Does the Dx of Lada matter if you are on Insulin already?

Type 1 and LADA
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Hi Group,
I have a question in general to you, does having the Dx of Lada matter if you are already on Insulin?

Background: I was (and am) on insulin and my A1C had been getting worse (from 5.3 to 10) with no change in diet, exercise and despite increasing the insulin (Bolus and Basal). It’s been like the insulin isn’t working for me and I wondered if something other than Type 2 could be at issue.

My Endo said, I don’t care to test you for type 1 as it won’t change anything and treatment will be the same. I’m my own advocate, and I had the tests done anyway. All of them were hugely positive, GAD of 160, IA-2 of 85, IAA of 175 etc.and the ICA nearly non-existent.

despite now maybe qualifying for a CGM, is my Endo correct? What changed for you, what do I ask my endo when I see him and what changes if anything?

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A diagnosis of T1 (LADA is really T1) makes a huge difference in treatment coverage. If you carry a diagnosis of T2 you will encounter significant prejudicial treatment from insurance and Medicare.

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I would ask to have my diagnosis officially changed to Type 1 for the reasons Brian noted above.

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In addition to a CGM, it may also alter your qualifying for an insulin pump, should you decide you’d like to use one (If you’re currently on MDI) in the future.

Good for you for being persistent. You’ve had the tests done. Your Endo should look at them, and your medical charts should reflect the proper diagnosis.

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Hi all,
Thanks so much for the feedback on this…it helps. I also have Gastroparesis, so the pump is on my mind as a possibility, though I’m a bit scared of it as I don’t yet know when I’m going to go digest …so the CGM is on my radar at this point.

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I can’t understand why some doctors think an accurate diagnosis doesn’t matter. Aside from @Brian_BSC’s mention of insurance coverage for a T1D vs. a T2D, an accurate diagnosis is important if you’re ever subject to hospital care. You don’t want front line care staff thinking of you as a T2D instead of a T1D. They may want to give you more insulin thinking you’re a T2D or they may want to add oral meds inappropriately.

Artificial pancreas technology is on the verge of commercial release in the next year or two. I suspect that T1Ds will have much less trouble getting third-party payers to pay for it than T2Ds – even though I think that is grossly unfair and not in our collective best interests.

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Yes it matters a lot imo. First you have easier access to what you need or may need as you said. Second there are real differences in treatment. You are at higher risk for things like dka. Everyone is different but I would want the correct diagnosis because the wrong one and a whole lot of other terrible mistakes nearly killed me. You are positive for antibodies so get your diagnosis changed with this endo or another. It will make a difference for you.

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Thanks, I was unable to get my Dx changed with the previous endo, who thought it was no big deal as I was on Insulin and what did it matter (hence the post)…as you know, it does. I’m now moving onto another endo…though it saddens me that they seem to be so poor in dealing with LADA with complications, wanting the patient who fits their formula…I would think they would want the challenge. I’m keeping up as my own advocate, learning what I can certainly using this site to help guide my questions / challenges to the Dr. Again, thanks all…

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Hi Everyone,
Thought I would share the new Endo’s opinion of having type 1:

  1. There are a lot of companion Auto-Immune that go with LADA, a thyroid issue, a digestive issue and an anemia issue - we should be checked for these. So far, I have tested for Thyroid Antibodies as well…
  2. All Insulin is not the same, the type of and amount of insulin CAN be different - a pre-meal shot using a different faster acting insulin was added to my routine. I’ve gone from readings 2 hours after breakfast (15 gram of carb) highs of 400 down to 185
  3. In addition to pumps or CGM, the insurance will cover intensive insulin classes, which are one on one.
    and bless the endo’s heart (I’m keeping her :slight_smile:) she understands that diabetes is no ones fault …and that control for LADA with complications is not easy but if you are trying and working with her she will help you…Yes I said HELP you…which is more than I’ve heard in a long time…

Again, I thank you all for the responses…

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I’m SO glad you sought another Endo. It sounds like great things are happening, and that you’ve found a real keeper who gets it!

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Qualifying for a CGM is a huge benefit. A new trial was reported at the ADA meeting indicating that a CGM is effective even for people using multiple daily injections. The CGM group improved their A1C 0.6% and many are talking about adding a CGM 1st before a pump or adding them together for better control. A T1D Exchange review of their Registry data found a similar improvement with a CGM.

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