagnosed me with LADA (this is 2006). Sometimes the blood work will come back as one then the other, etc. My LADA lasted until 2009 when I re-typed as type 1.

The others who replied have great info for you :)....And hope it helps you!