Chutes and LADAs

Type 1 and LADA
1

I’m 34 and was just diagnosed with Type 1 (or type 1b or type 1.5). I think at my age its considered LADA. I’m strictly on oral meds right now (Actos+Metformin) and definitely honeymooning. Can anyone provide any insight towards the debate of whether or not I should ask my doctor to go on insulin right away in an effort to preserve my remaining beta cells? I mentioned it to him and he seemed to think that the medication would accomplish the same thing, however another diabetes resource I’ve read advised not taking metformin for LADA.

I also noticed that at clinicaltrials.gov there are some studies to participate in, some of which require a recent diagnosis. Has anyone investigated this? Any input or recommended resources would be appreciated.

2

I would definately do more reserach. Alot of your care has to come from your own education on the subejct of being LADA. I was taken off Metformin after my diagnosis changed from Gestational Diabetes to LADA. I believe the research states that Netformin can actually cause your BETA cells to suffer and does not help to keep the cells producing. I was on Byetta for about 9 months, but hated the stuff. I now take Januvia and it’s been great. No side effects. That I really love. Byetta sucked for me. (Is that too blunt?) Anyway, I found out this week that after not taking all of my insulin like I was prescribed that my pancreas is almost on the blink. After 2 1/2 years I am finaly faced with the decision to choose a pump soon. I am fighting with it in my head, but I know my time has come. I just have to face reality and jump on board.

Keep this in mind, if you go to WEBMD and pull up the medication information on each drug you are prescribed or have heard of , it will tell you what the reactions and side effects are and who it is prescribed for and who is not advised to use it. You will rarely find anything that says that anything about LADA’s because we’re so odd. It will just say “this drug should not be used by Type 1 or Type 2 diabetics”. I think I may have confused you more. (Sorry.)

I don’t know if you are being treated by an endocrinologist or your GP, but I would definately suggest finding a knowledgible specialist for your life long care.

Good luck to you, Rebecca

3

Hi Aaron. IMO, your best option is to do your own research. I’m going to be off on the numbers here, but they’re at least in the ballpark. Type 1s make up something like 10% of the total population of diabetics. Of that 10%, something like 1% develope it late in life (i.e. LADA). So we’re a pretty small minority, but welcome to the club. As a result of being so rare, it seems a lot of docs just aren’t familiar with it. In fact, in my experience, most docs (Endos excluded) will treat you like a T2 simply because you developed diabetes late in life. I don’t think there’s a whole lot of known solutions for preserving your beta cells, but there are opinions out there. For me, mine were gone by the time I was diagnosed, so it wasn’t an option for me. So, bottom line, do your own research and find yourself a good Endo.

Rebecca, sorry to hear your honneymoon is coming to an end. At least you’re considering a pump right off the bat. When I was diagnosed, I wanted nothing to do with a pump. I was way to active to be tied to a device like that. I lived with injections for a year. Finally going on a pump was the best decision I’ve made. Yes, it’s a bit of a drag, but you get very used to them. Most of the time I forget it’s even there.

Good luck to both of you!

4

Thanks for the info. My endo doesn’t seem to have any issues with the Metformin. I constantly hear that getting on the pump is the best thing to do. What drawbacks were you worried about before choosing it? What is the problem with injections?

5

I guess the difference between LADAs and T1s is this notion of a honeymoon period. I can’t comment on it really, because my beta cells were dead and gone by the time I caught on to the problem. Aaron, when you say you are definately honeymooning, do you mean that you still have measurable insulin being produced by your body? I think the only draw back to taking insulin at this stage is you’ve got a huge variable that you can’t control (i.e. your own production of insulin). Just as you’re getting things under control, your beta cells might die off a little more and you have to recalibrate everything. On the other hand, I think I’ve read where taking insulin during the honeymoon period can give your beta cells a rest and do them some good. Your Endo’s going to know more about this than I would. But, as before, I would suggest reading as much as you can on the internet.

If you’re to the point that you are going to add insulin to your treatment and you’re trying to decide between injections and pump, go pump. The down sides to the pump are, you have this thing attached to you and the cost. Insurance should cover much, if not all of the cost. The pump, as I’m sure you’ve heard, is about the size of a pager and honestly, you get used to having it around real fast. The advantages to the pump over injections are huge. The pump can give you very exact doses versus injections where you’re essentially basing your dose off a plunger against a bunch of marks on a syringe. Pumps keep track of the doses you give yourself, helping to prevent taking too much insulin. Let’s say for example that you test your BG and find you need 2 units of insulin. Could be that you still have 2 units of insulin on board acting on that BG. If you’re on injections, you have to know that. If you’re on the pump, it’ll tell you. Your pump has functions where you can program in your insulin sensitivity and how much insulin you need to cover measured carbohydrates. It then does the math for you to convert your insulin needs from your carb intake and BG readings.

Probably one of the big advantages is programming a basal rate. I don’t know the percentages, but I know I am one who has different basal needs at different times of the day. Now that I’ve figured out my needs, they’re programmed into my pump. All other things being equal, if I skip a meal, it’s not a BG issue. I just go on with my day. When I was injecting, I used Lantus as my basal. Problem was, I couldn’t skip a meal. It didn’t matter that something came up (e.g. an unexpected meeting, having to pick up one of my kids, etc.), if I didn’t find some carbs, I was going to go low. It sucked.

If you’re an active guy, you can shift your basal programs around based on your activity on a pump. Much harder to do on, say, Lantus. For example, when I do cardio workouts, I try to plan a few hours a head and cut way back on my basal so I have less insulin in my system. It mitigates lows during my workout. When I ski, I know it’s just a 40% decrease in my basal program. When I took my family to Disneyland, 30% basal decrease let me walk around all day, no lows, no worrying about when to eat. It was nice. Conversely, if you do things that stress you out, even if it’s good stress, the pump handles that too. For example, when I play poker, I need a 40% increase in my basal rate. Even when I’m getting good cards. In a related experience, I took a very stressful 2 day certification exam last year. Same story. I discovered during a dry run that I needed to increase my basal. When the actual exam came around, it helped keep my BGs in range which allowed me to focus on the test, not my BG.

So, in short, way more control with a pump. If you’re insurance covers it, what do you have to lose? If it doesn’t cover it, I’ll tell you this. When I was considering switching from injections to a pump, and I’ll tell you I wasn’t eager to be tethered to some mechanical device 7x24, I did some reading. I looked for opinions. I found, without exception, diabetics who used a pump said it change their life and they’d never go back to injections. I’m happy to say, I feel the same way.

I hope this helps.

6

That’s exactly the kind of info I was looking for. I appreciate it.

Can anyone comment on how the transition out of the honeymoon goes? My numbers have been fairly steady for about 7 months now with just Metformin. Is there going to be a day where my BG just kinda lets loose and shoots for the moon, or will there be a gradual change that can be seen through migrating hbA1c scores?

7

Metformin is used for insulin resistance. This is a condition of Type 2 D and not for T1/1.5 As a T1/1.5 you are not producing enough insulin on your own.

8

I took metformin for 6 months with no lowering of BG. Also was on other type 2 meds with no change in BG. was finally diagnosed with t1. I would suggest you have type 2. insulin lowered my BG in the first days. Like the others stated, read and study.

9

I was honeymooning my whole time I was LADA. I became type 1 January of 09. I am just now thinking about switching to the pump. I agree with others, research research research. Overtime, I decided I can’t do MDI anymore and want to only have to change the infusion site every 3-5 days whereas now I am doing a total of 10 shots a week. So again, research :slight_smile:

10

Actually, adult onset Type 1/LADA is far more common than childhood onset Type 1 (LADA is a term for slow onset Type 1 diabetes in adults), two to three times more common in fact. One of the leading diabetes researchers in the U.S., Jerry Palmer, says in a 2008 book “Type 1 Diabetes in Adults: Principles and Practice” (Informa Healthcare, 2008) that adult-onset autoimmune diabetes is two to three times more common than classic childhood onset autoimmune diabetes (p. 27). John Walsh, author of Pumping Insulin, says that rapid onset T1 is about 5-10% of the total diabetes population and slow onset T1 (LADA) about 10-15% of the total diabetes population. So the vast majority of new-onset Type 1 diabetes is seen in adults.